Loss & healing: second trimester miscarriage

You don’t expect lightning to strike twice. Or at least, you sure hope it doesn’t.

After a very early pregnancy loss in late June of last year, I was bummed but hopeful. I knew the statistics: it’s known that at least 1 in 4 pregnancies end in miscarriage. Chemical pregnancies, which are losses so early that nothing can be seen on an ultrasound (what I had), are likely even more common than that, since many women may not even realize they’re pregnant before they aren’t.

In the month of July and the summer that followed, I enjoyed the rest of the summer adventuring. I was still bleeding when I took a camping trip to the North Cascades with my sister’s family over the holiday weekend, and when I went to Mexico a couple week’s later for my friend’s 30th birthday. I drank margaritas, taking small pleasure in the fact that I could actually drink for the first time in years due to pregnancy and extended breastfeeding.

In mid-September, I submitted Mount St. Helens, accomplishing a bucket list experience on the most perfect fall day. Taking in the views around me, I was a little relieved that I wasn’t pregnant again, that I could accomplish something just for me for what felt like the first time since I was pregnant with Nico. The vortex of pregnancy, birth, and extended breastfeeding is somewhat restrictive. I was thrilled to get to that summit, knowing just how strong I was.

Through the early fall, we were still hopeful to have a 2025 baby while continuing to live our lives. At the end of September, we took our first couple’s trip since Nico was born, an ill-fated excursion to Vancouver. It started with some pain that I thought was heartburn that wouldn’t be calmed by a high dose of tums on the drive north.

The pain worsened, and we stopped at a gas station just over the border to grab some Tylenol to see if that would help. I figured I would sleep it off. 20 minutes later, I was vomiting out the car window. We arrived shortly after at the 4 star hotel we’d gotten on points. I curled up in bed hoping I would sleep it off only to spend the entire night awake and vomiting, in excruciating pain.

By 6 am Gonza said “We need to take you to the hospital”. I tried to make it back to Seattle to our local hospitals but after a 1.5 hour delay at the border crossing I couldn’t take it and we ended up in the ER in northern Washington.

Thus we spent our couples’ weekend in the hospital with what turned out to be not just gallstones but infected, block-your-bile-duct gallstones which required emergency surgery. The little voice in my head whispered “maybe your body is protecting you — if you were pregnant this would be dangerous”. After surgery I got the all clear that we didn’t need to wait to keep trying for a baby.

And lo and behold, I found myself looking at a positive pregnancy test one month post-op. After my previous loss, I was a little more anxious. I had my first appointment and dating scan at 9 weeks. I waited for the ultrasound to confirm a viable pregnancy before asking the OB any questions. “There’s one baby, and it’s measuring 8 weeks 4 days”, she said. I could take a breath after that.

When the non-invasive prenatal test came back low risk, I breathed a little easier. I was more comfortable sharing the news with friends and family, and I started to pick up some new maternity clothes as I felt like I started to show really fast, a common experience after having one pregnancy.

My sister and I took bump pictures in front of the Christmas tree, cherishing the fact that we got to experience pregnancy together. I imagined the next Christmas with two new babies in our family. I got an accommodation to work from home for pregnancy related reasons, a huge relief in light of the 5 day return to office mandated by my employer for 2025. With a July due date, I would be out of office for the entirety of my busy season. I didn’t plan any summer camping trips, but did book a mid-September mountain cabin, hopeful I would be out on the trails with my new little one by then. Life started to feel like things were falling into place.

At my 14 week appointment, I heard baby’s heartbeat, and declined to hear the baby’s sex. We were waiting until birth, like we had with Nico. Everything was normal. When the doctor asked if I wanted the AFP (alpha-fetoprotein) test, I said “Of course!” As someone with healthy anxiety, I would definitely opt for any testing offered.

At 16 weeks I did the blood draw for AFP, which can identify neural tube defects. After 10 days, just as I was starting to wonder what was taking so long for the results to come in, I got a notification: “New test result” and immediately opened it to see the word ABNORMAL. Scanning the report with my heart in my throat, further down was “1 in 42 risk of neural tube defect”.

I quickly received an email from my doctor while I started to spiral, saying that they can confirm or rule out neural tube defects in the 20 week ultrasound I had scheduled for the following week, right before our trip to Ecuador, but they could try to move it forward. I asked for a sooner scan, and waited.

The pragmatic part of my brain said, “1 in 42 chance of a bad outcome still means 97% chance that nothing is wrong” while the anxious part of me was panicking, worst case scenario planning. Wondering if we would need to TFMR (terminate for medical reasons) in the case of a serious defect, and googling “how late can you get an abortion in WA state”. At least, I thought, my husband and I were on the same page about termination if it came to that.

Two excruciating days later, I found myself alone in the Kaiser radiology basement, hoping for the best and preparing for the worst. The tech scanned for about 10 minutes, then let me leave to empty my bladder. As I waited for her to return, the sense of foreboding grew the longer it took. Finally, she came back with a phone in her hand. “Actually, I have the doctor on the phone for you”. I knew it was not good.

“I’m sorry, but there’s no heartbeat. Baby was measuring about 14 weeks.” It was then that I remembered it wasn’t just neural tube defects that could cause an abnormal result on the AFP test that prompted the ultrasound, but also fetal demise. Or in lay person speak, a dead baby.

Jumping into fix it mode, I thanked the doctor for letting me know and asked about next steps. When you have a missed miscarriage in the second trimester, you generally need medical assistance. The radiologist on the line suggested I could try going directly to the OB floor and ask to get seen, even though I didn’t have an appointment.

In a state of numb disbelief, I walked through the Kaiser maze to reception at the OB’s area with many thoughts swirling in my brain. I’ve been carrying a dead baby around for 4 weeks. I have to tell Gonza the bad news over the phone, that is so shitty. How unlucky to I have to be to have two miscarriages in a row? Not only is is horrible to lose a pregnancy, but now I’m going to have to go back to commuting 5 days a week 1.5 hours each way which is extra awful. Why me?

When the receptionist asked how she could help me, I had to explain what happened for the first time and felt my face crumple. Then: “I just found out I had a second trimester miscarriage and the radiologist said I should come ask if anyone can see me”. She was so kind and was able to get me up to be seen within a few minutes.

The doctor was one I’d never met before, and I felt a pang of guilt that I was some random patient crying at her during lunch time. She was exceedingly kind, and spent over an hour with me going over information, connecting me with a clinic for my procedure the next day, ordering blood tests, and answering questions.

“What could have caused this?” was obviously the big one. Was something wrong with me? How long did we need to wait before trying yet again to add a second child to our family?

“It could be diabetes, or a blood clotting issue. We’ll test for those. If those tests come back negative, there’s no reason you can’t try again after your first cycle. We probably won’t get any live cells at this point from the fetus to test since the pregnancy stopped developing about a month ago”.

Did I cause this by drinking too much coffee? By weighing too much? Not particularly likely, but the wondering remains.

The next day I went to what turned out to be an abortion clinic, somewhere I never expected to be, right near my house. No partners were allowed inside. Surrounded by other women getting abortions, when I was taken to the intake room I asked the staff if they often saw women for miscarriages. “No, it’s pretty much just abortions”, the tech told me.

As someone who is adamantly pro-choice, I felt strangely upset that all the other women in the room were choosing to end their pregnancies. I didn’t have a choice for mine. Other thoughts were going through my head like, If my first pregnancy had been successful, I would be giving birth this month. Instead, I’m losing a second. Seeing the large birth control poster irritated me. Preventing pregnancy isn’t a problem here, keeping one is.

After getting a brief ultrasound to confirm there was fetal tissue to remove, I took two small misoprostol pills, stuffed against the sides of my cheeks, which was meant to help start the process of removing the tissue. An hour and a Xanax later, I was taken back for a dilation and evacuation, or D&E. I watched as they set up unfamiliar tools that looked like something out of a medieval hospital, my stomach churning at the thought of all the dead baby pieces that had been removed in this very room. One small blessing was that I was fully knocked out for the procedure. I wouldn’t have to see or hear what happened.

After I woke up, I had some snacks and then went out for lunch with Gonza to try to make a shit day a little better. Ordering a strawberry margarita because I could, I tried to see the good. “We could go skiing”, I said, something we’ve been wanting to try together for a while now but couldn’t due to pregnancy and breastfeeding. “Summer camping is back on” and “We can take a new couple’s trip to make up for the last one’s disaster!”

Thankfully the physical recovery has been uneventful. Up to now, the tests have not revealed a cause for the pregnancy loss. We may never know why it happened, which is its own kind of struggle.

There’s no happy ending here. We are in the messy middle, grieving the life we expected to have this year, which almost certainly does not include a new baby joining our family.

We’re taking it day by day, and some are easier than others. On my birthday weekend, 3 days after my procedure, we left Nico with my parents and spent a gorgeous sunny day in Seattle, sharing beers with a view of the water and then eating some of the best Thai food we’ve had, laughing harder than we had in a while. Then after lunch, I was crying outside the restaurant. “This isn’t how it was supposed to be”, I told Gonza as he held me tight.

Sometimes I’m fine. Then someone asks if we want a second baby and I have to respond quickly and remove myself or change the subject so I don’t start to tear up. Part of me wants to shout, “If we can, we had two losses in less than a year and nothing to show for it!” Sometimes I’ll feel weirdly relieved, with thoughts like “I’m glad I won’t be heavily pregnant in the hottest time of the year”, or “It will be nice to have another summer of adventures before we add in a second baby”. And then I’m panicking, what if it never happens for us?

I’m taking the next couple of months to recover. My job provides 10 weeks’ leave for second or third trimester pregnancy loss, which is a huge benefit. I’m going to be spending more time on my health, at the gym, walking more, and being outside. I’m going to be with Nico more, enjoying one on one time and adventuring together. I’ll be traveling — I’ve already booked a midweek cabin trip with my dad and Nico in March to the Olympic Peninsula. We are going to Turkiye for our family vacation in April. We’re planning a weekend couple’s getaway, possibly back to Vancouver to redo the fall trip we missed.

At the end of the day, despite the many silver linings that as an eternal optimist I look for, the sad remains. What makes me the most sad is seeing Nico getting older, learning more and becoming more independent, and desperately wanting a sibling for him that is relatively close in age.

And the reality is, we just don’t know if or when that will happen. When something rare happens to you, statistics mean less. I was part of the 1-2% of pregnant women who have a second trimester pregnancy loss. Just because I have a solid chance of having a successful pregnancy doesn’t mean it will come to be. Fertility is something that we have little control over. We can do everything “right” and there’s no guarantee that we will get a healthy baby.

It ended up being a blessing that we left for Ecuador a week after my procedure. I’ve always felt that it is easier to cope with hard times when you physically leave your typical surroundings, and that’s been proven true here, too. Instead of wallowing in our sadness, I’ve been spending time with Gonza’s family, revisiting our favorite spots, eating delicious food, and reading an inordinate amount (I think I’ve read 4 full books in about a week).

When we get home we will recalibrate and regroup. From there, what remains is hope for a healthy second child, and doing our best to live our lives fully in the meantime.