Spotting again…

I picked up my son yesterday — he fell asleep in my lap after lunch, and I carried him to his room. I toyed with the idea of just trying to ooze out of the chair and leave him asleep in it, but figured he’d get better sleep in his own bed. I considered the possible “carrying a heavy weight”-spotting connection, and said, “Well, I haven’t had any spotting for a while; maybe it wasn’t that anyway; am I supposed to go the whole 9 months making sure I lift nothing heavier than 10 pounds?? So, I carried him. And to add insult to injury (possible injury, although I hope not!) — he didn’t stay asleep.

This morning, I woke up to spotting. It’s not as heavy as the other times I had red bleeding, but it has been all day, which is longer than the other times; and it hasn’t seemed to have abated much if at all. Plus, I can feel slight cramping much of the time — it’s slight so that if I’m distracted I don’t feel it, but if I think about it, I can. So, I’m back on my self-imposed restrictions — I also had not been worrying about when or how many times or how quickly I went up and down stairs. No other possibilities spring to mind about what may have caused it. And I know it’s possible that nothing I did or didn’t do has caused it… but the onset was too similar to the other times — definite onset within several hours of carrying something heavy (my child, a frozen 20-lb turkey, etc.) — for me to just dismiss it as coincidence.

Some study suggested that more women who miscarried had done vigorous exercise (running, bouncing type exercises — quick, rapid motions) in their first-trimester miscarriage. However, I also read something many months or perhaps even years ago about a similar-sounding study (perhaps even the same one), that noted that the study in question was retrospective, and asked women perhaps many months or even a year after their miscarriage about their exercise habits. Time may have clouded the recall of these women; and if they knew that the researchers were focusing on the possibility that exercise may have caused miscarriage, they may have misremembered how little and how mildly they exercised; and the other women who did not have miscarriages may likewise have misremembered how how much and how vigorously they exercised. What would be far better would be to gather a group of women who were trying to conceive, and have the women keep an exercise diary both in the pre-conception period as well as at least through the first trimester (or at least until miscarriage), to see prospectively how exercise might affect pregnancy.

However, until I see that study (and perhaps even then, because I might be an exception to the rule!), I’m going to take it easy; try not to go up and down stairs too much; when I do go up and down stairs, I will go more slowly, and not race up and down; I will not carry my child or anything heavy for several weeks more at least (so no helping my husband bring the Christmas tree in!) and I will try to relax and not worry.

Actually, I’m not worrying, because I know that if I am miscarrying, there’s nothing else I can do to prevent it. Although I suspect that if this current bleeding ends in a full-blown miscarriage, I will feel some measure of guilt for carrying Seth to bed. Trying not to think about that, though…

[Update — this spotting did end up being a full-blown miscarriage, but I don’t really feel guilty. Perhaps I “should” feel guilty, but I honestly feel that while my carrying him may have kick-started the spotting, that the miscarriage was ultimately unavoidable.]

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The Allure of Bedrest

Before anyone gets hot under the collar about me thinking that lying in bed day in and day out for weeks or even months on end is “alluring”, let me start off with a disclaimer. No, I do not think that it is! While I’ve never had to endure bedrest, I have had some periods of sickness in my life that made being housebound or bed-bound extremely boring after just a few days. Even being able to watch TV constantly became irritating. I remember one sickness in particular when I was actually wishing I could go back to school! “So, if you don’t mean that, what do you mean?” Simply this.

When I had the previously mentioned episodes of spotting in this pregnancy, I started turning over in my mind anything and everything that I might have done to cause it. Even though part of my brain told me that there was nothing I did that caused it. After all, everything that I had done in this pregnancy, I had done at the same time in previous pregnancies (more or less — sometimes much more!), and hadn’t had a problem with it. But still I wondered: Ok, so I hadn’t done aerobics exercises, but maybe the abdominal toning exercises had caused it? I had gone up and down stairs a lot right before I noticed the red bleeding the first time, so maybe that was it? Surely it wasn’t sitting on the exercise ball!… was it? Ok, so I picked up my three-year-old when he was crying. Bad mommy! And I had done my yoga/relaxation exercises that I had discovered midway through my first pregnancy and hadn’t done in early pregnancy either of my other times — could that have caused uterine bleeding?

And that is what I mean when I refer to “the allure of bedrest.” There is the idea that somehow, something you did caused or at least contributed to the spotting (or miscarriage), and if you can just somehow figure out what that thing was and stop doing that, then you can make sure you don’t do that thing again. In my case, I did try to take it easy after the first case of red bleeding (as in, mostly sitting, sometimes lying down, minimizing trips upstairs, absolutely not picking up anything heavy, and no sex), and it seemed to help — the bleeding was minimal, lightening both in quantity and color as the day went on, and stopped before the day ended. But when I bled again in the middle of the night, after having done nothing more vigorous than walking ten feet from my bedroom to the bathroom, I figured maybe bedrest wasn’t helping. But I’m still trying to take it easy — in particular, I still am not picking up anything heavy. Just in case.

There may be some benefits of bedrest, in specific instances — I don’t know all the ins and outs, whys and wherefores, good and bad about bedrest, based on particular symptoms and risk factors. My mother-in-law swears that bedrest enabled her to maintain her first pregnancy (my husband and his twin brother) after she hemorrhaged in her first trimester. And there is often the thought, among both mothers and doctors, that “it can’t do any harm, and it might do some good.” However, that’s not always true! — I was reminded of a study I’d read about, done in Australia, of women pregnant with twins, undertaken to see if hospitalization with bed-rest, in the absence of any risk factors other than twin gestation, made any difference in their pregnancies, and specifically in the rates of preterm birth. [“The effects of hospital admission for bed rest on the duration of twin pregnancy: a randomised trial” The Lancet, Volume 326, Issue 8459, Pages 793-795] It did. Women who were randomly placed on bed-rest had a significantly higher risk of preterm birth than women who were randomly assigned to continue life as normal.

But for myself, I will say that had I not sat down and “tried to take it easy” when I started spotting and bleeding, I probably would wonder if perhaps I would have stopped, had I done so. There still remains an allure of bedrest.

[Update — I did end up miscarrying soon after writing this.]

I’m Pregnant… but spotting

This is going to be a TMI (too much information) post, with more questions than answers — I haven’t really done a lot of research into this topic, so maybe some of you who have gone through a similar experience can help me out.

LMP = Oct. 11

Average menstrual cycle — 29 days; although it has varied quite a bit this last year (that I’ve written down, which hasn’t been every month). In reverse order, it was 27d, 31d, 27d, 29d, 25d, 29d, 29d — that’s back through March; with the only other month I remembered to make a note of being over a year ago, and it was 31d. I will assume that most of the times I didn’t write it down, it was 29 days, because that’s what it usually is. Some of the short or long times by the calendar may have been actually more due to my noticing late at night some months that I had started, and other times not until the next morning other months. I will admit to some measure of embarrassment and perturbation that my cycles have been as varied as they have been, and I never noticed it. {shrug} It just never much registered in my conscious memory, and I assumed I was really quite regular.

I never “felt pregnant” any of the long months. Or short months, for that matter. But I know that not everybody gets early pregnancy symptoms. However, both times I was pregnant with my children, and no other times I was late, except this time, have I really thought I was pregnant, or “felt pregnant.” This “feeling pregnant” has mostly been limited to a greater awareness of my uterus and (primarily) breast tenderness/sensitivity. So, I’m going to say that any previous time I was later than 29 days, and wondered if it was possible I was pregnant, and then started in a day or two, that I really was not pregnant, just a longer than normal cycle. When I was pregnant with my older son, I felt the implantation (weird, I know), but had realized I had messed up on my calendar, so could be pregnant — although I knew numerous couples who had wanted to wait a few years after getting married to have children, and then when they decided it was the “right time,” discovered that they 1) were infertile; 2) had difficulties conceiving; or 3) had multiple miscarriages; so I had reason to believe that I might be no different. So, when I felt breast sensitivity, I tried to brush it off as being “pregnancy hypochondria.” It wasn’t — it was the real thing! Then when I got pregnant with my younger son, I was still nursing my older son and 1) I could feel my uterus contracting slightly when I nursed (although I wondered if it was in my head, because I suspected I was pregnant but was not “late” yet) and 2) if he had a bad latch, I gasped because it hurt so much and had to reposition him.

But this time, my boobs were sore, from before I could have known I was pregnant; and I was more aware of my uterus — I could feel little cramps, or sense a feeling of fullness — even though I had no reason to suspect I was pregnant, and still cannot pinpoint conception or any time I “messed up” with NFP [natural family planning]. Looking back at my cycle, it’s possible that I ovulated too early, and sperm that normally would have died before I ovulated was still alive and able to fertilize the egg. Or, it’s possible that I ovulated too late, and I thought I was “in the clear” when I wasn’t. Or, it’s possible that he didn’t withdraw in time, or some sperm came out pre-ejaculation. [To own the truth, I did suspect that at one point, but didn’t mention it to my husband at the time.] Sorry about the TMI, but now you know — yes, I do have sex. I bet you thought I didn’t! 🙂

So I suspected I was pregnant, but I had had a premonition that I would have a miscarriage at some point in the future — maybe it was a fixation I had on miscarriage, due to several blog friends having miscarriages, and several posts I’d written in the recent past. Not all of my premonitions have turned out to be true, but some have — like the fact that I could never picture my father walking me down the aisle in my wedding; or that I could never envision him becoming an old man. At the time, there was no reason to suspect anything, but he was killed in a car wreck a few years later, several years before I got married. So, I do pay attention to premonitions.

But I didn’t take a pregnancy test right away, because I thought, “If I have a miscarriage, I don’t want to know about it. I want to be able to pretend that it was just a late period.” Besides, I knew I had gone 31 days just a couple of months before, so I didn’t want to drag both kids into the store with me just to get a test, and I had no other reason for going into town; and if it was a late ovulation, and I really was pregnant, it might show up negative if I tested too early. Even though I ovulated right on time with Keith, I was still a week late before the pregnancy test showed anything but the faintest positive, and I had had two negatives before with one negative after the faint positive!

So, I was supposed to have started on a Monday, and I didn’t. By Friday, when I still hadn’t started, and my boobs were definitely sore and my uterus felt full and heavy, I finally told my husband, and went out on Saturday and got a test. It was a moderately faint positive (although I did take it in the middle of the day, so the hCG may have been less concentrated than had I waited and taken it in the morning). We told our mothers on Sunday, but nobody else. On Monday, while I was at my mom’s, I started spotting.

Even then (5 weeks gestation, dating from LMP), it was far too late to be implantation bleeding (especially since I had a twinge when I thought I might have felt implantation, 2 weeks before), and too late to be breakthrough bleeding like some women get, when they have a “mini-period” at the time their normal menstrual cycle is supposed to start. I thought, “Well, this is it — the miscarriage has started.” But it was pink, and fairly light, so I was still hopeful. I told my sister, who was at my mom’s with me — it was impossible for me to attend to anything she was saying, so it was either that, go home, or have her suspect I was on mind-altering drugs, or something! I didn’t want to be alone with this weighing on me, so I told her. Besides, she had had spotting when she was pregnant with her oldest child, although that was at 3 months gestation. We talked for a while, and as the day wore on, the spotting got even lighter, turned brown, and disappeared. I also told my other sister, because she had had three miscarriages, and I wanted to get her opinion as to “what a miscarriage was like” — physically, anyway — to see if I might be in the beginning stages of miscarriage. But since the spotting had stopped by that time, it seemed I was not miscarrying.

Several days passed, with not even a smidge of pink, brown, or red; and then Friday it happened again. I had been doing what I normally do; feeling fine; feeling better about not having had any more spotting. I had sold some stuff on eBay for my sister, the auctions had closed, so I was running up and down the stairs getting boxes and putting the stuff in boxes (nothing heavy — mostly stuffed animals), and finally had to go to the bathroom, and saw red. Like I was starting my period. Red. Not a good sign. Again – and even more strongly – I thought, “Well, this is it; I’m having a miscarriage — it’s started, and there’s nothing I can do about it.” That thought pretty much disrupted my peace, and I didn’t feel like doing anything but sit and read, or lie down and watch something, passing the time, while I was passing my baby. Sad, huh?

But instead of getting heavier, it got lighter — still red, but less of it; and by mid-morning, almost gone. Again. I had called my mom to let her know I was definitely miscarrying, so I had to call her and say that maybe I wasn’t. I couldn’t pinpoint anything that might be causing me to start bleeding. Especially since I had done nothing differently from the other two times I was pregnant, and I never had a smidge of spotting with either of them, from the time my period ended until I lost my mucus plug towards the end of pregnancy. Lifting heavy stuff? I was a waitress when I was first pregnant, so was used to carrying heavy trays with 4-5 heavy plates loaded with entrees multiple times per night; and I had a ten-month-old that I carried around during my second pregnancy, plus I had cloth diapers that I would usually have soaking in a 5-gallon bucket partially filled with water. Going up and down stairs? First pregnancy – not so much; second pregnancy, had the laundry and freezers downstairs, plus a playroom, so was on the stairs a lot. But I have decided to act like I’m postpartum and have experienced an uptick in lochia, so am trying to take it easy. — No lifting of my children (which is really hard, since my 3-y/o is a snuggle-bug and loves to be held), or anything heavier than about ten pounds.

So, that was Friday and Saturday. I sat around most of Saturday, and minimized my trips upstairs (which is where my computer is, so I don’t want to not go upstairs at all; but I try to stay either up or down, rather than running up and down all day at the drop of a hat). Saturday evening, I watched a movie while lying in bed. Taking it reeeally easy. Sunday morning, I woke up and felt my uterus cramping, went to the bathroom, and sure enough, it looked like I was starting my period. Again. I went back to bed (what else could I do?), expecting to have a full pad in the morning. Nope. Hardly anything. What there was, was red; but once again, it lightened up considerably, and faded to almost nothing over the course of the day.

I posted something on facebook on Saturday and announced it at church on Sunday, and got some good responses from my friends who themselves, their friends or their sisters had had miscarriages and/or spotting during pregnancy. One friend said that her sister spotted all through her first trimester of a couple of her children — so much that she thought it was a miscarriage, or was her period if early enough and even used a tampon — but she maintained her pregnancy, and had a healthy, normal child. And my mother-in-law reminded me that she hemorrhaged when she was pregnant with my husband and his twin brother — so much so that her doctor (very condescendingly) said, “I’m sorry, Mrs. Petersen, but there is no way you are keeping this baby!” (He also told her a few months later that there was no way she was having twins. Strike two!) But she did.

And again, last night, I spotted some more during the night (maybe it was because I lifted the turkey to drain the broth? it was an 18-pound turkey! but I only lifted it a little bit, and only once — made my husband lift it all the other times). So, nothing heavier than ten pounds? Minimizing trips up stairs. No aerobics (not like I was doing it much anyway). No abs exercises — not that I was really doing anything major to start with, but I really wanted to strengthen my abdominals and my back muscles before I started to show, to minimize the strain on my back later in pregnancy; but if I miscarry due to overdoing things, then I won’t have a “later pregnancy”, but will feel guilty about overdoing things.

Part of me says that it probably wasn’t these things — especially since it didn’t happen even in the slightest before; and I haven’t really been “overdoing” things at all. But, with the red starting after multiple trips up and down stairs, and the evening of or day after I picked up my younger son and felt a slight abdominal strain… I just don’t know. “Bed rest” hasn’t seemed to change anything; but with any increase of red not being soon after any “heavy” lifting, but at a minimum of six hours afterwards, is that a true association or merely a false coincidence?

It’s frustrating — this feeling of limbo. This nightly fear of miscarriage, followed by a daily minimizing of that fear, with the spotting being less. This “fish or cut bait” feeling — as bad as it feels to say that.

Is there anything a doctor can do to stop a miscarriage? I don’t think so. A vaginal ultrasound could confirm the existence and size of the baby, and whether or not the heart is beating, and making sure that it’s not ectopic. But it could not ensure that the heart will continue to beat, and could not guarantee that I will not have a miscarriage. If the heart is beating, that means I’m statistically less likely to miscarry, but it will not entirely eliminate the risk. And then, what are the risks of a vaginal ultrasound?

More questions than answers. More frustrations. More stress. Sigh…

[Update — I did end up miscarrying soon after writing this.]

Pregnancy and Infant Loss Remembrance Day

It was October 15, so I’m a little late. I didn’t realize there was even such a worldwide day of remembrance, until a few of my facebook friends posted it (mostly those who had miscarriages), and some of the blogs I read likewise mentioned it.

Many women experience miscarriage — I’m not sure of the exact percentage. It seems like I’ve heard that one in six pregnancies end in miscarriage, but I’m not sure how accurate that figure is. I know a lot of women who had miscarriages; many women have multiple miscarriages — my sister had three prior to her two successful pregnancies, and others have none. Many women experience babies who are stillborn, or who die in their first year of life.

Some women grieve as much over an early miscarriage as other women grieve over a full-term or infant loss. However, many people seem to judge women who grieve over early pregnancy losses, as if they were somehow less connected to their child, or they ought to have loved him or her less. Many infertile women grieve over their menstrual cycle, with every month being like a pregnancy loss, since it is evidence that there will be no child born from this month’s attempt at conception.

If you’re on facebook, I think you will be able to read this note (My Forever Child), with multiple links to information websites.

Pollution and Prematurity

Since September is National Infant Mortality Awareness Month, and since 67% of infant deaths in the first year occur in babies born prematurely, if we can lower the premature birth rate, we can lower infant mortality.

In June of this year, a new study was released, which showed a higher rate of preeclampsia and preterm birth among women who lived within 2 miles of the busy Southern California interstate system. Here’s the full study.

Abstract
Background: Preeclampsia is a major pregnancy complication leading to substantial maternal and perinatal morbidity, mortality, and preterm birth. Increasing evidence suggests air pollution adversely affects pregnancy outcomes. Yet, few studies have examined how local traffic generated emissions affect preeclampsia in addition to preterm birth.
Objectives: Examine effects of residential exposure to local traffic-generated air pollution on
preeclampsia and preterm delivery.
Methods: We identified 81,186 singleton birth records from four hospitals (1997-2006) in Los
Angeles and Orange Counties, California. We used a line-source dispersion model (CALINE4)
to estimate individual exposure to local traffic-generated NOx and PM2.5 across the entire
pregnancy. We used logistic regression to estimate effects of air pollution exposures on
preeclampsia, preterm delivery (PTD, gestational age <37 weeks), moderate preterm delivery
(MPTD, gestational age <35 weeks), and very preterm delivery (VPTD, gestational age <30
weeks).
Results: We observed elevated risks for preeclampsia and preterm birth from maternal exposure to local traffic-generated NOx and PM2.5. The risk of preeclampsia increased 33% (odds ratio (OR) =1.33, 95% confidence interval (CI): 1.18–1.49) and 42% (OR=1.42, 95% CI: 1.26–1.59) for the highest NOx and PM2.5 exposure quartiles, respectively. The risk of VPTD increased 128% (OR=2.28, 95% CI: 2.15–2.42) and 81% (OR=1.81, 95% CI: 1.71–1.92) for women in the highest NOx and PM2.5 exposure quartiles, respectively.
Conclusion: Exposure to local traffic-generated air pollution during pregnancy increases the
risk of preeclampsia and preterm birth in Southern Californian women. These results provide
further evidence that air pollution is associated with adverse reproductive outcomes.

What can be done about this? Not really sure. Move? Try to avoid the freeways, and use the car’s air conditioning system so the air goes through the filter (the researchers’ suggestion). Have a lot of plants in your house, if you live close to a high-traffic or high-emissions area? Perhaps get a personal air purifier?

It’s interesting that only about 60 years ago, doctors “knew” that the placenta acted as a barrier to protect the fetus (which it does… partially), so they gave drugs to mothers under the assumption that the baby could not be hurt. The nausea drug Thalidomide vividly proved them wrong (images of babies born after their mothers took Thalidomide here). Now, doctors are rightly concerned about the air we breathe.

What not to say to someone who has experienced a pregnancy loss

So far, I have not had a miscarriage or stillbirth, so I [thankfully] don’t have any personal experience with this. But I’ve heard some doozies of what other people have said to women who have lost babies. I’m sure others can add to this list:

  • “It was meant to be.” Yeah, okay, even if so — HOW DOES THAT HELP??
  • “You can always try again.” But she can never have this baby. Or, maybe she can’t just try again. What about that?
  • “It wasn’t really a baby.” Perhaps said with an early miscarriage; perhaps said about an ectopic pregnancy; perhaps said about a baby that was lost due to genetic problems. But even if said about a “blighted ovum” pregnancy… IT STILL HURTS. The pregnancy, the baby, was very real to her, even if only in imagination and anticipation. That loss is not diminished by thinking or knowing that there was a problem with the baby, nor by there not actually being a baby. Perhaps the hurt may even be made worse by this kind of statement, if the woman begins to feel bad for feeling grief over this very real sadness that others minimize!
  • “Well, at least you’re okay.” Maybe she’s not “okay.” Maybe she’s “okay” physically, but tormented mentally and emotionally. Did you ever ask her if she is “okay” or did you just assume it?
  • “It was just a miscarriage. It happens all the time. Get over it, already!” I can’t even think of a comment after this, because I just want to punch somebody in the face, and I’m not usually given to violence.
  • “Shouldn’t you be over this by now?” A milder variation of the above statement. Everyone grieves differently. Some people need more time and space than others.
  • “At least it was early, before you really got attached to it.” Ever hear of the process of pregnancy — fertilized egg burrows into the uterine lining, part of that becomes the placenta, the rest becomes the baby, joined by the umbilical cord — by definition it is an attachment! Again, why assume that the mother was not attached to her baby? Many women plan pregnancies even months in advance, so perhaps have been “attached” to the idea of a baby for longer than some women are even pregnant, and then lose not just the baby and those few weeks and months of pregnancy, but lose all those months of anticipation and hope as well!
  • “God had a reason for this.” I will say that I agree with this statement, but not with the timing. It may help some people to hear this, but quite honestly when it was said after I lost my father in a car wreck I wanted to smack the speaker. Not because I didn’t believe it, but because it just plain hurt, and hearing this did not help.
  • “This is because you…” or “If only you hadn’t…” Even if correct, it’s probably not the right time, and you’re probably not the right person to say it. Wait until a better moment, and also think before you speak. Think first of how accurate your statement likely is (because you know one glass of wine is probably not going to cause a miscarriage), and secondly, if your statement is correct (“shooting up with cocaine was a dumb idea while pregnant”), make sure the person can hear you and also make sure that the person hasn’t already come to that conclusion on her own. Because if you tell her that she caused her miscarriage when she already knows it, you’ll be rubbing salt in her wound. Now, if you lovingly say that and keep her from future miscarriage and pain… then that may be okay, if said in the right way, at the right time, and with the right spirit.
  • Any comment about somebody you know or heard of having an abortion, or anything you read about somebody abusing a child. This also applies to women who are struggling with fertility. I still remember clearly one blog I read, when I first started reading blogs a year and a half ago, written by some L&D nurse who had to take care of some teenager having her second child (or perhaps after-care for a second abortion), when the nurse herself couldn’t get pregnant. It was all she could do to maintain a minimum of care and good attitude, because she really just wanted to throttle the girl, because this girl was throwing away that which the nurse desperately wanted and couldn’t have.

What others can you think of to add to the list?

What can you think of that would be helpful to say? The only thing I can think of is, “I’m so sorry for your loss. I’ll be praying for you.” Perhaps also, “What can I do to help?” or “Can I make supper for you tonight/tomorrow?” or “If you need to talk, I’m here.”

Miscarriage Post

I’ve never had a miscarriage, but it is a fairly common event — the estimate is that 15-20% of known pregnancies end in miscarriage (losing the baby prior to 20 weeks and/or 400 grams), with even more pregnancies ending in miscarriage unknown and unnoticed by the woman, appearing like a late and/or heavy period. This post is one woman’s experience with a miscarriage. Although I’ve known many women who had miscarriages, I’ve never heard quite this description, on an emotional, mental, physical, and hormonal level.