G2 P1011: life after loss and D&C

This post may be a trigger for those who have had an abortion, miscarriage, or fetal loss. I wanted to share my experiences because in the weeks following our fetal demise, I read several blogs by mothers but couldn’t find a single post written by a physician mother. This post is also part of my healing process. In it, I will share some of my challenges and also will explain my D&C*. I have found over the past months that many of my friends and colleagues have experienced pregnancy loss. Almost every single friend I shared it with have experienced their own loss. We are not alone. I hope that this post helps someone in need.

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It’s been 2 weeks since my D&C, over a month since we learned that our little kidney bean sized fetus-baby had died, and 3 months after finding out we were pregnant with our second child.

Thankfully, the nausea has resolved, the fatigue has ended, and the waves of grief are less intense and less severe. But sometimes the grief washes over me and I can’t breathe. And I fall into my husband’s arms or I call him or my mother or my best friend A and I weep. And then I wipe my face and I go on.

Zo asked enough questions for us to know that we needed to tell him something. So, I recalled my time during residency with the Palliative Care Team and did my best at providing a 5-year-old appropriate explanation of miscarriage. “Mama, there is no baby anymore.” “No, there was a baby growing but it stopped growing and then it died and the doctors helped my belly feel better and now I’m feeling a lot better.” He pauses, looks around. Says “okay” with a smile and a hug and then “I’m going to go find my Wolverine so we can play.” And then we move on. Now that my belly has started to rapidly deflate, I’m not exhausted or nauseous anymore, his questions have become less frequent. He is satisfied with our answers.

One of the hardest parts of this process has been all of the changes my body underwent that feel downright wasted. Big old breasts that won’t nourish a baby and that sadly have deflated just like my belly. A big old belly that poked out immediately and still makes some strangers pause. I pray incessantly that no well meaning elder asks “are you pregnant?” because I have stopped telling friends about our miscarriage (I am allowing the message to be passed by osmosis because at this point, I’m tired of retelling it and everyone who needed to know now knows) and I’m not sure I won’t either curse them out or start crying. New stretch marks that show my body underwent a change and unlike my breasts and belly, they are permanent. They will always be with me.

The hardest places to go for me have been the gym and the Ob-Gyn office. The gym because all of the mirrors show me exactly what I look like. I tend to sit in the car for 30 minutes before going in. I usually have my worst cries there building up the courage to go inside to work out. Losing weight after having Zo was so easy. He nursed like a champ and I weighed less than my pre-pregnancy weight within 4 weeks. This time. No such luck. At the gym there is no cute baby to tell other people about. I see the eyes on my belly (folks probably thinking “this pregnant lady knows she needs to be at home). I see the bulge in my shirt. The popped out belly button. The widened hips. I know I have to work extra hard to fight the flub without the help from breastfeeding. It hurts. All of this good chunk and no cute baby to show for it.

The Ob-Gyn office because there are cute waddling pregnant women. After finding about about the demise, I transferred my care from a midwife community practice to an Ob-Gyn practice recommended by one of my friends. I literally could not go back to the old practice; when the office called to follow up, I quickly thanked them and hustled them off of the phone. I had to let them go, they are the practice where I was hoping for a happy, uncomplicated pregnancy. I just can’t go back there.

And now with the new Ob, I don’t want to go for my follow up visit (but I do, on time!) because I know I’ll have to tell the Tech who gets my vitals that we had a miscarriage. And then the sad response, the averted eyes. I want to yell “I’m not a leper” but all I say with a smile to make her feel better is “we are okay! I’m feeling much better and the procedure went great!”. And I don’t want to hear the Ob tell me “you can start trying again next month.” And when I say “we are taking a break, this was a lot to handle” he says “yeah, yeah, yeah, you’ll be back soon pregnant with the next one. You two are healthy, you can have 3 or 5 more kids if you’d like” I have such complex emotions that I can’t mount a response. I just sit and nod. I literally am too scared right now to think about getting pregnant again. So I read books and I read blogs and I talk to friends who have lost babies and they tell me I am feeling exactly how I should feel right now. Confused. Scared. Hopeful. Encouraged. Sensitive. Fearful. Apprehensive. Angry. Loved.

It is 1pm and I have been putting off going to the gym since 9am. It’s time to get up and go. Hopefully writing this post means that I won’t spend any time sitting in the parking lot. Time to work on this belly bump.

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G2 P1011. Gravid 2 (meaning I have been pregnant twice), Parity: 1 term infant delivered, 0 preterm infants delivered, 1 abortion/miscarriage, 1 living child.

*D&C - dilation and curettage. This is a procedure where the cervix is dilated and a curette, almost like a spoon or a scraper, is used to remove contents from the uterus.

My D&C:

• In my D&C a small vacuum was also used.

• I received conscious sedation during my procedure, meaning I did not require respiratory support. I was in the pre-operative area for several hours until a c-section was completed and then I was taken to the Operating Room and it was over within 15 minutes. The Anesthesiologist provided midazolam and propofol and I was awake within minutes after with no cramping. I was very hungry and ate lots of yummy snacks and a big lunch and then came home and was promptly sent to bed by my family.
• The Obstetrician performed an ultrasound before to confirm the demise and an ultrasound after to show that the products of conception had been removed. I asked for them and have them in my files.  
• I had light spotting for 3 days after. Then only spotting with exertion (embarrassing but this means after pooping) for 2 weeks, then it stopped.
• I have had intermittent cramping and just like my Ob promised, I dind’t need any medication stronger than ibuprofen 600mg as needed.
• I had a follow up appointment 10 days later and was cleared for all activities.

Guest post: Tampon Travesty

Another cycle. It's here. The anxious two week wait is over, and it's time for tampons. I got my period.

There are many blog posts and stories about struggling with conception. But these people aren't in medicine, they aren't in sync with the uterus, right?? They didn't have to memorize hormones and fun facts?? Right? Apparently not.

Well, we started struggling, and the foreign stories became relatable. Our trials have been so much more confusing in light of our son who grows older with every month we are unable to provide him the brother or sister I have longed for since the moment he was born. I guess they call this secondary infertility - I call it a giant, expensive, heart-breaking pain in the ass, which makes me cry on a regular basis, well by regular basis I guess I mean... approximately every 28 days.

We have been trying since our son was first born. We both want a big family, and that requires trying to have children, even during our simultaneous medical training, and what some would say are not ideal times. So, I gave up breastfeeding my son cold turkey (with ample frozen milk) to expedite my cycles returning. Well, they returned... and have been returning for close to a year now. I could have had my baby by now. I could be back to breastfeeding and snuggling, but instead I'm changing my own maxi-pads. I'm a strong woman, but this was not my plan, and I cannot will it away, or rely on our shared medical knowledge to fix the problem.

I know you're supposed to wait to see a reproductive specialist until a year, but waiting is not my strong point. We went a few months early, and are actively seeking care. It is hard to seek care as medicine folk. We are knowledgeable, but vulnerable. We want that second child so badly. So, we shall let the medicated IUIs begin.

I'm not sure why I'm writing this, but it sure feels wonderful. Partially, for my own sake and partially to break the silence of infertility. Here's a shout out to all my medical mommas trying to grow their family. A wish of wellness and fertility to all those trying and especially those struggling.

May the second pink line be with you.


MD/PhD Student Mom + Anesthesiologist Husband + One Son

Guest post:: Trying to conceive

Twice a day, during my typical 5am - 7pm style day, I sneak away to the bathroom with a little sealed packet.  In that little packet is a small white test strip.  I have a small plastic cup in my hand.  You can buy these little packets online -- 50 of them for about $10.  I  pee in the little cup and dip the stick, waiting to see what lines develop.  One dark line and one lighter line; nope, no LH surge.  Still not ovulating.  Then I wonder, for the hundredth time: is it my irregular schedule?  Is it the q3 call, even though it's home call, still tends to extend my work hours to the 80/week boundary?  Is it the stress of running an Orthopaedic Surgery trauma service?  Is it my complete lack of sleep?  I bury the little stick in the trash, hoping nobody notices it, and I rinse out the cup, dry it off and palm it, heading back to clinic.

I'm disappointed again today.  I do this twice a day -- looking for my LH surge, looking for a sign that I'm ovulating.  On my OR days, it's harder to test in that daytime window.  I usually manage at least one pee-in-a-cup time a day, though.  My cycles aren't regular enough for me to just count calendar days.  My basal body temperature pattern isn't consistent enough just to test around "expected ovulation" time.

When the two lines are the same color, I'll get home at around 7 or 8pm and try to coax some energy into my body in order to get some lovin' from my husband and work on this conception business.  Small windows in time where gettin' busy really matters.  Small windows of time in my life where I want to catch up on sleep.  In the 6 months we've been trying, there have only been one or two cycles where I was pretty sure I had an LH surge and I ovulated.  After those cycles, it was hard not to get hopes up.  Each time, blood in the underwear heralding menstruation left me disappointed.

Each morning, around 5am, I take my basal body temperature before getting out of bed.  All the temperature/charting folks say 3 hours minimum of uninterrupted, good sleep are necessary for a reliable basal body temperature measurement.  HA!  Have they ever met a surgery resident before?  My chart looks like a saw blade ... up down up down up down ... it's no wonder I can't figure out whether or not I've ovulated.  My OB/Gyn doesn't really know what to make of my temperature charts.  He tells me: "Sure, I'd love to say 'get more regular sleep,' or 'try for a more normal schedule,' or 'work on your stress levels,' but I was a resident once, too, and I know how ridiculous that sounds to you.  He's right - if I had a "normal" job, or a "normal" life, those would be reasonable suggestions.  I do what I can with the life I've chosen.

All of this is difficult, even though I've been off hormonal birth control and we've only been officially "trying" for about six months.  What compounds the difficulty, though, is that all this has to be kept under wraps.  Most women who start down the path of trying to conceive are, understandably, quiet about their journey, unless they have a kindred soul (who may also be trying) with whom to share their experiences.  Being a surgical resident just adds another level to the need for secrecy.

In my program right now, there are several male residents whose wives are pregnant.  All of those announcements were met with a lot of "way to go, man!"  "Congratulations!  When's she due?"  "Not much longer until she'll want #2, eh?  Too bad we've got residents' salaries!"  In my program, we average one woman for every 5 or 6 men -- and that's actually a good number, for an Ortho program.  There have been two women before me who had children during residency, and one woman in the class below me.  When they got pregnant, there were significantly fewer "YEAH!  Way to go!  Congrats"-type responses.  Instead, it was a whole helluva lot of "how much time are you taking off?"  "Wait, you're due during a rotation where you're q3 call -- who is going to cover your call?"  "We're going to have to book down that clinic for a month, aren't we?"  And while they were away on maternity leave - most of them took 4-6 weeks - there was definitely a fair amount of grumbling.  I found myself defensive for them: "If this were YOUR WIFE, I'll bet you'd be fighting for every single day of her leave," I'd tell the complainers.  The double standard still gets me.

And so I continue to sneak away to pee in my cup and look for signs that I might be ovulating, despite this ridiculous schedule and stress I put on my body, my mind and my spirit.  I'll deal with the double standard when I get to that point; right now, I'd just like to see two lines of the same color, and my husband and I will keep hoping.

-I'm an orthopaedic surgery resident on the west coast. No children yet.