At a Loss: What To Expect When You're No Longer Expecting

Photo by abcnews.go.com
It was May 2005, and I was quietly excited.

I believed I was 7 weeks pregnant. My doctor wasn't so sure. The embryo on the ultrasound wasn't big enough, and he didn't hear a heartbeat. I looked closer to 5 weeks along. This revised timing seemed unlikely -- I was sure of the exact date sperm met egg. But I wasn't going to let pesky details get in the way of my party. "Great!" I said. "When's the new due date?"

I'll say this for myself: The denial came from an honest place. I was 33. My husband, Scott, and I had been married for almost a year. We'd just bought our first house, in Los Angeles, with an extra bedroom (for a kid) and a sun-dappled backyard (also for a kid).

Our tangerine tree sagged with fruit. Hummingbirds sipped nectar from our flowers. So when the doctor said not to worry, I'd probably see a heartbeat at my next ultrasound in a couple of weeks, I didn't. I cheerfully filled my prenatal vitamin prescription. I began a list of baby names. I checked out pregnancy Web sites, including one that advised women who'd had ultrasounds like mine to "enjoy being with her pregnancy." I snickered, but put a hand on my belly and felt the presence of a baby. Tears filled my eyes, as crazy as that sounds.

Today, I'm grateful for my Hallmark moment. It was the only time I stepped away from fevered planning and enjoyed things as they were -- the finest minute and a half of my pregnancy. Two weeks later, the repeat ultrasound showed an empty gestational sac where a heartbeat should have been.

Surprise, Surprise
Every pregnancy is different. So is every miscarriage, though no one tells you this.

Books, Web sites, even physicians gloss over the subject. What to Expect When You're Expecting, which finds space for questions like "Is it necessary to shave your pubic hair before labor?", devotes only a few pages to miscarriage. These resources don't prepare you for the grief, guilt, and self-doubt that take the place of excitement.

And they don't fully describe the physical experience. They do mention that miscarriage can cause painful cramping and bleeding and sometimes requires intervention with drugs or a procedure called dilation and curettage (D&C), which involves dilating the cervix and removing the "products of conception." This sounds scary, but it's a piece of cake compared with what they don't warn about.

Rest of the story: http://abcnews.go.com/Health/Depression/story?id=4665859&page=1

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Why I understand Lily's pain

Tuesday, January 22, 2008 - After pop star Lily Allen suffers a miscarriage, Frances Burscough, who lost a baby three times, offers sympathy - and hope

It was with great sadness and a lot of sympathy that I heard of Lily Allen's miscarriage. This is always a tragic and traumatic situation to have to go through. But for someone - a young girl - to endure it in the public eye, including the full glare of the paparazzi, it must be unbearable.

She will be suffering not just the physical pain and discomfort, but also the inevitable sense of loss which is as real as any bereavement of a loved one. Added to the psychological effects, which could include anything from a sense of failure to a feeling of guilt, then the effects are almost debilitating.

During the course of my marriage I had three miscarriages. Each happened in different circumstances and for different reasons, but the worst one by far was the first.

The day I discovered I was pregnant for the first time was a Saturday. We had been shopping in Belfast and I had sneakily bought a pregnancy testing kit in Boots without my husband knowing, because I was sure I was expecting.

On the way home we stopped for lunch at Cutter's Wharf - at the time a brand new pub which had only just been opened and was a stone's throw away from where we were then living.

We had watched the place being built and couldn't wait to see what it was like. Patience was never my strong point. Which also explains why I immediately nipped into the Ladies and did the test, full of excitement and anticipation, while he perused the menu, completely unaware of the life-changing event about to unfold ...

What followed was a scene of utter joy. Hugs, laughter, tears ... completely spontaneous outpourings of love followed by a convenient outpouring of champagne. We were, after all, in the perfect place for a toast.

A few days later, the doctor confirmed what we already knew and the official ball started rolling - visits to the hospital to book my first scan, registering with a midwife and health visitor, buying maternity clothes and books about babies, writing to all my family and friends to pass on my tidings of great joy.

I felt so blessed I even started going to church again after a few years of neglect.

While I waited, as always impatiently, for the first scan at 12 weeks, my mum and dad booked a flight over from England. They, too, were overjoyed at the prospect of a new grandchild and wanted to help us celebrate. I was so glad they were coming at last.

Since we had moved to Belfast two years earlier they had been worried sick. Images of smouldering buildings and burnt-out cars were on the news every night and I wanted to show them all the positive things about living here and to reassure them that their newest family member would be safe and secure.

They arrived on Father's Day morning and we went out for a celebratory lunch to Newcastle's Slieve Donard Hotel - Part One of my charm offensive - where father and father-to-be were serenaded by a pianist before we took a stroll along the coast where the Mountains of Mourne sweep down to the sea.

They loved it and I was so glad. The next day, after my scan, we were heading off for a week's tour of Northern Ireland beautiful coastline and this was the perfect start.

Unbelievably ... I mean I didn't believe it ... I wouldn't believe it, there was no heartbeat. The shape of a baby showed up on the scanner, but it was motionless. And, worse still, silent.

The radiographer panicked and left the room to get a consultant, leaving us staring at the frozen image on the screen and, in the face of a nightmare, for what seemed like an eternity.

"I'm so very sorry ... " the consultant said after a few minutes of analysis and a few more pokes of the scanner handset.

"It appears that what you have here is what's known as a 'blighted ovum' ... it's effectively a foetus that cannot survive because it's heart has not fully formed."

He shook his head sympathetically as he said it, knowing full-well that by making such a diagnosis he would be breaking another two hearts. I was then given the bleak choice: be admitted now to hospital for surgery - or carry on as normal and wait for nature to take its course ie, a miscarriage, which could happen today, or in a week's time, or even longer. But happen it must.

Placed between a rock and a hard place, in shock and disbelief, it was difficult to make such a decision. But I chose the latter - to wait and see - just in case they were somehow wrong and/or a miracle happened.

The next few hours were a bit of a blur although I do remember I had to be helped out of the hospital because my legs gave way and I was wailing uncontrollably like one of those poor bereaved women you see in war-zone news reports.

Dad poured me a huge whiskey while mum comforted us. I was glad that they were there. I needed them and to draw on their strength. I was determined not to let this ruin our first holiday alone together.

"You'll be alright," my dad said. "Another one will come your way before too long."

Of course, he would say that. Mum had produced eight children without any complications. Her mum before her had had 14 - incredible but true - all without a hitch. Having babies was what we did. The following day we set off on our holiday, just as planned.

I couldn't let them down. And besides, I was sure that simply staying at home and monitoring my every moment for the early warning signs of catastrophe would be unbearable.

So off we went along the glorious coastline: Cushendall for lunch, Ballycastle overnight, the Causeway Coast, Bushmills Inn overnight, into Donegal.

My mum and dad were, as always, wonderful company and as sympathetic and understanding as they could possibly be under these extraordinary circumstances.

I still felt pregnant, still had the same hormones surging through my body, even had morning sickness like a normal pregnancy.

All this was to be expected, apparently, until my internal systems became synchronised and my hormones stopped sending the message to my brain that I had a baby on board.

I cried myself to sleep each night, but, thank God, I lasted the holiday without having to be rushed to a strange hospital.

One week after my parents arrived, I drove them to the airport and from there I headed straight to Belfast City Hospital and checked myself in.

It took me months to recover, but recover I eventually did with a lot of support from family and words of encouragement from my friends. Although two more miscarriages were to follow, within months I was given another chance.

I now have two wonderful healthy sons: living proof that life does go on even when you feel like the world has temporarily stopped turning.

I know how you feel, Lily, and so do millions of women.

But, like my dad said, You'll be alright.

I'm sure of it.

Source: http://www.belfasttelegraph.co.uk/features/btwoman/article3359745.ece

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Why Do Miscarriages and Stillbirths Happen?

The most common cause of pregnancy loss is a random chromosome abnormality that occurs during fertilization. For fertilization to occur, the chromosomes in the nucleus of both the egg and the sperm need to join into 23 pairs (46 total chromosomes). Sometimes this pairing does not happen correctly and that can impede the development of the fetus.

Other factors that could contribute to a miscarriage include:

• fertilization late after ovulation
• low or high levels of the thyroid hormone
• uncontrolled diabetes
• exposure to environmental and workplace hazards, such as radiation or toxic agents
• uterine abnormalities
• incompetent cervix, or when the cervix begins to open (dilate) and thin (efface) before the pregnancy has reached term
• certain medications (mostly prescription), such as the acne drug Accutane

Certain behaviors also increase the risk of a miscarriage. Smoking, for example, puts nicotine and other chemicals into the bloodstream that cause the blood vessels in the placenta to spasm, which decreases the blood flow to the uterus. Smokers also have a lower level of oxygen in their blood, which means the fetus gets less oxygen. Alcohol and illegal drugs have been proved to lead to miscarriages. There is no evidence that stress or sexual activity contributes to miscarriage.

Some of the common causes of a stillbirth include:

• pre-eclampsia and eclampsia, disorders of late pregnancy that involve high blood pressure, fluid retention, and protein in the urine
• uncontrolled diabetes
• abnormalities in the fetus caused by infectious diseases - such as syphilis, toxoplasmosis, German measles, rubella, and • influenza - or by bacterial infections like listeriosis
• severe birth defects (responsible for about 20% of stillbirths), including spina bifida
• postmaturity - a condition in which the pregnancy has lasted 41 weeks or longer
• chronic high blood pressure, lupus, heart or thyroid disease

Full article: http://www.kidshealth.org/parent/medical/sexual/miscarriage.html

Blighted Ovum

Chances are you didn’t even know you were pregnant or had just found out you were expecting when you received the shattering news that there is no visible developing embryo on the ultrasound. You are probably feeling sad and confused. As you take time to understand what this means, also take time to grieve as you would for any loss. And remember you are not alone.

What is a blighted ovum?
A blighted ovum (also known as “anembryonic pregnancy”) happens when a fertilized egg attaches itself to the uterine wall, but the embryo does not develop. Cells develop to form the pregnancy sac, but not the embryo itself. A blighted ovum usually occurs within the first trimester before a woman knows she is pregnant. A high level of chromosome abnormalities usually causes a woman’s body to naturally miscarry.

How do I know if I am having or have had a blighted ovum?
A blighted ovum can occur very early in pregnancy, before most women even know that they are pregnant. You may experience signs of pregnancy such as a missed or late menstrual period and even a positive pregnancy test. It is possible that you may have minor abdominal cramps, minor vaginal spotting or bleeding. As with a normal period, your body may flush the uterine lining, but your period may be a little heavier than usual.

Many women assume their pregnancies are on track because their hCG levels are increasing. The placenta can continue to grow and support itself without a baby for a short time, and pregnancy hormones can continue to rise, which would lead a woman to believe she is still pregnant. A diagnosis is usually not made until an ultrasound test shows either an empty womb or an empty birth sac.

What causes a blighted ovum?
A blighted ovum is the cause of about 50% of first trimester miscarriages and is usually the result of chromosomal problems. A woman’s body recognizes abnormal chromosomes in a fetus and naturally does not try to continue the pregnancy because the fetus will not develop into a normal, healthy baby. This can be caused by abnormal cell division, or poor quality sperm or egg.

Should I have a D&C or wait for a natural miscarriage?
This is a decision only you can make for yourself. Most doctors do not recommend a D&C for an early pregnancy loss. It is believed that a woman’s body is capable of passing tissue on its own and there is no need for an invasive surgical procedure with a risk of complications. A D&C would, however, be beneficial if you were planning on having a pathologist examine the tissues to determine a reason for the miscarriage. Some women feel a D&C procedure helps with closure, mentally and physically.

How can a blighted ovum be prevented?
Unfortunately, in most cases a blighted ovum cannot be prevented. Some couples will seek out genetic testing if multiple early pregnancy loss occurs. A blighted ovum is often a one time occurrence, and rarely will a woman experience more than one. Most doctors recommend couples wait at least 1-3 regular menstrual cycles before trying to conceive again after any type of miscarriage.

Last Updated: 12/2006

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Compiled using information from the following sources:

Current Obstetric & Gynecologic Diagnosis & Treatment-Ninth Ed. DeCherney, Alan H., et al, Ch. 14.

Source: http://www.americanpregnancy.org/pregnancycomplications/blightedovum.html