Pregnancy After Loss: What You Need To Know
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Pregnancy After Loss: What You Need To Know
October is Pregnancy & Infant Loss Awareness Month. There are so many topics we could discuss in relation to this, but the one I want to touch on that no one appears to talk about is pregnancy after loss. The grief and pain associated with the loss of a pregnancy, infant, or child are unimaginable and unfortunately still taboo to talk about.
Whether you are supporting someone going through pregnancy after loss, or you are experiencing it yourself - know there is support out there. I’d like to share my story to help others who may be experiencing the same thing.
Reproductive Health Challenges
Throughout my late teens and early 20s I struggled with my menstrual cycles, without a clear explanation. Every care provider I saw wanted to put me on birth control to ‘regulate my cycles’, and sometimes I let them. Finally, I found a wonderful clinic that specialized in Reproductive Endocrinology when I was 23. I received a diagnosis of polycystic ovarian syndrome (PCOS) and we worked on a variety of treatments (cyclic progesterone, weight loss, Mediterranean diet, stress reduction, sleep enhancement, etc.)
My First Loss
I experienced my first pregnancy loss shortly after coming off birth control when I was barely 21 years old. My pregnancy ended in a first-trimester miscarriage, and I wouldn’t have even known I was pregnant except I was experiencing increased bleeding and pain that sent me to my OBGYN. Being so young, and having this be so unexpected, I still can’t remember my definitive emotions surrounding my first loss. However, it was the life event that sparked my interest in my own fertility, given this wasn’t something I had ever learned about. I didn’t have a great experience with my OBGYN. They were unsupportive, and simply said “this is normal, 25% of all pregnancies end in miscarriage.” Even though I wasn’t intending on becoming pregnant, something wasn’t sitting well with me about “normal” and “pregnancy loss” being in the same sentence.
Subsequent Losses
I came off birth control in my late teens because the hormones were not treating my body well. I had recurrent headaches, and high blood pressure - you name it, I had it. I felt a world of difference when I came off all medication. Shortly after, I became pregnant for the first time and also had my first pregnancy loss. “This is normal,” my OBGYN said. I experienced my second pregnancy loss shortly before turning 23 years old at 8 weeks pregnant. I went back to my same OBGYN who again repeated “this is normal!” This time they threw in the phrase “oh well, you’re overweight. That’s a risk factor for miscarriage.” I felt guilty, I felt ashamed. Again, I wasn’t trying to conceive, but I also wasn’t avoiding conception. So many questions started flying through my head. Would I be able to carry a pregnancy when I wanted to? Or would they just keep telling me this was normal? Would my body keep failing me? I was on the heavier side, and my BMI was never within normal limits, not even as a child.
I decided to switch OBGYNs. Every OBGYN I went to brushed me off for one of two reasons (or both): 1) I was overweight and “should probably lose 10% of my body weight to carry a successful pregnancy” and/or 2) I wasn’t actively trying to conceive, which means I wasn’t open to any fertility medications or treatments. I simply wanted to figure out the root cause of my failed pregnancies.
That was when I found the clinic I went to and Dr. Rachel Urrutia (who is an absolute godsend). Between ages 23-26, I went on to have three more pregnancy losses all between 6-14 weeks gestation. I felt robotic at this point. Get pregnant, lose the pregnancy, go without a period for a few months, menstruate, ovulate, get pregnant, lose the pregnancy…and so on and so forth. My body was tired, my mind was numb. I was very much going through the motions. As a data-driven person, I had 6 pregnancies - according to the statistics, only 1.5 of those should have resulted in miscarriage …right? On my last “regular” loss, I actually worked an overnight postpartum doula shift as my loss was happening - this is how normalized pregnancy loss was for me.
The Loss That Nearly Took My Life
In April of 2020, shortly after the pandemic hit, I had a 6th positive pregnancy test. At this point, I had learned so much about fertility with Dr. Urrutia, that I knew I was pregnant before my missed period. I called her, and she told me to come in and get my pregnancy hormone levels drawn (as we normally do) and to practice mindfulness and stress reduction techniques. Before I could do that, I started experiencing excruciating pain and pressure in my lower right pelvic area. The hospital that my OBGYN had rights at was about an hour away from me (yes, I traveled that far to see her normally).
After moving all day (yes, I moved my entire apartment through all of this pain), I went to the closest hospital. I was brushed off, as usual (and even more now with COVID-19) - they told me it was probably just gas or a stomach virus. My urine pregnancy test was negative (I wasn’t even 4 weeks pregnant yet). I begged them to please help me, that something wasn’t right. They drew my hCg (pregnancy hormone) levels, and I was in fact pregnant. At this point, I was screaming in pain - I informed them I had gone through many pregnancy losses before, and that this was different …this was not right. They did an ultrasound and ultimately saw that I was having an ectopic pregnancy. So, my fertilized egg got stuck in my fallopian tube and if I didn’t get it treated immediately, my tube would rupture. I briefly remembered a family story about one of my aunts losing her life from a ruptured fallopian tube.
Next barrier to treatment: the hospital I was at did not have the correct staff to treat my ectopic pregnancy. My options were to get it surgically removed, or to travel 1 hour to UNC Women’s Hospital where a qualified nurse was available to administer methotrexate. Methotrexate is actually a cancer medication that is also utilized to dissolve cells in an ectopic pregnancy - and only specific nurses are allowed to administer the drug.
I was terrified of having surgery, but I was also terrified of waiting too long and losing my life. I made the informed decision to go to UNC and get methotrexate. As you can imagine, this was not a smooth process at the height of the pandemic. Twelve hours later, I finally received methotrexate and was able to go home and grieve peacefully. This loss shocked me - it was different, it was traumatic in that I thought I knew what to expect but was thrown a curveball.
Another Pregnancy? This One Will Just Result In Loss Too.
Continuing to go through the motions, on June 28, 2021, I took my 7th pregnancy test. One of the major risk factors for ectopic pregnancy is having a previous ectopic pregnancy. So of course, I got in with my OBGYN right away and started doing ultrasounds and lab draws to ensure everything was okay. At 4 weeks, I was okay. At 8 weeks, I was okay. At 12 weeks, I was okay. Things were progressing as normal, and that was absolutely terrifying. I expected to lose this baby, I expected my body to fail me again - so as each week went by and I didn’t have cramping or bleeding, I felt like I was living in a dream that would eventually be ripped out from under me and put me right back in that deep, dark place of grief and loss.
I never reached a point in pregnancy where I felt “safe.” I thought that seeing my baby at my 20-week anatomy scan might make me feel better…it didn’t. I thought that reaching the “point of viability” at 24 weeks would make me feel better…it didn’t. I thought feeling my baby kick (at 26 weeks) would make me feel better…it didn’t. I thought passing my gestational diabetes test (which meant fewer risk factors for me and my baby) would make me feel better…it didn’t. In fact, I was so convinced I would lose my baby, that I had almost dissociated from my pregnancy. I didn’t tell anyone (except for my birth worker friends) that I was pregnant, and I did practically nothing to prepare for having a baby - because I just knew I wasn’t bringing one home.
The grief, anxiety, and panic really hit me when I was diagnosed with pre-eclampsia at 34 weeks. I had experienced regular, “normal” first-trimester and early second-trimester loss, and I had experienced an ectopic pregnancy - what was my next type of loss going to be? Would I have an intrauterine fetal demise, and give birth to a sleeping baby?
Thankfully, I didn’t. My rainbow baby was born on February 9 of this year, and while he had a short NICU stay, he is now 8 months old and thriving. My point is, healing isn’t linear. There isn’t always a “safe point”. I still think about the pregnancies I’ve lost, the trauma it’s done to my body, the stress it’s put on my mind, and the fear it’s put on my heart. Even at 8 months old, parenting after loss brings its own set of challenges.
My biggest regret: I never talked about this …with anyone. I never talked about how being pregnant after loss deeply impacted me, how I lived in a constant state of fear and anxiety every single day.
My ask of you: reach out for help if you are experiencing pregnancy after loss. There is support out there, and if no one else understands - I do.
Resources
Here are some resources for Pregnancy & Infant Loss, and Pregnancy After Loss: