Wednesday, August 1, 2012

My misdiagnosed miscarriage (version 1)

This was originally a guest post on A Mother In Israel.

The ultrasound at six weeks, second pregnancy

About a year ago, I left an anonymous comment on this blog [A Mother in Israel]. In response to the disturbing story about feticide at 40 weeks, I shared my own fears about prenatal testing here in Israel. When should I call my doctor to get his confirmation of the news I’d only discovered two days before, via two faint (and very welcome!) lines on a home pregnancy test? I didn’t want to go through the roller coaster of inconclusive early ultrasounds I’d experienced during my first pregnancy, the summer before.

Back then, at my first appointment, when I was still giddy, terrified, and freaked out that I had woken up with cramps the night before, my doctor had glanced at the ultrasound screen and said “There’s nothing in your womb.” Then he moved his wand a bit, squinted, and said, “Wait, no, there it is. But it doesn’t have a heartbeat.” This can be normal, he explained—often a fetal pole is invisible at five weeks, and my dates were probably slightly off. He drew his mouse cursor across the screen and measured the little black blob that I already thought of as my baby, and received an estimate of its age: four weeks five days. He sent me for a blood test and told me to come back in two weeks.

On to the roller coaster. The results of the blood test to confirm my pregnancy were great! Mazel tov! At seven weeks, we saw the flicker of a faint heartbeat! But the sac was growing slowly and was shaped irregularly, losing “days” every time it was measured.

Perhaps I should have known that something was off when my doctor still hadn’t sent me to any blood tests beyond checking my pregnancy hormones, but then I wasn’t yet familiar with the thirst of Israeli kupot cholim (health funds) for the blood of pregnant women. Besides, I had gotten pregnant my first cycle trying, and my mother had had four textbook pregnancies, so surely fertility problems and miscarriage were things that happened to other people. Stories on the site The Misdiagnosed Miscarriage helped convince me that what looked like a “blighted ovum” was no doubt a healthy baby nestled in a tipped uterus.

So I told everyone I was pregnant– my family, fellow board members of the Haifa English Theatre, the dressing room lady at Mango. I was convinced that I needed maternity clothes and loosened my belts. I bought plane tickets to fly to the US at the end of my first trimester and was sure I’d be “showing” by the time I returned from it. We concluded that my doctor was simply a negative person, delivering good news with the enthusiasm of Eeyore.

And then I went back to my doctor at nine weeks five days. Another ultrasound. No heartbeat, just a collapsed crescent moon with a smudge on it where my baby should have been, measuring just seven weeks along. The doctor diagnosed me with miscarriage after studying the ultrasound for five seconds. I grabbed the ultrasound wand and tried to make him look harder—my baby couldn’t be gone. I asked him for a referral to second opinion, which he printed out in a huff, telling me that he was the best doctor in the area and that if I used the referral, I should never come back to him.

Three days, and two ultrasounds from two different doctors later, I sat in the recovery ward of Rambam hospital, post D&C (Dilation and Curettage, the simple surgery that removes early pregnancies)—utterly, literally, drained. Not pregnant. “There will be no miracles here,” the last doctor had told me, before sending me in to surgery to vacuum out my womb.

So when I finally got pregnant again, six months later (after a delay caused by my emotional recovery more than my physical one), I dreaded that first ultrasound. I dreaded that limbo of not knowing, that “chetzi mazel tov” (half congratulations), those weeks of being told that probably everything was ok, or then again maybe not. We got the time wrong for our first appointment, so I sat in my new doctor’s office for three hours, heart pounding, preparing for the worst.

And then it happened.

I had waited until six weeks into my pregnancy for this first appointment, when every pregnancy website told me that there should be a heartbeat on the ultrasound. Instead, all we saw was a misshapen black blob, or maybe two black blobs, neither the size they should be, and neither containing anything that looked like even a yolk sac. My new doctor seemed as stricken as I was, and he searched for a long time to try to see something more clearly, trying different angles, pressing his hand on the outside of my stomach. He sent me for blood tests on consecutive days. While my hormone levels were very high, making a mistake in my dates almost impossible, they weren’t going up as quickly as they should have been– at this stage in pregnancy, they should have been doubling every 48 hours. Mine, on the other hand, were on track to double about every 30 days. I came in for a second ultrasound at six weeks and four days into my pregnancy, and left that appointment with a referral for a second D&C. At least this time I didn’t have to wait in limbo– I had a definite answer. Another “missed abortion.” (I never bled or lost all pregnancy symptoms in either of my pregnancies.)

This time, I decided to wait for the miscarriage to happen naturally. I went back to my normal life– drinking the occasional beer, going on a shallow scuba dive, running hard intervals. (I wasn’t in the mood to be gentle to my body.) This time, I was determined not to live in denial. The stories on that misdiagnosed miscarriage website convinced me that it was a good idea to wait for miscarriage at home, but that was the only concession I was willing to make to the tiny possibility that this pregnancy wasn’t over. I felt oddly free, no longer stressed that everything in my environment, including stress, was probably damaging my baby. I posted tearfully on miscarriage support forums online and tried to wrap my head around the scary world of multiple miscarriages. I felt oddly grateful for this long goodbye to my second baby.

Four weeks passed, though, and nothing happened– not even a cramp. The mild pregnancy symptoms that I thought had gone away in my sixth week seemed to be back. It was growing harder to tamp down that bit of hope. I called my doctor and set up an appointment, ready to think about “taking care of it” if we saw the same thing on the ultrasound.

As my doctor examined me, I focused on the gray curtain in front of the examination chair.

“Maya… do you realize what we’re looking at here?” he asked.

I turned toward the ultrasound screen.

There was a little gummy-bear-shaped fetus, measuring ten weeks one day, right on target. Even I could see her fiercely beating heart. As I stared at the screen, eyes welling up, I swear I saw her wave.

The ultrasound at 10 weeks
Why am I sharing this now, with my beautiful three-month-old daughter sleeping on my chest? Partly it might be a desire for vindication– see, commenters who told me that five-week or six-week ultrasounds weren’t inconclusive, I was right after all! Partly it might be because I’m still processing how lucky I feel that I didn’t use that referral to a D&C (though sorry, dad, but my baby’s story is not nearly as dramatic as Tim Tebow’s). And in a way I feel conflicted about telling my story, because reading stories of misdiagnosed miscarriage only fed my denial during my first pregnancy (though they might have saved my baby’s life during this one). I’m grateful for the prenatal care that we get here in Israel. I’m glad that I get to decide which tests to take based on my preferences, not my bank account. (Women in the US usually don’t get their first ultrasound until around week eight to 12 of their pregnancies, and thanks to the great expense of health care in the US, more women there wait for miscarriage to happen naturally than here in Israel, where the few people who knew thought I was crazy for not getting a D&C). I don’t know if I’ll pass up on early ultrasounds in (G-d willing) my next pregnancy, because I would probably drive myself just as crazy waiting for week 12 on my own. I don’t regret getting a D&C in my first pregnancy, because I’m fully convinced that pregnancy wasn’t viable.

But the thing about going through almost any kind of pregnancy twist is that you quickly find other women who experienced the same thing. As crazy as it is that my doctor told me my pregnancy was over in week six– when it really IS too early to be sure of what you’ll see on an ultrasound– I now know personally of three other women in Israel who were told something similar, thanks to early prenatal testing. Neither of my doctors volunteered the possibility that I could wait for miscarriage on my own. In 2010, misdiagnosed miscarriage made headlines in Ireland when a woman was told her pregnancy wasn’t viable and was given an abortion drug, only to discover a healthy baby when she sought out a second opinion. How often does this happen in Israel?

Misdiagnosed miscarriages are rare– far more rare than you hope they are when you get diagnosed with miscarriage. At the same time, they do happen, and they happen far more often when miscarriage is diagnosed before ten weeks, which happens far more often when women are lucky enough to get ultrasounds so early. Our healthcare system, which makes giving birth so inexpensive and easy, also makes ending a “nonviable” pregnancy inexpensive and easy. What would have happened had I gone to the hospital with that referral for a D&C? Would the final ultrasound before surgery (which I’m told sometimes doesn’t even happen) have caught a heartbeat or reason to wait? I’ll never know. But I do know that if I had gone to the hospital and they hadn’t found a reason to stop me from getting a D&C, I would be talking about my second miscarriage, not my daughter Nitsah. No matter how warm her body as she sleeps heavily against my right shoulder, that thought gives me chills.

Thank G-d that, sometimes, there are miracles here.

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