So, now what?

Three weeks from the miscarriage, and it's largely behind me, on most levels. The first week was hard, physically: not so much emotionally, after the first 48 hours, because I had to keep going, whatever, to help my parents through Mum's surgery. But I did too much, too soon, and didn't give myself long enough physically to get over it. It took ten days or so for the bleeding to reduce from period level to spotting level, and then another week of on-off spotting. I saw the pregnancy clinic nurse one last time, two weeks down the line, and got signed off with a negative pregnancy test. I suppose the second week was mostly spent getting over the first week.
But then, the evening after the clinic signoff, 17 days after the miscarriage, I noticed stringy cervical mucus again, and the last drips of bleeding stopped. Two days of lovely (I suppose) egg white mucus, and now that's stopped, so presumably I am now in a luteal phase again, although my breasts don't feel that sore yet. And, just about as the bleeding finished, I felt my stamina return more or less to normal.

So. No medical intervention, two weeks of recuperation, and here I am. Not bad going, for 41. But what do I do now? Sure, anyone can have a miscarriage, any time. But the older, the more likely. I am one person, not a demographic average, and so I don't know whether this was an unlucky chance, and next time might be fine, or whether this is what I can expect from here on in. And that Down's risk, that I was so worried about, hasn't suddenly gone away.

Some of the google sources say one is more fertile in the few months after a miscarriage (not that fertility, as such, was exactly a problem anyway); but that's not going to do much for my egg quality, if that was an issue. It's quite nice not to be pregnant, in a way, too: all that rare meat and shellfish, and not feeling sick, and fitting through narrow spaces sideways. There are compensations in everything.

But I look at Mizuko's tree, and I wonder. And I worry that I may sideline my real, live, loved children because I'm too busy wondering whether to try again for the hypothetical third child that I may never have.

I don't know what to do.

Trusting my body

In the last post, I wrote that I'd be having a D and C (or an ERPC, as we should now catchily call it, "Evacuation of Retained Products of Conception, yuck) on the following day, unless nature intervened first.

Nature did, with a vengence. (Vengance?) I should trust my body. I was given one that works well. I really, really wanted a picture of the baby, when I knew secretly that things had gone wrong, and my body hung onto it until I got one, and started miscarrying about 2 hours later. I bled gently all of that Thursday, nine days ago, and took the children to school on the Friday morning, and came home and did some gentle housework for a couple of hours, and then the main event, as it were, began. I began bleeding like, literally, a stuck pig. One of the various leaflets I'd been given said that I should call the hospital if I soaked through more than two sanitary towels in two hours. The other said I should call the hospital if I "bled heavily" for more than two hours. After bleeding through two sanitary towels in about ten minutes, I realised I was going to be following plan B. I was on my own - John was at a meeting he couldn't miss, two hours away. The uterine pain wasn't bad - I haven't had so much as a paracetamol through any of this - but the blood flow was scary. I was taken aback when I read that I might pass blood clots the size of egg yolks: even more disconcerted when, incredibly, just such clots began slithering out of me. At Mum's suggestion, I began squatting over a bowl, so that I could assess just how much blood I was passing (lots), and so I could check for the actual membrane bits, which the nurse had told me would be clearly different from blood clots. There was blood sprayed all over the bathroom. I would spend five minutes squatting over my bowl with a warm wheat bag pressed to my abdomen, then go and lie down on the bed (on a towel!) for ten minutes, then go and do it all again. I phoned Mum every half hour, so she knew I was still conscious - I was worried in case I bled enough to lose consciousness, and indeed I did bleed enough to push my pulse rate up a bit. I reckon I lost about a pint of blood in the two alloted hours. I kept telling myself that this was a natural process, that my body knew what to do, and that I should trust it; but I couldn't but begin to worry in case the haemorrrhage didn't stop.
And then, after about an hour and a half of this (or several years, depending on one's perspective), I passed something which, floating in my bowl of blood, looked quite different; pink and fluffy. I fished it out: it was a little collapsed translucent bag, edged with a border of pink villae like sea anemone tentacles. This, clearly, was the gestatational sac. I hoped that might be the end of the experience, but no. Just after the sac appeared, John turned up too, fresh from two hours in a traffic jam, and just in time to be there when the placenta followed the sac, a collapsed bundle of membranes and livery bits, about the size of a squashed satsuma.
And that, more or less, was that. My body had known what to do. There were one or two more half-hearted blood clots, another cramp or two, and then it was clear that things were basically over, and I was onto the lying in bed and being brought cups of tea stage. Since then, over the following eight days, it's been a gradual process of recovery, physically. I'm still intermittently bleeding, but each time there's another spate of bleeding it's less significant. There have been no uterine cramps for about three or four days now. Given that I've had no choice but to be much more active, much sooner, than I would really have chosen, due to Mum's hip replacement and consequent hospital visits, trips to check on my father, and so forth, I think my body's done pretty well, overall.

Mentally, it's been all right, on the whole. I don't think I could begin to compare the distress with what people must feel who have to deal with one or more miscarriages before they manage to have a live baby - if they ever do. If I'd had this baby, it would have been a bonus: I already have two healthy, intelligent children, and anything more would have been more than I'd expected. Having said all that, I have bouts of incredible sadness for the loss, not so much of what the baby was, but of the potential that it never reached. It was a child of mine, that will never experience anything, that missed out on almost all of life except the first rush of primitive development, and I can't but be sorrowful for what will never be.

I found the embryo; given my veterinary and pathological training, I wanted to see it. There it was, inside the gestatational sac, about the size of a grain of rice, just as the ultrasound technician had described it. I got out my old medical embryology textbook, the one with the gruesome pictures in it, and looked at the chapter on early development, and sure enough, there was a diagram of poor little Blob, at about 28 somites development, about 4 weeks development (6 weeks gestational age); so it had indeed died about 4 weeks before I lost it and 2 weeks before I started to spot, just as we'd thought (and the return of coffee tolerance was indeed a very bad sign, if I'd only known). When I compared Blob with the diagram, though, there was one huge difference: Blob had a huge fluid filled cyst in its middle, which shouldn't have been there. Of course I don't know what genetic or chromosomal problem might have caused this, or if it was just a freakish accident of development, but it was clearly a) incompatible with life b) Not My Fault and c) something that caused it to die long before my body expelled it, ie. a problem with embryonic development, not with my ability to hold onto a pregnancy as such.
I don't know if we'll try again, but at least knowing what happened, to some extent, helps me very much with coming to terms with losing Blob.
The other thing that has really helped is marking its little existence. I found, via the babyfruit blog, a link to an article about mourning miscarriage in Japan - "Mourning my Miscarriage" - an article which I found enormously helpful.
Inspired by this article, largely, we went, on the morning after the miscarriage, to the excellent garden centre of the Royal Horticultural Society at Wisley, and bought a little maple tree, which we planted in a square grey pot that now stands on the patio just outside the back door. In the soil, under the roots, is my little Blob, or, as we can also call it, our mizuko baby (the Japanese, according to the article, call miscarried or stillborn fetuses "water babies" or mizuko babies). On top of the soil are five smooth, round river pebbles: each of us chose one, and I chose one for the Mizuko baby; in that one way, we will remember that there were once going to be five of us.
I wanted a sort of temple bell, that we could hang above the mizuko tree and ring if we wanted to mark our thoughts about the baby, or let its spirit (if there is such a thing) know that we were thinking of it. I had a look on Ebay, and found that there was a plethora of tourist Eastern tat, but nothing Japanese and individual. So I did a sort of general search for bells, and found a number of crotal bells (that's crotal, not scrotal), which I had never previously heard of. It turns out that, from medieval times until a couple of hundred years ago, sheep, ponies and other livestock were commonly decked out with bells, both so their music beguiled the stockman's lonely day and to help keep track of the animals concerned. I vaguely knew this, but I didn't know that these things were called crotal bells, or that those who spend their weekends trudging round fields with metal detectors are apparently always finding crotal bells, and often selling them on ebay. So I began distracted into buying a number (more than I really needed) of crotal bells, and some red silk thread to hang them on. I've spent the last couple of days making a plait of red silk, and then we'll choose the best few bells and hang them, together with a tiny silver charm of a baby's foot, which I also bought from ebay, above the tree. And then I'll feel I've done what I can to mark Blob's brief life.Since the whole tree thing is borrowed from a different culture, it's nice to tap into our own by using bells that were made hundreds of years ago in our ancestors' country, by people just like our ancestors (if not actually them). It feels right.
Already, I only sometimes look at the tree as I go past it. There are good days and bad days; yesterday, a week since the miscarriage, was dark: today the sun has shone and I've been busy, and I haven't thought of it so much. But it will take time. If we try again, I think it will fade more quickly than if we don't: but as to whether we do try again or not, it's too soon to say, too soon even to blog about.

Long, detailed, gory post. But I spent the evening before my miscarriage desperately searching the net for descriptions of other people's experiences, so maybe this will help someone. I'm glad I let my body do it, and that I didn't need to have a D and C; because if I had, I wouldn't have had the embryo to bury, which would have been great pity, for me: and I derive some comfort from knowing that, if I couldn't carry my little blob to term, I could at least deliver it at home, the way it was meant to be lost, rather than relinquishing control to the medics. I'm 41, I've given thousands of anaesthetics, but never had one. I was very lucky, this time, to avoid it, but I'm sure I've recovered more quickly as a consequence.

So far, we're doing all right.