I was relieved to be greeted by Jeannie, the ultrasound tech I trusted most at the hospital. She began the scan, and worked for what seemed a long time. She could find the sac, but its location was making it difficult to finds what she was looking for. She called in the reinforcements. Two radiologists arrived and began their own exam. I had been subjected to many trans-vaginal ultrasounds in the past, but none were as invasive and painful as what the to radiologists put me through. the inserted the probe and began pushing, twisting and otherwise jarringly manipulating it around what was an accommodating, but not altogether large space. I half-expected the probe to come exploding through the top of my skull. But the pain was not for naught. The doctors fund what they were looking for. The first thing they discovered was the cause of my bleeding. There was a small hematoma in he gestational sac. Basically, it is a pocket if blood that, in my case, was leaking for whatever reason. But they also found the gestational ac, the yolk sac, and, amazingly, my little baby, looking like no more than a blob, but with a tiny heart beating away. I cried, just a little. I went home feeling a little better, but concerned about the hematoma. I knew mine was small, but I also discovered, through endless googling, that it could grow, and it could endanger my pregnancy and possibly, if things got to a certain point, my life. But, I was encouraged when my doctor informed me that the pregnancy was not ectopic, so one worry had been eliminated. He did tell me that the heartbeat was not as high as he would have liked, but that it was still early and we would check again in a week or two. Another to add to the worry column.

Deja Vu

At approximately week 5 and a half, the spotting began. Honestly, I don't remember how much it was. This was four years ago. But I do remember clearly the terror. A check by the doctor revealed that it was nothing, and an ultrasound showed a gestational sac and a yolk sac. Fine for now, but what I really wanted to see was a heartbeat. It was too early for that. My anxiety level had vaulted itself to new heights, despite my doctor's reassurance that all was fine and it was likely a side effect of the progesterone. A week later, it got worse. I felt a dampness, made a hasty retreat to the bathroom (thank God it was recess at school and someone could keep an eye on my students) only to discover I was no longer spotting. This was full out bleeding. A gush of bright red blood. Shaking, I made my way to the office and informed the principal (she knew I was again pregnant...I told her just for this reason, in case something were to happen). My doctor had me come in right away. The nurse ushered me into the exam room and inquired "You had a miscarriage last time too, right?" My heart sank as I heard the words I dreaded, but was sure were true. I silently wiped the tears from my eyes and tried to keep my composure as I waited for my doctor. The examination showed my cervix was closed and the active bleeding had slowed. His attempts to comfort me were met with my declarations, through tears, that I was not optimistic, as this is what happened last time. He understood my fear and urged me not to give up hope, and he scheduled me for an ultrasound. the second ultrasound revealed that all was well, but still no heartbeat. I knew, at six weeks, this was not abnormal, but I was still frightened. I would simply need to wait for another ultrasound in two weeks or so, when a heartbeat would be visible in a viable pregnancy (or even, in the case of my previous pregnancy, a non-viable one). The next day, I was summoned to the office to take a phone call. It was my doctor, informing me that the radiologist had a concern about my ultrasound. The sac was implanted so high up in my uterus that they feared it was ectopic. I knew this wasn't good, but my doctor reassured me by telling me that he felt it wasn't the case, but because of the danger of ectopic pregnancies, I needed to go for an emergency ultrasound. Again, I left school. I was grateful for the student teacher I had taken on that semester. While he couldn't be left solely responsible for the classroom, he could assure that routine was disrupted as little as possible when the sub was there, and it was one less thing to worry me.

Again

I had to wait to tell my husband, but I couldn't keep this to myself for two whole days. (I'm awful with secrets). I called my mother. She's superstitious, so she was very cautiously thrilled. The first time we were pregnant, I though she was crazy. Now I got it. The two days until Mark came home were two of the longest I'd had, and somehow he kind of knew. (I guess my declaration on the phone that I had a BIG surprise for him got him thinking.) He was also cautiously thrilled. I had already come to the realization that a pregnancy after a miscarriage carries a heavier burden of worry. You are on edge until you pass the point in time that you miscarried previously, and even after that, you don't ever lose that nagging feeling that something is going wrong. A sort of waiting for the other shoe to drop for the entire time you're pregnant. Because I had been vigilantly taking my temperature, and because I appeared to have a relatively short luteal phase, I was technically just under four weeks pregnant when I found out. This would be a long 36 weeks, I imagined. I called my doctor's office the next business day and was terrified when the NP told me I could wait until I came in to get my prescription for progesterone suppositories. Didn't she get that I was a wreck? Didn't she get that every second without these suppositories could spell doom for my unborn child? I realized I would have to wait, and I hung up the phone and sobbed. I left the Clomid on my dresser, to be safe. My appointment to confirm the pregnancies was two days away and I was sure something would happen in those 48 hours. It didn't. I got my prescription, found myself a compounding pharmacy, and thus began the nightly ritual of inserting a cold glycerin suppository into my vagina. Ideally, this would continue until 12 or 13 weeks of pregnancy, at which time the placenta could be counted on to maintain things and the chilly white torpedoes could be abandoned. And the days ticked by...about twelve of them to be exact

One year

So here I was in mid-September. I had begun teaching my second year of first grade, and it was one year from the weekend I had discovered I was pregnant for the first time. My husband had planned a road trip to Pittsburgh with some of his buddies, which was fine. I'd spend some time with a friend, whose husband also happened to be part of this road trip. I'd read. I'd do school work. I'd relax. I'd wake up on Saturday morning to another high basal temperature. As per instructions from the automatic software I'd used to chart these temps, I'd take a pregnancy test. And when it was positive, I'd take another. And then, because I really didn't beleive it was true, I'd go buy one of the new digital ones that actually displays the words "pregnant" or "not pregnant" And when this, the third test I'd taken, read "pregnant" I would tremble. I would cry. And I'd regret that my husband wasn't home. I couldn't tell him over the phone. I'd wait two more days to tell him in person. And, of course, I'd begin worrying.

Summer

I didn't want to work that summer. Once school was out, I really wanted to go home, close the blinds, and wake up pregnant in September. I'd wake myself for my daily dose of Zoloft and my weekly therapy appointment, but other than that, I had big plans to check out of life. My husband, God bless him, discouraged me from this. He was worried, and he thought the distraction would be good. I knew he was right, so I got a job. It paid poorly, but it kept me out of my house and usually, out of my head. My fiend had her baby, a little boy. I couldn't bring myself to go to the hospital. A maternity ward would have sent me over the edge. I visited when they got home. I cried when I left. Summer ended. My vigilant temperature taking every morning and monitoring of my fertility signs proved futile. It was fall again. I was still not pregnant. My doctor and I decided that Clomid was in order. I would fill my prescription, and on day 5 of my next cycle, I'd begin taking the Clomid. I filled it, and placed the bottle right on top of my dresser where I stared at it hopefully and prayed for my period to begin.

The first time - part 2

I thought that, once the bleeding stopped in December, I would be free to try to conceive again. I was convinced that it was the only way out of my funk. My blood draws in December were not encouraging. The plummet in HCG that I anticipated did not happen. My levels continued their painfully slow decline. My OB continued to apologize to me. I was nearly on a first name basis with the lab tech. It didn't make it any easier that my blood was being drawn at the same hospital where I would have delivered this baby. I hated every pregnant woman I saw, and it seemed to me that every woman I saw was pregnant. My coworker's sister, unmarried and living very much a single lifestyle, accidentally became pregnant. The irony and cruelty of that was stinging. My best friend continued on with her pregnancy, as did my neighbor, whose due date had been two days before mine. My brother and his wife learned they were expecting their second. And all this while, according to blood tests, I was still pregnant. My womb was empty, my morning sickness gone, but my blood tests were telling us each week that I was, technically, not "unpregnant". Granted, each week I was a bit less pregnant. But not enough to be truly not pregnant. And until that happened, I could not try to get truly pregnant again. This continued until sometime in mid-February, when I was officially declared chemically, hormonally non-pregnant. It had been four months. I had been sure when it all began that within four months I'd be pregnant again. I thought that, for sure, it would be a month, maybe two and it would happen. I began religiously taking and charting my basal temperature each morning so that I would know for sure when I did conceive. I had a history of irregular cycles, and this would make things more clear. The clearest thing of all was that our first, "accidental" pregnancy, had been a fluke. Winter became spring, and I was still not pregnant. My neighbor had her baby, and Mother's Day arrived. The day before my due date. I was in pure agony. Primal pain I never knew was possible. By summer's start, I was hitting the bottom, certain I would never, ever be a mother. I called my doctor and admitted that I was no better than I had been back in October when it began, or in December, when he had offered me anti-depressants and I had declined, certain I would be through this in short order. And really, perhaps, I was worse. I asked for a referral for counseling. He complied with my request and gave me the drugs as well. I had never wanted to take them, but I knew I needed something, so I accepted. I had been so totally unprepared for the depth and intensity of the pain I would experience over this loss.

The first time

My pregnancy with Amelia was not our first. In the fall of 2002, we were happy, but surprised, to discover that I was pregnant. We had planned on "trying" beginning in late fall of that year. I wanted to complete the school year (I was teaching first grade) and secure my permanent teaching certification. But, we were thrilled with the prospect of becoming parents, albeit a couple of months before we had planned. My due date was May 12, 2003. The day after Mother's Day, and the day after my own mother's birthday. A spring baby! I soon found out that my neighbor and friend was pregnant with her second child and due on May 10. I anticipated the fun our little children would have together.
We were sent for an early ultrasound, and the baby measured a couple of weeks smaller than expected. I wasn't the least bit worried. I had never had regular cycles, and that's what due dates are initially based on. More importantly, I had no idea the bleak prognosis for embryos whose measurements are that far behind. I asked for a picture, but the tech wouldn't give me one. Said there wasn't enough of r a picture, we wouldn't be able to make out anything. I figured I'd just get one the next time.
A week or so later, I began bleeding. Spotting, really. The doctor saw me, and did an exam, which showed everything looking the way it should (i.e. cervix closed) ordered two rounds of blood hormone levels done, and I was told to stay off my feet. One round wold likely tell them nothing. What we needed to see was the second number significantly higher than the first. HCG levels need to double every couple of days for the first ten or twelve weeks of pregnancy. My levels on Tuesday were approaching 80,000. On Thursday, my blood was drawn again, and I could call on Friday for the results. I spoke to the nurse of the other doctor in the practice, as my OB generally doesn't have office hours on Fridays. The nurse said my levels were just over 90,000 and everything looked fine. I questioned that, as that was not at all doubling, but she said that the doubling slows down eventually. I was almost 10 weeks...the leveling off usually happens at 12, but I was new to pregnancy and unaware of this, so I accepted her assurances that all was well. My husband and I proceeded on a planned trip to Pittsburgh to visit our oldest niece, a freshman at Pitt. We brought one of her three sisters with us, and, confident all was well, shared our news with our nieces. They would have a new cousin in the spring. We shared the news with the friends we were staying with, as well. We were walking on air.
The following Tuesday, I showed up for a previously scheduled follow-up related to the spotting. My OB looked concerned, and he confirmed this as he discussed the numbers with me. He was not convinced that all was well and scheduled me for an ultrasound for the following day. My husband was to be on a business trip in NYC, and he didn't think he needed to be at the ultrasound, because we were, after all, convinced that everything was fine. Instead, my mother traveled 150 miles to be with me for the ultrasound. I tried to tell her that everything was fine and the trip wasn't necessary, but she insisted; I am still deeply grateful to her for this.
We showed up for the ultrasound on Wednesday afternoon. It was one of the fun ones...the transvaginal ones where they give you a "wand" of sorts, all covered with goop, and have you insert it into your vagina. the tech then moves it around to get a view of things. The tech, in this case, didn't have much to say. A red flag had I known better. She did her thing and left the room. When she returned, she told me that the doctor was on the line for me. I was again speaking to the "other" doctor, not mine. She informed me that the heartbeat, which we had seen two weeks prior, was now gone. The embryo (always "the baby" to me) had already started to disintegrate. In short, our little baby had died. There was nothing to be done. It was over. My mom and I cried for a little while, and then went to call my husband. He was already on the train on his way home. Intuition? A couple of hours later, we met him at the train, and he and I stood in the train station, embracing each other and crying.
I was overwhelmed by the amount of grief I felt. After all, I had never seen this baby, never held it. I had essentially lost something totally intangible. Yet I couldn't recall having ever been in this much pain. I wanted to stay home and never, ever leave my house again. And I hated that first ultrasound tech for refusing me a picture. It would have been my only remembrance. My only picture of my child. Instead I had nothing.
We saw the doctor the next day (MY doctor this time) who informed us of our choices: a natural miscarriage or a D & C. We opted for natural, for two main reasons. First, I feared the scarring that was a risk after a D & C, and could make future conception difficult. The risk was minimal, but I didn't want to take the chance. But more importantly, I couldn't bear the idea of having my baby, however small and unrecognizable as a human being, torn from my body. I couldn't do it. I wanted it to be as gentle and natural as possible. My doctor assured me that generally, the process starts within 2 weeks of a "diagnosis" of miscarriage. Then, it is usually 4-6 weeks until periods return and the journey of conception can resume. So we waited. Two weeks passed. I followed my husband around he house when we were home, almost afraid to be alone. I only really left to go to work. I cried every day and I was tortured by the thought that the demise of my child had somehow hurt him or her. I know now that an embryo cannot feel pain, but then, I was so sure that it could. What was I doing at the exact moment that my baby's heart had stopped? Did he want me to hold him? Did he suffer long?
During this time, a close friend found out she was pregnant. I was alternately numb and agonized. I hope that somewhere I was happy, but at that point, I could not find it. My own grief was so thick and heavy and my vision beyond it was obscured. Two weeks passed. Nothing happened. The doctor sent me for bloodwork each week to check my hormone levels. This HCG, famous for doubling, also has a half life. This half life differs from woman to woman and determines, in conjunction with how high the levels were at the time of "diagnosis", how long one can expect before the physical miscarriage begins. Home pregnancy tests generally detect HCG at a level of 25. By doctor's standards, I would no longer be considered pregnant when my levels were below five. My levels were high, my half-life unbearably long. It was taking forever for my levels to drop. But they were dropping. There is no way to make the HCG levels drop more quickly, except to do a D & C. Remove the pregnancy, kill the hormones.
Just about a month after the "diagnosis", my body finally began to let go. It was November 10, 2002. Coincidentally, another of my friends gave birth to her first child that same day. The bleeding lasted a month. It wasn't heavy enough to warrant concern on a physical level but from an emotional standpoint, I was beginning to wonder how much more I could take. I continued to go to work every day. I continued to get my blood drawn every week. And I continued to grow more and more miserable.