How to Have a Miscarriage

by Amanda Holm

You’re going to need some Gatorade. For the fluids, electrolytes, sugars. Or instant chicken broth, if you can get someone to make you a cup, because you’re going to be there for… Wait. Back up.

Start over.

You’re 40 years old, and this is your second marriage. You’ve waited until you’re ready. Waited so many times, really. Until you got remarried. Until your husband got back from the deployment, got through graduate school. Bought your house that you will never move from, because you hate moving and refuse to do it again. There’s room in it, even if your kids (two boys from your first marriage, one girl from his) have to shift bedrooms to make way for the baby. They’re all so big, those kids. No bottles or diapers left to deal with among them. You don’t entirely know how they’ll take this, but it won’t be through toddler tantrums, at least, when the baby comes.

So you start to try, and that’s the happiest time. You’re just old enough that you’d begun to take the kinds of medications that preserve old people — cholesterol pills, blood pressure. But trying to get pregnant, you get to stop taking those. Once the test comes back positive, anyway. And that is a great day, although you and the husband pretend to take it calmly, keep your hopes under wraps. Anything can happen, after all.

But it becomes real very, very quickly. Painfully. Not the cramps and heartbreak, that’s later. When you hit about eight weeks, the morning sickness kicks in. “Kicks,” pretty literally. It’s the heartburn kind and the algebra of it works out so that you can never be not eating. Or drinking that Gatorade. You’re never without a Jolly Rancher at hand (now, months later, you may never look at one of the damned things again). Because when you’re not eating, you’re hurting, burping, repeating that mantra that it’s going to be worth it, it will all be in service of a goal.

Conveniently, the sickness hits you right at the culmination of your major work project for the year. You’re sitting in training classes, paying as much attention as you can while your brain’s second track plots what you can eat next to stave off the cycle of belching and burning that appears whenever you’re not physically in the act of eating or drinking. You gain a bunch of weight, but again, that’s okay, that’s pregnancy.

What you can’t do is keep things fully under wraps. The weight can be written off, file it under “people gain weight,” but you’re going to have to tell some people what’s going on, why you are acting ill and not like your usual self. One weekend you visit your mom’s house and it’s clear you’re under the weather. Your mother being your mother, this becomes an issue of concern, and follow-up phone calls make it clear she wants to know you’ve been to the doctor to be seen about this illness. When it gets to the point that she is discussing this with your own siblings so that they might goad you into following up, it becomes untenable not to share the news: You explain that you have been to the doctor, you know what this is.

Your family is — well, not overjoyed. Appropriately joyed. Very happy for you, although with a touch of the same Slavic reticence that attends your family tradition of not throwing baby showers until there’s a baby to shower. Your husband tells his parents too; it would seem lopsided not to. They are excited — their only child, your husband, is going to have a second child of his own (your boys are their grandkids too, but you can acknowledge that it’s something different for them, now). You’ve also let your boss in on the secret, to explain why you don’t stand at your desk any more, why you’re always subdued and haggard. She’s excited, too.

You never expect the excitement. You expect a lot of Jesus, forty and pregnant, you’re crazy, what are you even doing, as this is secretly a little bit of how you are feeling. The first friend you tell, especially — she’s had four kids, got divorced, got snipped, is never going down that road again. But she only has happy words for you on the phone. Hearing others voice the hopefulness you can’t even quite say out loud feels so good that you tell three more friends, who have similar reactions in varying degrees. But that’s your limit. You do have those.

So that’s where you are when you go in for the genetic counseling and ultrasound appointment. You’ve been pregnant for eleven and a half weeks and you’re hoping against hope that the sickness is ending soon. Your husband is there with you, and the dozens of questions they ask “high-risk” couples like yourselves — all the risk is in your “advanced” age, mind you — feel like a ritual incantation. If you are still not bleeding, and still feeling morning sick, and successfully complete the call-and-response rigmarole, then surely you’ve fulfilled the magical requirements of this pregnancy.

You carry that confidence into the ultrasound room, watching the black-and-white monitor while the tech mauls you with the wand. That’s okay, you know, that’s what they do. And after a while, a tiny figure does appear on the monitor. But the tech is curiously silent. She tells you to clean up and dress, and leaves with a few bland, non-committal words about fetching the doctor. The little figure stays on the screen, and it’s only now, writing this, that you realize that was a still shot, that it wasn’t a live feed of what was continuing to go on — or not — inside you.

The doctor comes in, after you spend a long, long moment in the room with your spouse, carefully thinking about nothing. “We have some issues,” she begins, and proceeds to methodically break your hopes into small pieces. There is a lot of crying. You will feel later that you owe that doctor no small portion of your sanity. She stays there in the room, answering questions, watching you, never looking away, never rushing you, not the least bit. She knows that today her role is being there. Bearing witness. She is old enough that she must have seen this many, many times. You later wonder if she got into this field knowing this day would be part of it. You want her to know that she is perfect, that you see her being unflinching and stalwart, watching over you until the questions are exhausted and you think you can leave, even if it is to go back into a world where there was never going to be this baby.

As glad as you were to tell who you told about the pregnancy, you are exactly a hundred thousand times as unglad to bear this news. You call your boss first, because the primary impact on your immediate life is that you will need to be off work for at least a couple of weeks. This is what they call a “missed miscarriage,” where the fetus lived to perhaps eight or nine weeks of gestation, but your body stayed pregnant all the same, put you through that nightmare of sickness and stress for nothing. Less than nothing. That anger comes a little later, not just yet. In any event, you won’t be back at your desk until the material of the pregnancy is gone, one way or another.

But your boss. When you call her, she lets out almost a shout of anguish like you would never have expected from her. That is the extent of her breaking down, though. She can be a stickler and hard driver, but she is unstinting in her understanding of this situation. Take the time you need, we will work out the medical leave details, we’ll see you in a few weeks. This is definitely one of those things, if you can manage it, to set up ahead of time if you are going to have a miscarriage — work for a good company and a good boss. Recognize your tremendous good fortune in this.

It’s hard to feel any good fortune when you call your mother. She is just as crushed as you might expect. You knew this would be the worst of the calls. And it undoes you. You talk it through with her, but that is the most you can do on this day. You can’t remember whether you ask or she offers to give the news to your siblings, but you are grateful not to make those calls. And glad that someone else can help shoulder your mom’s hurt. You can’t bring yourself to call the friends, either. You ask your poor stoic husband to make those calls, in addition to telling his parents. Later on, one friend, a mutual friend who knew him first and then became close to you, notes it is the only time she has heard him cry.

That is the first day of not-pregnancy. The second goes little better. You go back to your OBGYN, who advises you on options. You could have a D&C, but the idea of general anaesthesia and surgery horrifies you irrationally. On a more sane level, you object to medicalizing this experience any further, and want to give your body a chance to resolve it naturally. The doctor explains how that will work, how it will feel. There is talk of the cramps, of the gush of fluids that will arrive at the culmination. The timeline isn’t clear — any day, or weeks from now. This isn’t appealing, but you like the idea of giving your body a chance to redeem itself. Or, you can stand the idea without wanting to run for your life, like you do when you think about the surgical option. As though you could outrun any of this, anyway. You will wait for it to come instead.

And so that’s the beginning of the waiting. It is awful, but not unrelentingly. You resent that it is, and that it isn’t. If you had questions about the effects of state of mind on pregnancy, they are answered by the almost-immediate disappearance of the vicious heartburn and sickness. The intellectual knowledge of the pregnancy’s non-viability seems to have wrought this distinct physical change, and your gratitude is voluminous. You never would have guessed that being able to not eat would be such a relief. You relish that, and also resent your enjoyment of it. You spend a lot of the following couple of weeks enjoying and resenting everything around you in turn.

Not your husband, though. He is a rock. He stays home with you as much as he can, and you honestly enjoy it. You feel guilty over the occasional stray thought about the luxury of taking two straight weeks off work outside of Christmastime. But mostly — you can’t properly say you have “fun,” because that isn’t on your spectrum. You pass the time, mostly pleasantly. There is a lot of TV- and movie-watching. Not a lot of going out and about — you can’t be sure that something dramatically messy won’t happen while you’re away from home. And you do spend a large share of time grieving, feeling angry or sad either in the background or foreground.

You are able to shield the kids from the worst of it. You hadn’t talked to them about the pregnancy and certainly aren’t about to start. You allude to “going through a sad time” and tell them not to worry. They are comforts to you without knowing it. They reduce the scale of this tragedy from monumental to minimal. You have had a turn at motherhood, two turns, and this cannot take that from you.

You are aware pretty continuously, for that matter, of all the things that make this less terrible. Husband (both the existence and character thereof), family, boss, work situation, children. Home. Comforts.

Like the Gatorade. Now you can loop back to that. You spend your two weeks off waiting for intermittent bleeding and cramping to ramp up. This is not terribly painful in a bodily way, but it is thumbscrews to your equanimity. Finally, heading into your final weekend of time off — and it could have been extended, but that’s not the issue — early, early one morning there are major cramps. Like the contractions you felt in labor, but in miniature. You are in bed, and you breathe through them, and there is more bleeding, but not the burst the doctor said to expect. You call your mother and ask her to come stay the weekend, as your kids will be at your house and you might be out of commission. Oh, and it was her birthday, the week prior. You can celebrate, as odd as that may seem.

So. Early the next morning, a Saturday. The contractions resume. This time you are ready. It’s time to go sit in your bathroom, and finally, finally that telltale burst of liquid comes, and here you’ve reached the limit to what you can or should put into words. You will be there, on that toilet, for a few solid hours. That’s where the Gatorade comes in; it’s mead of the gods when one of your internal organs is methodically dumping its contents. Your husband (you should try have a spouse, preferably a high-caliber one, if you’re going to get into this mess) should wait outside the door, ready to bring you anything at all. The waves of contraction-ettes continue and subside, and they hurt kind of a lot, but what’s worse is your legs falling asleep. You feel like you have to be careful about changing positions while the bulk of the material is passing.

“The material,” you should know, is not recognizable as anything. You’ve heard that in some cases it is, but thankfully, for you, that tiny still figure on the monitor is never identifiable. There is a lot of blood and menstrual-like tissue. You wait out this purgation in a favorite old t-shirt and no other clothes, and you sip your sports drink and bouillon and you don’t dehydrate or vomit or die. Eventually the cramps subside. And, depending on your definition, it’s over.

This means you’re an old hand when the second miscarriage comes along just about five months later. Not that knowing the drill helps much; it doesn’t. You start bleeding literally the hour before the first ultrasound this time, which happens two weeks earlier in the process, so your brain is already brimming with curses and anger. You expect the bad news. You don’t even see a little figure on the ultrasound screen. There is no doctor to be your shieldmaiden through the process of accepting this one, but that’s okay — the tech telling you what’s up in a sympathetic tone and expressing her condolences is enough. What does help (or “help”) is that you didn’t tell anyone, and that you never even got sick, spent no interminable weeks stewing in your own stomach acid. All that showed on the screen was an “egg sac,” no tiny human potentiality that you could identify. Nothing to see here. You leave the lab and call your husband with the news, unsure of whether you are too callous or not enough. This time you go back to work that same day.

In fact, absent our new-fangled pee sticks and technology, you wouldn’t have known about this miscarriage at all. You would have had a several-weeks-late, extra-heavy period, the end. You might guess what happened after the fact, but there would be comfort in a less-definitive narrative. So you somewhat rue the knowledge, but you remember that without knowing the previous time you would have been rudely shocked at the actuality. Knowing you were pregnant is also what made you tell everybody you care about, and then hurt them. This means you are glad you didn’t tell anybody this time.

But you also wish you could. It burns you to keep eliding this from your life, particularly when talking to your mother. It’s worth it, not dragging her through it with you — it would have been the third awful thing in her life right then — but it stings, too. After a while you start wanting people to know. There’s no shame here, although there is some desire for privacy. But you find yourself telling a friend. That first friend that you told the first time. She is going through her own, much worse, hell at the time. She is brilliant and supportive anyway, maybe even because of her own circumstances. You remember for not the first time that letting people in and letting them help is a gift to both of you.

And that’s when you find yourself writing this, feeling sure you should be writing this. You should write about it, let it out and let it go. Write it now, before you try again, before you can have any inkling of a conventional happy ending. The happiness of your ending can’t wait for or depend on the “she DID get pregnant and HAD her baby and they lived happily ever after” conclusion. You imagine putting it out there, and someone reading it and feeling good for having read it, or recognized themselves. You imagine offering sympathy to people who have been here and accepting it in return. How to have a miscarriage is, you keep breathing. It will end. You will keep going.

Photo via gabrielcarlson/flickr.

Amanda Holm is an editor at heart, but will write original thoughts under duress. She documents the scents of the Motor City at @smellsofdetroit.