Recurrent miscarriage and anxiety

Her blood pressure was high- she told me soon after we started her annual visit.

“I just get so nervous at doctors offices…especially the OBGYN.”

I explained to her it’s very common- there’s even a name for it “White Coat Syndrome.” She seemed relieved. We talked of ways to make sure her general blood pressure was normal outside my office- like at her primary care provider or at-home monitoring. She went on to tell me she has been feeling anxious lately. She’s always had anxiety but the past few months it has been ramped up- every since her miscarriage.

Reviewing her OB history she told me she had an unplanned pregnancy a few months ago and a few days later miscarried. The experience plunged her into a deep anxiety. She had a family member announce her unplanned pregnancy around that time too, which added to her complex emotions. We launched into a conversation about loss. She has had multiple miscarriages and two living children. Her recent miscarriage made her realize she how she in a way would want another child but doesn’t think she could handle the anxiety behind the risk of miscarriage. We were able to come up with a reliable birth control plan that would take away that anxiety. “It made me realize I guess I should be happy with the two children I have.” I understood her thinking, but wanted to shout, No! You can want more children! You deserve to go through a pregnancy without anxiety! I instead comforted her how I could. We side tracked a bit and talked of her family member who announced her pregnancy early, about how difficult it can be to watch others go through pregnancy without any obvious worry, without the real threat of miscarriage and loss hanging over her head. She was tearful at times and I think it felt good for her to say the words and feel validated.

At the end of the visit, she looked at me, tears still in her eye. “Have you gone through something like this, “ she asked hesitantly.

“I had a baby last year and she died after birth,” I told her. “I’ve never miscarried before. It’s a different kind of loss, I know, but I do know what it’s like to have the same feelings you do.” We talked a little more about loss and watching others seemingly easy pregnancies. She was good to me- expressed her sincere condolences and was very sweet. But what I appreciated most was the gratitude in her eyes. I could tell she just felt so thankful to have someone who understood.

Have you been on the other side of things- able to be the comforter, showing understanding?

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Day 26: Healing Ritual

I have lots of healing to do.  Too much anger and bitterness.  I work with my therapist several times a month on such things.  Before pregnancy I worked with her on my anxiety and some compulsions I had and then in pregnancy she worked with me on my fear of miscarriage and stillbirth and the anxiety around the unknown and poor prognosis my baby was given.  Sometimes we simply did talk therapy and sometimes she worked with me on techniques to deal with my anxiety.  What do you do when your anxiety is justified?  In pregnancy, mine was.  We worked on distraction- it was the best tool I had when things got bad.

There is no set ritual I have, especially nothing I haven’t already mentioned- exercise, puppy, puzzles, etc.  My ritual differs everyday.  My ritual is distraction.

Today my distraction was a book group outing to the farm.  One of our members moved to a quiet corner of the state and we visited her new house (old farm house) and met her new husband and acquired furry family.

#CaptureYourGrief

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Grieving expectations

I came home and Chris was in the middle of watching an episode of Walking Dead. We watched the first two seasons together, but then I somehow fell off- sometimes the intensity of the show got me a little too worked up. When we first started watching it, I couldn’t watch it when it was dark out of alone, that’s how much it creeped me out. Now Chris is a season and a half ahead of me, which is okay because we each have our own shows we watch when the other is not there. Having exhausted Friday night Lights early into my grief, I now am captivated by Scandal. I watch while on the elliptical.

This night I was working late, doing some evening hours in my office. When I came home he was in the middle of the episode, so we watched the rest together. There was a scene with two women and a baby. One asked the other “were there children?” trying to ascertain if she lost any family in the zombie outbreak. She nodded and then turned away from the woman who was holding the baby. A few moments later, after a messy spit up, the first woman practically thrusted the baby into the second woman’s reluctant arms so she could clean up. She held the baby at bay at first, but then brought her closer and cuddled her in a pool of tears. The first woman came back to witness the second woman’s grief and healing.

The scene angered me. I should be pleased that the show recognized the difficulty in baby loss and how a babyloss mother might feel in the presence of a small child- and I am pleased. I’m angered because I feel like that’s what’s expected of me. Of course, holding babies will be hard, but I should do it, have a good cry and then all will be well. I’ll hold babies again, no problem.

I think it tapped into feelings of guilt and shame I have about not wanting to hold babies. Technically I did hold one, but there are other babies I feel I need to hold (and if I dig deep emotionally, I want to want to hold them- does that make sense? Is that too many “wants?”). Family babies. The holidays are fast approaching and they are causing me so much anxiety. Holidays when I was supposed to have my baby. Holidays where there will be other family babies. This scene tapped right into my anxiety and self-consciousness around what is expected of me. Just hold the baby. Have a good cry. Have your emotional meltdown- you’ll feel better after. I imagine them thinking. (who is “them?” everyone! Family, friends, colleagues, everyone.) Well, I don’t want to. I’m not ready.

I am constantly told that there is no right way to grieve. But then why do I feel like I’m doing wrong after watching that scene?

Do you feel like you’re not living up to grieving expectations?

The screams I swallow in the patient rooms

“Answered many questions” is often a code phrase we use in charting.  Some patients simply have an abundance of questions needing answers.  It can often be in stark contrast to ones who don’t ask any.  We always answer their questions, though sometimes we might suggest saving some for a future visit if we are running out of time.  A detailed conversation about pain relief options for labor is better had in the third trimester, so when a patient asks about epidurals at their second prenatal visit, I’ll often give an abbreviated answer, so that we can focus on more appropriate topics for the stage of pregnancy that they are in.  When I see our code phrase in someone’s notes, I enter the room prepared to be more directive in our chitchat, so I don’t run late and thus respecting my other patient’s time as well.

A few minutes into our visit I wish someone had written the code phrase, so I would have been better prepared.  The hard part with her questions was that they didn’t really have an answer.  She just needed to talk about her anxieties.  I am someone who understands anxiety, so I am usually quite understanding when a patient needs to talk things out.  I think I may have lost this sense of understanding when Mabel died.

After entertaining her questions about multiple physical complaints, reassuring her that all she felt was normal, she launched into her concern about the First Trimester Screen, a basic screening test for Down Syndrome and Trisomy 18.  She was scheduled for later in the week and was nervous because she knew someone who had it and the doctors had told her they thought the baby had Down Syndrome.  The expectant mom chose a CVS and then had to wait two weeks for the results.  The baby didn’t have Down Syndrome, but those two weeks of waiting and worry were just awful!  She couldn’t imagine having to do that! She was so nervous about going for the screen because she didn’t want to have to deal with a false positive, like that.   She was so anxious, how awful.

“If you knew your baby was going to have Down Syndrome, would you terminate the pregnancy?”

“No.”

“Then don’t do the test. It’s optional.  If it’s going to cause you more stress and the results wouldn’t affect your thoughts on your pregnancy, maybe your shouldn’t do it.”

Usually I’m having the reverse conversation with patients.  When women decline the test I have to confirm with they that they truly understand what they are declining.  Many women feel that they are low risk (no family history “young”- less that 35) and so are declining because they essentially think they are invincible.  I have to confirm with them that knowing they had a baby with Down Syndrome or Trisomy 18 wouldn’t change their thoughts- they would continue the pregnancy regardless.   The last thing we want as providers is for someone who declined testing because they didn’t truly understand what they were declining, to end up with a baby with one of those trisomies and wish they has made another choice.  It’s not my job as a provider to make them feel bad about their decision- I soley want them to understand them fully and embrace them.

“But I want the ultrasound!” she said when I suggested the test seemed to be causing her too much stress.  She continued on about how anxious she was.

That was it.  I couldn’t take it anymore.  I wanted to take her by the shoulders and shake her, screaming,  “I know!  I know EXACTLY how it feels to be told your baby might have Down Syndrome and have to wait for the CVS results!  I KNOW! And you know what?  That’s not the worst.  The worst is living with the fear of miscarriage and stillbirth after you get the positive results.  The worst is to accept those results and welcome that baby only to be told months later that the baby would likely die.  The worst is to live out the rest of the pregnancy afraid to bond with the baby, unsure how to respond when people congratulate you and to cancel your baby shower because you don’t know how to celebrate the baby.  The worst is not being able to keep her inside you longer, where you know it is safe and she can breathe.  The worst is hearing the doctor say she is going to die. The worst is seeing her face vent free for the first time in her moments of death.  The worst is holding her lifeless body and then giving it to the nurse never to hold her again. THAT is something to worry about.”

But I don’t say any of those things.  I swallow those screams and let them sit there in my belly, churning in sadness, anger and annoyance.

“Well, this is one of those hard choices you make when you become a mother.” I say curtly and end the conversation.  I reach for the doptone to listen for her baby’s heart rate, signaling to her I am not going to talk anymore about it.

Come home safely Chris

My husband returns home tomorrow.  It’s been two week since he sat next to me on the couch watching Orange is the New Black.  Two weeks since he fired up the grill for a fajita dinner.  Two weeks since I kissed his sleepy face goodbye as I ran off to bootcamp at some ungodly hour.  My husband had been summoned to Japan to take tours of facilities and sit in hours of meetings for work.  It was been a long two weeks.

For a year and a half of our dating life we lived apart.  When he applied to the competitive two year rotational program at work, knowing he could be placed time zones away from me for eight month periods, I said to him, “Ok.  But I want you know that I’m in this for the long haul.  If you go away, I expect that we’ll still be together when you get back.”  For sixteen months he was in Pennsylvania, commuting back to Connecticut on the weekends to see his girlfriend.  It could have been worse, I know.  It could have been Canada or Puerto Rico or Troy, Alabama, but it still wasn’t Connecticut.  After sixteen months he came back and three months later we were married.    Turns out he was in it for the long haul too.

In the scheme of things two weeks may not seem like much, but this will actually be the longest we’ve ever been apart.  It comes at a tough time too.  I’m still actively grieving, adjusting to my return to a job full of triggers and battling emotional mood swings.  Enough time has passed and I appear to be functioning, so I’m not on people’s radar as much.  The first week, I turned out to be quite busy, which was nice.  The second week, I have had less invites (not none, though), but that turned out to be a good thing.  I was a bit in the doldrums and needed time by myself, something I haven’t felt I needed in a long time.  I guess without my rock, my Chris, I don’t function as well.  The thirteen hour time difference didn’t help- his morning is my night and so we were always catching each other on our way out the door.

Right now he is on a direct flight from Tokyo to New York.  I can’t help but be worried.  In the past few months I’ve developed an acute sense of worry about my husband’s well being.  I have him email me when he gets to work every day, just so that I know he didn’t get in a car accident.  This year I’ve faced what many would call one of the worst possible things- but I know differently; it could be worse.  I could lose even more.  I could lose Chris.  Being struck by tragedy once has made me sensitive to the idea that other tragedies can happen, as unlikely as they might be.  This is a normal process of grief, I know, but normalizing it doesn’t lessen it.  A commercial plane was just shot down mistakenly and almost three hundred people lost their lives.  That news story has amplified my worry about Chris’s travel.  Sixteen hours in the air, with no way to contact me to tell me he’s fine.  I’m holding my breath until he lands.

The long weeks ahead…

I’m having so much anxiety looking at the weeks ahead.  Chris and I will have a few days home alone together and then he goes back to work on Monday.  I’m already dreading it.  I’ve been so fortunate that I have had Chris around for so much time.  My mood is so variable throughout the day and when I have crying spells, it helps to just tell Chris what I’m crying about.  When he leaves, who do I tell?  There are so many people who have offered to lend an ear, which is kind.  But people work and sometimes picking up the phone is hard or if I do, which one do I call?

The next weeks stretch out in front of me too far to see the end.  What do I do with my days?  I envision many mornings in bed- which is more or less how I’ve been spending them so far.  I’ll need to exercise.  I’m hoping my body will be ready to do something real next week.  This week I’ve been walking, with some side effects- warnings that I shouldn’t do too much too fast.  My pubic bone still bothers me after walking.  It caused me discomfort in pregnancy and that discomfort lingers.  I know the mechanics of it- there’s a joint that separates to allow a baby to pass more easily through the pelvis. It’ll come back together, but it takes time.  I took myself to the chiropractor, to get some help and hopefully heal more quickly.  I really wanted that help, but I knew going back that I’d have to tell them about Mabel- I’d have to say the words.  They knew the story.  I say “they” because they are a husband and wife chiro team.  I usually see the wife and was supposed to for my first visit back, but she was out sick so I saw her husband.  I was tearful in the car just before getting there but held it together until he asked “how are you feeling?”  He could see I was no longer pregnant, so I felt the need to explain.  “I had my baby a week and a half ago and my baby died,” I blurted as I began to cry.  It’s so awful to not only say those words but to see people’s reactions.  He was very appropriate but people are scared of the grief, especially when it’s so raw.  There’s not much to say.  He said, “if there is anything we can do, let us know.”  I told him he could make my pubic bone feel better.  I think that gave him the needed out to move on.

 

I’d like to go back to bootcamp, but I’m scared.  I only went for three weeks before I went into the hospital.  It was long enough for people to recognize me, but not long enough for people to really know my story.   When I go back, I imagine people will ask how the baby is or say congratulations.  It will be part of the process.  I know I’m going to get better at saying it- my baby died.  Maybe I should say something more.  My baby died.  We knew she was going to be sick when she was born.  Her name was Mabel.  It might give people something more to respond to.  Might show that I’m ok to talk about her.  It’ll all be an experiment- try different phrases, see how I feel, see how others respond.  The other hard part of going is that bootcamp was that it a very pregnancy-associated experience for me.  I only went in pregnancy.  I probably wouldn’t have gone if it were for the limitation pregnancy placed on my body.  I used it to help deal with the mental turmoil I was trying to process in pregnancy.  I’m sure I can use it to help with the mental anguish I have now.  But in the beginning it may be hard.

 

I’ve made some dates.  I’m so anxious about being alone, I’ve set up many dates.  So far at least one every day next week.  I think it’ll help me get out of bed in the mornings.  I know I have to be alone at some point.  It’s an important part of the grieving process.  I know the days will get easier.  I both look forward to and dread the time that it doesn’t hurt so much.

 

The next six weeks just seems like such a long time.  It feels wrong and it feels right.  My body is so nearly physically recovered that six weeks seems too long.  But my mind is so far from recovery, will six more weeks even be enough time to be ready to return to work?  Returning to work means returning to some sort of normalcy and routine, re-introducing myself to the life I had before Mabel.  Returning to work also means facing pregnant women every day.  I interact with 20-30 patients every day.  Some will be pregnant.  Some will be unhappily pregnant or uncomfortably pregnant and I will need to care for them and their woes.  Some will know I was recently pregnant and ask about the baby.  Times like these were I yearn for that office job where I can just make one big announcement and be done- not have to relive the pain over and over again as I learn how to say my baby died without derailing the visit.

 

The six weeks also feels long because I’m supposed to have a baby during that time.  Six weeks would feel so short if I were breastfeeding and bonding and sleep deprived.  I wake up in the mornings, with my arms around my body pillow, thinking I’m supposed to have a baby right now. There is supposed to be a little warm body in this bed- not a pillow.  Or if I’m being really realistic I think, I should be going to the hospital right now- seeing my baby.  When Chris gets back to work, I’ll wake up and it’ll be just me, physically recovering quickly.  I feel almost guilty.  I know I’m in no way able to return to work at this moment, but I can’t help that little bit of guilt from creeping in.  I also feel it when people bring food.  People are supposed to bring food when you have a baby and are too busy with the baby to think about cooking.  What’s keeping me from cooking?  There is no baby.  It’s just me.  So I’m dealing with grief mixed with guilt about the time it takes to grieve.

 

I saw my therapist yesterday and we talked about how to survive the next weeks.  She suggested mindfulness and distraction.  Doing some things that are normal.  I talked about how it’s even difficult to be around friends because I’m not the Meghan I usually am- I think I’m  hard to be around. I’m not engaging. People don’t know what to do with me.  She assured me that my friends still want to be around me and I should do some things I used to do.  My friends are getting together for a happy hour tonight.  I’m going to try to go, though it feels weird. Inappropriate even.  I’m going to the bar two weeks after my baby died?  It feels wrong.  I wasn’t supposed to even be considering it, because I was supposed to have a newborn.  But it was my normal before, it used to make me happy.  I’m trying to do the things that people suggest.  I’m trying.

I’m not ready

I’m not ready.

 

I have been working so very hard about not thinking too far ahead into the future.  I still try not to think too much about the “whatifs” regarding after the baby is born.  Working so hard, that I am neglecting some preparations.

 

I had my last outpatient ultrasound today.  We were going to measure growth- which made me nervous.  Growth, or lack thereof, is one thing that could derail our plan.  If baby’s not growing, time to deliver. Induction starts and a long inpatient stay is avoided.  I want ready for delivery.  I don’t think baby is ready, and I am certainly not ready mentally.

 

When they measure growth, the sonographer takes measurements of the baby’s head circumference, abdominal circumference and certain leg and arm bones.  As she does them, a little figure pops up on the bottom of the screen. The figure says how many weeks the head or bone or belly is measuring.  I’m 33 weeks and 5 days.  The measurements I could see were seeming to be closer to 29-31 weeks.  Normally I wouldn’t think much of it because clinically I know that third trimester ultrasound can be off by 3 weeks or so.  But I was watching two weeks ago as they took the same measurements and the numbers didn’t seem to change much.  As we waited for the doctor I told Chris “I don’t think the baby grew.”  But after all the calculations, the baby had growth 300gm in the two weeks (we needed a minimum of 200gm to feel good about growth- and keep me pregnant.)  Four pounds even was what my little karate carrot weighed in at today.  27%.  Good movement. No fluid. Small bladder. Barely visible kidneys (though that’s also a function of the low fluid-harder to see organs in general).  I get to stay pregnant!  I got a dose of rescue steroid to help with the baby’s lungs in the event of delivery in the next two weeks (a shot in the butt! the first butt shot I’ve had as an adult, or as far back as I can remember). I return tomorrow for the final steroid dose.  Friday I have my last prenatal appointment with my midwife. I am making some concrete moves to prepare.  Though in those minutes between sonographer and doctor, as I waited to see if I’d have to deliver now or not, I realized just how unready I am for the birth of my baby.

 

I go to the hospital in 3 days and I have done no preparation.

 

I feel like I have little documentation of this pregnancy. I know of three photos of me where I am visibly pregnant.  I did not envision doing the weekly “here’s my baby bump” series, but I did think I’d want photos of me pregnant to show my children when they got old enough.  And even now, I feel like it would be proof- proof that the whole thing happened.  In case I have no baby to bring home, I want to be able one day to point at a photo and “see, look, I was pregnant once.”  Now I have three days to make that history.  Maybe some hospital pictures would be in order.

 

Packing.  I made a hospital bag a few weeks ago- a small one with just the necessities, that I bring with me to appointments- in case they send me right over to the hospital, like they did at 27 weeks.   But I haven’t packed a long-term bag.  I haven’t even made a list (and I am a list maker).

 

And I think I ‘m in denial that I’ll actually have to labor.  It’s not that I’m planning on a c-section (though I certainly know it’s an option if there is significant distress); it’s more that I haven’t gotten to the stage that I honestly believe the baby will come out of me.  We did a childbirth education class (yes, even midwives do childbirth prep- so no excuses for patients who don’t think they need it!).  I have started a playlist for labor songs.  I have a tennis ball for back pain and heating packs for everywhere else pain.  But labor still seems so theoretical to me.

 

I was at the chiropractor today and she knows all the basics of my situation- she’s all business when she asks about it, but in a good way.  She asked if I’m ready to go into the hospital.  She also asked if I was ready at home.  I told her no, not at all.  I haven’t been planning to take a baby home.  If this baby joins us in the world living and breathing, s/he will be having a nice long stay in the hospital.  I figure we can do the shopping then.  If it looks like the baby is working towards discharge, then we can buy a crib.  Then we can build a baby wardrobe of especially girly or boy-y clothes.  Then we can share the baby registry Chris and I had been working on before the oligohydramnios.  Then we buy whatever medical supplies our baby needs.  I realize I might need a few things in the interim, but that’s what family and friends (and amazon prime) are for.   Breastmilk storage bags and bottles for the nourishment I can save for my baby when s/he can eat.  Nursing bra. Baby outfits for photos.  A little baby hat.  A lovey.

 

I need to buy a baby outfit.  Something classic, simple, natural.  We will consider it a coming home outfit.  Though really, I feel like I need it in case we bury the baby.  Another form on coming home.  If that’s the case, I want the outfit to be something special- something I’ve picked out with love.  And I can’t imagine that I’ll want to be shopping for an outfit if I’m actually planning a funeral.  So this I want to do ahead of time, but I just can’t seem to bring myself to do it yet.  I’ll put it on the to-do list.

 

I need to make a to-do list.  Something to refer to when I hit boredom in the hospital.  Or if I’m feeling particularly anxious, something I look at to find something to distract me.

 

As I begin my preparations to go into the hospital, I am constantly struggling with both relief and fear.  I am excited, in some ways, to give up the burden of anxiety and let others watch my baby like a hawk.  But I am terrified of what’s going to happen.  There is still a lot of unknown.  If I only knew, for sure, I would be there for three solid weeks, I could work hard on adjusting to the “after” birth during that time.  Maybe begin to realize that I will labor.  But I could go in on Saturday and be delivered that day, depending what the baby shows on the monitor.  I could end up with a very quick c-section, skipping a long labor that might in many ways be therapeutic to experience.  I’m terrified of the emotions I’m going to feel, the further uncertainty I will face with a sick child.  Will I bring the baby home?  Will I be caring for my baby full time?  Have I just had my last days as a midwife?

 

For now, I am going to plan on a nice extended stay.  My baby has been a mover and gets a good BPP (Biophysical Profile- an ultrasound test for fetal well being- looks at certain baby movements and fluid) score- 6 out of 8, the best a baby can get with no fluid, so I’ll consider that an A.  My baby has been getting straight A’s, like his/her mamma, since 27 weeks. This makes me believe my baby will behave on the monitor.  I plan on laboring and pushing out my baby.  I am tall, confident in my ability to push out a big baby, so a small one should be a piece of cake, right? My midwives will be patient with my baby to allow me every chance at a vaginal birth if it’s safe for us.  I am planning on a live baby.  I think I’ll meet our little carrot and hear a cry.  Maybe even have a tiny moment of skin to skin as the cut the cord?  I plan a team of pediatrician helping my baby breath and see what s/he can do on his/her own.  Beyond that, I have no plans.