Knocked Up...Knocked Down

The new plan...and delays

During the course of my counseling sessions early in 2004, I decided I DID want to keep trying to have children, and made up a plan for how I would proceed that included details such as who I would tell and solicit support from if I became pregnant and whether I would do prenatal testing.  The main jist of the plan was that I was only willing to have one more miscarriage if it was a later one, but if I had a fourth loss that was an early miscarriage ("chemical pregnancy") I would try one more time.  If I had a fifth miscarriage, we would move on to adoption.  Husband and I geared up to try again in April.

Then, late in March, I awakened to an episode of severe abdominal pain, the worst physical pain I have ever experienced, which was so bad that it debilitated me and caused almost constant vomiting.  I actually thought I might be dying.   I went to the ER, fearing appendicitis.  They gave me morphine, which stopped the pain (I was never so thankful for anything in my life!), but they could not determine the cause of the pain, although they suspected I had passed a kidney stone.  I was given a prescription for Percocet and Phenergan to take in case it happened again and sent home.

April, 2004:  Early in the month, I awoke to another episode of abdominal pain, identical to the first.  Percocet and Phenergan didn't help (I just threw up the Percocet anyway), so I went to the ER and once again got morphine, but no answers.  It made me afraid to try to conceive until we determined what in the world was going on.  I felt like yet another anvil was dropping out of the sky onto my head.

Later in the month I was awakened with another episode of the excruciating pain, on the day that would have been the due date of our third baby.  I once again went to the ER, where they gave me morphine and still suspected kidney stones, but couldn't ascertain any definite cause. 

As if that day, the "due date" of our lost son, wasn't bad enough already, three or four separate nurses, techs, and doctors, during the course of the day, said "Have you ever had a baby? Well, mothers who have had kidney stones say that passing a stone is even more painful than natural childbirth!"  My friend who lives in my neighborhood and who had gotten pregnant at the same time I had gotten pregnant with our lost son gave birth to her healthy son elsewhere in the same hospital that day.  (Can you see why sometimes I feel like events are conspiring to steal my sunshine?)

May, 2004:  I finally was referred to a urologist who determined what was wrong with me:  a blocked ureter, probably caused by scarring from a kidney stone.  Why the ER hadn't run the test the urologist ran and given me an answer the first time was beyond both me and the urologist.  I had to have surgery to unblock the ureter, walk around with an uncomfortable stent in my ureter for a few weeks, have the stent removed, then wait until July to have a kidney function test to ascertain whether I had suffered kidney damage from urine backing up in my kidney due to the blockage. 

So, there was no trying to conceive for us until after July.  On the one hand, I was very frustrated at the delay, but on the other hand, I had a free pass to put off a potential miscarriage for a few more months.  In hindsight, I think the extended break was good for me emotionally and physically, despite my ticking biological clock.

July, 2004:  The kidney function test revealed no kidney damage!  Hurrah!

August, 2004:  I threw a baby shower for a close, formerly infertile friend (hosted it at my house and made all the food and cake for the 35 guests! Lots of work, whew!).  I made it through the whole thing without crying or feeling depressed, a big achievement for a recurrent miscarrier.

September, 2004:  Once again started trying to conceive, on RE's regimen...

Christian counseling and lessons learned

February, 2004:  To help me deal with my three miscarriages, I was going to weekly counseling sessions with a Christian counselor, with homework.  I liked my counselor.  She is a bit younger than I am, petite, kind, straightforward without being harsh, insightful, practical, and she has a sense of humor.  Her voice is soothing and soft.  She had recently had a miscarriage herself, and she understood. 

I began to understand that I had not really grieved my first two losses, and therefore, the third loss just pancaked on top of those.  I had tried to run away from grief, to avoid crying, to put on a brave face to the world, to avoid the feeling the pain.  I was afraid that the pain would swallow me up and destroy me if I didn't hold it back, that once I opened the floodgates my mind and heart would be washed away with the grief.

I was so afraid of the sadness (which seemed weak and helpless to me) that I was stuck in the anger (which somehow seemed more empowering).

I had a homework assignment of writing a letter to God telling how enraged I was about everything, no holds barred.  It was pretty ugly, but it helped me to let the anger go.

I realized that part of my fear of the sadness of grief came from my grandmother.  When I was 5, her husband died, and she had to spend some time in a mental hospital.  The way it was explained to me was that she was so sad over Grandpa Merle dying that she couldn't tell what was real and not real anymore and needed some medicine to help her.  In reality, his death just triggered in her a full blown bipolar disorder that (according to my counselor) had probably been simmering in her since early adulthood.  But, being a child, I didn't understand this. 

After the hospital got her somewhat evened out with medication, she came to live with us for a while until her medication was completely adjusted, and I didn't like it.  She would rise at dawn and manically scribble her "memoirs" all over the pages of my children's books.  Other times she would sit and stare coldly at me.  I emotionally learned the lesson that grief=dangerous and bad, because it can literally drive a person crazy.

March, 2004:  Continued weekly counseling.  Cried a lot more.  One of my homework assignments was, when I was feeling like it, to cry in front of my husband and, separately, in front of a good friend, in order to get over the unspoken rule in my family that crying is shameful, and to quit being so emotionally autonomous.  The tears uncorked a lot of pent up tension in my heart and mind; they were cleansing.  As I opened up and experienced the sadness of grief, I softened and the anger started to melt away.  I felt less "frozen" emotionally, and was even able to catch glimpses of joy again.

I began to understand that grief is healing and necessary, not crazy-making, and not to be avoided, but to be fully experienced in order to move on.

To avoid obsessing about the miscarriages or about what to do next, my counselor had me use the technique of establishing a certain time of day (say, from 7 p.m. to 7:45 p.m.) to really think about those things and to wallow in them.  Other than that, when the thoughts came into my mind, I was to push them out with other, more pleasant thoughts that captivated me (such as planning a dinner party or decorating my living room), and to reassure myself that I would take time to deal with the troublesome thoughts at the designated time. 

A similar technique was to limit my talking about the miscarriages or about what to do next in the procreative realm.  Husband, bless him, was my main, patient listener.  I was to limit my conversations with him about the miscarriages to either: (1) 20 minutes per day or (2) to one point that I want him to help me resolve (eg., if I get pregnant again, should I have CVS testing done?). 

I was supposed to think of someplace to "put" my pain, so as not to feel burdened or mired in it.  My idea was that every day when I took a shower or bath, I would think "Now I am washing away all the pain I felt yesterday, and it is going down the drain.  I will never have to feel that day's pain again."  If I needed a quicker fix, I would write my painful thought on a piece of paper and then crumple or rip it up and throw it out.

At first, I thought all these techniques sounded goofy, but they actually helped.

I had to write a letter to our lost children explaining to them, in a way that a child would understand, why the the losses occurred.  I did that, and I told them of the hopes I originally had for them, the things I had wanted us to do together, and how much I loved them and missed them.  That was very sad, but healing, and it made me realize that they are in heaven together with Jesus, where there is no pain, no fear, and no Trisomy 13, and that someday I will be there, too, where every tear will be dried.  Since they are in heaven, the miscarriages really weren't hard on my babies, just on the parents they left behind.  As a mother, that makes me feel better.

I studied more about the character of God, what he had (and had not) promised me, what I can legitimately expect from him.  Ultimately, I chose to keep my faith and to believe in the goodness of God's character, in part because the alternative and the effect it would have on me seemed so negative. 

I realized that my miscarriages were not punishment from God and understood that this TRULY is a fallen world; Jesus promised there would be trouble in this life; God never promised me a healthy baby, but he did promise not to forsake me (and God is there, always, whether I sense his comforting presence or not).  I tried to let this sink in, and my prayers changed from asking God to protect me from pain to asking him to give me the strength to bear tragedy without allowing my heart to become hardened or my soul to become bitter and withered.

This was the biggest lesson I learned: that there WILL be horrible, painful circumstances in this life that I will have to deal with, but that I have the choice, with God's help, not to allow them to embitter or break me.  The true "life" of my soul unfolds in my thoughts.  If my thoughts are my dwelling place, my house, then to keep my house clean, I have to fill it with Jesus, his eternal perspective, his love, his peace.  I have to focus on what is true and good.  It's the only way for me to keep my heart soft and open, my soul whole, no matter what circumstances life throws at me.  It's a daily, hourly struggle, but so worthwhile.

The spiral down

My first and second miscarriages were hard, but the third miscarriage broke my heart and ushered in one of the darkest, most confusing periods of my life.  I think I can summarize my initial path through grief as follows:

September, 2003:  Shock and denial, anger (directed all over the place), inability to function normally for a few weeks due to major grief brain fog (for example, I completely forgot my password for my voice mail at work), sadness.  I clutched at the idea of adoption, thinking I would do anything just to get a baby in my arms as soon as possible without having to risk another miscarriage.  My emotional pain was so deep that I remember thinking "Now I understand why a person would do drugs or commit suicide to escape pain," but I didn't do anything self-destructive; I wouldn't even have a drink in the state I was in.

October, 2003:  Functioning more normally on the surface, feeling less hormonal, but depressed.  I ate lots of chocolate that month.  It was a struggle to keep going to work and to get through each day.  I was feeling very resentful at the raw deal I had gotten, and despite the fact that I generally am not a jealous person, I was feeling very jealous towards people who had children easily.  Immediately after my third miscarriage in a row, I had to return to work to do extra duties and assignments in order to cover for my male co-worker who seemed to lead a charmed life and who had taken six weeks off (parental leave) because his uber-fertile wife had just had their third healthy baby in a row.  The unfairness of it just steamed me, and I am ashamed to admit that I had some pretty hateful thoughts about the poor unsuspecting guy.

November, 2003:  Denial ain't just a river in Egypt.  I did my best to squash all baby/miscarriage thoughts and instead focused on planning a trip to Paris.  I obsessively researched hotels, restaurants, and attractions and planned everything down to a nub.  Due to the denial, I felt like the anger and sadness had lifted a bit, so I thought I was getting better overall and moving on about the miscarriages.

However, the doctors found a blockage in one of my dad's arteries that month, and he had to have angioplasty and have a stent inserted to clear the artery.  The procedures went fine, but my dad's heart trouble just fueled my feeling of waiting for the other shoe to drop, for the next person I loved to be snatched away from me.

December, 2003:  Trip to Paris!  Husband and I had a wonderful time!  Came home right before Christmas.  Christmas was tough.  We couldn't bear to put up a large, fresh tree that year and instead bought a tabletop artificial one.  Seeing little nieces and nephews "with their eyes all aglow" as they opened gifts while we sat there childless for yet another Christmas just about did me in, when considered in conjunction with all of the holiday photo greetings we received filled with other people's smiling babies and children.  It seemed like we were the only infertiles in the universe, and I was so sad for what we had lost, especially in light of the ubiquitous reminders of how effortlessly others had families. 

January, 2004:  Sank into a dark place.  It became harder and harder to get up, go to work, and function normally.  I felt like a failure as a woman because I was barren.  I was mainly angry, angry, ANGRY about the losses and completely confused about what to do next.  Except for anger, I felt emotionally paralyzed: stiff, like cardboard, frozen.  I couldn't feel joy, I couldn't cry.   I wasn't sure if I could ever risk losing another baby, but I didn't want to remain childless, either.  I read books about adoption, but couldn't get comfortable with it. 

To make things even worse, Husband's mother, who is the glue that holds the extended family together and whom I am very fond of, was in a horrible car accident on icy roads.  On a highway, her sedan was hit by a delivery truck, bounced off the cement median divider, and was hit by the truck a second time.  Her lungs collapsed, her ribs were shattered, and for the first few days in intensive care, it was questionable whether she would live. (Thank God, she did, and later made an almost complete recovery.  But that January, we had no idea how things would turn out.)  I spent weeks running between work and the hospital, making food for Husband's father, trying to be supportive of Husband, and praying that his mom would be okay.

But I was angry at God and didn't trust him anymore; I even began to doubt whether everything I had believed about God and Jesus were true.  I didn't doubt that God existed, but I wondered if he wasn't just some uncaring SOB in the sky. 

My spiritual crisis was the hardest part of all; wasn't my faith supposed to comfort me and keep me going at a time like this?  Well, it wasn't; it was just making everything more complicated.  If God was in control, why did he allow my mother-in-law (who is such a nice person that her kids nicknamed her "Saint Cathy") to be hit on the highway?  Why did he allow me to repeatedly conceive, just to repeatedly snatch my babies away from me?  The third loss, especially, seemed like a cruel joke.  What had I done to deserve barrenness?  What was I supposed to be learning?   

I didn't want to lose my faith.  I kept going to church each week, but I just wasn't feeling it.  I felt like my prayers were bouncing off the ceiling, going nowhere, to no one.  I felt abandoned by God and couldn't find him.  I had fallen down a dark hole.

It was hard for me to admit that I was stuck and needed help, but I finally made an appointment with a Christian counselor who had experience in dealing with pregnancy loss, both personally and professionally. 

That decision was a turning point for me.

Testing, testing, 1,2,3

After my third miscarriage, I had to accept that now I was medically considered to be a recurrent miscarrier, and therefore infertile.  Not just a normal person who had had one or two miscarriages, which are "normal" or "flukes" or "just bad luck."  A recurrent miscarrier.  Or, to use the precise medical terminology, a "spontaneous habitual aborter."  (Hey, if I am going to be a habitual aborter, at least I'm spontaneous about it!  "Spontaneous" sounds like more fun, like someone who would hop on a plane to Vegas on the spur of the moment!) 

There was no more denial, no more pretending to be normal; it was time for me to see a reproductive endocrinologist (RE).  I sought recommendations from other infertiles and made an appointment with Dr. S.  First of all, I must say that seeing an RE is a much better experience when you're in my shoes than seeing a regular OB/GYN.  There are no visibly pregnant women in the waiting room to make you sad over what you have lost, and the magazines in the waiting room are not full of pregnant women and babies--"Architectural Digest" is the standard fare.  The staff are polite and sensitive.  Dr. S's nurse is a recurrent miscarrier herself, so she understands.  And Dr. S is positive and reassuring.  He told me that he was sorry and that I still had good odds of having a baby (something like a 60 % chance of a live birth with my next pregnancy, not bad).  He prescribed a list of tests as long as my arm, and I had them all done.

Hormones:  normal, check.  Structure of my uterus, tubes, ovaries, cervix:  normal, check, looks great.  Autoimmune factors:  none, normal, check.  Basically, everything:  normal, check.  Reason for recurrent miscarriages:  unexplained, (except for the third one, which was due to Trisomy 13 in the baby).

It was great to know that I am normal.  I felt like a little bit less of a freak.  However, it was supremely frustrating not to have an answer.

The plan for trying again was for Husband and I to take a round of antibiotics, just as a precaution to rule out ureaplasma/mycoplasma issues, to use ovulation predictor kits to pinpoint ovulation, to insert vaginal progesterone suppositories twice daily after ovulation (on the can't hurt, might help theory), and to take one baby aspirin per day after ovulation (again, can't hurt, might help with autoimmune clotting issues--even though the tests showed I didn't have any such issues).

Okay, now we had a plan in place.  We just had to muster up the courage to try again, which was no easy feat.