Quatro

Probably the least revealing thing about the series of posts I wrote in August about whether or not to have another baby was that deep down, I always knew that I wanted to. I was just scared. Scared that we wouldn’t be able to handle three.

Perhaps this was God’s way of making me feel secure in the decision to have three babies — His way of letting me know that we have enough love, enough patience, enough space and enough money.

I don’t have doubts anymore. I know I would like to have a third baby and I know we’ll figure it out.

My fourth miscarriage made that clear to me.

Even though I went off birth control in July, with the intention of trying in the fall, we (mostly I) still had been so indecisive about whether or not it was the right decision.

As soon as I felt supremely confident in the “yes” decision I would exuberantly proclaim the news to my husband, and then the next day, or the next hour I would have doubts.

In the past I’ve said that I’m incredibly lucky that it only takes me a couple of months to get pregnant. And that held true this time; it only took three tries.

And then nine days later I already knew it wasn’t going to work out. I wasn’t even five weeks pregnant yet.

I got a positive pregnancy test on Saturday, November 19 which was only day 24 in my cycle (for those of you not familiar yet with pregnancy lingo and logistics, that’s REALLY early — I had been having very short 26-day cycles.) That Monday, I called my midwife’s office and she had me start hormone testing right away. My first hCG test was 51, which was indicative of a 3-4 week pregnancy. My progesterone level was 19, which was fine, but a little low. HCG levels are supposed to double every 48-72 hours and progesterone levels should increase 1-3 ng/ml every couple of days. These initial values were my baseline and would be used to compare with the results of tests every 48 hours to see if the numbers were rising appropriately. (http://www.americanpregnancy.org/pregnancycomplications/earlyfetaldevelopment.htm)

Flashback

Through early hormone testing when I was pregnant with Bean, my doctor discovered that my initial progesterone level was 28, which was really great. My follow-up test showed that my level had actually dropped to 26, which was still a good number, but your progesterone level is not supposed to drop. My doctor proactively put me on a synthetic progesterone — Prometrium. His theory was that perhaps I was experiencing early losses because my body was not making enough progesterone to support the pregnancy until the placenta takes over and starts making it at 12 weeks. These hormone tests also showed that my hCG level was doubling every 48 hours. While synthetic progesterone exists, if your body doesn’t make the hCG hormone, there’s nothing you can do.

Since I’ve had problems with my progesterone in the past, my midwife had me start taking Prometrium right away as a precautionary measure. My next hormone test was on Wednesday, November 23 and my hCG level was 94. A little concerning because it didn’t quite double. But the nurse told me it was the “gold standard” for hCG to double in 48 hours and that she didn’t think I should be worried. Further research on my own showed that indeed she was right and that as long as the hCG was increasing by 60% in 48-72 hours, the pregnancy was still viable.

The smallest alarm sounded in my head, but I quieted it with optimism and positive thoughts because my God, it was still SO early. My first hCG test with Bean was when I was 4w3d pregnant and that level was 142. Here I was only 3w6d pregnant and my hCG was 94. Doing the math, I figured that my hCG would be 376 by the time I hit 4w3d with this pregnancy — way ahead of the game!

My next text was Friday, November 25. I took time out of my Black Friday shopping to stop in at the clinic. The nurse called me about two hours later with the news. For some reason, I knew it wasn’t going to be good. My hCG was only 113.

I was so confused. In the past, my miscarriages have always been announced by spotting. My negative association with seeing red spotting is so high that even when I’m not pregnant and not trying to get pregnant, just getting my period makes me fearful and feel like my body has failed. And then I have to consciously remind myself, “I’m not pregnant. This is supposed to happen.”

So the fact that I wasn’t spotting and my hCG level was only 113 was confusing. The nurse said that some women can go on to have normal pregnancies, but it didn’t look good.

All weekend I held onto the slightest possibility of hope. I still didn’t have any spotting. I changed my mental outlook — instead of feeling like the miscarriage was a foregone conclusion like I had all the times in the past, I tried the power of positive thinking. I tried to believe in it, to will the pregnancy into existence. I pictured the number 226 in my head, and thought, even if it’s only 200 it will be okay. I prayed.

By Monday, November 28 my hCG was back down to 51 again.

I didn’t start spotting until Wednesday.

My emotions were all over the place.

I was sad, but not devastated. It definitely wasn’t as heartbreaking as my first two losses before I had any children, before I knew if I could have children.

I was a little jealous of all the pregnant celebrities.

I was immensely thankful for the two beautiful children I have here on earth.

I was very grateful that it didn’t happen later. For me at least, miscarriage is emotionally and physically easier to deal with when it happens so early.

Technically, this pregnancy, like my very first pregnancy and subsequent miscarriage, was considered preclinical, or a chemical pregnancy. A chemical pregnancy “occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of the woman’s expected period. The woman may not realize that she conceived when she experiences a chemical pregnancy.”

In other words, if someone hadn’t been trying to get pregnant and testing and tracking their cycle, they probably wouldn’t even have known they got pregnant and miscarried; they would have just thought their period was a few days late. But I did know, and even though they were chemical pregnancies, they’re still counted as miscarriages.

The Disappointment

Mostly I guess, I’m disappointed. I’m disappointed that this is so hard for me. And hard for everyone, really, who has love to give to a baby. Why is it so hard? It should be so easy. You have love, you want to give love to a baby, so you get pregnant and have one.

Why doesn’t it happen like that?

I’m disappointed because I thought we found the “cure” for my losses. After Bean was born I did a battery of tests that turned up nothing unusual that could be causing me to lose pregnancies. While my doctor could never be 100% certain, we thought my trouble was my too-low progesterone.

So, naively I guess, I thought that taking the Prometrium would mean that loss wouldn’t continue to be a problem for me.

I’m very disappointed that early pregnancy is not filled with joy and happiness for me. When I get a positive pregnancy test, I’m filled with excitement and joy for about 5 minutes. And then the worry, anxiety and trepidation set in because I don’t want to get ahead of myself. Because I know I have to take things one day, one hour at a time — the visits to the lab, waiting for test results, the many ultrasounds.

While I’m thankful for these hormone tests and ultrasounds, because I would rather *know* than not know, ultimately they don’t really help me control anything, which is what I really wish I could do.

The Anxiety

After this last loss I picked up the book To Full Term from the library about a woman’s monumental struggle to bring her son into the world after her first child (a daughter) was born 12 weeks premature, then suffering two miscarriages (one at 13 weeks and one at 8 weeks), and then losing twins at 20 weeks. It’s almost incomprehensible that one woman would be put through so much. Her journey truly is remarkable, not only because it was through her own dogged determination and insistence that doctors listen to her, but because she has now created a resource for other people. A way for women to stand up and fight for their unborn babies and to seek answers after a loss.

I could completely relate to author Darci Klein’s description of getting a positive pregnancy test:

“I should be thrilled. I wanted this. I try to imagine holding a tiny baby in my arms. Awestruck. But my thoughts quickly turn to all those other sticks with two lines, all the thwarted promise.”

In the book, Darci describes how she’s told her husband that she’s pregnant with less and less fanfare.

I’ve been there. Not so much with telling my own husband, but how we tell our closest friends and family members. I still have the digital photo of Monkey at 10 months sitting underneath the Christmas tree holding a sign that says “I’m going to be a big sister,” in a hidden folder on my computer hard drive. We had that photo printed and framed and we gave it out to our parents and siblings as a surprise Christmas gift. Three days after Christmas, at my six-week ultrasound, the doctor couldn’t find a heartbeat.

I started crying when I read Darci’s reaction when she started spotting in her pregnancy with her son:

“‘Don’t panic,’ I say aloud. I repeat the words in my head, but my chest heaves from the familiar threat of bright red blood, just like I saw when I lost my first baby at 13 weeks, and later with my twins.”

It’s an all-too familiar scenario for me.

The Stress

Everyone from friends to doctors to co-workers will tell you to relax during your pregnancy because increased stress can harm the baby. But telling that to someone who has experienced a loss is so counterproductive.

“Multiple studies have confirmed that pregnant women who’ve had a loss experience far more anxiety during future pregnancies than those who’ve never miscarried. After loss, women must push aside the constant whisper that things could go wrong again.”

The Fear

It’s funny how quickly you forget how truly hard it was to bring a baby into the world after you have the baby safely delivered in your arms. When Husband and I were embarking on this latest round of trying, we honestly didn’t even discuss the past difficulties.

Those memories all came rushing back for me the moment I saw the positive pregnancy test and started going for the hormone testing and waiting anxiously for the results phone calls. I remembered again how hard it is. And I couldn’t escape it. Every two seconds I would remember that I was pregnant and it affected all of my decisions (don’t have too much caffeine, don’t take any ibuprofen, don’t have any cold cuts or soft cheeses, how much should I exercise?).

To be perfectly honest, part of me is scared to try again. I’m scared I’ll get pregnant and then lose it again.

I can relate when Darci says she wasn’t prepared for the fear.

“I feel almost embarrassed that I hadn’t anticipated the most obvious risk of all: the gripping terror that I may lose another baby.”

Just last week I tried to convince myself that two kids was perfect. I thought about all the reasons my life would be easier with two kids instead of three:

• No need to worry about fitting two car seats and a booster in a too-small sedan (or the alternative — buying a new car).
• No worry about having enough space in our house. The girls could share a room for a few years so that we could have an upstairs toy room, and then when they’re older and don’t have so many toys, and more importantly, want their privacy, we can move Bean back into the room she has now.
• No more struggles with breastfeeding and the internal guilt of having bottle fed my babies for the majority of their infancy.
• No more diapers since Bean is almost potty trained.
• No postpartum blues and the strains of only getting 2-3 hours of sleep at a time.
• No real worries about having enough money to do family trips (at least not any more than it will be for one kid).
• Not having to deal with one kid feeling left out (as much) because there wouldn’t be a “middle” child.
• Always having an even number of people in our family, which also makes those family excursions easier (because everything comes in a “family four-pack”).

And then a friend posted a picture of her brand new 15-minute old baby, and I didn’t see the diapers, the breastfeeding struggles, the car seat dilemma, the potty training, the money concerns, the space constraints, or the lack of sleep.

I saw this perfect little creature who had just joined their family. A brand new life. And I knew that I still wanted that one more time. I want to be handed my newly delivered baby and relish in that moment again. That moment when we get to meet the new person we created. I want the newborn yawns and the first bath, the itty bitty clothes and the extra cautious drive home from the hospital.

I’m still skittish though. I don’t know how many more times we can put ourselves through this. I am so unbelievably thankful for the two beautiful girls I have. More than anything, I don’t want to try so hard for something and end up disappointed about what I don’t have, instead of thankful for what I do have.

Part of why I wanted to share this very private personal struggle is because I think many more women in my life than I realize have struggled with pregnancy loss. It’s almost never discussed. And my biggest takeaway from Darci Klein’s book was that we must fight for ourselves, fight for answers, not accept the antiquated obstetrics guidelines that most doctors are so quick to offer, and move beyond secrecy and silence. I plan to write a follow-up post in the coming days with some resources that I found helpful.