The Aftermath of Miscarriage: Seeking Answers, Finding Problems
By: Paulina Slama
Tags: Postpartum Depression, Miscarriage, Infertility, Family, Pregnancy

Five days after my miscarriage, I had a follow up with my OB. I sat in the office and watched 3 other big bellied expectant moms glowing with pride and waiting for their appointment. Meanwhile I had my arms wrapped around my stomach, absent of a son, trying to hide the shame that was a failed pregnancy. I was 15 pounds heavier and even feeling my pain of producing milk for a baby that wasn’t there. I had no choice but to allow my body to go through all the things it does when it delivers a child. Meanwhile, on the inside, I was mentally screaming at my insides about their betrayal. I did everything right. I worked out 6 days a week, ate all the good-for-you foods, drank water, never touched the bad stuff. I treated you like gold and you betrayed me of the one thing I needed from you. My OB saw me and gave me what felt like the obligated well we tried hug. I just wanted my answers.

In the appointment, I came to find out that between the time of seeing his nurse practitioner a week prior, to the follow up with the perinatologist two days later, to going to the hospital two days after that, my cervix shortened by half each time. Miscarriage, no matter what could've been done, was inevitable. But they don't tell you that, do they. It's always just a couple concerns. Their job is to make you feel as comfortable as possible for as long as possible. It's only right, right? According to him, my daughter's case of PPROM (Preterm Premature Rupture of the Membranes) at 34 weeks was no coincidence. She’s likely my last relatively full-term baby I’ll ever have. Additionally, he wanted to diagnose me with a little thing called Cervical Incompetence. Not only is the amniotic sac that gets created in every pregnancy going to be weak and cause PPROM, but my cervix can also fail and shorten at any moment. I can make a healthy baby, I just can’t keep it.

So what were my options?

He suggested that a trans vaginal cerclage (TVC) was my best option at that point. It's a stitch they put around the cervix to try and keep it closed and stop it from shortening too much. The success rate on that was about 75–85%. Assuring, but not great. I could also opt for an abdominal cerclage, in which they cut me open and perform a mesh stitch at the top of my cervix, from the inside. That provides almost a 99% success rate against cervical incompetence. Even better. But I needed a second opinion and decided to follow up with my perinatologist.

It was the day before Thanksgiving, when I was able to see my high risk doctor. I walked into her office and received the same awkward and obligated hug. Her job was to deal with broken women,but at least she was able to hit me with the straight facts now that I've gone through losing my child.We both knew I wasn’t about to give up trying. We were straight shots with each other and I appreciated that, after the formalities, we could speak to one another without beating around the bush.

In that appointment I discovered a couple of things: The first being that she can’t diagnose me with cervical incompetence or recommend an abdominal cerclage until I've had multiple miscarriages or failed TVC’s. You mean to tell me, I have to build a collection of dead children for me to qualify? As if I didn’t feel like enough of a failure, I had to prove it. It also posed a risk for uterine rupture and did nothing to help the larger case of PPROM. Well, we can at least rule that option out and figure out the TVC option, right? Wrong. Due to my past of ruptured membranes, a TVC was contraindicated. TVC’s have a reputation of causing PPROM, which I already had a history of.

There was no fixing this. I can try to stop the cervix from shortening but if I can't stop the membranes from rupturing, I had no shot at getting near full term. All the hope that my OB gave me prior to this was completely shot down. I had two doctors, with contradicting views, but they both agreed on one thing: I’m still unlikely to make it full term, no matter what.

So where do we go from here?

If I want to get pregnant it was suggested I do so within 3 months after miscarriage, if I was emotionally ready. PPROM and the possibility of cervical incompetence doesn't get easier over time and the older any woman gets, the harder this is for the baby to go full term. But trying soon after miscarriage can actually increase the chance of keeping baby safe. So no pressure, but hurry up. Once I’m pregnant I go on a progesterone supplement to safeguard the uterus. After that, and once I'm in the second trimester, its full bedrest. I can get up to go to the bathroom and that’s it. I have to make sure there is as little pressure on the cervix as possible and if I run into any complications and my cervix starts to shorten, we would have to run the risk of the cerclage and be admitted on hospital observation until birth. This also comes with zero guarantee it will actually work.

I wanted to break down, yet again. But I had broken down so many times in pity, I just didn't have the energy to do it then. I took my orders, gave my labs, and relayed to my husband. What else was there to do? We need to try soon, with no guarantee it will work. And that also came with the orders that if we do try, expect to lose my freedoms to a bed. What about our daughter? What about our pets? What about my job? We just bought a house, how were we going to do this? Part of me said just to hold off and stop thinking about this, but I couldn't. It was like an instinct that took over to keep trying and don't waste this time. I wasn't able to let any of this go or loosen the grip of wanting to try again. I had to fight this somehow, but the consequences were mounting.