The construction of pregnancy

or to be more specific, this last pregnancy.

We always want to give meaning to things, to associate them with what we feel they should be linked to. On a Monday in April we saw our consultant and heard that neither PGD (as we don't have a balanced translocation, and it is flawed anyway) nor PGS (as it is also flawed) would help us. Up until then I had been feeling that although we might have a family, it would not start in our kingsized bed. We then visited the small-but-very-convenient-for-our-London-flat clinic, and they also quite honestly told us they didn't think they could help. It is entirely possible that we then went straight home and conceived Sprout. Either then, or over that weekend.

The previous day, my friend A who was 3 days older than me, and the mother of two under-5s, died. We heard about this on the Sunday and went to her funeral the following Friday, a week before I found out I was pregnant.

I could not help but feel that this last pregnancy was linked to her. At the start I felt that either a) it was her soul coming back [cheesy, I know, and definitely not something I'd normally think) or b) that because she had had a miscarriage previously, it would be her first baby's soul or c) because she had died, this meant the pregnancy was doomed or possibly d) because she had had a successful pregnancy following a miscarriage* then this would be OK.

I didn't think that much about these associations, though obviously a fair bit about A herself, over the weeks of the pregnancy. But now I am thinking about them again. Just thought I'd share that.

In other news, I tried to get an appointment at May's V. Pricey Alternaclinic but they have no spaces for when I am down in London next week, so I will give them a ring after they fail to give me a cancellation, and try to nip down some other time. However, the idea of having a break seems to have gone out of the window. Possibly more on that shortly, but I don't think I'm taking my laptop away with us, so you may have to wait another week.

*In fact, I happen to know they didn't take a break after her nearly-14-week miscarriage and conceived their first daughter immediately.

The construction of childlessness

One of the problems with our particular version of not-being-able-to-have-kids is that everyone we have talked to about it, who is professionally involved with it, has a different construction on it.

Doctors and nurses see recurrent miscarriage, and long gaps between (some) conceptions as a medical problem. They can't explain it in our case, but they do have at least some medical interventions which have some success in getting to a live birth of a child genetically related to us, which is their goal.

Alternative practitioners seem to view it similarly - my previous acupuncturist was very focussed on getting and keeping me pregnant, and not on helping me stay sane. Although I had my first reflexology appointment yesterday, and the therapist seemed more focussed on general wellbeing, helping me relax and work through my grief, which my old acupuncturist was not really - she even said "so, you've had a period" when I miscarried at 5w.

Social workers see it as a social problem. If we are able to give up on the idea of having children that are genetically ours, they will be much more willing to work with us towards their goal of gaining permanent families for children who do not have them.

We have not consulted any psychologists (well, I've consulted myself and some colleagues, and I did see the scary shirt man) but I don't know of any particular school of thought that would direct a decision one way or the other, the main emphasis being on being happier with what is happening in life anyway; in other words, it is constructed as a cognitive problem - if you look on yourself as childless, you will not be satisfied, but if you look on yourself as childfree you might be.

Going back to the alternative practitioners, I am wondering about seeing a different acupuncturist and/or a TCM specialist. I feel in need of at least a short break, so now might be the time for some herbs, if appropriate. Any suggestions in the NW of England, or London, gratefully received.

(I have a little more to post about The Hospital Experience but that one seemed to want to come out now).

Sad

I was feeling overall better today but remembered later - and was again reminded because Mr. Spouse remembered - that we were supposed to be going for our nuchal scan today, which was booked at the 8w scan, so even before the 10w-scan-that-never-happened. For a complicated work-related and season-ticket-related reason he had to buy a return to the same place we get the train to for the hospital, today, even though he wasn't going there.

That is just the kind of thing that makes me come over all sad. He is such a girl.

Next

Next morning - Weds, 30th May - I rang the local hospital to find out if they had a scan time first thing for me, which they didn't, so I rang the specialist hospital and was told that in order to have an ERPC* at that hospital, my scan had to be there, and that they could fit me in at lunchtime for a scan, and it was likely they could then do the ERPC that night. So I packed my bag (forgetting dressing gown, slippers, and earphones to listen to music on my phone) and we set off, ringing the local hospital as we passed it to tell them we weren't coming.

We needed to go to A&E at the specialist hospital but as it is specialist, and the labour ward is elsewhere, it was relatively quick, and I suspect almost everyone there is in for a similar problem. A quick triage and we were sent downstairs for a scan, where the radiographer did a thoroughly decent job including using visual doppler and narrowing in on the chest area, but couldn't find anything resembling a heartbeat. As I posted previously the foetus was much more as I expected in shape - similar to the previous week - and did not look like it had disintegrated, only like it had not grown further - it still had a distinguishable head and body, and measured 7w6d.

Of course we have since racked our brains for anything that might have happened around 5d after our second scan but that particular Tuesday was quite relaxing so, although we know intellectually that it is unlikely anything I did caused the foetus to stop growing, it is helpful to actually feel blame-free too.

Back up to A&E and a few tears were shed while a junior doctor talked us through the options - well, rushed over medical management, didn't mention expectant management, and talked more about surgical management. I mentioned for the first of about five times that we needed analysis of the foetal material. While we were waiting to be allocated a bed someone in the next cubicle was having a very loud doppler with a pregnancy of uncertain gestation, "about 16 weeks".

I had at this point not had anything to eat since 8.30 and no water since midday, before the scan. They found me a bed and at about 4pm confirmed they'd be able to do the ERPC that day, and that I should be able to go home at 10pm, but I decided I didn't want to arrive home woozy at nearly midnight, so Mr. Spouse went and got me a magazine (forgetting chocolate - he was in trouble later) and went home. More waiting, I went down for the op, and eventually came back to the ward and demanded food. I spent most of the rest of the evening demanding more food, and asking to go to the shop to buy chocolate, and not being allowed to go. I think I finished my magazine, and my first book, and checked various things on t'internet on my phone, and dozed off about 10.30 after the other girls on the ward (unidentified serious gynae op, and huge ovarian abscess) had watched the first Big Brother, and the old lady in the next bed (some type of gynae cancer, removed) had started snoring.

I did have my earplugs, but about 4am was woken by an emergency admission, one of those things that actually makes you feel lucky - early 20s, suspected ectopic, very frightened. I tried really hard not to cry too loudly, and read most of my second book, until drugs came round at 6am and I went back to sleep.

Before Mr. Spouse arrived one of the doctors from the miscarriage clinic came to see me, admired my (Paul Frank) pyjama bottoms, and said how sorry (blah blah) she was to hear this, and then totally blew me out of the water by saying how encouraging it was that we had got this far, we had never got this far before, what they are doing must be working, etc. etc. I have to say that I hadn't thought at all that it was encouraging - more along the lines of, they do everything they can and still it doesn't work - but perhaps she is right. Except she isn't really going to just tell us to go away and give up, is she? Or is she? I have since thought that maybe, if there are two problems (rubbish embryos with genetic abnormalities, and an unsupportive environment), if we can sort out the second, then possibly luck will lead us to have a chance with the first, statistically.

We went back home about midday on the Thursday, after they had finally found me some anti-D (as I'm Rh -ve, and this was my first surgical management). The girl in the next bed still hadn't been scanned, and was getting very fed up of being on a drip. I gave her my magazines and commiserated about waiting for a scan when you are nervous.

I spent the next two or three days in a complete haze, mainly in bed ringing down for things to be brought to me, not even really making it onto the laptop. I think those days were more upsetting for Mr. Spouse, with me being so out of it, and his emotions being very raw, but he was at home with me, and very solicitous too I may say.

It's late, and I'm getting over the (ahem) tiredness from yesterday which followed on from the black tie do of the day before, so I will sign off. Probably only one more update installment - Hospital Visit Mark 2.

Incidentally we (as in, our household) don't do Father's Day - something that Mr. Spouse told me when his father was alive, so it's not that he wants to avoid it because of not being a father yet, or because of missing his father who died last year - my own father has never even mentioned it, except possibly to agree with my mother (always wise, at least when she's in the room) when she bemoaned its artificiality when we were children. I don't remember her acknowledging it when her father was alive either - even though she expected something from us on UK Mothering Sunday, and called her own mother on US Mother's Day. So. I haven't commented on it. But Mr. Spouse has been a bit out of sorts today. Though I think it's his Open University assignment, and the same (ahem) tiredness as me, to be honest.

As he's now asleep I'm not going to wake him up and say "oh, were you upset because it's Father's Day and your dad died last year". I'm nice like that.

*Evacuation of Retained Products of Conception. I think in some places they still do D&C as standard, or else a lot of women are told that's what they are getting, as I've seen a lot of people still referring to D&C, even for recent pregnancies. I even saw an online gynae query where the gynae "wasn't familiar with the abbreviation ERPC". But I believe ERPC is best practice now.

In all its gory detail

You realise this is mainly for me, not for you, OK? So feel free to nod off.

Tuesday 29th May, a.m.: After having had a small amount of brown blood (and I mean small - titchy in fact) over the weekend, I rang Liverpool and got Accident & Emergency who said yes, I could come in, they could not promise to scan me that day, but they could check my cervix. I decided to book a G.P. appointment for that day as a quicker way to check if it was closed. My friend J rang, who had the day off and who I'd completely forgotten might come down to see me if she wasn't too tired after being on call. She is a consultant anaesthetist who lives about an hour and a half away from me. This point will become important later. I realised that there was no other day that week for her to come, and at that point was feeling OK, so I asked her to come down that morning and planned to have lunch with her.

After she arrived, I opened my birthday present from her (she is a busy woman!) and that was my last panic-free moment. The paper is, I think, still sitting in the dining room. One part of the present was a blank book and I remember thinking I could put stuff relating to the baby in the book. That is also still sitting there. We decided to walk into town and get lunch, and I nipped to the loo where true panic set in - I found some red blood. I wasn't even sure whether to tell her but decided she'd know what to do. I remember saying "I don't know what to do now". She suggested that I needed to eat (that was a mistake, really as the place we chose to eat took over an hour to serve us some rather mediocre sandwiches - we chose it as it is on the same side of town as the hospital, and there isn't much else out there except my work) and that going to A&E after that would be quicker than waiting for the GP, who probably wouldn't examine my cervix anyway.

So, about 3pm we were in the hospital and after we had refused the medical student trying to put a canula in and the A&E registrar had failed she did it herself. It is very handy having someone bossy and knowledgeable in a hospital, even if she doesn't know as much about fertility/miscarriage as I do - which made me feel slightly better. By 4 we'd been taken up to an examination room in the gynae ward, and finally at about 4.30 I'd been examined, pronounced to be closed, the bleeding had pretty much given up and I and was about to go home feeling much better, with a promise of a scan slot at some time in the morning. J didn't know what they meant by a follicle tracking appointment [which might have been free] nor when I explained I thought it was for the IUI they do at a different local hospital did she know what IUI was. And she didn't know the condoms in the box on the shelf were for TV scans.

We'd been talking about her pregnancy (she didn't find out till she was 19 weeks - she was on the mini-pill and religious about taking it, but had been vomiting - her daughter was just 7 - she is a big lass but although I only saw her after the birth, having not seen her for a few years, I don't think she was that big!) and antenatal testing (she pointed out, quite rightly, that if the baby had a fatal condition I would be wasting six months to a year of my fertility if I didn't terminate early), and everything felt calm.

Then one of the radiographers (I'm assuming - whoever it was, I've never seen him before, and even J who likes her patients unconscious was aghast at his lack of bedside manner) arrived with a portable scanner although I actually felt very calm, and somehow knew it wasn't going to be good, even before he switched much too quickly from an abdominal to a TV scan. The previous scan had been abdominal and very quickly found something - although looking back now I think even if things had been OK he might not have been able to see much since the resolution is very poor on the portable scanner. But I suppose it was probably best for me not to hang on in hope, as in the first pregnancy I had an overnight of hanging on in hope when Mr. Spouse had given up.

On the TV scan the foetus was measuring just 7w - smaller than when we had seen it nearly 2 weeks previously - and he could not see a heartbeat, and the shape was really blobby and not at all foetus-like. I managed to hold it together until J took me home, by which time Mr. Spouse was there, and she went and made a cup of tea while I collapsed, sobbing, into his arms. At this point I was thinking that the foetus had deteriorated into a mass of undifferentiated tissue, and had been partly reabsorbed, and even was wondering if the first miscarriage (empty sac at 10+2) was in fact more advanced than we had previously thought, but had been reabsorbed. I was also feeling even more depressed (personally) than after any previous miscarriage - serious thoughts of self-harm and even suicide), which very much worried Mr. Spouse.

I've known J since we were both 18, but she isn't a very touchy-feely person - I was very touched when she pressed my shoulder before leaving and said "take care of yourself".

We were still promised a full scan the next day, either in an early morning slot or mid-afternoon. I can't really write much more now, but having started the story I think I'm going to have to finish it at some point. Nudge me if you think I have gone off into a deep depression (honestly, I wouldn't be able to write this if I wasn't feeling a whole lot better).

Isn't that what they say about giving birth?

that the only reason people go through it more than once is that you forget how awful it was? I think that must be what has happened to me with each miscarriage. I look at myself from the outside, thinking how other people must see me, and I think that I must seem, to them, who have never experienced it, rather like those who have experienced seven, ten, teens of miscarriages appear to me - slightly crazy and slightly obsessed.

I mean this with no disrespect to those who are in this boat - in some ways I find their stories inspirational - but although I know (either personally or online) several people who have decided that they have had enough of trying to get pregnant, either on their own or with medical help, I am not sure I know of anyone who made that decision after recurrent miscarriage. I have read that once you've done three properly regulated IVF cycles your chances start to drop, but there don't seem to be those statistics for recurrent miscarriages.

But I also feel that, with this 4th or possibly 5th miscarriage, that I have entered the big leagues. I had various blogs on my bloglines list of people who had had 2 or 3 miscarriages, but several of them have recently moved to the "parents" section (one through adoption, but most through carefully monitored pregnancies, just like mine was...). I know there are more people out there, some of them who are being seen at our clinic. I am not sure how much lower our chances are now (I'm guessing about 50% per pregnancy). Like I say, I don't know if our chances are now about the same with each pregnancy, or are exponentially dropping.

I'm just trying to carry on carrying on here, watching TV, avoiding having my mother to stay, eating peanut butter candy (Thalia is fantastic, but thank you to the other people who offered, you are also fantastic), buying shoes, weeping in cafés, arguing with Mr. Spouse and then both of us apologising, avoiding pregnant friends and those with babies (managed two yesterday on the 10 minute walk to and from town). Mr. Spouse says he is trying to be happy for them by thinking that he couldn't possibly wish this on them.

Back home

I was discharged at lunchtime yesterday, and had to take a taxi home (ill-timed out of town meeting for Mr. Spouse - in fact he was slightly grateful they admitted me as he had to leave at an ungodly hour in the morning and was worried about leaving me at home, in pain and bleeding), but actually found that I felt a bit better than even before I started feeling worse, if you get my drift.

However today I had a migraine (haven't had one during any of the pregnancies - I'm guessing it's the hormone crash) and started feeling a lot more emotional. I had a quick trip to the GP - basically for some tea a sick note and sympathy, both of which I got. She even asked how Mr. Spouse was doing, which impressed him. I'm signed off (which here means you are not allowed to go back to work) until the 25th June. There's one more week of term after that (mainly whole-department meetings, which I may cry off and try to catch up with some students) and we are then on holiday for our annual pre-school-holiday-price-hike trip for Mr. Spouse's birthday. I may go back and see her again (instead of my registered, nice-but-male GP). But she'll need to refill her tissue box first. One tissue! How pathetic is that!

I just about made it to the market and managed to buy a few small things and make it home again before my tears won out over my clenched teeth. Mr. Spouse kindly rang work and told them how long I will, provisionally, be away for, I think also leaving the message that I'd been admitted again, to emphasise that I Am Poorly. Very Poorly. I also seem to have failed to set up my email out-of-office message correctly, so I updated that today, and my irate students will at least have some idea when I am coming back.

I may, as I said, write more about all this when I feel up to it, but I just thought I'd reassure you that I am at least alive, and at home. The pain and bleeding are almost gone, though I am rattling with the antibiotics and as zonked as I wish to be on the good painkillers, there was a little fluid on the scan, so no repeat ERPC, and the swab for infection wasn't back yet when I left, but I think they wanted to be on the safe side and dose me up with killer antibiotics.

Oh how nice

I'm in hospital. Again. A lot more bleeding, clots, and some very severe pain led to a trip to the out-of-hours GP service (a lot quicker than A&E), followed by transfer to the gynae ward, where I am currently languishing, waiting for the good painkillers and some antibiotics.

Trivia

There is a young man I know, through message board/blog route (so when I say "know", you realise I haven't met this person) and he, though only in his 20s, has recently lost his wife. There is more to the story, but this is a tragedy of such huge proportions that you don't really need to know more, though I may post a bit at some point. When this happened, I noticed that fairly quickly he started posting about things other than this huge tragedy on his blog, and on the message board.

I thought this was a bit weird, but I think I understand a bit more. I don't feel ready to process or write much about Sprout and how we lost him (for some reason, we have been referring to the baby as "him"), but I need distraction, more than TV/knitting/reading/napping can provide, so I have also been reading, and occasionally posting, about things that I then think "this does not MATTER. Why do I care about this? Why do I care about anything?".

I'm still in a bit of pain, though not unmanageable, hardly any bleeding, though my whole pelvis seems to be objecting in unison, as I've been having a bit of pain on urinating. No heavy bleeding, clots, or fever though so I'm pretty sure I haven't got an infection, still taking the codeine/gin in alternation. My mother sent home-made brownies (and roses, in the same jiffy bag, rose-scented brownies are surprisingly nice), and Mr. Spouse found peanut butter chunky Kit-Kats which aren't quite Reeses, but are still pretty good.

No-one is at home. Please leave a message after the beep.

The anaesthetic has left me tired and groggy, and the painkillers ditto - just one codeine makes me dizzy and sick, though it works, so I have been taking it at night, plus you can alternate it with NSAIDs, and I'm still quite crampy. I think it's been Mr. Spouse who has been feeling more emotional today than me, as apart from an hour or so in the middle of the night in the hospital, I haven't really been seriously crying. I think I need to be able to feel something to be able to feel sad. It is very different to the previous "natural" miscarriages (the first one was medically managed but apart from timing it was similar to a spontaneous loss).

I'm trying to make sure I have what I need for the next week or so at home but I'm also afraid I'm going to go into recovery autopilot, and just do things that pass the time without helping me feel better - I don't know if the things that made me feel better in the past will be the same ones.

Don't know if I'll describe the whole process, just salient bits, or none of it, but not just yet.

Later: Sent Mr. Spouse out for coffee, lemons to put in the G&Ts (don't worry, I won't mix them with codeine), peanut butter, and Reese's peanut butter cups. They don't have peanut butter cups in our Sainsbury's. Do they have them anywhere in the UK? I think this is a mother's-milk craving - before you could get peanut butter over here, my mother used to bring it back when we visited her parents.