Wednesday, August 1, 2012

Misdiagnosed miscarriage, version 2

Note: a shortened version of this was posted on the blog Offbeat Mama.

Just over a year ago today, I was diagnosed with my second miscarriage. And not only did my doctor turn out to be wrong, but the misdiagnosis may have been the best thing that could have happened for my pregnancy.

In the summer of 2010, I had missed miscarriage that ended in D&C (dilation and curettage, the simple surgery that removes early pregnancies) at about 10 weeks. At first I believed that I NEEDED to get pregnant again RIGHT AWAY and that I was DEFINITELY READY... but when I found myself blubbering to my husband about how I didn't feel at all excited about getting pregnant again, just stressed out, and that I never thought I would feel excited again, we realized that we weren't actually ready. After trying again for one month post-D&C (when I'm convinced that Yom Kippur falling pretty much exactly on ovulation day didn't help!), we took time off. I got my two-star scuba diving certification and started training for a half-marathon, doing lots of yoga, and generally trying to keep myself busy and enjoy NOT being pregnant as much as possible.

After a few months we felt ready to try again-- TRULY ready, excited-to-be-parents ready, optimistic ready. On our second month trying, on Valentine's Day, I took a pregnancy test a few days before I thought I actually had a chance of seeing a positive... but there was a faint second line!! We were delighted... and stressed out, and intimidated at the thought that I was supposed to run a half marathon in just a few days. Ok, maybe the stressed out and intimidated part was mostly me. I had this tape playing in my mind that said something like "don't stress, stress is bad for the baby, OMG I'm STRESSING OUT, I'm DAMAGING IT, NOOO I NEED TO STOP STRESSSING.... AAAAAH!!!! STRESS!!!!" I barely slept at all for the first few nights after getting that positive pregnancy test. While I think I had recovered from the miscarriage enough to be excited, it still played with my mind... and for the record, telling a pregnant woman not to stress because stress can hurt the baby is basically the MOST stressful thing you can possibly say to any woman who is, shall we say, a bit high strung.

I was also debating whether or not to run the half marathon, and I decided not to-- I didn't want to blame myself if this pregnancy, too, ended in a miscarriage. Instead, I ran the 10K at the same event, feeling nicely over-trained and horribly smug whenever I sailed past a huffing and puffing non-pregnant guy. The first person we said the words "I'm pregnant" to (ok, technically "Ani beheraiyon"-- we live in Israel) was one of the race coordinators who agreed to change my registration to the 10K when we explained my "delicate condition."

On March 1st, I had my first doctor's appointment at 6 weeks exactly. We waited three hours to see him because I had the time wrong, and I sat in the waiting room with this growing feeling of dread. Last pregnancy, it felt like I got scarier and scarier news at every ultrasound... the baby was too small, its heartbeat was too faint, there was no heartbeat, it had stopped growing... now, seven months later, just after what should have been my first baby's due date, I sat in my new doctor's waiting room, getting up to pee every five minutes, fearing the worst.

And then it happened.

The doctor didn't see a fetal pole on the ultrasound, just a sac. He also started drawing pictures on his pad that looked kind of like deer antlers, explaining to me that he thought my uterus was bicornuate, and that I was carrying the baby in the left side. Yes, this could be the cause of repeated miscarriages. He sent me to get my HcG levels drawn: 38,000 one day, 40,000 the next-- high (so high that every website I googled told me that there should DEFINITELY be a baby and a heartbeat seen on ultrasound) but not going up fast enough. One website told me it would take something like 76 days for my HcG to double at this rate, while it's supposed to double every 24-72 HOURS at this point in pregnancy. I also felt a little crampy, convinced that my breasts were less sore than they had been the week before.

So when I went back for a second appointment four days later, at what should have been 6 weeks 4 days, and heard more bad news, I was expecting it. I had to ask my doctor specially to print out a picture of the ultrasound... I've found that they don't give you pictures when they think your pregnancy isn't viable.

He diagnosed me with another missed miscarriage, and told me that lots of women have two miscarriages and go on to have healthy babies. It didn't feel that way. It felt as if getting pregnant (or rather, staying pregnant, since we got pregnant on our first or second try both times) was going to be this insurmountable barrier, as if something so effortless to so many women was going to be incredibly difficult for me. I felt as if I had plunged into a different category, the scary world of "multiple miscarriages," compounded by this news about my defective uterus.

The doctor printed out two referrals for me to take to the hospital the next morning-- one for a D&C, one for medically-induced abortion if that's what I preferred. I asked him if it would be ok for me to wait this one out to see if it would happen naturally. He said yes. I said I'd give it two weeks.

And then I went home.

I had cried so much in the days between the two ultrasounds that now I just felt numb. Even calm. My baby, my poor little nonviable baby was still inside me, which didn't bother me the way it seemed to bother other women on the Babycenter miscarriage support forum. I felt like at least I would get a longer goodbye this time, at least I could wait for natural miscarriage so that I would have no doubts that this had to happen in the end. I knew it could take a while; I read the stories of women who waited four weeks, with pregnancy symptoms churning along, before finally releasing their babies. I felt a kind of peace with this, a kind of confidence that waiting would be the best thing. I just hoped the miscarriage would happen on its own before my doctor would pressure me into getting a D&C.

In the meantime, I went back to my normal life. I ran faster and harder, intervals and tempo runs. I ate poached eggs with runny yolks, camped out all night on the rocky ground beneath Masada fortress and didn't worry about lack of sleep, drank a small light beer on two separate occasions. I didn't eat sushi, but only because our favorite sushi shop had closed. I reveled in iced coffee, hot "cafe hafuch."

And yet I felt I was living in a twilight zone between "pregnant" and "not pregnant"-- those jokes about how you can't be "a little bit pregnant" didn't seem funny anymore. In the Ein Gedi Spa at the Dead Sea, I decided to dip my toes in the sulfur water pool rather than go in with my whole body, thanks to the big signs prohibiting pregnant women from entering. When we took my parents on an introductory scuba dive in the Red Sea coral reef, I agonized about whether to go with them-- I had to sign that I WASN'T pregnant on the waiver before entering the water. But it was such a short and shallow dive that I decided to risk it.

I didn't want to give in to the "denial" that kept whispering in my ear about that bloat in my lower stomach, about the breast soreness that was back in full force, that light nausea in the evenings-- the "denial" that kept playing pictures in my head of going in for another ultrasound and seeing a developing baby on the screen. I felt that I had let denial string me along too much in my last pregnancy-- my doctor was gloomy about my prospects at every appointment then, but I had dismissed him as an Eeyore, and I told grandparents, second cousins, fellow theater board members, acquaintances, friends all about my pregnancy at just 7 weeks. And then told them the sad news at 10. This time I was going to face reality. It felt important to stop taking pregnancy precautions so that I could truly wrap my head around the loss of this second baby. But still, I didn't go in that sulfur pool, I didn't go on a deeper or longer scuba dive (even though I had the opportunity), I avoided any medication that could be harmful during pregnancy, and I kept taking my prenatal vitamins.

Three weeks after my last appointment, I called my doctor, ready for him to yell at me for waiting longer than I'd said I would. Instead, he wasn't worried. He scheduled an appointment for me in a week. I was grateful for more time to wait, more time to let this happen naturally instead of being pushed into making a decision to end this pregnancy.

I didn't bother to set the appointment for a time when my husband could make it. It would be at 10 weeks 3 days, so I knew that it was now or never-- if nothing had changed for the better on the ultrasound, I felt ready to take medication to end this pregnancy. My main question was whether I could wait until after the 5.7K field race that my husband and I had registered to run that weekend, back when it had seemed my pregnancy would be long over by this point. I didn't even look at the screen when my doctor inserted a wand to see what was going on with this pregnancy; I studied the gray curtain beyond my feet, ready to hear the worst.

"Maya, do you realize what we're looking at here?" my doctor said. And then I turned to the screen. And there was a moving, beautiful, heart-beating, perfectly-sized 10 week fetus.

I started crying-- maybe one of the only times in my life that I've burst into tears because of pure joy. This was literally my dream, this was that moment my "denial" kept playing in my head. This was my BABY, my actual kicking baby, there on the screen. At 10 weeks, my last pregnancy had looked like a smudge on the ultrasound, a little gray spot at the edge of the long, collapsing wedge of sac. This baby was waving at me.

The doctor also told me that he no longer saw signs of a bicornuate uterus on the ultrasound. He thought possibly originally there had been twins, leading to the high HcG numbers and odd ultrasound results, but I'd lost one early on. He was practically on the verge of tears himself.

The next few days felt more dreamlike than anything I've ever experienced in my life. I couldn't stop smiling, and while I passed one restless night after finding out the news (should I sleep on my side? What if something happened to the baby now?) but I found the calm that I'd felt when I thought I was miscarrying returning. This baby was strong. She (a girl, though I didn't know it then) had thrived during the interval running, the sleepless nights, the-- *gasp*-- caffeine consumption. She was tough, and one nervous mother couldn't change that.

In retrospect, being misdiagnosed with miscarriage was perhaps the best thing that could have happened to me. During the two weeks between finding out that I was pregnant and being told I had miscarried, I twanged with fear. I felt like the agent of my baby's destruction, not just its growth. When I thought I was waiting for miscarriage, for the first time I did something simple: enjoyed being close to my baby. When I thought I would lose her, and there was nothing I could do, I allowed myself to do nothing.

I wish I could say that I lived in constant bliss for the rest of my pregnancy, but I still had my Google-fueled panic-stricken moments. (The most infamous of these: an emergency trip to my doctor's office at 20 weeks when vanilla-scented toilet paper convinced me I was leaking amniotic fluid, which women on my birth board swore smelled sweet.) But in the moment when we discovered my baby on ultrasound, a conviction began to germinate, one that would blossom when I saw her emerge pink, slippery, and determined, at the end of October: that my baby was strong, and that I could put some trust in her and give myself a break.

That Friday, I ran the 5.7K and didn't even bother going too easy-- while I made sure I was never overly out of breath, I also pushed myself just enough to pass a teenage girl on the slope down to the finish line. I finished just under a half hour, winning third place overall among women, thanks to the 11K race at the same event that siphons off the serious runners. At our next ultrasound, our baby had even picked up an extra "day" of growth between appointments.

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