Men & Miscarriage

My husband and I haven’t talked too much about our miscarriage. Certainly, some of that is due to his degree of separation from the miscarriage — he wasn’t pregnant, I was; he didn’t bleed, I did; he didn’t pass any tissue, that happened to me. But I know it affected him. Many men don’t deal with their feelings nor show their feelings the way women do, so I didn’t really expect him to talk too much about it, nor do I think he was handling things “wrong” by keeping his feelings to himself. I hoped to be open to hearing what he had to say, if he wanted to say anything, but I didn’t want to pressure him or pry. Maybe I was wrong in being more reticent, although I did ask him a time or two, just to show that if he wanted to talk, he could.

The pregnancy was not planned, although when I told him that I thought I was pregnant (the exact quote was, “I haven’t started my period yet”), he got this goofy grin on his face (he asked, “when were you supposed to start?” — which was Monday and the conversation took place on Friday afternoon). When I asked him how he felt a few days later, he admitted that he wasn’t totally happy, because of the various reasons we were not planning on having a baby, but “what can you do?” and that he was somewhat happy. Which pretty much mirrored my feelings — it wasn’t in our plans, but obviously was in God’s plans, so we needed to rest in His judgment.

Then when I had the first red bleeding and assumed I was miscarrying then (a couple weeks before I actually did miscarry), he said he was sad “but what can you do?” and that was all he said. In the interim space, between then and when I fully miscarried, we didn’t discuss it. When I passed the tissue, I asked him if he wanted to see it. I wouldn’t have been surprised if he said yes, or if he said no. He went into the bathroom for a moment, and came out with red-rimmed eyes. I think it made it more real for him. For my part, I think had I seen something that looked like a baby (perhaps I should have opened up what I learned from another story might have been the amniotic sac, and then it might have been visible?), I know I would have been sadder, because it would have seemed much more real. Knowing my husband, I wasn’t totally surprised at his reaction, and actually felt a little bad that I had not been sadder or more grief-stricken at the sight.

In our society, I think we forget that men experience miscarriage too — different in many ways from how women experience it, but they have a loss just the same. Certainly, not all men are going to be happy that they’re going to be a father and may be happy that the woman had a miscarriage (after all, many men will pressure a woman into an abortion to avoid fatherhood); but I would think that the average man is going to feel some sense of loss. Men are different, and some may feel only a slight loss (the baby may be less real, almost as if its just imagination, until the woman starts to show, or he can feel the baby kick, or some other thing happens that makes the baby real to the man), while others really struggle.

Before having my miscarriage, I was going to write a post entitled “Baby Boom” because there were four women at our small church who were all pregnant, and due about 6 weeks apart from each other — I was the latest, two others are due just days apart, and a newlywed couple was the first due. While four pregnant women may not be much for mega-churches or other large churches, for our church that was about all the women who could/would reasonably be pregnant — leaving out those too old, or who have decided their families are complete, just had a baby, etc. I still was thinking of posting something along those lines, and then found out last night that the newlywed couple lost their baby. And today at church, I found out that one of the other mothers is having problems with her gallbladder and will likely have surgery, and I don’t know how that might affect her pregnancy. So, I’m not in the mood to write a jovial post about the 4 3 2 possibly 1 new baby due next summer.

At our church, we have morning service, potluck lunch, and then afternoon service. At lunch, I sat at the same table as the newlywed couple, and of course miscarriage was the subject of part of the conversation, but it did not dominate — there were other subjects, many humorous. I was sitting opposite the couple, and could see that the woman was handling things okay, but it seemed to me that the husband was struggling a bit. There were times he would only smile when others were laughing; or he would chuckle a bit, and then look like he was going to cry — subdued, grieving, but trying to keep his spirits up. Prior to getting married, this young man would dote on the babies and young children at our church, and he was thrilled with the news that his wife was expecting — he really wanted to be a daddy.

I mentioned my observations to my husband, and he said a little something about himself having experienced loss (with tears), and now this other man as well, and then prayed for him. It was obvious that the man appreciated it, and I wonder if he had gotten much emotional support (from either men or women). When we announced our miscarriage at church, almost every woman and several of the men came up to express their regrets; my husband didn’t get nearly the same level of attention, although he experienced the loss of the same baby. Men experience miscarriage too; but I think we as a society often forget that, and/or take their silence or reticence or stoic appearance as proof that they don’t feel loss and aren’t mourning or grieving. Had I judged only on superficial appearances (rather than closely observing my husband and also this man), I might think that too. But judging on the more particular inspection, I might think that the miscarriages affected the men more deeply than the women… or at least, in a different way.

Yes, women often experience more grief than men do, at a miscarriage; but that doesn’t mean it is always that way. Let’s not forget the men.

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Easing the Anxiety of Pregnancy after Miscarriage

In response to a recent post, someone included a link to this article in a comment. I liked it, and wanted to share it.

Even though I had never experienced a loss of any sort (early, middle, late miscarriage, fetal demise, stillbirth, infant death), the following description of these post-loss mothers resonated with me, mirroring my feelings during this pregnancy:

“‘One Foot In — One Foot Out’ describes women’s sense that the pregnancy is uncertain, so they steel themselves emotionally by acknowledging that the pregnancy may not end with the birth of a live baby,” says Côté-Arsenault. “They cushion themselves against attaching to the new baby.

“For most of these women, carefree enjoyment of a pregnancy is not possible. Instead, it is a balancing act between trying to insure safe passage of the baby while maintaining emotional stability.”

There was always a nagging something in the back of my mind; but I tried to ignore it and overcome it, and be attached to the baby. I think I did for a while, but then something happened when I started spotting the second time, and I just felt like it was a farce. I was living under the sword of Damocles, although I pretended like I wasn’t, and acted like I wasn’t, and tried to convince myself that I wasn’t. Perhaps that was my body telling my mind what my uterus already knew; but perhaps not — some of these mothers in this article did not truly believe they were actually going to have a baby even in late pregnancy, although they did.

“It would be wonderful if pregnancy losses were acknowledged openly in our culture too,” she said, “but at least hospitals in this country have gotten better about helping women acknowledge a lost baby,” noted Côté -Arsenault. “When a baby dies, giving the mother the baby’s photo, footprints and handprints is much more routine. We have made progress. Now we need to recognize the impact of perinatal loss on subsequent pregnancies.”

Being open about my miscarriage has brought a lot more response and sympathy from women who have had miscarriages than I would have guessed. I knew that a large percentage of women have had miscarriages, and I knew a lot of my friends in particular had had miscarriages; but there were a lot of women who told me about their miscarriages, when I had not know that before. And I don’t know why. Certainly, some of it is that I was not close friends with them at the time they had their miscarriage(s); many of my facebook friends are people I see once a year, or perhaps even less. But I was surprised at some of them — multiple miscarriages, even, and I never knew it. And then all the stories from those who had not miscarried but had experienced spotting and even bleeding — I never suspected it to be so many.

It’s almost like women are expected to just accept the miscarriage and go on, not telling anyone that they were pregnant unless absolutely necessary — almost like it’s a secret. A naughty secret. Sure, some people are private; some have probably heard some not-so-sensitive comments on their loss, so I understand why some wouldn’t broadcast the news of their miscarriage. Others like to keep the news of their pregnancy private, to have something just to share between them and their husbands, until something happens that makes them need to tell (start showing, morning sickness they can’t hide, etc.); and then if they happen to have a miscarriage before they’ve told, then they’ll just not mention the pregnancy at all. I understand that; but I think many people do themselves and others a disservice. Because then it remains hidden, it remains not talked about, and through peer pressure, or not wanting to be an oddball or whatever, nobody else says anything either. It’s almost like a girl being sexually abused by her step-dad, and thinking she’s the only one; then finding out 20 years later that he abused all of her sisters, plus his own daughters, and a few neighborhood girls as well. A wall of silence.

Now, I’m doing okay. I really thought I’d have a hard time with this, but I’m not. Perhaps that may change at some point, but so far, so good. But many others hurt deeply and grieve terribly, over early or late losses. And if the wall of silence remains, they don’t know whom to turn to, for someone who has gone through a similar experience. Perhaps they even think they’re the only ones. But if they are likewise silent, then those others who have previously experienced loss won’t even know that they are going through or have gone through the same thing, and need comfort. And the cycle perpetuates.

That’s one of the reasons why I was so open about this pregnancy and miscarriage, despite (or perhaps because of) my uncertainty and fears. I want to help break the cycle, and break down the wall of silence. Because we are not alone in this world, and we shouldn’t have to act like we are.

Remembering…

…all the women for whom Mother’s Day is a sad or bittersweet occasion. I know that today will be hard for you; you’re in my prayers.

Monday morning quarterbacking

Over a year ago, I happened across a YouTube video that led me to a blog called “untangling knots” which I won’t link to but should be the top search result if you Google it. The video was a montage of pictures of a baby who was stillborn or nearly so; and I searched through the comments until I found the blog that told the rest of the story. You can go read the birth story, then come back. (I’m not linking to it, because I have some questions which may be distressing to the mother, and I don’t want to cause her any pain — she’s been through enough, and reading what I have to say won’t help her, nor bring her daughter back.)

Basically, the woman had an uneventful pregnancy, and went into labor with little contractions at first and then suddenly had strong contractions which sent her to the hospital — still unsure if this was actually real labor, because it didn’t follow the typical “labor pattern” of slow, mild contractions gradually lengthening and strengthening. Apparently, when she was admitted, the baby’s heartbeat was there but they wanted more monitoring because they said it was “tachy”. They didn’t explain this very well to the mom (or she didn’t remember or write it down, which is understandable considering the jumble of events), and she was asking for her epidural and upset that the nurse couldn’t find a vein. There was an OB in the room, but another OB was walking down the hall, and heard the baby’s heartbeat and didn’t like it, so he came in and requested to break her water. I assume that the purpose of breaking the water was either to check for meconium or to place an internal monitor on the baby’s head. The mother consented.

When her water was broken, mec came out, they lost the fetal heartbeat and could only hear maternal; either the internal didn’t show anything or they couldn’t get it properly placed; a quick ultrasound was performed and showed no fetal heartbeat. The mother was raced back for an emergency C-section but it was too late. The baby was kept alive on life support so the mother could wake up from surgery and spend time with her alive, and then the parents had to make the decision to withdraw life support.

The mother credits the passing OB with the fact that her daughter was even born alive.

The post after the birth story has preliminary autopsy results (and I never found more in-depth ones, so will assume that the “working theory” on the baby’s death was confirmed) showed that the baby basically had a weak heart that was unknown and unknowable prior to the onset of labor; that the labor coming on fast and strong was too much for her to handle, causing her to pass meconium; and that all these things together combined to cause her death.

Now for the “Monday morning quarterbacking.” While the mom credits the passing OB with her daughter’s live birth, I wonder if he is not also to blame for her ultimate demise. The baby may have been showing signs of fetal distress prior to her amniotic sac being broken but she had a heartbeat until then.

As the mother said, a baby passing meconium is not a death sentence, nor is the particular heart defect this baby had, nor is having a strong and fast labor (after all, how many women are put on Pitocin in order to make their natural contractions stronger and labor happen faster? and how many stories abound of women barely making it to the hospital in time [or giving birth accidentally out of the hospital] because labor and birth went so fast that they couldn’t make it). But the baby had a heartbeat while her amniotic sac was intact.

If the doctor suspected fetal distress from hearing the baby’s heartbeat, he could have done an ultrasound with the sac intact, and probably seen meconium. Apparently there was an ultrasound machine in the room (perhaps a Doppler — just sound, no picture), since the birth story made it sound like everything took place in that one room.

Had the doctor not intervened, it’s possible the baby would have died anyway — after all, the contractions were so strong or long that the baby was showing signs of distress — although the heartbeat was apparently not so bad that the OB already in the room was concerned. But had he made the call to perform a C-section in the face of fetal distress rather than an amniotomy, the baby might have lived. Monday morning quarterbacking.

It may have just been coincidence that the baby’s heart stopped beating about the same time that her amniotic sac was broken; but perhaps she was able to tolerate contractions (though in distress) with the fluid cushion, and they became intolerable without it. It’s also possible that the baby also suffered a cord prolapse with the ruptured amniotic sac. The first time I read this story, that’s what I thought had likely happened; then on pondering it (I didn’t read anything but the “birth story” post for a very long time), I thought maybe the death was due to vasa previa or velamentous insertion, and that when the doctor had ruptured the amniotic sac, it tore the umbilical cord from the placenta. However, the preliminary autopsy results showed that the placenta was normal. In re-reading the birth story post, I realized that a cord prolapse was more possible than typical with a first-born child. In the lead-up to the “labor” part of her story, she said that she never really “dropped” — that the baby didn’t engage in the pelvis. (It’s possible that the baby was in fact engaged, although the mother never felt any different; but most first-time moms will feel the baby engage a couple or three weeks before birth, although fewer second-time and later moms have their babies engage.) When the baby is still high and “floating” and the amniotic sac ruptures (either spontaneously or artificially, as in this case), it’s possible that the umbilical cord can get swooshed down below the baby’s head as the amniotic fluid rushes out. My sister’s second birth was a planned home-birth which ended in a non-emergency transfer to the hospital, after she was “stuck” at 6 cm dilation for some 8 hours; the midwife didn’t want to break her waterat home because the baby was too high, and she didn’t want to precipitate a cord prolapse, so they went to the hospital. So it may be that losing the baby’s heartbeat when the doctor broke her water was just an unfortunate coincidence. It may be that some trauma or shock of having the amniotic sac be broken and/or the fluid rushing out or losing the fluid cushion was too much for the baby’s delicate heart to handle. Or it may be that the amniotomy precipitated a cord prolapse which sent an already fragile condition into a lethal one. I suppose we’ll never know.

Of course, this is what lawsuits are fought over — one expert witness (which I am not! I’m just a curious thinker) saying, “If I had been in charge, this wouldn’t have happened.” And this is why medical malpractice insurance costs so much — when a baby dies or is injured, a jury of 12 people will almost certainly find fault with something the doctor did, even if it was done with the best intention, and with the best of his knowledge. I don’t think that the doctor intentionally caused harm; and he may have done the best thing. But the thing that gets me is that the baby had a heartbeat (however fast or slow or distressed) until he broke her amniotic sac. That’s the thing that has stayed in my mind for the past year or however long it’s been since I first read the birth story: the heartbeat disappeared when the sac was broken.

Losing Christopher

Here is a blog entry from one of my friends — someone I knew when we were teenagers, though I rarely get to see now. She had a stillborn son at 24 weeks, lost due to Trisomy 18. She wrote her entry on the seventh anniversary of his death, in hopes that it will help someone who is grieving, or to help those who comfort others who are grieving. Click here for the first part, and here is part two.

Kick Counts — Fetal Movement

This is a very important subject, because many women who have had children stillborn reported a decrease in movement a few days prior to fetal death. Recognizing that your baby is not moving enough may save his or her life. If, for some reason, the placenta is not functioning properly, or if the umbilical cord is knotted, or if the cord is wrapped around the baby’s neck, then the baby may not be getting enough oxygen.

One of the natural mechanisms that the body has to keep itself alive, is to divert blood from less necessary parts (arms, legs, etc.) to the vital parts (heart, brain, etc.). We see this in adults who experience trauma or shock. So, when there’s a diminished supply of oxygen, the baby will typically move less — conserving energy as well as keeping the brain more fully supplied with oxygen.

Towards the end of your pregnancy, the baby may not kick quite as hard, or move more gently (less room inside for him or her to move), but there should not be a significant decrease in movement. Doing a “kick count” every day will help you to recognize if your baby is moving less. This isn’t to scare you — the stillbirth rate is low — but losing a baby at the end of pregnancy may possibly be able to be avoided by a little vigilance on your part. You can take the approach of bonding with your baby, and just concentrating on his/her movements, and feeling the connection you have with him/her while s/he’s still inside you.

Here is a great website that has a lot of information about doing kick-counts, and also about stillbirths in general. I hope that you will never need this information. Just as you will take every precaution to preserve your baby’s life and health after birth — always using a car seat while driving, making sure a blanket is not over his face while he’s asleep, double-checking medication dosages before giving him anything — so you can take this small precaution to help preserve your baby’s life and health before birth.

My husband’s best friend and his wife lost their baby to cord strangulation almost three years ago. She noticed a decrease in movements, but thought it was just the normal change in movements that happens before birth. Then she noticed no movement. On her due date. She is still afraid, almost three years later, to get pregnant again — afraid of going through the heart-wrenching loss of another child prenatally. Many causes of stillbirth are unknown — sometimes because an autopsy wasn’t done, other times an autopsy was done but there was no explanation for the fetal demise. Doing a kick count can’t completely eliminate stillbirth, but if it can prevent even one death, it’s worth it.

To Full Term

When tag-surfing today, I came across this post which talked about the book To Full Term by Darci Klein. I’ve not heard of it before, but it sounds really interesting. It deals with miscarriage, and the author’s struggles with miscarriage and pre-term birth, and what she wished she knew after her first pregnancy ended. Here is an excerpt from her website:

The book weaves in medical information that can help prevent loss, and urges women to seek testing after miscarriage to protect future pregnancies. Medical guidelines don’t require physicians to test for a cause of miscarriage, saying that doctors can consider testing after two or more losses. So unless families ask for testing, many get no diagnostic evaluation.

I didn’t know this. I was correctly diagnosed only after enduring my daughter’s preterm birth and losing four children. Sadly, my experience is not rare. Doctors who specialize in diagnosing causes of loss regularly see patients with three, four, even five losses – and no prior testing has ever been completed.

My sister had three miscarriages before she had her two pregnancies that she carried to term. After the first miscarriage, everyone said, “It’s just one of those things. Maybe the baby was deformed in some way, and this is just nature’s way of taking care of the situation.” After the second miscarriage, she asked her doctor for diagnostic tests, but was told that they wouldn’t do it until she’d had three miscarriages. Three. Three dead babies. Three heart-aches of several months’ duration. [I’m not sure if it was her insurance company that wouldn’t pay for the referral, or if the specialist wouldn’t accept patients without that many fetal deaths.]

But the problem was fairly simply diagnosed and repaired: she had a septated uterus, possibly due to DES exposure when she was a fetus. She had laparoscopic surgery to remove the uterine wall, and was able to carry two babies to term. (Since there was the possibility that her miscarriages may have been due to low progesterone, she was also placed on medication in early pregnancy. Even though it was more likely that her miscarriages were due to the septum than low hormones, she didn’t want to take that chance, so used them for both of her successful pregnancies.)