Miscarriage: when the clinician becomes the patient

There has been an abundance of women opening up on social media and in the press about their experiences with miscarriage and fertility. It's heartening to see that the pain and tears associated with these struggles are becoming easier to talk about. But not everyone has the same experience when they have a miscarriage. I know because I had a miscarriage earlier this year when I was 9 weeks pregnant. Would you believe me if I told you I didn't shed a single tear when I found out? Don't get me wrong, I was sad, I just didn't cry. I'm embarrassed to say it which is why I don't like sharing my miscarriage story.  Not because it's an uncomfortable topic, but rather, I feel judged for responding the way I did. I'm afraid that if I tell people my story they will view me as cold and heartless and think less of me as a mother and as a woman. But here I am telling you now so you can understand why I reacted the way I did.

I diagnosed my own pregnancy with a positive home pregnancy test and it was confirmed with a pelvic ultrasound showing a strong heart beat at 6 weeks. I scheduled another OB visit and ultrasound at 9 weeks. When I saw the ultrasound tech measure the gestational sac, I instantly knew I miscarried. There was no fetus. There was no movement. I remember looking at my husband and saying those words, "There is no heartbeat. I miscarried." The tech glanced over at me, speechless, and quickly left to fetch the obstetrician.

When the tech left the room, my husband and I had a few minutes of privacy. I looked at him and asked if he was ok. The look on his face told me he was devastated. In shock, he asked me if it was something we did to have caused this. He wondered if it had been those few bites of sushi I had a few weeks ago or maybe because I was still CrossFitting during my pregnancy. I did my best to reassure him that it wasn't our fault. We did nothing wrong. I tried to explain chromosomal abnormalities in embryo development, but I could tell he wasn't really listening. For the moment, I had to step into my role as a medical professional and console my husband for his loss.

The thing is, I know the science behind miscarriages. In medicine, we call it a spontaneous abortion. Fifty percent of the time spontaneous abortions are caused by chromosomal abnormalities. This means that the fetus isn't developing normally, usually because of a missing or extra chromosome. This occurs by chance during the process of fetal development when the embryonic cells divide and replicate.

The most common risk factors of miscarriages include:

  • Maternal age >40
  • Smoking
  • Medications
  • Alcohol (high intake or more than 3 drinks per week during the first trimester)
  • Cocaine
  • Extremes in maternal weight (underweight or overweight)

I had none of those risk factors. I was young and healthy, as are most women are who experience a miscarriage.

I can't tell you why I didn't cry during my miscarriage. Perhaps because I was raised in a strict Asian household where we weren't overly emotional or maybe because I wasn't surprised that this had happened. maybe because I just recently diagnosed and treated a 30 year old with a miscarriage a week prior. I vividly recalled my 30-something year old patient sobbing as I broke the news that she had miscarried at 11 weeks. I sat with her and chose my words cautiously to help ease her grief.  I remember telling her "This is not your fault. You are not broken. Your body did not fail you. Sometimes these things happen due to chromosomal development. You are not to blame." But I know she stopped listening to me after I said the words "miscarriage".

This time, it was different. I was the patient. It was surreal being on the other side of that conversation. When my OB told me I miscarried, we spoke about the miscarriage in technical terms, as two clinicians consulting on a case. There was no hand holding, tears or hugs. Not because I wasn't sad but because I truly understood why it had likely happened and that there was nothing I could have done to change the outcome.

I didn't really need comforting. The news didn't tear me apart. I probably wouldn't have responded the same had I been 25 weeks pregnant but I knew in this case, the miscarriage was beyond my control. But I also knew that even if I never had another baby I would be okay. My husband and I have had lengthy discussions about being adoptive or foster parents. It's something I have always been drawn to and has been as viable an option as any other. We have the financial means, we have a loving home and we know we can love a child, regardless if they are made from our DNA or not. For me, this miscarriage didn't change anything. It was disappointing but it was not life changing.

The same can't be said for everyone, for some, this might have changed everything. Heartbreak for days, weeks, months, sometimes even years. Anger at their bodies for failing at what women should be able to do easily and naturally. Fear that they may be more susceptible to miscarriage if they were to try again. I know this because I hear these fears all the time, I see the sadness, I feel the heartbreak in my patients.. I hear her ask me why God doesn't want her to be a mother? Why is God punishing her? What did she do to cause this miscarriage? When I hear these words, all I want to say is "This is NOT YOUR FAULT! Stop blaming yourself, your body, your past and your choices for this loss."

Miscarriages happen. Truth is, it happens ALL THE TIME. In fact, 80% of women will experience at least one miscarriage in their lifetime, whether they realize it or not. So let's all decide to be loving to ourselves, our friends, our coworkers and our sisters. However you grieve a miscarriage, however long you carry that loss, just know it was nothing you did and you are not dysfunctional. Just a human who managed to make it through your own fetal development with more or less all the right chromosomes. 

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