G3

In the OBGYN world we describe a woman’s pregnancy history in terms of G’s and P’s.  There is an alpha numeric code that tells the story- “GTPAL.”

G stands for gravida. It’s the number of times a woman has physically been pregnant.

T is for term- the number of term pregnancies a woman has had.  Any baby born at 37weeks or after counts here.

P is for preterm births, those babies born after 20 weeks but before 37 weeks.

A is for abortion. This is a medical term, not a political one.  Medically we call any end of pregnancy before 20 weeks an abortion.  It may be spontaneous, aka a miscarriage. It may be elective, aka a termination.  A also includes ectopic pregnancies.

L is for living children.  No further explanation needed.

To make it even more confusing we shorten the the GTPAL to G_P_ _ _ _.  In this instance G still stands for gravida and P stands for para- para meaning the number of births (term or preterm). It might be better to explain by example:

A woman who has had one term living child with no other pregnancies would be a G1P1001 versus a woman who has had one living preterm child would be a G1P0101 versus a woman who has had one miscarriage and no other pregnancies would be a G1P0010.

It can be used to describe a pregnant woman too.  My friend who is pregnant for the first time is expecting twins.  She is currently a G1P0000.  When she has the babies, if she has them at term (fingers crossed) she would be a G1P1002.

Make sense?

So why does this matter?

As of late, I have recently added a new G to my history.

After Mabel I became a G1P0100.

After Felix I became a G2P1101.

I am now a G3P1111.

My loss story continues.  I’m having a very early miscarriage.  So early I barely became attached. But it has still stolen the breath out of me.  Did I take five pregnancy tests just to be sure? Did I figure out my due date? Sure did. Think about maternity leave? Toss around baby names in my mind? Imagine telling Felix he’d be a big brother? Dream of a living sibling for me son? Did I get excited? You bet. So when it turned out to be just a shadow of a pregnancy, a whisper of something I’ve been wanting and trying for since Felix was born, I grieved. I am still grieving. I feel broken in so many ways, untrusting of my body, unsure of my ability to be happy.  I know I will find my way out of this darkness- I have crawled out of deeper holes.  But in the meantime, I will mourn my little whisper…

 

 

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?

Sunday Synopsis

Listening to the screams of a bereaved mother–  We are not always easy to be with in our grief.  Our sorrow is uncomfortable.  Our moans of sadness are hard to hear.  But it is our right.

My right to be a mother- an honest mom speaks out.   Postpartum depression after miscarriage is real.

Annie Lennox: Son’s death Changed my Life.  We don’t often hear of celebrities who have experienced babyloss, so I am struck when I hear of one.  As sad as I am to hear there are more of us in the club, I am thankful that those with star power can speak out and bring more of a face, more attention to babyloss.

TTC After Loss: The Negatives: Whew! this one is right on if you’ve ever tried to conceive after loss.  The hope that comes with the idea of another baby (not a replacement one, as we all know) can seem so uplifting.  But we have to remember that with trying to conceive comes disappointment for some or many.  Trying to conceive after babyloss can be miserable.  miserable.

The unique grief of mothers without living children.  I found this article so accurate.  I especially appreciate the part about a rainbow not making it better- that not everyone gets a rainbow.  We need more help and support learning how to cope without or despite a rainbow.

What it means to hold space-Who holds space for you?

A grieving mom’s request A Short, concise, well written article, which sums up some of my requests.  How about you? (thanks to LosingBennyBear for sharing!)

Sunday Synopsis

Changing early pregnancy etiquette– I like this article because it keeps on the theme I”m seeing more and more of in mainstream media- let’s talk about our losses!  espeically miscarriage- the hush hush secret.

THe healing power of animals.  This is like my story, sort of.  We got our puppy six months after Mabel died.  I needed something to love and mother.  It’s not a save-all.  Getting my puppy doesnt undo the grief of burying my child, but I found comfort in it.  Do you have an animal in your life that has helped you in your grief?

I hope that you never know.  I love this article for addressing the grief olympics that sometimes comes in the bereaved world.  I also love that it says “be there…even when you are pushed away.” to those who want to support us.  I can’t say how important this one line is to me.

Couples who chose not to have children are selfish, Pope says. Not to bring in any debate about religion, but any thoughts on this?  I think of couples who lost babies to due multiple miscarriages, due to life limiting conditions, due to stillbirth, due to reasonless reasons.  What if they choose not to go through the pain of another pregnancy?  What of the couples who struggle with infertility?  There just feels likes there’s too much behind being childless for people (religious heads or not) to judge.

Words of Advice from Baby Loss Moms

At the end of my talk to my local midwifery students, I gave them a handout, that speaks volumes.  You may recognizes some words, because they were simply taken from the comments section in response to my question of what would you like midwifery students to know about baby loss.   Feel free to comment if you have more advice to give! Here is the handout:

Words of Advice from Baby Loss Moms

 

“Video clips of ultrasounds meant so much to me and I would have like a recording of my daughter’s heartbeat if they could have given me one. At the time I didn’t know it those would be my only memories of her. I appreciated when my doctors were honest but sensitive.” -mother of Caroline, carried to term after a Trisomy 13diagnosis, who lived for 58 days.

 

“I think they didn’t tell me anything because they had no clue what was going on themselves and wanted to wait until they had more info- but, that choice made things much worse!!!! Talk to the patient, you have to talk them through what’s going on, you have to tell them. Also: if there’s a chance a baby might not make it, you have to prioritize letting the parents see the baby while working out the logistics. I didn’t get to see my kid until after he was gone. I even asked but was told it was too complicated. That’s still absolutely devastating to me, and probably always will be….One other thing: I was given the choice to go to private room on postpartum, or to a different floor. I really appreciated having a choice.” –mother of Sacha who died day after birth from unexpected brain tumor

 

“Perinatal loss can be such an “ambiguous loss”. It was so validating to see everyone reinforce that he really was a real baby (a concept that almost all brand-new mothers struggle to comprehend at the moment of birth).” –mother of Sacha who died day after birth from unexpected brain tumor

 

“Even if the death occurs later, call or write or visit the parents. We so appreciated that one of our midwives and her intern were able to make it to the ceremony we held for Paul. But a call would have been just as meaningful…. If applicable, invite the parents to share a photo of their baby for the baby photo board or book.”mother of Paul who died unexpectedly a few weeks after birth

 

“And for subsequent pregnancy: if you need to discuss the death of the previous baby, give notice in advance so the parents can prepare (especially if you need them to tell their story, or to dig into traumatic events). Also I was offered a viability scan I didn’t “need” but that was really reassuring.” mother of Paul who died unexpectedly a few weeks after birth

 

“With miscarriage (or infant death in general I suppose), even if there is ‘something wrong’ with the baby that you can prove with genetic testing, no one should ever say ‘It’s OK- the baby had a problem anyway.’ I’ve noticed a lot of pregnancy books use this kind of logic, and it’s bad. We don’t throw out people or stop caring about them because they’re sick, so what are we supposed to feel better that our baby that died wasn’t perfect, and that caused his death?” –mother of Serphim, who died of Potter’s Syndrome five hours after birth

 

“Encourage parents to hold, kiss, love, bathe their baby… If you’re uncomfortable handling a dead baby, please ask one of your colleagues to take over. This was our only negative experience with the staff- and it felt awful to have someone reject our precious babies. Remember that these parents need your care, support, love perhaps more than anyone else on the floor.” –mother of A&C, twins who died after PPROM at 20 weeks.

 

I was that woman, sitting in the OB office following my 19 week anatomy scan when the midwife came in with a student and very coldly and matter-of-factly started to explain the slight anomaly found on ultrasound. When I started to cry the midwife offered little support and I could tell she was busy and I think she really believed the finding was nothing major and that I was over-reacting. It was the student who came back into the room alone and sat with me, let me cry, and explained what was going on as best as she could.   So my advice to your students is that there will be days in clinic when you are busy and running behind and stressed, and these are the days when you might have to break bad news to a patient (or several patients), and your pager might be going off, and your receptionist might be reminding you that you have 3 patients in the waiting room, and you will probably have a huge stack of papers on your desk that need to be reviewed… but in that moment, for that patient- your time and presence is what she needs most.” –mother of Clara, carried to term after a Trisomy 18 diagnosis and born still at 36 weeks

 

“It might be tempting to let the parents know that their loss isn’t a big deal compared to what other people go through, but that can be very disturbing to the grieving parents. Don’t tell them it was nature’s way of getting rid of damaged goods. It was their baby. They loved that baby and would have done anything to save it. To you, it was a blighted ovum, or a common Trisomy problem, or ‘barely even a positive’ – but to that family it was precious and beloved. The loss is still very real no matter how unformed the physical person may have been.” –mother to baby lost to miscarriage

 

“Our nurse hung a doorsign of a baby in an incubator on our door so that those entering my postpartum room would know that we had a NICU baby. That was great as it eliminated any too-cheerful questions. However at my six week postpartum checkup, the doctor didn’t know my baby had died.” –mother of Anderson, born at 24 weeks who lived for 26 days

 

“Cyr, take photographs- YES. And remember, you can never tell a loss mom that her baby is too beautifulm too perfect, too special and too unique. She will never hear this as her child grows. Give her a lifetime of school picture Oohing and Aahing in the short time you have with her. Use the baby’s name.” –mother of Anderson, born at 24 weeks who lived for 26 days

 

“I was pregnant with our 2nd baby and had our first u/s at 9 weeks. They couldn’t find a heartbeat. I t was hard and still is. I recall the u/s tech saying ‘oh I just know you’ll be back in 3 months pregnant again!!!” She was just so hopeful. But that’s not what I wanted to hear. I needed to honor THIS baby and THIS loss. So overall, I just wanted the midwife team to honor the present and respect what we are going through at the moment.” –mother of baby lost through miscarriage

 

“To make sure parents have all mementoes of their baby that they would like; to make sure parents know they have no been ‘cast adrift’ from the unit- you become so close to staff whil your baby is being cared for going home is like an estra wrench on tope of the loss of your baby; to make sure parents know how to access counseling. I would also add a couple points about traumatic birth- whether it’s something like PPH or an illness such as preeclampsia and HELLP syndrome- that mums know where to get information about what happened to them and why, and how to access support/forums/debrief about the birth.” –mother of Hugo, born at 24 weeks and lived for 35 days

What more do you have to add?

Sunday Synopsis

Why I don’t want my miscarriage to stay a secret- great post that brings miscarriage into the babyloss community.  Miscarriage is a different kind of loss than stillbirth or neonatal loss, but there is still so much grief that can accompany it.

How should an abortion be– WARNING.  I know I have many readers who will not like this article. I post it not to make a huge political statement, but instead I post it because it fits into my latest theme- feeling pressure to grieve the right way.  I also post it because people terminate a pregnancy for many reasons- including medical, because her health is at risk or the baby has a fatal condition.  Babyloss is a taboo subject, as is termination- so there are some similarities there.  They come with complex and nuanced feelings with pressure about how we are supposed to feel.  Many people in the babyloss community might feel complete different/separate from the abortion community and that’s OK and totally reasonable too.  I post only to show that people in different circumstances can also feel the pressure of how to grieve/not grieve appropriately, just like us.

Here are just some of the people living with an extra chromosome and rocking it– I love this.  In some ways it’s a very nice contrast to the article above this.  Yes I am pretty open minded about people’s personal decisions when choosing to continue (or not) a pregnancy- it’s their choice.  And most (up to 92% some sources say) women choose to terminate a pregnancy with a Down Syndrome diagnosis.  Getting the diagnosis means at best a lifetime of caring for a special needs child, likely a host of medical problems, and a disability of unpredictable significance (mild to severe).  At worst it means a miscarriage, a stillbirth or a dead child.  When people make their decision, I just hope they also consider the info in this video.  No one is guaranteed a perfect child and those with trisomy 21 can do so much more than we sometimes imagine.

Speaking of dead moms– I love the ending of this.  “Sometimes speaking of death isn’t necessary, and sometimes sharing it isn’t possible. We do as we do to get through. We eat the black jelly beans.” As Mabel’s birthday approaches, I’m torn between wanting to shout from the rooftop and huddling down, not speaking of her and keeping her memories to myself.  I have just ordinary days like that too.  Speaks to my recent theme- there is no right way to grieve.

Just think of the midwifery care you can provide to patients…

This post that popped up in my email reminded me very much of the conversation started on one of my Sunday Synopsis’s in the comments. I’ll be honest: I haven’t read the whole thing- and I’m not sure everything resonates with me, because of of the religious aspect.  But it falls under the “things not to say to the babylost” category. I don’t bring it up to start more conversation on the topic, but instead I wanted to share one point that hit me-

3. “Just think of the ministry you can have someday to parents who have lost children.” No. At least not the ministry you’re thinking. That would require me to say that God is somehow in this for them and I happen to know that’s not helpful. Plus, I don’t want that ministry. I’ve spent twenty years of my life trying to serve God full time.  I’ve put every major decision of my life through “God’s will” as a filter, including setting aside life dreams for myself.  All of the big things I’ve tried to do for him have been heartbreak for me.  I think I’m done with ministry at this point. – See more at: http://www.calebwilde.com/2015/01/23-spiritualized-comfort-cliches-to-avoid-when-a-child-dies-3/#sthash.q30SIzFp.dpuf

I have received similar comments that irk me just a bit. I am not religious and therefor not providing ministry, but I am a midwife and provide care. It could have easily read “Just think of the good midwifery care you can provide to patients going through loss.

Yes. Now that I’ve experienced loss myself, I do think I provide even better care to women as they experience their own- from infertility to miscarriage to stillbirth and neonatal loss. I have learned so much and become a resource for others in my medical community. I am unafraid (less afraid?) to help support my patients through their grief.

BUT, it does not make me feel better about my own baby dying. I like to think I gave decent care before- I might even have a few patients who could vouch for me on that. And even if I didn’t, frankly, I’d rather be a crappy midwife with a living child that a super compassionate midwife with a dead one.   The comment implies that I needed my daughter to die so I could grow personally and professionally. I know plenty of other care providers who could use similar growth, but I don’t wish a dead child on them.

I can see how Mabel’s death has made me a better midwife in some ways, but I don’t really need anyone to point it out or use that to make me feel better. It invalidates some of my grief. Yes, I think I show much more compassion to my babyloss patients, but it was a crummy journey to get there. I would have preferred to avoid it, thank you.

Sunday Synopsis

Acceptance in Infertility– This article is reminicent of the many articles out there about what not to say to babyloss moms and of some of the conversation started here in the comments.  A different topic (though I see infertility as babyloss too, whether it be from recurrent pregnancy loss or inability to become pregnant at all.  we who have had babyloss share a lot with our sisters who struggle with infertility).  I appreciate it for the same message we’ve all been sharing.  Words are powerful and sometimes well intention. benign seeming words can convey another whole message to the receiver.

Helping Families Cope with Perinatal Loss– I picked this one up on Wrapped Up In The Parentheses and have been slowly working my way through it.  (confession: I’m not done).  But so far, it’s been fascinating- validating, if nothing else.

Early Pregnancy Loss– a babyloss friend emailed this to me.  I like it because it I think it sums up, from a different perspective, the idea behind my post and the conversation it brought up.  Yes, loss is different depending on what kind of loss it is- early pregnancy, stillbirth, neonatal loss- BUT everyone has a right to be sad based on their loss.  Its seems we all just want validation that what we have gone through is hard and sad.  it is.

Sunday Synopsis

10 types of disenfranchised grief– though the list addresses miscarriage and abortion, I’m going to argue that babyloss in general should be counted.  Though, in a weird way, I consider myself “lucky” in the babyloss world (hah!), because my daughter technically lived for 6 hours and thus gets some recognition for life, I also feel disenfranchised because few people met her, so she wasn’t real to them. Plus she had birth defects, and I constantly worry that people think she was worth less because of them.  And then there are those who lost babies to stillbirth- the same kind of disenfranchised grief.  And those whose babies lived only inthe NICU.  When it comes down to it, people listen easily when people talking of their parents,  or grandparents dying, but nobody likes to hear about a dead baby.

64 things about grief– do you agree? anything else you’d add to the list?

Grief Gifts Guide– What do you think?  Did you get any gifts like these for the holidays?  Did you get anything else that you would add to the list?

Confessions of a burnt out physician– Though this might not resonate with those non-providers out there, I hope it can help bring some understanding.  I do love so many aspects of my job, but the intense timing of it is not one of them. I’m given 15 minutes to see patients- whether it’s a simple fetal heart rate check or discuss their recent miscarriage.  It’s not a lot of time.  It does force me to put up some barriers and boundaries, which is not how I envisioned practicing when I enrolled in midwifery school.  ah, reality.  I also post this because I know many of you have had difficult experiences with your providers.  This is not an excuse for bad behavior, but perhaps can provide insight into the pressures at work.  I remember a patient being ticked about waiting 45 min for her routine prenatal.  I wanted to tell her, “I’m sorry I’m running late,  but I just spent all that time talking to the patient before you who is carrying a baby that is going to die.” I couldn’t and didn’t, so I simply apologized.  Sometimes the stress of closely packed patients can make some providers even leave the profession.

Experiences which expanded my empathy  I find babyloss has certainly expanded my empathy in many ways.  I am much more sensitive to loss in general, especially at work.   Though, sadly, I also find some situations harder to find empathy as well.  You?

Finding a little fulfillment

I’m overdue for a post, I know. Some weeks there are plentiful moments that grab and illustrate my grief and other weeks there are no new moments just the same old same old, repeating “my baby died” or she is not mentioned at all. For the most part this week was the latter, hence my absence from writing. But there have been a highlights to my week.

I gave a talk to the midwifery students at my local school of nursing. I felt GREAT afterwards. My only regret was time management. I was there with another babyloss mom who is the program director of our local babyloss bereavement nonprofit and the main goal of our session was to give the personal side of things- they were to have a lecture afterwards on the clinical side of babyloss. I, of course, was happy to share every detail about Mabel’s story- and I did, getting far more detailed than I usually do because these are students who understand what oligo means and pulmonary hypoplasia signifies. I talked and talked and talked and then was out of time- so just ran too briefly through all the notes regarding points I wanted to make on how to help bereaved parents. The best part, I think, was the handout I brought. I took all the comments you wrote and took quotes from them- labeling it “Advice from Baby Loss Moms.” Beside each quote I wrote who said it “mother of Sacha, who died of an unexpected brain tumor the day after birth” and “mother of Clara, carried to term after a Trisomy 18 diagnosis and born still at 36 weeks” and “mother of baby lost to miscarriage.” I took suggestions from everyone who commented and know that the students read your words and knew of your baby.

Being in the school and talking in front of the students made me feel very fulfilled. I was reminded how much I enjoy teaching and how much I have to teach. I think doing more of this will help me bring some satisfaction back to my job.

The rest of the week was relatively unremarkable- except for one day. I started off with a patient who knows Mabel’s story and has told her kids about her even. After a big hug and a quick but genuine cry, she gave me a gift from her oldest daughter. A pink carrot with Mabel’s name written in 4 year-old script.

IMG_5847

The following two appointments were remarkable as well. One, another babyloss mom, whose first child was stillborn, is finally pregnant again after too long a struggle with infertility. I am constantly awed at how unfair the world can be sometimes. We embraced and each shed tears- I told her of all the times I thought of her son, including in May, when I was at a babyloss Mother’s Day event, where we lit candles for babies taken too soon. When it was my turn, I lit a candle and said it was for Mabel but also for the other babies I had cared for- for Giada, for Mia, for Noah, for Olivia…and name all that I could remember. It was a good visit. Following it was another patient who was newly pregnant after miscarriage. When I couldn’t find a heartbeat last time, we both cried. I was thrilled to see her back and back so soon.

I remember feeling this way with patients before my loss, but the emotions are so much stronger now. Part of me wonders if I could just have a practice with the babyloss, but that is not feasible. A nice idea, huh? A waiting room full of patients who know loss? In another world…

 

How was your week? Did you find fulfillment anywhere?