Our missed miscarriage
By Juliana Kassianos, Transformational Fertility Coach, Yoga Teacher and Founder of The School of Fertility
In May 2018, my husband Steve and I went for a 10-week pregnancy scan only to find out the heart-breaking news we'd had a ‘missed miscarriage’. I hope that by telling our personal account of what happened and what’s worked for us on our healing journeys so far, we can help those of you who have been unfortunate enough to have gone through something similar.
Steve and I were incredibly lucky in that we managed to get pregnant quickly. It was the month of our wedding and eager to start a family, we thought we’d start trying, as we knew all too well how long it could take for us to conceive. Within the month I started to notice my breasts becoming more tender, so I took an early pregnancy test, but disappointingly it came back negative.
To allow time for any pregnancy hormones to build up, I left it a few days after my period was due before taking another test. I impatiently waited for the result to show on the screen. My heart missed a beat when all of a sudden the word 'Pregnant' popped up. Buzzing with excitement, I took a photo, just to make sure my eyes weren't deceiving me.
Steve had already left for work and although I was dying to tell him our exciting news, I managed to hold it in until he got home, as I wanted us to be able to share the special moment together. He was over the moon. Everything seemed to be going to plan for us. We’d spent the previous year renovating our house, getting it ready to be a family home. Now we could look forward to spending our first Christmas as a family, what with our little one due 21st December 2018.
From the beginning, I tried my best not to get too emotionally attached to the pregnancy, as I knew how common miscarriage is. But of course, there were times my mind would wonder, and I'd start to brainstorm baby names and browse ideas for the nursery. I found myself counting down each day as it passed, hoping to get through the first trimester and into the second, when the chances of miscarrying decrease, the symptoms of pregnancy start to subside, and we could begin to tell those close to us our happy news.
THE INITIAL SCAN
On Saturday the 26th May 2018, Steve and I were in the living room waiting to go to our 11:30am 10-week pregnancy scan at a clinic just five minutes’ walk from where we live in Essex. We’d decided to pay for a private scan before our NHS 12-week scan, to make sure all was going well with the pregnancy. I wanted to put our minds at rest that it wasn’t ectopic, there was a heartbeat and it was developing at a normal rate, especially as in a few days we were due to go on a family holiday abroad.
For the whole morning, I couldn’t seem to get rid of a nervous unsettling feeling in the pit of my stomach. I found myself unable to sit still as I paced the room, counting down each torturous minute. Steve gave me a comforting hug and tried to reassure me that everything would be okay, but as much as I wanted to believe his words, part of me knew it might not be. At 10 weeks we were so close to reaching that 12-week hurdle. I hadn’t had any bleeding and my pregnancy symptoms of bloating, nausea (mostly in the evening), heightened sense of smell and tender breasts were still in full force. Focussing on my breath to calm my nerves, I tried to think positive thoughts.
Finally, it was time to leave, so we eagerly headed off hand-in-hand to the clinic. Soon after we arrived, we were shown into a room with a huge TV screen on the wall. I lay down, rolled down my jeans and had cold ultrasound gel squirted on to my abdomen. The lady who was doing our scan placed the probe on the gel and started to move it around. As she did, I saw on the screen a big black gestational sac, but that was just about all I could make out, which frightened me as I knew I should be seeing more. Giving a nervous glance to Steve, he took my hand and gave it a loving squeeze.
She was silent for what felt like a lifetime. I kept asking her what she was seeing and if there was a heartbeat, but she didn’t reply. I sensed pretty quickly things weren’t as they should be and a few minutes later she said the words we'd been dreading to hear, that "it didn’t look good". What exactly did that mean? I felt so frustrated, I just wanted to know what we were dealing with. She then asked that I relieve my bladder (having drunk a litre of water as per instructions before the appointment) and come back into the room for an internal scan so she could have a closer look. I rushed to the bathroom as quickly as I could, as I couldn’t bare the distressing suspense any longer.
Once back in the scan room, she inserted the probe intravaginally and there in front of us on the huge screen was a shape of a baby, but with no flashing heartbeat. My heart sank. She zoomed in to measure it and asked if I was absolutely certain about the time we conceived – at just 16.7mm, it was much smaller than it should have been. I always have regular periods, so I knew there wasn't any chance the dates were wrong. She then delivered us the devastating news that the scan was showing the foetus had stopped developing at eight weeks one day – it was supposed to be at 10-weeks one day. We'd had what she called a 'missed miscarriage', a traumatic term that meant although our foetus had in a sense died, my body hadn’t recognised this, so had kept the pregnancy going instead of initiating a miscarriage to expel the pregnancy tissue. I couldn't quite believe what she was saying. How had I not sensed something was wrong, surely I should have known? It didn't seem fair that the placenta had kept releasing hormones, almost tricking me into a false sense of security that all was okay with the pregnancy, when really it wasn't.
She left the room giving us a few minutes alone to try and take in what had just happened. Although I had anticipated the scan may not be good news, it was a shock to see the image of our lifeless foetus on the screen and to realise I’d been carrying it for two whole weeks without knowing it had stopped developing. After all, my pregnancy symptoms were still present, and I’d had no warning signs like bleeding or even spotting. In that moment I felt utterly robbed of our pregnancy, robbed of our happy scan moment and robbed of all the dreams I’d visualised for us and our little one. Within just a few minutes, our World had been turned upside down. The whole situation felt unreal, as though it wasn’t really happening, and a wave of emotion came over me as I burst out crying, supported in the arms of Steve.
When she came back in the room, she advised that we go to the hospital to have another scan to confirm what she was seeing and to discuss our options. As we excited through reception, I noticed a sign that said, buy a teddy with your baby’s heartbeat… trigger one. I then looked over at the heavily pregnant women waiting to be scanned next… trigger two. Then there were the scan photos we choose to keep, encase the hospital needed them…trigger three. Each trigger was an overwhelming swell of emotion that hurt deep-down more than words can describe. I desperately just wanted to run out of the clinic and be back home alone with Steve. I walked back to our house clutching Steve’s hand, feeling nothing but numb with pain and pure dread in anticipation for what was to come next.
THE CONFIRMATION SCAN
As soon as we got home from the scan, Steve rang the maternity department, who told us to come in. I made a move to grab my bag, but Steve stopped me. We hadn't had a chance to catch our breath let alone start to digest the devastating news of our 'missed miscarriage'. Knowing all too well how I tend to close myself off when I'm hurting, Steve knew what I really needed at that moment was to be held in his arms and to be reassured it would all be okay. That no matter what, we'd get through it together. We’d both wanted our little one so much, not even a comforting cuddle with our long-haired moggy ‘Zorba’ could soothe the pain we were feeling inside. All we could do was be there for each other.
Putting on sunglasses to hide my red puffy eyes, I collected my ‘Maternity Records’ folder and left with Steve for the hospital, a 25-minute drive away. When we arrived, we made our way to the maternity department, where we were asked to take a seat. Wanting to stay clear of all the pregnant women, we chose a quiet empty room to the side, so we could be alone and away from any painful triggers. I was still in shock, everything was happening so quickly. One minute we were planning our year in preparation for our little Christmas arrival, the next minute it had all been snatched away from us in one fell swoop. It didn’t feel fair.
A nurse called my name and directed us into a consulting room. I felt like a zombie, just going through the motions – first blood pressure check, then temperature, followed by a blood test. It was only when another nurse mentioned how it might not be possible to have a scan that day as they were busy, that I felt myself spring back to life. There was absolutely no way I was going to wait a few days, what with it being a bank holiday, before having what we already knew confirmed again. I just wanted everything to be taken care of. I asked her as calmly as I could if she could please squeeze us in and that we were happy to wait as long as necessary. She seemed understanding and tried to reassure me she’d see what she could do.
While we anxiously sat in the waiting room, Steve had the horrible job of letting our parents know what was happening. We’d already told them about the pregnancy and knowing we had the early scan booked in, they were anticipating our call. I was so grateful he was informing them as I really didn’t feel up to speaking to anyone at that point, let alone give them disappointing news. As he went and made the phone calls, a couple with their newborn baby walked past. It was heart-breaking to know we wouldn’t have that moment with our little one inside of me. It made me feel incredibly sad for what could have been had we had the happy scan I’d quietly dared to hope for.
After a while we were thankfully informed they could fit us in for a scan and were directed into another room. Looking blankly up at the ceiling, keeping my eyes away from any screens this time, I waited to hear their assessment. As we sadly expected, they confirmed we’d had a ‘missed miscarriage’.
THREE MANAGEMENT OPTIONS
We were told we’d need to see the consultant to discuss the options available to us and after more tiring waiting, we were called into another room. The consultant was very sympathetic to our situation and spoke calmly as he explained the three options available to us.
1. THE NATURAL APPROACH
The first option was to wait naturally for the miscarriage to occur. Contractions of the womb would be felt like strong period pains and I’d bleed the contents of the uterus out. He explained how with this option there was a small risk of infection and that we’d need to look out for the following symptoms: excessive bleeding, unpleasant discharge, lasting pain and high temperature.
As nothing had happened since the two weeks our foetus had stopped developing, it didn't make sense to us to take a "wait and see" approach. Plus, I couldn't bare the thought of having to carry it any longer than I had to, what with knowing it was lifeless inside of me. I just wanted to manage the situation as soon as possible.
2. THE MEDICAL APPROACH
The second option was to take pills to initiate the miscarriage. This first step involved taking orally a tablet of Mifepristone, which blocks the action of the hormone progesterone and causes the lining of the uterus to break down, and the pregnancy sac along with the foetus to be bled out. I would then be able to go home but would have to return 48 hours later for a second lot of treatment.
Then, I’d have to take two tablets of Misoprostol orally and four tablets of Misoprostol intravaginally – this would help relax the cervix and speed up the process. I’d then be observed for half an hour and if all was okay, I’d be able to go home with four more tablets of Misoprostol: two to be taken orally three hours after I took the initial two tablets of Misoprostol orally and if I hadn’t miscarried yet, another two after three hours. There’d be a risk of haemorrhage and I’d have to return in two weeks for a scan to make sure the miscarriage was complete.
This sounded like an extremely prolonged process that would be both physically painful and emotionally draining. Then there was the worry that as with the natural approach, I might have the traumatic experience of potentially seeing our foetus that would bleed out of me.
3. THE SURGICAL APPROACH
The third option was to have surgical management of miscarriage, otherwise referred to as ERPC – Evacuation of Retained Products of Conception – not the most pleasant-sounding of terms. The operation would mean going under general aesthetic. It involved dilating the cervix and inserting an instrument into my uterus through my vagina, which would be used to remove the pregnancy tissue. There would be a small risk of: having a reaction to the aesthetic, infection of the womb, tear in the cervix, a hole made in the uterus and heavy bleeding. Also, if it turned out that not all the tissue was removed, a further operation would be required. Following the operation, I would then be likely to bleed for up to 14 days.
Steve and I didn't take long to decide that the surgical approach was the right choice for us. It sounded like the fastest way to manage our 'missed miscarriage', as well as the least painful of the three, both in a physical and emotional sense. We were very fortunate to be able to get the procedure booked in for the following day. I was so grateful as I know it's not always the case in these circumstances and it could have potentially been an agonising wait.
Feeling completely deflated, we made our way back home. That evening, Steve suggested we stay over at my parents house, as he knew I'd feel comfort being around my family and in the house I grew up in. We didn’t stay up for long though, both tired, emotionally exhausted and not in the mood for ‘small talk’, we soon headed up to bed. I lay on Steve’s chest in a consoling embrace as I tried to drift off to sleep, knowing I’d need all the strength I had to get through what was to come.
THE DAY OF SURGERY
I couldn't sleep, thoughts kept racing through my head as my mind tried to process the heart-rending events that had happened. It was like watching a movie where scenes flickered at superspeed from the distressing moment we saw the image of our lifeless foetus on the huge screen at our initial scan, to the hospital where we'd chosen to have a surgical procedure to remove all traces of its short, but precious life. It was on repeat, playing again and again until the shrill sound of my alarm at 6am, broke the reel. It was like waking up after having a bad dream, only to realise I was still in it.
As I'd be having an anaesthetic, I wasn't allowed to eat or drink, not that I could have stomached anything anyway though. I packed a small bag with all my medical notes in and soon after, we left for the hospital. We arrived at 7am and made our way to the department. It was surprisingly quiet, which I was so thankful for. I'd had horrible visions of being surrounded by pregnant women and newborns, which would have made what was already hard to deal with, no doubt 10 times worse.
I was asked to undress into the hospital gown they provided and some really tight hospital stockings, which Steve help me squeeze into –like the ones you get for flying. Then came lots of repeated medical questioning such as if I had any allergies, followed by blood tests and swabs to test for MRSA (an antibiotic-resistant superbug).
All the staff were so kind. Each one used the phrase “I’m so sorry you’re having to go through this”, which felt soothing at the time. We often hear people say They’re so common” or “I know so many people who have had one”, which although maybe true, can feel a little bit dismissive when everything's still so emotionally raw. I appreciate though until you experience a miscarriage, you can't fully understand how it feels and so it’s hard to know what supportive words to offer.
Just after 9am, our consultant came in to run through any questions we had. At one point she took me off guard by asking us what we'd like them to do with the foetus; whether we wanted to have a service at the local crematorium or for it to be donated for scientific purposes. It was a question we hadn’t thought about, but we knew straight away the answer. We choose for them to use it to help advance medical research, as this way something good could potentially come from what had happened and signed a form to give our consent. By this point, I’d slightly disconnected from the reality of the situation, shutting down my emotions as a coping mechanism to help get me through the surgery.
At 9.50am our consultant came back with a trainee to insert some tablets intravaginally that would help dilate my cervix to make it easier to operate. Not the nicest experience, but at that point I really didn’t care, I just wanted the whole thing to be over and done with. By 10:30am I was ready to be wheeled down to the operating theatre, so I hugged goodbye to Steve who I knew would no-doubt be pacing the corridors, anxiously waiting for me to come out of surgery.
I felt slightly nervous about the operation, as I'd be going under anaesthetic and there were some small risks associated with the surgery. These included having a reaction to the aesthetic, infection of the womb, tear in the cervix, a hole made in the uterus and heavy bleeding. The girls in the operating prep room were amazing though and helped calm my nerves by chatting to me, whilst they prepared me for surgery and did the necessary checks. They explained how they’d administer the anaesthetic and not long after the cannula was in, everything became a bit of a blur.
I then remember waking up in a room outside the theatre freezing cold. I started to shake so much they put what they called a ‘Bair Hugger’ on me; a blanket they fill with hot air, which quickly helped to warm me up. They said the surgery had gone well. It was such an immense relief to know that nothing had happened that would affect our chances of conceiving again, as this is something that had played on my mind. After checking my vitals were all stable, they wheeled me back up to my bed.
There I met Steve who had been waiting patiently for me, it was now around 12.30pm. He slowly helped me back on to the bed and soothingly stroked my head whilst I rested as the anaesthetic wore off. After just over an hour the drip I’d had was now drained and disconnected. I tried to keep my fluids up and feeling somewhat hungry, I made my way through a sandwich.
Visiting the bathroom, I noticed I'd started to bleed a little, which hit me quite hard as it homed in the fact that I was no longer pregnant with our little one, that just like that it had vanished from our lives. It made me feel so empty inside. In that moment, I felt so grateful I had Steve to lean on and look after me – he didn't leave my side. I couldn’t imagine how horrendous it would be to go through it all alone.
Our consultant came in to let us know the surgery had went well. She reminded us that we weren't to have sex for two weeks and I wasn't to use tampons, this was due to risk of infection. Steve and I were both eager to start trying again, so we asked her if instead of waiting a couple of cycles, which was recommended, whether we could start trying after I'd had one period, as this would still allow the lining of my uterus to refresh. She said it was fine, as long as we felt emotionally ready. It was so uplifting to hear – already getting ahead of myself, I started to work out the week, months and potential due dates in my head.
After having my blood pressure and temperature checked, we were given the go ahead to leave. As Steve helped me into my clothes, I looked down at my breasts which were huge in my eyes – a whole bra size larger than normal. I hated them as they were a visual reminder I didn’t want to have. I desperately hoped they’d shrink back to their normal size quickly – something I never thought I’d hear myself say!
By 4pm we were back in the comforting surroundings of my parents’ house. I realised now was the time that I had to reconnect to my emotions and start to manage the process of healing. Part of me was angry that we were having to go through it, I felt fear at the thought that it may happen again or that we might never be able to have a baby, and a general need to escape somewhere far away, just the two of us.