My Story - The Fourth One (Part 1)

I have been absent from my blog for a while. I needed to take a break. I needed to take some time to heal before sharing my fourth and hopefully final miscarriage story. I think I am finally to the point where I am ready to share it. This blog is named for our baby boy that we lost in July. The following is his story and I dedicate the next two posts to him with all of my love. 

Two months after all of the follow-up appointments from the third miscarriage, I decided I was emotionally ready for another pregnancy. I went back on Clomid the beginning of May. My experience on Clomid this time around was much harder, with some intense ovarian pain.

We went up to my parents' house for the Memorial Day Weekend. At that time, I was three weeks into my cycle and had started the progesterone. I noticed, on the trip up, that I was craving salt and french fries - not usual for me. I felt quite tired over the weekend but thought it could be due to the progesterone, the drive up, work etc. Throughout the weekend the ovarian pain continued and I decided that if it didn’t let up by the time I got home I would call Dr. J’s office and have her check for an ovarian cyst. 

We had a great weekend with my parents. Before we left my mom and I were sitting and talking. At one point she touched my hand and recognized it was very warm. She turned to me and said, “I think you are pregnant. My hands always got hot when I was pregnant.” I hoped she was right, but was afraid to hope too much because I didn’t want to be disappointed. That night on the drive home my husband and I stopped and had dinner. I felt sick afterwards, like pregnancy type sick. I started to wonder if my mom was right. As I was still one week away from being able to test, I had to wait it out. All the while the symptoms were intensifying dramatically, especially the nausea, which I knew was (ironically) a good sign.

As the week went by, the ovarian pain eased off a bit. I tried to not get my hopes up too much about the possibility of being pregnant because I didn't want to be disappointed. Deep down I was excited but I was also anxious and scared. Scared to be pregnant for fear I would miscarry again and scared that I was wrong and wasn't really pregnant. I wanted to be pregnant, but the miscarriages had caused conflicting emotions. Finally, the following Monday June 3rd, I faced my fears and decided to pick up a HPT. I still technically had one day before I was supposed to test, based on when I started the progesterone, but I was getting anxious and knew that I needed to know. My husband hadn't come home from work yet and I figured if it was negative I could discreetly throw the test out and not worry about it. I took the test and watched as it turned positive. I immediately called my husband, who was on his way home, and told him the news. He was excited. My next call was to my Mom. I told her that her suspicions were correct - I was pregnant.
  
The following day I notified Dr. J’s office about the pregnancy and they put the orders in for my HCG blood draws. I went to the lab the following day, Wednesday, on my way to work.

With each of the previous HCG tests, Dr. J emailed me with the results and only called if something was wrong. This time, for reasons I’m still not sure of, her office decided to call to tell me everything was fine. I was pleased to know the results so quickly, but the first time they called me it scared me to death. One of the medical assistant’s called while I was at work. I had my cell on mute and didn’t see that I had missed a call until I had finished for the day. When I noticed I had missed a call from Dr. J's office, I assumed something was really wrong. I was so nervous and scared, I could barely enter in the password to my voicemail. When I finally got to the message, I heard the cheerful voice of the MA telling me that my counts were really good – a 347! That was over 100 points higher than my first HCG count in my last pregnancy. I knew this was a good sign and I was thrilled and incredibly relieved and grateful!

Two days later, after my next HCG test, Dr. J’s MA called me with the results of my second count. This time I was more prepared and wasn’t quite so terrified when I saw that I had a message from her office. My second HCG count was even better – 864. The count had more than doubled, and was higher than any measured count from my prior pregnancy. Again I felt very reassured, relieved and grateful!

With all of the increases in HCG levels and my natural progesterone plus the supplemental progesterone, I started to feel even more pregnancy symptoms. I had the cravings, aversions to food, fatigue with alternating insomnia, moodiness, sensitivity to smells and nausea – boy did I have nausea this time around. Zofran, crackers, Preggy Pop Drops and prayer got me through it but it was really rough some days.

About ten days after I learned I was pregnant, we flew to Arizona for a family wedding. I had been warned by my sister to take my Zofran before we left because pregnancy does strange things to your stomach when you fly. I was glad I listened. The way down was manageable except I kept smelling very strong body odor that was grossing me out -  thank you extra sensitive pregnancy nose. I know it wouldn’t have turned out so well if I hadn’t had the Zofran in my system. While in Arizona I pretty much lived on Zofran. It made the intense nausea manageable and made me feel somewhat human. Unbeknownst to me at the time, I hadn’t been drinking enough water and was starting to get dehydrated. I had no idea how easily you can dehydrate while you are pregnant in the summer. Each of my prior pregnancies had been in the winter so dehydration wasn't so much of an issue. On Saturday night, just before the wedding reception I started to spot. I was terrified and pretty much a nervous wreck inside the rest of the weekend. My husband and I prayed together, but I was still scared stiff. At that time I was almost six weeks along and I couldn’t bear the thought of losing another baby, especially away from home.

Thankfully the spotting stopped by the next day, the day we flew home. On the way home we had a plane that was having major problems with the air conditioning.  As in, the air conditioning was kaput during the first half of the flight. There's nothing like being pregnant and trapped in a crowded aluminum cylinder at 30,000 feet with the hot sun beating down and no air conditioning. The flight crew apologized to us for having a plane that was probably a toasty 85-90 degrees inside for the first hour. To a pregnant lady like me it might as well have been a 120 degrees. I got sicker and sicker and more dehydrated by the moment. I have never been prone to air sickness, but it was all I could do to not throw up everywhere. I didn't want to gross myself and all the other passengers out with the smell of vomit on a hot plane. I was also afraid that once I started throwing up I might not stop until we landed. Instead, I fanned myself madly with the emergency landing instructions, prayed and drank all the juice and ice water the flight attendant would give me. I have never been so glad to land in my whole life. We exited the plane as soon as humanly possible and got into the nice air conditioned airport.

The next day I felt horrible. I had an awful headache and was still feeling the effects of dehydration despite drinking tons of fluid. I decided to take the day off work and just rest. That afternoon, I began to spot again - quite a bit. I called Dr. J's office and they scheduled an appointment for me the next morning. I was terrified and spent the whole night, hardly sleeping, certain that I was going to miscarry.

The next morning my husband and I went to Dr. J's office. I was so nervous and upset that I felt even more nauseous than usual. Dr. J came in with a clinical fellow she was training (Dr. D). Dr. J spent some time before the ultrasound preparing us to not to be disappointed if we couldn't see a heartbeat. Dr. D performed the ultrasound. As she zoomed in on the baby, Dr. J just about jumped with excitement and pronounced, "we have a heartbeat!" I was shocked and started to cry. I had been so convinced that I was miscarrying that I never imagined we would see a heartbeat. What was even better was that the heartbeat was normal for six weeks gestation and the baby was measuring right on schedule. We were thrilled and felt incredibly blessed! Dr. J instructed us to schedule a follow up appointment for a second ultrasound in two weeks.  

I waited out the next two weeks. I continued to feel really sick and nauseous. I was grateful for the sickness because I knew it was a good sign. With the positive ultrasound results I felt reassured about the pregnancy. The spotting had stopped since my last appointment and I was starting to feel optimistic. The first week went by smoothly. The second week was a little rocky as I started to feel anxious about the pregnancy again. I have since read that anxiety is very common in pregnancy after miscarriage. Hopefully I will remember that the next time around.

Our second ultrasound occurred on July 2. I headed to Dr. J's office, alone this time as my husband had to work. I felt more confident than last time because I hadn't had any spotting for a couple of weeks. Just prior to going in to see Dr. J I stopped by the restroom. Much to my shock, I had started spotting on the way to her office. Needless to say I was really relieved that I would have another ultrasound shortly. Unfortunately for me, Dr. J was running behind and I had to wait. The whole time I felt the fear and anxiety building. Dr. J finally came in. I told her about the recent onset of spotting. She performed the ultrasound and noted that the baby and gestational sac looked good. She didn't see any blood coming from the sac. She suspected the spotting was tied to dehydration, caused from a very hot summer. As Dr. J continued with the ultrasound, she could see a good strong heartbeat. My fear and anxiety melted away. Dr. J turned on the volume so I could hear the heartbeat. It was the most beautiful swooshing sound I have ever heard! I had dreamt about that day and it had finally come. The baby was still measuring right on track - exactly eight weeks. I was so happy and grateful. Dr. J printed out the ultrasound pictures for me.

With two ultrasounds showing normal gestational development and strong heartbeats, Dr. J gave me an excellent prognosis (chance of success was 93 - 95%). She then released me to the care of my regular OB. I had selected a doctor at University Hospital (Dr. S) that I had heard really good things about. I was very excited to see the regular OB because it meant that the pregnancy was stable and progressing. I scheduled my first appointment with the OB for just over two weeks later - July 19th. At that time I would be almost 11 weeks. I was so happy, it was surreal. This was really happening and I was further along than I had ever been and had a strong pregnancy too. Life was good... it was really good!

My Story - The Fourth One (Part 2)

During my final visit with Dr. J, she told me nausea usually improves sometime in the ninth or tenth week of pregnancy. She was right and I was relieved to start feeling better. The pregnancy seemed to be progressing smoothly and I was so excited.

My appointment with Dr. S (my regular OB) occurred when I was 10 weeks 5 days. I was thrilled to be in the double digits and felt like we had reached a major milestone! My appointment was first thing Friday morning and I made it right on time. My husband was running a bit late but was on his way. The nurse called my name and escorted me back to an exam room. She did the preliminary check in with my vitals etc. The nurse then handed me the prenatal packet. This was real and I was excited. Dr. S and his nurse practitioner came in and introduced themselves. Dr. S is the head of general OB at University Hospital. I had heard wonderful things about Dr. S and I was impressed with him right away.

Dr. S decided to do a quick ultrasound in his office. Since I had experienced so many previous miscarriages he wanted to give me some reassurance by seeing the heartbeat again. One of the things that really impressed me about Dr. S is that he connected with me on a human level. He was compassionate. He understood that because of my miscarriage history I needed a little more reassurance than someone who has never experienced pregnancy loss. The clinic where Dr. S saw me had an old ultrasound machine. (This clinic had a new machine on order and had borrowed an old dinosaur from another clinic while they waited for the new one to arrive.) As Dr. S performed the ultrasound he thought he could see the heartbeat. However, because the baby was still quite small and the old dinosaur machine couldn't do an internal ultrasound, he suggested that I head over the hospital to have an ultrasound in the maternal fetal medicine department just to confirm that everything was OK. Dr. S was confident that using the high quality ultrasound at the hospital we would see the heartbeat very quickly. Because everything had been going so well and Dr. S and my husband and I were all convinced everything would be fine, my husband left for work and I headed over to the hospital.

I checked in at the maternal fetal medicine department and waited to be called back. As I sat in the waiting room, I watched a couple come out and announce to their family the results of their gender ultrasound. I was excited to be there in a couple of months myself.

The technician came in and called me back to a room. She had me lie down on the exam table and prepared to do the ultrasound. I watched the large television screen on the wall that was connected to the ultrasound machine. As the technician scrolled over my belly I saw a beautiful side profile of our baby. I was amazed how much the baby had grown and how incredibly clear the picture was. I was savoring the moment. Nothing could have prepared me for what I was about to hear.

As the technician focused on the baby's chest, I couldn't see the rhythmic flickering of the heartbeat. I thought maybe I was missing something. The technician indicated she was having a hard time finding a heartbeat on this little one. She would need to do an internal ultrasound. The technician left me alone for a couple of minutes to get ready for the internal ultrasound.

The technician came back in and began the internal ultrasound. She focused in again on the baby's chest. Still no cardiac motion. She turned on the microphone and listed for the heartbeat. Nothing. The technician turned to me and said, "I'm really sorry." I didn't know what to say in response. I was in complete shock.

The technician left the room and the attending maternal fetal medicine doctor called Dr. S. After informing Dr. S of the results, they patched him in to talk to me.

"Does this mean my baby is dead?" I asked Dr. S in a state of shock, horror and disbelief. Dr. S replied, "Yes Caroline, the baby is dead. I am so sorry." I had been watching the ultrasound and knew there was a problem when I didn't see the strong, rhythmic flicker that had become so familiar with our previous ultrasounds. Even after seeing this ultrasound with my own eyes, I still couldn't believe it. I wanted to scream "No!" I sat there numb as the tears started to roll down my cheek. This was the baby that had been given a 93 - 95% chance of success. This was the baby that had been right on with all of the milestones and was developing perfectly. This was the baby that was healthy. This was the baby I supposed to be able to hold. This was the baby that was supposed to make it. This was the baby that was supposed to be...

Dr. S suggested that my best option would be to have a D&C. Due to the size of the baby and the fact that I hadn't begun to show any signs of miscarriage, he was concerned that miscarrying at home would be quite brutal on me.

I called my husband and through my agony and tears, relayed the horrible news. Neither one of us could believe what I had just been told. The technician returned to the room and told me I could leave when I was ready. I thought to myself, "Where do I go? I just found out my baby is dead." I was in such a state of shock that I was afraid to drive. I pulled what was left of myself together and walked out into the hall. I found a chair and sat down. I called my parents and told them what happened and then I started to cry again. Usually I am quite a private person, but for the first time in my life I didn't care if people saw me crying. I was reeling from the shock and pain.

As I was sitting in the hall, I looked up and noticed Dr. S was coming toward me. He had apparently finished with patients in the other clinic and had come over to the hospital to do rounds. He stopped right away and again expressed his sympathies to me. He then talked strategy and told me they (meaning him, my RE and maternal fetal med) were going to do a "full court press" to figure out why I couldn't stay pregnant. I appreciated his kindness and his willingness to be assertive in finding a solution to our problem. Even though it was a dreadfully hard situation, it helped knowing I had this medical team in our corner.

After speaking with Dr. S, I found my way over to a little chapel around the corner. As I walked in, it was dark except for the light shining through the stained glass at the front of the chapel. The chapel was empty. It was a small room. I sat down and offered one of my most heartfelt prayers as I began to sob. I told God that I knew he had always been there for me and that now, more than ever I needed him to get me through this. I told him that I didn't know how I would do it but that I knew he did. I pleaded for his help and comfort.

After a few minutes of praying and sobbing, I felt like I was finally in a position where it was safe to drive. I walked out of the little chapel and looked down the hall towards the maternal fetal medicine department. I thought about how much life had changed in the two hours since I had walked through the door. I turned to leave and then remembered that I didn't have a picture of the baby. I walked over to the maternal fetal medicine office and asked for a picture of the ultrasound. They were happy to oblige. I'm really glad I have a picture of our baby. The pictures from the hospital were the clearest ultrasound pictures I had and it makes what I went through more tangible somehow.

On my way home I received a call from my husband. His boss, after learning about what happened that day, was very understanding and encouraged him to take the rest of the day off. My husband and I spent the afternoon together and tried to get through a small part of what was facing us.

Over the course of the weekend, we decided that I needed to have one more ultrasound before I had the D&C. I called Dr. J's office on Monday morning. They were wonderful and got me right in. Dr. S had left town for a couple of weeks and I felt like I needed to have Dr. J confirm what I had been told on Friday. Dr. J had been through my two previous miscarriages with me. Somehow I needed to hear the news again from her.

When I met with Dr. J she expressed her sympathy. She conducted an ultrasound and confirmed that the results we received on Friday were correct. Meeting with Dr. J gave me some added comfort and peace about going forward with the D&C.

Since Dr. S was out of town, one of the RE fellows  (Dr. D who had been with Dr. J at my first appointment in June) was scheduled to perform my D&C. Dr. J gave me her full confidence in Dr. D and her ability to perform the D&C.

The next day was the day of my D&C. My husband and I arrived at the hospital at 8:00 a.m. I have a hard time with general anesthesia – it makes me really sick and groggy. Because of this I opted for conscious sedation. I didn't want to sleep through the procedure and in spite of the effects of the sedation didn't allow myself to fall asleep. I emotionally needed to be awake to say goodbye. Going through the D&C was a very difficult experience for me. It seemed to be such a horrible and unnatural way to part with someone that I loved so very much. I hope to never have to do that again.

At the admonition of Dr. S and Dr. J, we requested genetic testing be performed on this baby. We met with Dr. J about three weeks after the D&C and she reviewed the results with us. We learned that I had been pregnant with a genetically normal baby boy. To this day we still don't know why we lost him. I have undergone additional tests but have yet to find specific answers to explain this pregnancy loss. We have since met with the head of maternal fetal medicine (and Dr. J.), and have come up with a game plan for the next pregnancy.

Each of the miscarriages has been hard for me and I have grieved each of them afresh. This last one was particularly traumatic because we had every reason to hope and plan for a healthy pregnancy and baby. It has taken me a long time to find a place for it. It is slowly getting better and I am grateful to be where I am. I don't think there is a day that goes by that I don't think of and miss our baby boy.