The Quiet Refrain

(Early miscarriage and chemical pregnancy loss post)

For nearly a month I vomited up almost everything I ate. I stepped on the scale and counted the pounds I had lost. When I spoke to the nurse (over the phone, she never saw me in person), she asked me if I was underweight to begin with, or had some weight to lose. I told her I guessed I had a few extra pounds; I wasn’t dangerously thin even after the 18 pounds I’d shed.

She told me this was normal. I should try eating saltines in bed when I first wake up. I should try ginger chews. I should take vitamin B6 and Unisom.

I tried not to feel angry with her, this woman who had never met me. She didn’t know I had tried it all already- the saltines in bed, the ginger chews, Unisom and B6. She didn’t know what I was already secretly thinking. A quiet refrain: something is wrong.

I carried a flask of mouthwash in my purse everywhere I went. I made a new habit of keeping my microphone muted, turning off my camera so no one in my zoom class or work meeting would know if I had run out of the room to vomit again. When I worked in the office, I had a trash can at my feet, just in case I couldn’t make it to the one unlocked bathroom on the floor. I felt grateful the rest of the office was pretty empty, no one would hear my retching through the paper-thin walls.

There were some foods that were okay, at first. Frozen waffles. Vanilla ice cream. Saltines. Jello. But before too long, they each would turn on me. I’d once been concerned about cutting down on coffee. It turns out, it’s not hard to stop drinking coffee when even saltines won’t stay down.

I spoke to my friends, my mother, my partner’s mother. Everyone kept repeating “You should eat saltines before you get out of bed!” “Have you tried ginger chews?!” Like these were the positive affirmations that I needed to hear. To tell me the quiet refrain was not true.

The one I came to hate the most, “Nausea is a sign of a healthy pregnancy!”

______________________________

Everything about the ultrasound technician was sunny and upbeat. The way she talked, the swing of her blond ponytail, her ever-present smile. Despite her scrubs, she looked to me like she should be on her way to a soccer game.

Her demeanor had changed only slightly. She was still smiling, still sugar-sweet when she spoke, her ponytail was still swinging from side to side as she moved. But I already knew. Things weren’t right. There should be a heartbeat.

She acted as if she just didn’t have the wand angled right- like she could keep trying and find what was missing. But I knew. The quiet refrain was true. Something was wrong. And I shouldn't have let myself feel that tinge of hope for all this time.

The doctor wouldn’t be in for an hour. So Blonde Ponytail said I could go take a walk and come back, if I’d like.

I walked through the neighborhood streets bordering the hospital. As I walked I identified plants in the well-manicured yards. My partner walked alongside me, nodding and asking the names of the trees we passed. He knew I just needed a distraction. He stopped and bought a breakfast sandwich, and asked if I wanted a bite. “I can’t eat that.” He held my hand.

Later, sitting alone in the doctor's office, I listened as he told me this was not my fault. I said I knew a lot of women who have had miscarriages. I know it’s common. He made sure to tell me it was too late- as if predicting I might fight to try and keep it. As if I didn’t understand what no heartbeat meant.

When I got home, I thought about how unfair it was- to have felt so sick for so long, to have vomited up even the saltine crackers. All while assuring myself I was working towards something, a future I could imagine but that was just out of reach.

It is called a missed miscarriage, or silent miscarriage, or sometimes a missed abortion, when a pregnancy aborts, either due to the fetus dying or ceasing to continue development, without the physical symptoms typically associated with a miscarriage such as cramps or bleeding. News of a missed miscarriage often comes as a shock to those who experience this, as there are no or minimal physical signs that the pregnancy has aborted. For some women, the only indicator is a lack of symptoms. When I first started learning about missed miscarriages, I continually found articles that quoted women who “just didn’t feel pregnant anymore”. For me, that wasn’t the case. I knew morning sickness was typical during pregnancy, and some women struggle with severe nausea. I had no idea I was no longer pregnant, because nausea was my entire existence.

It felt like a punch in the gut when I googled signs of miscarriage and learned that nausea was sometimes on the list. Should I have known? Should I have identified that one moment when it changed from good nausea to bad? The doctor told me development had ceased at 7 weeks, meaning I had carried on, thinking I was pregnant for nearly a month afterward. Meaning the worst of my sickness came after I had already lost it.

I didn’t fold over in pain, bleeding and scared as my sister told me she had when she miscarried. I just felt more and more nauseous, vomited more and more times each day, and tried my best to keep taking the prenatal vitamins, even though I’d usually hack them right back up after. I tried to keep doing the normal things, working and attending classes on Zoom, developing my odd regimen to conceal my constant vomiting from the world, and reminding myself what it was all for. Even though it had been weeks since I felt human. And some part of me knew something must be wrong. Brushing away the quiet refrain, I tried to assume it was just my anxiety. I wanted to do things right. I had a purpose.

The doctor told me my options.

Option 1. I could wait. My body would expel the matter eventually. I’d feel cramps, I’d bleed. I wouldn’t know when it was coming. It had already been 3 and a half weeks, and it had not happened on its own yet. If it went badly, I may still need to come into the hospital.

Option 2. I could take a pill. It would induce the event at home- I’d feel cramps, I’d bleed, I’d know it was coming soon, but not exactly when. If it went badly, I may still need to come into the hospital.

Option 3. I could schedule a procedure at the hospital. There would be topical anesthetics and a cocktail of anxiety and pain meds to make me loopy. I may still feel some pain, but I would know exactly when it was coming.

I asked what my insurance would cover. I thought about the savings I had stockpiled for diapers and doctors and baby furniture. I thought how cruel it would be to spend it instead on a procedure to tell my body this pregnancy was really over.

The woman from billing called me the next day. She had checked my insurance; the procedure would be covered except for my co-pay. She apologized for my loss. She was the first person to say that to me. I booked the procedure.

I told the few friends who knew about my pregnancy. I chose to send a group text even though I knew it was awkward. I started the message with a warning “this is a group text, please don’t reply in the thread.” I just couldn’t stand the thought of crafting text after text repeating the news.

A friend asked me what I needed. I told her honestly- I needed help cleaning my house. I’d been nauseous for so long it had gotten out of hand, when I looked around and saw the piles of dishes, dust along the baseboards, overflowing hampers, cluttered table tops, I felt even more like a failure. She came over and cleaned while I pretended to clean too, my pride not allowing me to lie on the couch while she worked. But I couldn’t move much because I was still just a blink away from vomiting, and my charade at cleaning was unconvincing. Another friend delivered flowers to my front porch. My coworker (who I’d told early on about my pregnancy so she could make excuses for me when I ran out of Zoom meetings) told me to take off as much time as I wanted, she would cover for me as long as I needed.

I tried to feel aware of all the small graces. How lucky I was to have good insurance, how the doctor and the woman from billing were both kind to me. How the drugs and anesthetic would assure I had very little pain. How I had managed to create a community around me, 3,000 miles from my family, so that at a time like this, I could still feel surrounded by love.

I scheduled the procedure for Thursday (the dreaded no-heartbeat ultrasound had been that Monday). I had spent over an hour on the phone with my sister the day before. I told her how I wasn’t even sure if I felt sad. I had known better than to let my pregnancy feel real yet. I wasn’t attached. Not really.

In the waiting room, a surge of emotions hit me anyway. I sat in the same seat I had waited in earlier that week. My eyes landed on the same planes: the signs posted on every other chair informing patients where to sit, the corner with the children’s toys and the height chart on the wall in the shape of a penguin. There were two other women in the waiting room, both visibly pregnant. I tried not to look at them.

I took the pill I had been instructed to take right before the start of the appointment (it was next in the procession that had been detailed to me over the phone: take the first pill the night before. Take a dose again in eight hours. Take the second pill the morning before the procedure. Take the next one right before. Take the rest as needed every 4 hours.) and waited to feel the calming effects.

During my ultrasound, they had allowed my partner to be in the waiting room, and even to join me in the exam room while Blond Ponytail did my imaging. They told me they make an exception for partners during ultrasounds. There was no exception allowed in the waiting room as I went in for my procedure. My partner was told to leave and come back when I was done. I thought about how the ultrasound was our experience together as parents, but my miscarriage was somehow mine alone.

The nurse was kind. I told myself to be sure to remember that part when I think about this experience later. She made light conversation, told me to look at her face while the doctor got started. The procedure went by quickly, and there was almost no pain. The nurse brought me a pack of Nutter Butters and sat with me on a bench outside the hospital while I waited for my partner to pick me up.

I slept most of the rest of the day, medicated into a stupor. Thankfully, I didn’t vomit once after the procedure. It was like the chapter had instantly been closed.

_________________________

My next pregnancy, and subsequent loss, were easier in most ways I suppose. I started getting dizzy spells, similar to the ones I had the week of my first positive pregnancy test before. My hair was suddenly amazing- thick and shiny and holding a perfect natural wave. I took two positive tests, and told only my partner. We didn’t celebrate; I was unwilling to acknowledge this pregnancy until I could surpass the hurdle of the 10-week ultrasound. I kept on like normal, save for not drinking wine or more than one cup of coffee, taking my prenatal supplements, and going to bed early. I didn’t call my doctor for a pregnancy confirmation appointment right away as I had the first time- what had that done ultimately but get my hopes up?

But of course, perhaps unavoidably, my hopes did go up. I thought about how much it softened the blow to be pregnant again already. Maybe by March, which would have been the month we welcomed a new baby in the alternate reality I had spent so much time imagining, I wouldn’t feel so terrible if I knew the future I imagined would be taking place in June instead.

After two weeks I was not feeling nauseous like I had the last time. I wondered if that was a good sign or bad. I noticed my hair starting to shed. I took another pregnancy test to ease my worry. This time it was negative. I took another. Negative.

It’s called a chemical pregnancy, when a miscarriage occurs within the first five weeks. This type of miscarriage is exceedingly common, in fact, researchers estimate that chemical pregnancies may make up as much as 50% of all conceptions (Bellenfonds, 2021). If I hadn’t been watching my body so vigilantly for any sign, I may have just thought I skipped a period. If I hadn’t developed the habit of carefully tracking my cycle, I may have noticed nothing at all. I may never have even known that for just shy of 6 weeks, I once again was on my way to become a parent.

The short span of chemical pregnancies is one of the reasons it’s so hard to accurately report just how common miscarriages really are. Some women don’t even know they have had them.

This second miscarriage was easier physically than my first- I wasn’t sick, I didn’t require a medical procedure, all I had was a single line on a plastic test stick, where two weeks before there had been two lines. This time, I wept.