Michelle is crossing her fingers again.
She is happily pregnant, just as she and her husband, Jason, had planned, and she’s still in the first trimester. There’s no factual reason for Michelle to worry that this pregnancy won’t end in the successful birth of her first child. Yet, this is her third pregnancy, and Michelle is understandably anxious.
“I can’t wait until I’m huge and uncomfortable,” the 29-year-old muses as she thinks about other patients in her OB’s waiting room, many of whom are farther along than she has managed to get in pregnancy. “Right now, I live ultrasound to ultrasound!”
As far as test results show, there’s nothing wrong with either Michelle or Jason, nothing that would lead to miscarriage. Still, like so many couples have learned, the loss of a pregnancy in the earliest weeks is far more common than most people realize. Most often, there’s nothing that could have prevented the majority of these losses, and no way to determine whether it will happen.
An Unsettling First
Michelle and her husband, who is 30 years old, did all “the right things” before deciding to have a baby. “We owned a home, we did all the preparations you’re supposed to do, and the time was just right.”
The couple enjoys a healthy lifestyle that includes regular exercise, no smoking or alcohol, and good nutrition. “There was no reason why I would think we might have any problems having a baby.”
After using ovulation home test kits and tracking her basal body temperature, they conceived their first pregnancy.
“Everything was progressing normally until the 14th week,” Michelle recalls. She experienced a bit of spotting which she believed was likely due to exercise. “Upon examination, they said my cervix was fine, but they couldn’t hear the heartbeat with a Doppler.” An ultrasound was performed, the third since her pregnancy began, and there was no heartbeat detected this time.
Up to the point of her own pregnancy, Michelle had virtually no experience with issues around conception or being pregnant. She was the first in her group of friends to try for a baby. She had joined an online forum to find out a little about getting pregnant. “And since I’m an only child, there was no one around me going through any of this,” Michelle says, “It was good to be blissfully ignorant.”
Once it was determined that there was no longer a viable pregnancy, Michelle underwent a procedure known as dilation & curettage (D&C) at the recommendation of her doctor.
“That was pretty hard,” she remembers, “It’s not that physically painful; you’re under general anesthesia and it’s only day surgery. But emotionally, it’s hard to wake up from that and realize that it’s all over.”
The few days between the ultrasound and the D&C were also difficult. “I had to walk around for a weekend knowing what was coming. It was indescribable.” The follow-up appointments at her OB’s office, surrounded by pregnant women in the waiting room, were equally hard.
A Certain Kind of Acceptance
First trimester miscarriage is a part of life that doesn’t get much public discussion, yet it occurs in as many as 25 percent of all pregnancies.
Most often, women in particular find out from their own experience how common miscarriage is, as their friends, relatives, even mothers, come forward into the light with their own stories.
Rather than deterring a couple from trying to conceive again, however, the commonplace nature of early miscarriage in the general population can be thought of as part of the process toward having a healthy baby. The vast majority of these embryos are chromosomally abnormal to the point of not being viable. If most of them made it to term and delivery, the result would be the loss of infants within hours following their births. The female body has pregnancy-related processes that result in spontaneous miscarriage when the embryo’s bodily systems are so malfunctioning that life will not be sustainable.
Michelle and Jason had the remains of their first pregnancy tested for genetic problems. The results took more than a month to come back. Although the ultrasound tech had pronounced the baby a boy, the test results said “healthy baby girl.” Michelle said it was explained to her that sometimes means the tissue sampled for testing may actually have been her own, and not the baby’s.
The lack of conclusion was disheartening, but the couple started trying to get pregnant around three months later.
Trying again, after losing their first, was a different experience. “We didn’t take anything for granted this time,” Michelle explains. “It was more emotional. An element of fun was taken away, I guess. But it brought my husband and I closer together. It solidified in our minds how much we wanted a baby.”
Three months later, she pregnant again.
“I took a million home pregnancy tests. Scrutinizing how dark each one was…”
She also switched OBs to a smaller practice that had glowing reviews online. She also found information on Internet that was upsetting. In addition to the first “pregnant or not” blood test, Michelle received several more to watch the level of hCG — the hormone emitted when a woman is pregnant — rise. “What I was reading online was that my hCG levels were on the low side, but the doctor’s office always told me everything was fine.”
The first ultrasound showed an embryo that was a little behind in development. Michelle worried more. “But I kept telling myself that there was no way this was going to happen a second time. With the testing that we’d done after the first one, I was convinced that it was just bad luck.”
Around her 7th week, an ultrasound revealed that this pregnancy was a blighted ovum, essentially a pregnancy in which there’s no embryo developing. “It was devastating, but not as much as the first one,” she recalls, “The worst part was when my hormone levels went down a thousand points in one week. I was really weepy and just exhausted.”
To resolve this miscarriage, Michelle took Cytotec, or misoprostol, a drug sometimes used to help the uterus empty itself in very early loss or blighted ovum. She had no unwanted side effects, but the resulting bleeding was upsetting.
Positive Choices and Results
Two losses in a year left Michelle wondering if she would ever be able to have a baby.
By now, she’d begun working in the business offices of Shady Grove Fertility. Her co-workers convinced her to see Dr. Jeanne O’Brien, who administered several more tests on both Michelle and her husband. All results were normal. They were advised to try and conceive again without intervention.
For a third time, Michelle conceived. “This pregnancy is terrifying,” she confides.
She was prescribed progesterone supplementation until her 12th week, as an added way of caring for the early pregnancy. Other than that, she has not been asked to do anything differently. Still, Michelle has decreased her level of exercise, just in case, to low-intensity activity like walking or biking around three days per week. It’s a choice that just makes her feel like she’s doing all she can to promote success with this one.
She also feels lucky to have occasional ultrasounds when she feels particularly anxious.
Strong Optimism Prevails
When asked if she or her husband have any special totems or superstitious items for reassurance — such as symbols of fertility or babies — she explains how she simply uses the power of upbeat thinking. “I try to think a lot about just holding the baby, and staying as positive as possible. Good luck charms — I tried them for the other two, but you know what? What’s going to happen will be, and I’m going to hope for the best.”
It took Jason a bit longer to join her in the optimism. “He just started to feel better, less guarded, once I got further along in this pregnancy. Now that he’s seeing my growing tummy, Jason’s starting to get involved and happier.” For some people, men and women, trying to remain detached from the emotions early on is a normal coping mechanism after previous losses.
Right now, Michelle’s enjoying the parts of being pregnant that many women see in a different light.
“Everyone else who’s pregnant is miserable and complaining, but the whole time I’m thinking ‘This is great! The hormones are doing what they’re supposed to be doing!” Michelle laughs.
So far she’s having severe nausea and feels her clothes getting tighter. “I see women who are farther along, and I just can’t wait until I’m at that point. Sometimes I wish I didn’t know about hCG and hormone levels and all that stuff.
Michelle feels that the research she did both online and through “stacks of books” helped her feel less alone and afraid after her first miscarriage. Her family has been supportive throughout the experiences, as have her co-workers and friends. “I know not everyone does this, but I told everyone about each pregnancy, because it helps to have them know why you’re going to all of the doctor’s appointments. And then they’re there for you if something happens.”
Michelle credits such a supportive network and naturally positive attitude for getting her through the rigors of trying to have a baby. “I keep my goal of a healthy baby in mind, all the time.”
