This is what happens to the bodies of the women you know.
On Monday, December 5 at 6:30 a.m., I was kneeling on the floor in front of my toilet, hand plunged into the nearly opaque dark red water, fishing for the warm clumps that had sunk to the bottom. I had cleaned the toilet the night before in preparation, and the sterile specimen jar from the doctor’s office was waiting by the sink. I carefully sorted through the mess in my hand, looking for something to stand out. A small grayish oval with a black dot on the side emerged, no larger than my pinky nail. So that was the head, then. I put it in the jar and my hand back in the water, halfway up my forearm, to search for the body. Another grayish lump, nothing discernible, but then I wasn’t looking too closely because the dizziness was overtaking me.
This was my third miscarriage.
THE FIRST
On February 7, 2012, I texted my husband Lane from a department store bathroom stall to ask him to please do some research on whether I should be worried about sharp, stabbing cramps and bright red spotting. I was about 9 weeks pregnant for the first time, and there was still so much I didn’t know about what was unfolding in my body. I couldn’t look it up myself because the bathroom stall was in Paris, and I didn’t have internet service on my phone, just SMS. He reported back that very possibly everything was fine; so I told myself everything was fine, over and over and over. The cramps subsided and the bleeding stopped, but I wandered through the shops in a daze, not wanting to waste my “fun” extra day in the City of Lights, but unable to enjoy it through the freezing cold rain and the fear.
We went for our first ultrasound the next week. Because it was our first, we didn’t know that it was taking too long for the doctor to locate the heartbeat, which should have been fast and obvious. When she told us that there was no heartbeat, that the baby was dead, I remember thinking that this particular doctor, so shy and soft-spoken, was ill-equipped to deliver this sort of news. She was kind, but did not inspire confidence; she answered all the questions we asked, but not the ones we didn’t know to ask. She offered nothing to help us deal with our grief.
A D&C (dilation and curettage) was the recommended treatment. I could wait to miscarry naturally, which might take weeks; or take pills to induce the miscarriage earlier, but both carried the risk of incomplete delivery, hemorrhaging, and infection. I was just approaching the period of gestation where a D&C was recommended over other methods, and I couldn’t handle the emotional toll of carrying around a dead baby for weeks, waiting for my body to let go, so we scheduled it.
Here’s what’s not in the straightforward and antiseptic descriptions of a D&C you might research ahead of time: the cervical dilation hurts. Two and a half years later, when I gave birth to our daughter, it would take me hours from the start of contractions to open to the point needed for the D&C; in the doctor’s office that day, it took about 10 minutes. The local anesthesia dulled the pain, but there was no masking the fact that the doctor was using a series of tools, each one slightly larger than the last, to wrench open my cervix. The aspiration took half as long and didn’t hurt at all, but the thought of what was happening made me queasy, like having my blood drawn does. When it was done, they asked Lane back to look after me; they told him I was really strong and managed the pain well.
It wasn’t until after that miscarriage that I learned how common they are. But even if you know the statistics — that perhaps 20% of confirmed pregnancies miscarry — they are easy to dismiss. After all, it’s much more likely that you will be in the other 80%, isn’t it? But 1 in 5 is still pretty high, and once you start telling your friends that you had a miscarriage, all the miscarriages around you come out of the woodwork. “My sister had one. My best friend had one. I had two.”
Why didn’t I know that before?
THE SECOND
On October 31, 2012, we went back to the doctor, this time at week 8 of my pregnancy. I had asked to see another doctor in the practice, so the delivery was different, but the news was the same. No heartbeat. The baby was developed to only 5 or 6 weeks. I felt that my body had known something was wrong, but only in retrospect.
Because there was less tissue at this point, I could more safely choose misoprostol to induce miscarriage, accompanied by a prescription for Vicodin to relieve the pain of the cramps. Truly, I don’t recall if she said “cramps” or “contractions” — I had no reference for the latter, so I must have heard the former. I took the pills and went to bed, planning to take the Vicodin as soon as I felt the first twinge.
To say this was a mistake is an understatement. The early contractions woke me, and if the Vicodin did anything at all it was quickly eclipsed by unrelenting pain. About an hour and a half in the waves became one solid wall of contraction that lasted an hour before I could discern any space in which to breathe, to relax my body. Lane could do nothing for me except to fetch a bowl because I thought I was going to throw up from the pain. The doctor had said she was prescribing a refill in case the pills didn’t work the first time, and it wasn’t until the middle of that long night that I realized I had no idea if she meant the pills wouldn’t do anything or that the pills would induce the contractions but I still wouldn’t miscarry and would have to do it again.
I miscarried in the toilet the next morning, and continued to bleed for five days.
I told Lane that he needed to remember that I could never do that again. Never. I needed him to remember that for me, and to remind me, because I knew that the memory of pain fades — that’s how the brain works. “Remember this for me, please,” I said.
THE THIRD
“I’m surprised you chose the pills; you told me after the last time that you would never do that again,” he said when I got home from the doctor’s office. This was Friday, Dec. 2. It was the third ultrasound, right at week 12; we had seen the heartbeat together on two previous occasions and thought this one would be routine.
As soon as the tech brought the image up on the screen, I knew it wasn’t. “I’m not seeing a heartbeat,” I said; she stayed silent. She added measurements and notations to the still shots. “YOLK SAC” — that should have disappeared weeks ago. “I’m not seeing a heartbeat,” she repeated after me, a few minutes later.
The image tech took me straight to the privacy of an exam room while I waited for my doctor. “I’m so sorry,” she said when she entered. “It’s OK,” I answered. “No, it’s not,” she said.
THE ODDS
After the second miscarriage and months of failing to translate basal body temp and cervical mucus tracking into another pregnancy, we went to a fertility clinic seeking answers. My hormone levels were great and my eggs were plentiful, but I have a “balanced translocation” of my chromosomes. It’s an unusual but not unheard of condition — estimates range from 1 in 500 to 1 in 650 people. The result is that I have a much, much higher risk of miscarriage with each pregnancy than average, because only about half my eggs will have the right amount of genetic material.
So it’s a numbers game. We developed a plan — three rounds of IUI (intrauterine insemination) to speed up the next pregnancy, and if that didn’t work, we would move to IVF with pre-implantation genetic testing on the embryos. I got pregnant with a good egg on the first round of IUI, and gave birth to our daughter the following summer. She’s amazing.
When we found out I was pregnant again a few months ago, I tried to keep my expectations in check. Still, two miscarriages, one healthy child, and around a 50% shot with each egg…the next one should be a healthy child too, right? But that’s not how statistics work.
I had some mild cramping and spotting over the weekend after my appointment, as though now that my brain knew, my body was finally getting the message. I set my alarm for 5 a.m. Monday morning, took the misoprostol and the first Vicodin, and got back in bed, expecting contractions to start about 10.
An hour and a half later, I delivered a mess of uterine lining and fetal remains with not so much as a menstrual cramp. I salvaged the remains for pathology, then had to call Lane to get me back into bed and put the specimen vial in the refrigerator until I could take it in for pathology, because I couldn’t stand up on my own. I was still expecting the misoprostol-induced contractions to start and eating another Vicodin every two hours, but by noon I realized that for once I was on the right side of a failure rate. It never kicked in.
FETAL REMAINS
A few days ago, I was reading about Ohio State Representative Jim Buchy, co-sponsor of the so-called “heartbeat bill,” which aimed to outlaw abortion in that state after 6 weeks (Governor Kasich vetoed it last week, but signed a ban on abortion after 20 weeks into law). When asked why a woman might want an abortion, Buchy said, “It’s a question I’ve never even thought about.”
Mr. Buchy, for your edification: I have a balanced translocation of the 12 and 21 chromosomes (which, as you may recall from biology, come in pairs). It’s “balanced” because some genetic material swapped places on one half of each pair; I still have all the right stuff, just not where it’s expected to be. An egg of mine may get the normal chromosome from each pair and be perfectly normal, or get both swapped chromosomes, and inherit my balanced translocation. But they can also get the swapped chromosome from one pair, and the normal chromosome from the other, and therefore have too little or too much genetic material — an unbalanced translocation. This results in either miscarriage or severe birth defects.
For the one pregnancy where I made it through my first trimester, we had a CVS — chorionic villus sampling — done at 13 weeks to make sure the baby didn’t have an unbalanced translocation. If it had, I would have had an abortion, no question.
So there’s one reason, Mr. Buchy, and all the other men (and even some women) out there making decisions about women’s bodies without considering us at all. And there are as many reasons as there are women; it’s not for you to judge which reasons are legitimate, because they all are.
Today, December 19, is the day that new regulations were to go into effect in Texas requiring women’s health clinics to bury or cremate fetal tissue from abortions, miscarriages, or ectopic pregnancy surgery, regardless of the period of gestation or the woman’s wishes. (Thanks to the Center for Reproductive Rights, these regulations have been temporarily blocked, pending a hearing.) Obviously, the inclusion of miscarriages and ectopic pregnancies is just cover; this is an attack on abortion rights with the twofold goal of conferring “personhood” on a fetus and adding unnecessary expense to the procedure, thus circumscribing availability.
Supporters say the purpose is to provide dignity to “unborn infants,” or to impress upon women that it’s not “just a blob of tissue,” so that generalized idea might outweigh whatever very personal reason they have for seeking an abortion. But let me tell you, it is just a blob of tissue.
The first blob was properly (and safely) disposed of as medical waste, the second blob was flushed down the toilet, and last week’s blob was sent off to the lab. They were possibility in flesh; but asking me to believe they were children is asking me to believe that three of my four children are dead.
I expect there will be some strong responses to my choice to publish these words, and these photos. But this is simply what happened to my body — and to the bodies of other women you know. There is blood, and heartbreak, and pain; and also blood, and joy, and life. If we can’t look at the blood, and read the words, and know the stories, how can we ever hope for laws that honor the women who experience it all?
[Note: It was kindly pointed out to me by a reader that my initial characterization of my D&C was medically inaccurate. I’ve now amended that paragraph and apologize for any confusion; I was not at my most clearheaded while undergoing this procedure.]
