manual vacuum aspiration

They say it’s good to warm up with a joke – skip if you are easily offended because REALLY sick humor is one of the things getting us through right now:

WES: (last night) Is there anything I can do for you?

ME: You don’t by any chance know how to perform a manual vacuum aspiration, do you?

WES: Let me get the Dyson.

ME: Yeah, I’m pretty sure there’s a setting for that.
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So. Surprise – it’s done.

I went to work today. That may seem crazy to you, but I really barely considered staying home. The idea of just sitting around the house, even if a friend came over, was hideous (Please excuse the number of times I will most likely use the word hideous in this post. It just fits). Far better to go brain dead and sit in meetings. I am pleased to report that I was correct. I made it through meeting after meeting and felt "better" (if such a term can be used today) with each one.

The other reason I wanted to go to work was to get the untelling over with. I untold everyone, including people who hadn’t yet heard I was pregnant. Anyone who noticed… well, what I looked like today… and asked what was wrong, I told. And the amazing fact was that 75% of the time, it helped. This is because the majority of women I told felt moved to tell me that they had also had a miscarriage or two. I swear to you this happened at least five times. I knew they were common – four friends have had one in the past couple of years – but it really was striking with the random middle aged co-workers.

And now – WHAT NOT TO SAY TO A PERSON WHO TELLS YOU THEY ARE MISCARRYING.
"At least you can get pregnant!"
I swear that it seemed like anyone who had NOT had a miscarriage let this line fly. One of them, a very recent new mommy, let it fly before an "I’m sorry" even passed through her lips – "But you got pregnant!" Indeed.

This. Is. Not. Helpful. At. All.

I have to say that I even prefer those people who say, "It happened for a reason." Because there’s a good chance they’re right. There is a good chance that there was something chromosomally wrong with The Penguin. And if so, this was a "blessing", nature, The Right Thing. We all know how Wes and I would have responded to finding this out later – same result, far more hideousness.

And does anyone else find it weird that I started REALLY freaking out about genetic testing stuff on Thursday, which is the day the baby probably died? Does anyone else think some tiny part of my brain knew something was up? Does anyone find it REALLY weird that my sister dreamt, on Saturday night, that I had had a miscarriage and had to have it suctioned out? Yeah. We do.

OK. So, to continue, I am TOTALLY NUMB today. Except for one rather impressive case of Losing It Bigtime in the OB waiting room (BABIES _ EVERYWHERE_I’M_NOT_KIDDING), I held it together like crazy today and it wasn’t even that hard. I expect to lose my mind sometime in the next six weeks. Stay tuned.

Now… I want to write down what it was like for two reasons – one, I know that I will start to block this day from my memory (if that’s possbile) and I think having the details is important. And two, there weren’t a lot of MVA play-by-plays out there when I was searching. What I found last night was page after page about abortion, with maybe a paragraph here and there about how it is also used for missed miscarriages.

I had a "missed miscarriage" at 8 weeks 2 days and this was discovered when I was supposedly 9 weeks along (yesterday).  This means I had no bleeding, no decrease in pregnancy symptoms (though in retrospect maybe my boobs got a little eensy bit less sore), and no warning whatsoever that anything was wrong. I was not even expecting to have an ultrasound yesterday, as I had seen the heartbeat 8 days earlier and thought I would be waiting for the 12 week nuchal stuff. Fortunately, this practice I stumbled into (yesterday was the first time I had been there) is TRULY AWESOME and follows my lead on everything. When I said that I’d rather they understand what’s up (they had trouble with the printout from my RE) and that I would love a chance to see the heartbeat again, they were right there with me.

They not only have an ultrasound room at this office, but also a dedicated sonographer whose job is to do this all day. I have had to tell myself this several times ("she must see this all the time, right?") because what happened with the sonographer made me realize what a hideous job that can be. Happy sometimes, yes. But also sometimes hideous.

I sort of knew immediately. I just saw the heartbeat last week. Fluttery, strange. I knew what to look for. I also knew the baby should be moving around a bit by now. It was immediately clear that there was no movement at all and no fluttery blinking heartbeat. The machine has a cool little screen just for the patient to look at, and I looked closely. Eventually I said, "Is there a heartbeat?" But I kind of knew.

She took a deep breath and exhaled loud. She poked around a little more. She pushed the wand in harder to look closer. Finally she said, in an incredibly sympathetic voice, "I don’t see a heartbeat. I am so sorry."

She did some really rapid measurements of my uterus as I started to lose it. She was done by the time I was really out of my head. I sat up too fast and half fell off the table, sliding to nearly be on the floor as I started to wail, animal-like. The only thing I can compare it to was the one year anniversary of my mother’s death, when I just lost it and scream-cried for hours. While she was finishing up, I grabbed my cell phone and called Wes, crying into the phone that the baby was gone and he needed to come there. He hung up immediately to leave his office.

The sonographer went to see the midwife and then took me to her. They put me in an exam room and I sat on the little seat and just wailed. WAILED. It is a wonder I didn’t have an asthma attack. The midwife came in and was extremely compassionate and sympathetic and wonderful. I was having a hard time calming down, so even though I told her I wanted to hear my options for the whole miscarriage thing and didn’t need to wait for Wes, she just gave me a quick overview and then left me alone. Which was perfect. I did need Wes there. In fact, even when Wes arrived 20 or 30 minutes later, and I had calmed into some sort of creepy zombie state, I couldn’t make up my mind between the Misoprostol to bring on a miscarriage at home or the MVA that she explained to be a much milder procedure than the D&C I thought she would offer. She told us it was a manual vacuum that pumped out the contents of the uterus and while there was cramping and pain for a few moments, there was really no recovery time at all and it would be over fast. She looked at my face and said I should sleep on it and call her in the morning. And I will just say several more times that this. midwife. rocks.

By the time we were home, we had basically decided. I poked around the Internet and found all the abortion stuff and felt sad. I read about the home miscarriage stuff and how painful and bloody and scary it could be. I thought about the fact that my fibro acts up every single month with my day of bad period cramps and this could be days of that but worse. I called a friend who’d had one. But basically, fast predictable pain and fast getting-it-over-with was a pretty easy decision. We also realized that maybe it would mean they could do the chromosomal tests to see what was up and that would be invaluable in helping us as we move forward with possible future tries (don’t ask – I don’t know – probably – couldn’t tell you when).

I cried a lot when we finally got to bed, but a huge part of the tears was my utter fear of the procedure even though I knew it was the right choice. I really did not enjoy my HSG and that was rapid and really mild. I knew this would be a hell of a lot worse and I. was. scared.

I also woke up at 3 am and was then completely unable to get the image of the dead baby sonogram out of my head. It was like a horror movie. I woke Wes up and we hugged and hugged and then he made me toast and I fell back to sleep by 4:30, vowing to take my fibro medication the next night so I could sleep through.

So today. I was at work, I called the midwife (in between constant untelling) and she called me back and I told her we’d decided on the MVA. She said she would schedule it and call me back and it would most likely be Friday. Not sure what to expect, I thought Friday was best because I’d have Labor Day weekend to recover.

But a few hours later, when I was in another meeting, she called to ask if I could come in right away and do it today. At first I wavered, as I had already counted on getting two days of work in, taking advantage of the numbness to get my SAD library under control (boxes of books. everywhere. awful.). But she said that there were 2 doctors in and that would just be that much safer and that convinced me to duck out of my meeting and head for the subway.

I had to go right away because I had to have something (maybe Misoprostol, actually) inserted into the vagina to "ripen" (soften) the cervix so it would be easier to put the tube in. It needed to be in two hours before the procedure. She did that and gave me prescriptions for one valium pill and two antibiotic pills. She also instructed me to get Motrin and take some and I remembered to get the Motrin but didn’t take it until right after when they realized I hadn’t taken it. But it was fine. I also remembered to get pads, which will be my closest friends for possibly the next two weeks (ACK ACK).

I went back to the office after popping the antibiotic. Wes met me and we sat in front of the office (which is in Soho) watching people go by. I took the valium. When I started to feel a tad woozy, we went up to the offices and were taken to a room to wait, as by now the whole office knew that I was The Woman Who Cries When Faced With Baby Carriages.

The procedure was going to be at 4:30. At about 4:25, a nurse came and took me to the sonogram room. A few minutes later, the nurse, the midwife and one of the doctors (the one LaGiulia originally referred me to, actually) came in. The midwife’s only role was to stand next to me and help me stay calm. She was magnificent.

They put a paper sheet over my knees and it acted as a curtain so I couldn’t see what was going on. They turned the nifty little patient screen away from me so I couldn’t see that either. She used the dildo-cam to look at the embryo again and said that it actually looked like it was getting smaller (reabsorbing, as Estelle mentioned yesterday, only not in a way that would have resolved well on its own). This sort of helped because it seemed so disgusting to me.

This is as good a place as any for this fact – there was something entirely animal-like about this whole thing for me. I went from happy mommy one who is pregnant with a precious baby to EWWWWWW get the dead baby out of me. In about an hour. It was, by the time I walked out of the office, revolting to me. I. wanted. it. out. So anything that helped my really gross feeling about it was fine. I am sure that the emotional stuff will hit hard and I know I will have to grieve the loss of the baby we might have had. But on a gut physical level, it. was. hideous to me.

So. After she looked at it again, they put in the speculum and cleaned my cervix with betadine. Then I had to cough twice – once for the shot of local anasthetic and once for the insertion of the tube. I expected this coughing business as it was what my RE had me do for the dye-up-the-tubes test several months ago. All of that was, while not pleasant, fine and relatively painless. Pinchy and yucky, but not bad.

She asked the nurse for the dilators and inserted something else vaguely pinchy. And then right away she started pumping. She was using some sort of manual pump and it cramped. It cramped a lot, but sort of like a worse version of bad menstrual cramps. I could stand it. I moaned just a bit. I took some deep breaths. It was OK.

And then she asked for the Number 7 Dilator which is my new nemesis. Inserting it hurt like a bitch. And then, pumping with the Number 7 Dilator was a WHOLE different level of pain. If I could have caught my breath and formed a sentence (I think I managed the weak word,  "hurts."), I would have asked if this was what labor was like during childbirth because that definitely crossed my mind and I was curious. But, like stereotypical childbirth, I was busy breathing. I couldn’t do anything except breathe. Otherwise I might have crabwalked backward away from the Number 7 Dilator and that suddenly strong-seeming pump.

And then she was done. And she put the dildo-cam back in to see if it was all gone. She explained that it can be hard to tell because of all the blood (Oh, how tortured I had been last night worrying about how it would have to pump out something actually connected to my uterus and HOW on earth would that happen and how gross was that!), but she thought it was all gone. She called the other doctor in to consult with her and they sort of pointed and head tilted and my doctor asked her, "Do you think I should do a third pass?"

And I was thinking PLEASE GOD DO NOT DO A THIRD PASS.

And the other doctor gave a firm no and that was it. They took everything out. Wes was whisked in. The doctor talked to us about what to expect as far as bleeding (up to 2 weeks, possibly 3 but they want to see me in 3 weeks to be sure it stops), and what they would be doing with the stuff they’d send to the lab. It will take 2 weeks to get results and the most likely scenario is a "sporadic chromosome" which just means the whole thing was random and the embryo was missing some important stuff and it was a fluke and doesn’t raise my likelihood of future miscarriage. There is also a possibility that it could be extra chromosome bits and then we would test my blood to see if it was from me or from the donor. And obviously, if it’s the donor, we will switch. There is also a slight chance that the cells they need won’t grow and we won’t be able to know anything. But she said that once a heartbeat is seen, that’s less likely. She also said that most cases where a heartbeat has been seen are the flukey sporadic things. But we’ll know more later. Information junkies that we are, this is HUGELY comforting to us.

I stayed on the table a bit longer because it was cramp-o-riffic in there, but eventually I tried sitting up and realized it felt better. Standing was better still, although I felt shaky and unsteady and weird. The valium, by the way, definitely made me a little woozy and surely helped my muscles not tense too much, but the experience of the suction thing was not the sort of thing you could just glide through on a valium cloud. It sort of woke you right up. Still, valium’s valium and I’m never one to turn down a good drug. It may be what’s allowing me to write this right now.

Then we got a cab home. My sister came over briefly and it made me happy as much because I love her as because she is having a really hard time with this and has grief of her own and I thought seeing us and seeing that I’m fine and as normal as is possible might be good. So I felt better that maybe she wouldn’t worry as much.

And now it is time for bed, I think. I feel totally zombie-like and imagine this could last a while. And, to be honest, it’s what happens after zombie-ville that scares me now.
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A note on language:

Number One Least Favorite Dead Baby-Related Phrase: "She lost the baby."
I did not LOSE the baby. I did not misplace it. It died.

Runner up: The term "miscarriage"
I did not somehow mis-carry the baby. I did not carry it poorly. I carried it just fine. It died.

I try to be sensitive to social mores. Most of the people I told today, I told I was miscarrying. But I didn’t like it. When possible, I said, "The baby died."

Language is important. Being careful and precise and honest with language is important. Weird misogynistic uses are everywhere. Just something to think about.

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Finally – I really can’t thank you all enough for your kind words. A special thank you to those of you who posted such kind things on your own blogs. I will never be able to express how grateful we are and how much it means to Wes and me.

This. is. really. hideous. crap.