October 15th

Today is National Pregnancy and Infant Loss Remembrance Day. According to the official site, the entire month of October was designated as National Pregnancy and Infant Loss Awareness Month by President Ronald Reagan in 1988. There are so many organizations out there to help out these days with loss of infants and pregnancy: First Candle, Pilari, and the T.E.A.R.S. Foundation, to name a few. But in 1988, there wasn't much. People hurt in silence. As a friend said to me, the hurt will be there forever and ever. But we can heal by moving forward. Into the future, and into life. We honor our children today. We honor the memories of those who are not with us by celebrating the ones who are, or by crying, or by lighting a candle, or by sharing our stories.

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19 Weeks, 4 Days
Grapefruit

I feel my son squirming. Now is pretty much the halfway point, though most people would just say 20 weeks is. I'll probably post something to that effect in a couple days. Probably in the next week, the Hubs will be able to feel the squirming, too. I haven't gotten around to digitizing the pictures from last week's ultrasound, but suffice it to say, our child looks like Jack Skellington from The Nightmare Before Christmas. Good thing we like that movie! As I remember my child who did not join us in August, but who passed away in January, I am struck by the feeling that I am still blessed. I feel my son move again. He's getting comfortable. He still has a long way to go before he joins us. And I am not going to rush him.

The Honesty of Children

The three-year-old will look me in the face (when I can see his wet pants and the circle on my favorite blue chair) and say, "No!" when I ask him if he peed on my chair.

The six-year-old will look me in the face and say, "He just fell down!" when I saw her push her brother less than a half-a-second ago.

But sometimes, they don't know how to be anything other than honest. And sometimes, it's brutal.

Many parents opt to wait to tell their children that another one is coming. Sometimes, they wait until one of them rudely shouts out, "Mom is FAT!" Sometimes, they wait until after the first trimester is over. Sometimes, they wait until they get the positive result back from the doctor's office (serum test) after they've peed on a stick at home. So, we're those last people.

When we found out we were pregnant, we couldn't wait to share the news with our little ones. They have only been asking for like MONTHS if we were going to have more babies. They had even chosen the gender they preferred (each originally chose a same-sex sibling, but then the boy changed his mind and decided that he wanted a second sister). The eldest even chose a name (Daisy Sunrose). Don't ask.

So, when we found out we had miscarried and there would be no new baby after all, it wasn't easy to break the news to them. This, after all, is the very reason that so many parents choose to wait.

The younger is three. I think he had forgotten there was a baby in Mommy's tummy. He seemed sort of oblivious. The older is six. She knew, but nothing we said really explained it to her. She seemed confused. "The baby is coming early?" she asked. No, not that. "But the baby's not in your tummy anymore?" Right. "So where is the baby now? Is she at the hospital?" No, no, no. Finally, I said the hardest thing I've ever had to say. "The baby died, honey. The baby is in heaven." Click. Light bulb. The look of recognition on her face was enough.

But then, she came over and kissed my tummy and said, "Goodbye, baby."

She probably couldn't understand why I was crying. Or maybe she did. Which is why maybe she thought it would somehow make me feel better to know how glad she was that I could pick her up again. Only, it didn't. I cried more. Daddy had to take over for a while, as I went to lie down.

Sometimes, kids don't know how to be anything other than honest. And sometimes, it's better to hear the lie.

The Thing We Never Talk About

Today, I'm going to talk about something that nobody talks about. People don't really want to talk about it. It's hard. It's sad. And if anyone has to endure it, they want it to go away quietly because it's too hard to share. I'm talking about miscarriage. And it happened to me.

Within the past two weeks.



These are the things I have learned about miscarriage in my Internet research and conversations with my health care provider.

Why Does it Happen?
The short answer: no reason, or a gazillion reasons. The longer answer (but still not very satisfying), is that sometimes abnormalities within the egg or the sperm (e.g., not enough chromosomes, too many chromosomes, errors in the DNA code that instructs the embryo on how to form, etc.) cause the development to stop early. Sometimes, environmental factors (e.g., toxins in the water, air, or food; exposure to "something" that one should not have contact with in pregnancy) impact the developing embryo. Sometimes, there just is no answer.

How Often Does it Happen?
The short answer: a lot. The longer answer, according to The Hope Exchange (a website providing help after pregnancy loss), is that as many as 25-33% of all known pregnancies end in miscarriage, and up to 40% of all (including pre-positive pregnancy test) pregnancies end in miscarriage. Most of these pregnancies are lost in the first trimester, though some pregnancies are lost after 20 weeks (called stillbirth beginning at 20 weeks).

Am I Normal?
This is a hard question. My personal philosophy is that "normal" is a setting on the washing machine. But in the grander scheme of things, miscarriage is an unfortunately common experience. Almost 20% of the adult population has experienced the loss of a child (either in utero, or at some time in their lives). About 80% of miscarriages are one-time occurrences. Most people who experience a miscarriage only experience it once. Health care providers only conduct testing after three consecutive miscarriages (unless there is some indication in your medical history to check for problems before that).

What Should I Do if My Pregnancy isn't Viable?
There are three options on how to manage a pending miscarriage from the healthcare perspective.
1. Watch and wait. This is the fancy medical term for "natural" miscarriage. If the gestation stops progressing early (no more than about 7-8 weeks), even if not detected until later in expected pregnancy duration, the body will begin to expel the tissue on its own. 90% of miscarriages using this procedure will effectively end in complete miscarriage (e.g., all pregnancy-related tissue is expelled).
2. Medicine. Taking misoprostol (brand name: Cytotek) will expedite the miscarriage process. The body would still expel the tissue, but the process would occur faster (over a matter of hours, rather than days). Expect to have diarrhea, substantially more cramping than a natural miscarriage, and possibly more bleeding. If the watch and wait method has ended in incomplete miscarriage (e.g., some tissue from the pregnancy remains in the body), this medicine is used to "help" the process along.
3. D & C. Dilation and Curettage (or, more commonly, Dilation and Suction) is a very common treatment of miscarriage that works 100% of the time, no matter what type of miscarriage you are having. This is a medical intervention that involves sedation with anesthesia, local anesthetizing of the cervix, artificial dilation of the cervix, and suction of all tissue from the uterus.

Wait, there are TYPES of Miscarriage?
Yes, there are a few types. Embryonic Demise or Blighted Ovum is when the pregnancy has started but stops progressing for some reason. This usually happens very early in pregnancy. Incompetent Cervix is when a pregnancy is affected later (usually in second or third trimester) because the cervix is weak and begins to open due to the pressure from a growing baby. These happen in 1 of 100 pregnancies, and usually only if the cervix has been affected in some way by previous surgery, a previous traumatic birth (excessive tearing of the cervix), malformed uterus, or other defect. Anembryonic or Empty Sac pregnancy is when the pregnancy begins and a gestational sac is formed, but no embryo develops at all. These types of pregnancies usually require either the medicine or D &C approach to managing the miscarriage because the body will only naturally expel the tissue about 2/3 of the time. It may also be helpful to know that the medical term for miscarriage is Spontaneous Abortion. Abortion when it relates to pregnancy means "stopping the progression of pregnancy," and spontaneous means "it just sort of happened."

How do I Deal with Miscarriage?
This is a very personal thing. Miscarriage results in grief for many families. If it is your friend who is experiencing a miscarriage, imagine that she is experiencing the death of her child. Because she is. The pain and grief is unimaginable. And because of that, she may be acting angry, sad, indifferent, or any combination. Grief is funny that way. Most often, people feel angry and direct it at anything and anyone who happens to be nearby. Do not take this personally. If she's acting like she's in another world somewhere (this is called dissociation), she probably is. The real world keeps going on as if nothing happened. Her internal world is a mess of emotions and pain, and she can't really function there either. So she might "go away" for a while to help herself function in the real world and not necessarily address the internal mess. That's okay for a little while, but ultimately, we all have to face that grief. Otherwise, we might forget our way back to those emotions, and they'll keep poking their way into our lives in situations that are totally inappropriate. Like making us lash out at our spouses or children or friends.

Dealing with miscarriage is a challenge because people don't talk about it. Nobody knows what to say. Nobody has the right words, so they say nothing. Or they change the subject. Or they pretend nothing's wrong because they think that might be helpful. In actuality, it sends the message that our pain is insignificant, or that we can somehow be able to move on faster than we would if grieving a person we'd actually met. But what so many fail to realize, is that parents have made plans, have hopes and dreams, and maybe even imagine they know the little life they've created. They love the child they haven't met yet. And when a miscarriage happens, all of those things become meaningless or lost. They become part of the grief. And in some way, there's a darkening of hope for the future because their new little future is no more. They have to find out what their life is again. Now that it's missing a very special someone they've dreamed about, maybe before that someone was even conceived.

Sometimes, people rely on their faith to help them through this difficult time. Sometimes, people have crises of faith and blame their Deity(ies) for what has happened. Sometimes, people rely on friends who have had this experience. Sometimes, people become angry at friends because nobody has experienced the pain they feel right now. Sometimes, people quietly endure the grieving process. Sometimes, people choose to seek help from a therapist. I have chosen the latter because, again due to my personal philosophy, I am a therapist and cannot sell something I wouldn't choose to buy for myself. Therapy allows me to be angry, sad, afraid, confused, and whatever else I go through, without judgment. And therapy allows me to find the answers I seek within myself. Because they are there, even if I can't see them right now.

Am I going bald?

So you've had a baby about three months ago.  Your body has recovered pretty much to the point it was before you got pregnant (although your abdomen may appear otherwise).  Your muscles may still be a bit weak in the abdominal wall, and you may have some extra flab, but for the most part your body functions have resumed "normal" activity.  Of course, if you are breastfeeding, there is that major change, too.  One thing you may be experiencing now (like I am) is hair loss.  A lot of hair loss.

This seemingly unnatural and excessive evacuation of hair from your head is due to the growth cycles being disrupted during pregnancy and not (let me repeat, NOT) from breastfeeding.  Your hair passes through a three-phase life cycle: anagen (growth phase) - which can last an average of three years, catagen (transition phase), and telogen (resting phase) - which lasts from 1 to 6 months with an average of 3 months.  Normally, about 85 to 95 percent of the hair on your head is growing and the other 5 to 15 percent is in a resting stage. After the resting period, this hair falls out — usually while you're brushing, washing, or otherwise agitating it — and is replaced by new growth.  The new (anagen) hairs actually push the old (telogen) hairs out of the follicle.  During a normal, non-pregnant, non-postpartum time of your life, you'd lose about 100 hairs per day.

During pregnancy, the boost of estrogen extends the normal growth phase of the cycle so that more and more of your hair is growing rather than resting.  Hence the thick, sexy hair you had while pregnant.  Once you give birth, estrogen levels plummet.  Of course, about 3 months postpartum (on average), the telogen (resting) phase has completed and progressed back to anogen (growth)... and the hair falls out of your head seemingly all at once.  Hair may come out in clumps, or you look at your brush and it's furry, or your shower drain has to be snaked almost daily... personally, I feel like I could make at least one wig from all the hair on my bathroom floor right now.

There's more.  Hair texture, color, and level of oiliness or dryness could change postpartum as well.  If you had wavy hair before, it might be stick-straight now.  It could be super-oily when it used to be on the dry side.  It could be coarse when it was once baby-fine.  You really get all kinds of surprises along with the gift of motherhood.

The good news is, sometime between 6 months and 1 year postpartum everything goes back to normal.  Your hair resumes its normal growth cycle, texture, etc.  However, if you still notice a lot of these changes beyond your baby's first birthday, you could be iron deficient (also a common postpartum ailment).  Your health care provider can prescribe a supplement if necessary.  Another possibility is hypothyroidism (low thyroid hormone) - another fairly common postpartum condition that can easily be remedied by your health care provider.  If you are concerned, the doctor's office is your first resource for help.

WHAT TO DO:

1. Experiment with your hair.  Try a shorter haircut or a textured one, cut some bangs (to minimize the appearance of the whispy baby-hair along your forehead), or use a wash-and-go method rather than excessively styling.
2. Try some different hair care products that bulk up the hair.
3. Change your comb/brush to one that is less likely to tug and stress the hair (wider-tooth combs are better during this time).
4. If you have long hair, check your baby OFTEN for one of your hairs wrapped tightly around the baby's toes, fingers, or (yes, even) penis.  This is called a "hair tourniquet" and can be very painful to your little one.  If he or she is crying and you've already done the typical feeding, diapering, and fatigue checks, this should be the very next thing you look for.

I'm holding out for sometime between three and nine months from now.  Until then, I just know I have to clean the bathroom a bit more often than I enjoy.