On August 29, we went in for our first appointment with the midwife (our practice has you alternate appts between the doctor and the midwife for a number of months before choosing; even though we knew the doctor, we started with the midwife). She took a history, did a pelvic, etc. We talked about proper diet, exercise, and finally my discomfort with the fact that I was losing symptoms. She offered to do an ultrasound using the portable machine in the office -- "just to give you peace of mind" -- but was sure to note repeatedly that the machine was somewhat low quality and she wasn't great at using it. She initially went for the transabdominal, but concluded she would be able to see better vaginally, as my uterus was tipped. I didn't really care -- I was just waiting for that peace of mind.
When looking transvaginally, she seemed concerned, but I had no idea what to be looking for to guess at the cause of concern. She asked me again how far along I was. Those who have been through this before know that is never a good question to hear when you have that wand all up in your business. I should have been 7.5 weeks, but she said she could only see a sac, and it was measuring at 6.5 weeks. She said she was worried, but again noted the low quality of the machine and her lack of expertise and told us she was going to call the radiologist and see if they could see us right away. I sat there and bawled. P just held me. Eventually the midwife came back, telling us to head to the radiologist across town, but to stop on the way out to have the bloodwork done that we had discussed when we still thought I was pregnant, "but we'll cancel some of the screenings, since we don't think there's a viable pregnancy anymore. At least you know you can get pregnant." Bitch.
As I quickly realized was going to be a common occurrence in this world, when we got checked in at the radiology lab, the woman behind the desk commented on my last name, asked if I was related to my mother in law. They used to work together in labor and delivery. Awesome. I had to tell her not to say anything, since my MIL doesn't know anything -- that we were trying, were successful, or were potentially having a miscarriage. Oh.
The waiting room was full of pregnant people, and I found myself extremely resentful, passing judgment on all of them -- they looked too young, too clueless, too anything to get to be pregnant when I might not. I was glad they called us back quickly before I lost it. The tech again started with an abdominal ultrasound but quickly switched to the vaginal. I still didn't really know what to look for, but knew I saw something that looked like a rice krispie with a white flicker. The tech said absolutely nothing. After a while of manipulating the wand, changing the area of focus, blowing the view up, and doing it all again, she said she was going to get the doctor, which is also always a bad sign. But I knew I had seen that flicker.
The doctor came in and we went through the same routine again -- manipulate, center, zoom, repeat. Finally he said, "well, that there is the sac, that is the baby, and that is the heartbeat." The expression on his face, though, made clear that he still had bad news to come. "The heartbeat is irregular. Watch." We saw it beat steadily for a few seconds, then seem to stop, then beat steadily again. I kept thinking, maybe it's just the angle, or something is in the way, or maybe he just sucks at his job -- how the hell does he know? "The heart also seems to be in the wrong place, but anatomy at this stage can be tough to see and interpret." And, it was measuring small -- 6.5 weeks instead of 7.5.
Our rice krispie was small but alive, but, he told us, there was very little chance that this would be a viable pregnancy and, even if it was, there was a good chance the baby would have severe medical problems. He said we should pray for the best but prepare for the worst. We would continue to monitor the situation, but we should expect to miscarry in the next week or so and should come back in a week or ten days for a follow up if it hadn't happened. The doctor kept touching my arm, trying to be caring and empathetic, but it was creepy -- he still had his hand on the fricking wand, still inside me. I couldn't cry in front of him.
P and I were supposed to be leaving on vacation two days later. The u/s doc thought we should go anyway, if we thought it would help and were feeling up to it. Whatever was going to happen was going to happen, and it would be depressing to waste a vacation sitting home waiting to miscarry. The midwife thought we should cancel. She seemed certain that I would need to go to the hospital in the coming days, and I didn't know where the nearest hospital was in relation to our destination (our cottage in Ontario). She thought it was too secluded, too remote, and we should postpone. The whole thought was incredibly depressing, and I wasn't sure how much fun vacation was going to be, but really couldn't handle the thought of cancelling for the exact reason the u/s doc said -- a vacation wasted waiting for death was too crappy to imagine.
On Friday morning, P and I got in the car with the dog to make the ten hour drive to the cottage. Per the midwife's orders, before we left we went online to research hospitals in the area and called to confirm that they had an emergency obstetrics unit. We were sure to drive by the closest one on the way up. Every twinge I felt I was sure was a cramp and marked the beginning of the end. Every time I went to the bathroom, I was sure I would look down and see that telltale smear of blood on the tissue. I had a meltdown at the beer store on our first full day -- all of a sudden, I was struck by the absurdity of me, standing there while P picked out beer for himself, not drinking because I was still pregnant, even though I was waiting to miscarry our dying baby. I prayed a lot that week, not that God would save the baby but that He would give me the strength to deal with the loss. I wanted to feel hopeful but felt extraordinarily defeated. As I feared, it was tough to enjoy being there.
But I read a lot, sat out on the dock, went swimming, went for walks. And, as the week went on, I started to have a little hope, a recurring daydreamy fantasy that the doctor was wrong, that the baby was fine. Maybe we were that small percentage with whom he sees what he saw but who go on to have viable pregnancies, ideally without severe medical issues. He had said to expect to miscarry within the week, but nothing was happening. Though the weather outside got stormy, hope began to slowly emerge in me, like the sun burning away a thick fog.
We got home on Sunday the 9th and had the follow-up ultrasound appointment the next day. We had a different doctor, different from the one we had the first time and in a different room with a different tech, and again with the LMP question over and over. And again with the abdominal and the switch to the vaginal. This time, right away I knew it wasn't good. The sac looked bigger but the rice krispie didn't, and the flicker was gone. This doctor was all business and bluntly delivered the news that there was no heartbeat and that, while the sac was the right size, the baby was still too small; while it had grown, it hadn't grown enough. I am sure he said other things, but I don't really remember them. I just remember bawling, trying to cover my face, wishing I could sink into the chair and just disappear.
I was supposed to be going to a friend's baby shower in the office that afternoon but didn't really think that was the best idea, so I went home. I think I cycled through all the stages of grief simultaneously over and over in the car on the way home, with a lot of time spent then and in the coming weeks vascillating between extreme anger and sadness, often colliding and leaving me extraordinarily bitter. When we got home, I informed the dog he was going to be an only child for a while longer. I cried a lot while P and I sat staring vacantly at the TV.
My doctor called that evening. I found the call very comforting -- unlike the midwife, who seemed to begin every sentence with "at least," the doctor seemed to recognize that wasn't what I wanted to hear. We talked about grief and we discussed the options -- wait and hope to miscarry naturally, go the medical route, taking medication and hoping it induces a miscarriage, or go the surgical route. She took the time to explain them to me and didn't push too hard for any one choice, giving pros and cons of each and asking me to call when we had decided what we wanted to do.
I did some research online and decided on the surgical route but I couldn't bring myself to call her to tell her. I must have been in the denial stage of grief at that point, because I kept convincing myself that if I waited a miracle would happen. No miracle happened. We met with the doctor in person on Wednesday and scheduled the D&E for Friday, September 14.