What it means to be pregnant

I had a miscarriage this winter. The embryo, if there ever was one to speak of, didn't develop past 7 weeks. I found out at 14 weeks and passed the pregnancy at 15 weeks. That was three and a half weeks ago.

I have seen enough pregnancy losses in my time at the birth center, amongst family and friends, and thus far in medical school, that I always keep myself open to the notion that a pregnancy may not work out. When I found out I was pregnant in November, I was not anxious or pessimistic, just realistic about the possibility of loss. I felt sick and crabby and tender - all normal pregnancy symptoms, all reassuring. Somewhere around 9 weeks the symptoms fell off, but that was not too unusual and didn't alarm me. We never heard a heart beat.

In spite of my awareness of pregnancy loss, I was nevertheless surprised and saddened and disoriented to see on the ultrasound that my growing uterus was nothing but an empty sac, a dark vessel full of fluid and a little cellular detritus but no baby. The map of our lives was suddenly redrawn. The vision of a healthy summer baby that I had been cultivating felt like a sham. My interpretation of my changing body had been all wrong - I wasn't pregnant and I wasn't having a baby. I had been tricked.

I was weepy and kept thinking about how foolish I had been, thinking I was pregnant all this time. How could I have read so much into the nausea, the fatigue? How could I have been so utterly mistaken about how my year would unfold?

As I passed the pregnancy a week later, with the help of a little misoprostol and a very kind friend to support me, I found the experience more interesting than sad. It was kind of like labor, but only the beginning of labor, in the same way that I'd only had the beginning of a pregnancy. I was relieved that my bodily experiences finally matched my understanding and expectations. I felt kind of lucky to get to learn about pregnancy and miscarriage in such an intimate way.

What I gave birth to was definitely not a baby, and there was none of the ecstasy or agony or high drama of a live birth. But I saw that Jeremy and I had created something. Some unique biologic event had transpired and I had gestated our conception these weeks and now the pregnancy was done. I no longer felt that I had been tricked into thinking I was pregnant. I realized that I had just been wrong about what it means to be pregnant. My view was too narrow. Most of the time one sperm meets one egg and a healthy, beautiful baby is created. But pregnancy can be something else - the genes can be all wrong and no embryo develops, or it starts and then stops growing, or the pregnant woman decides to terminate, or there is a normal fetus that dies spontaneously. Sometimes really freaky things develop, like hydatidiform moles or cancers. Miscarriages (and blighted ovum and abortions and all the others) are pregnancies too, just so far from what I hoped and expected for myself that I hadn't really consider them comparable to the normal gestation I'd had with Ethan. But really they are all on a continuum, and I just happened to have one of the other varieties.

This miscarriage is teaching me that pregnancy doesn't mean baby. It means something new and and unique has been created inside a womb. This type of creation inherently brings intense physical and emotional experiences for the mother. Whether it ends in an epic push or a quiet trickle of blood or a noisy vacuum aspiration or in surgery, this new something inside our bodies comes out. And the emotions may be so many things and so many things at once - loss and joy and fear and pain and annoyance and regret. But the hormones of pregnancy (whether in normal proportions or wildly abnormal) and the reality of some new biology following it's own life trajectory inside of us stirs the heart. Pregnancy starts with gametes and takes a woman on an journey, of flesh and of feelings, whatever the outcome.

Perhaps this is obvious, but somehow feels like a new truth to me. To see how my no-baby pregnancy is the same as the pregnancy that brought me beautiful Ethan in these fundamental ways helps me to understand and appreciate this chapter in my reproductive history more completely. It's sad and unexpected but awesome and beautiful too.

This miscarriage has also helped me to realize that if Ethan is the only child we ever have, I have been deeply blessed. I do expect to have more babies, and hopefully soon, but I know now that anyone else that joins our family is a bonus. We have already had such a gift in the utter love, the joy, the fun, the closeness, the insufferable whiny-ness, the late nights, the rage, the challenge of parenting. We are so lucky.