I wrote the following post back in week six, when miscarriage was in the forefront of my mind. I never posted it because I wasn't sure if I was getting my point across the way I wanted to, and also because I still suffer from the stigma of admitting a miscarriage.
Sadly, I have miscarried again. We found out yesterday, and as I am farther along this time than last time I am expected to have not only a period-like event but a mini-labour as well. So, right now, I no longer care about stigma, and therefore I am publishing my post from five weeks ago. Perhaps I will even blog the process of miscarrying. I don't know yet.
PS - according to my book, the statistical likelihood of having a "random factor" (ie no underlying problem, just chance) miscarriage twice is 15% to the power of two, or 2.3%. Guess I beat the odds.
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Miscarriage.
Even the word makes people get uncomfortable. I would say that this topic is one of the last great taboo subjects of American society. Why?
Statistics of miscarriage occurrence vary wildly - I've heard everything from "one in twelve" to "one in three" pregnancies end in miscarriage. I also noticed that the statistic was lower in general pregnancy books (don't scare them!) and higher in books specifically about miscarriage (reassure them!). More recently I've seen "about 15%" in pregnancy books, which is roughly two of every thirteen pregnancies. But unless you've had cause (such as your own miscarriage) to specifically talk to your friends or relatives about them I bet you don't know if anyone you know has had one. Why? Why is it so secret?
On Monday December 6th, 2008, I had a miscarriage. It was terrifying, even though I had about two days of warning that something was going wrong. It happened in the middle of the day, at work. My workplace at the time had a very open "if you feel sick, go home" policy with no penalties, so I begged illness and went home. Even three years later, the rest of that day and the following day are too painful for me to write about without crying, and I'd only known I was pregnant for ten days. Never underestimate the physical, mental and emotional pain that is associated with a miscarriage.
So, other than "painful", what is a miscarriage?
Miscarriage: The Belief
There seems to be a strong societal belief that a miscarriage can be caused by the woman doing something wrong - exercising too much, or getting upset, or eating the wrong foods, or just not being Good Enough to make the pregnancy succeed. The woman internalizes all of this throughout her life. After all, no one talks about miscarriage, so it's this terrible secret, and why is it secret if it's not bad? "I must have done something wrong for this bad thing to have happened to me when no one else I know has had it happen," the woman thinks. "If it were normal and common wouldn't everyone talk about it?" The very fact that no one talks about it lends credibility to the idea that it is something secret, something shameful, something to be hidden away and not talked about.
Miscarriage: The Fact
Most miscarriages - about 80% - occur in the first trimester. The few that occur later are usually due to some other already known underlying problem. A first-trimester miscarriage is really a natural abortion - the embryo is not developing properly, and will not be viable or will be severely disabled, and the body says, quite matter-of-factly, "this one didn't work out - let's try again." In some cases, there's no embryo at all, just a shell. The body suddenly realizes this and stops wasting energy resources on something that doesn't matter.
The activities of the mother have absolutely no bearing on the result. It's a biological process like breaking down sugars or healing a wound. Whether you decided to stay up late and eat ice cream or stressed all night over a work problem doesn't affect miscarriage any more than it would these other processes.
In addition, with the advent of early home pregnancy tests over the last few decades more women are able to discover their pregnant status much earlier than they used to. This also means that very early miscarriages and "chemical pregnancies" are detectable now. In previous generations they would have been brushed off as a late period, which occur naturally at various times in a woman's life for various natural reasons.
There are urban legends, almost, of external physical effects impacting the development of a first-trimester embryo. These are often severe physical shocks - major car accidents, or in the ones I heard recently, spending hours standing next to huge vibrating speakers at a rock concert. I have no way of knowing how much truth there is to these stories. There can be a cause and an effect but they aren't necessarily connected.
After a miscarriage women are generally advised to wait for one to three natural cycles to take place, depending on how she is feeling and the length of the failed pregnancy, before trying again. Some women try again straight away. Others wait a while. Others, like me, are ready before their bodies are. It took over a year for my cycles to return to normal after my miscarriage. I have charts showing what they looked like. One was over three months long with almost random bleeding throughout. When dealing with this, it's very difficult for a woman to "move on" and forget what has happened.
Early Pregnancy: What It's Like
The first trimester (at minimum - I have no experience of the second) of a woman's pregnancy is spent in a state of mild agitation. The first two weeks of a pregnancy technically occur before you're even pregnant, so those are fine. The next two weeks, for someone trying to conceive, are called the "two week wait" - an agonizingly slow period of time when it's too early to test and you have no way of knowing if this time will be successful. There are a myriad of online discussion boards where women can help each other obsess about potential symptoms and analyze home pregnancy tests for "squinters" - tests that are ohhhh-soooo-faintly positive. Sometimes it's really helpful to be able to talk about these things with like-minded people. Other times its enough to drive you up the wall.
All of this happens before the partner is even aware that something might be going on. After all, from his perspective and with no visible proof to the contrary nothing is going on. By the time he can be advised of the good news the woman is already completely absorbed by events, heart and soul. It can't be helped when you are monitoring your body so closely.
At the end of the two week wait there will be one of two outcomes. A negative result, to someone who has been trying for months, years or decades, is crushing (see the absorption mentioned above), and the cycle slowly repeats. I suspect this part is slightly baffling to the partner...after all, haven't there been hundreds of normal, nothing-happening cycles in your life already? Yes...but it's different when you're trying to get pregnant. Entire portions of your life - nutrition, exercise, vacation plans six months in the future, whether you'd prefer to be huge in the summer or the winter - have been adjusted around this might-have-been.
Once you get your "BFP" (Big Fat Positive) you can graduate to the next level - a slightly paranoid one. Every trip to the bathroom is accompanied by a flash of fear - will there be blood? And if there is, is it normal "implantation spotting" or something worth worrying about? Going to the bathroom and seeing nothing out of the ordinary almost feels like you've won a prize. Every abdominal twinge and pain is turned over and over in your head. That cramp there...it felt like the ones I get before my period starts. Is it going to go away? What if it doesn't? A few women experience really scary false alarms - large quantities of blood, gripping pains - which are only truly eased by trips to the doctor for ultrasounds and blood tests.
Those who have never miscarried carry the fear of the unknown with them every step of the way. Those who have miscarried know the anguish that accompanies it and dread its return. I've done both, and I can honestly say that it was worse the first time around.
Then there are the physical changes - enlarging breasts, changing waistline ("more bloat than baby" at this point!), fatigue, appetite changes, nausea. If people notice and start to suspect, it puts another layer of stress onto the woman - because if the pregnancy is known about and then ends in miscarriage she will bear the brunt of well-meaning but hurtful comments from her friends, family and coworkers. (Never, ever, tell a miscarrying woman that it's for the best or that she can always try again later.)
So much of this stress and anxiety could be lessened if we looked at miscarriage as something that occurs normally, naturally, in a large minority of pregnancies, and through no fault of the mother. The specter of miscarriage gains its power through the very secrecy and shame that keeps it hidden. We have the ability to change that by speaking openly and honestly about miscarriage. It's not easy; when Martin first said that he wanted to mention our miscarriage on the blog, my first reaction was "no way - it's private!" But I've since realized that my own experiences would have been much less upsetting if I'd been raised in a world where miscarriages were just a normal part of many women's lives.
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