The Little Embryo That Couldn't

 Staring at the screen in front of us, my husband grabbed my arm 30 seconds before the doctor said: “There’s no heartbeat.” 

He already knew.

I’ll always remember those words; how they stabbed my soul and jolted me into an inconsolable state of loud gasps and uncontrollable tears.

I remember thinking to myself: “The twinkle light went out.”

In case you’ve never seen the heartbeat of a six-week embryo in a live ultrasound, picture a tiny blinking dot that goes on and off, on and off, on and off. Like Christmas string lights, but Polly Pocket edition.

Miscarriage 101

The official terminology for miscarriage is spontaneous abortion. I learned that ‘miscarriage’ is used conversationally to avoid associating spontaneous abortion with induced abortion (the elective kind). Regardless of your word preference, both are defined as the natural loss of pregnancy before 20 weeks of gestation.

The American College of Obstetricians and Gynecologists (ACOG) estimates miscarriage is the most common form of pregnancy loss. And according to this Stat Pearl article from The National Center for Biotechnology Information (NCBI), 26% of all pregnancies end in miscarriage and 80% of them occur in the first trimester.

Many women are aware that miscarriage is a possibility. Some might catastrophize about it, some might pray for it not to happen, and some just don’t give it the headspace—I was a mix of all these women. I’d heard that miscarriages were more common during the first trimester and heard the stories of women who’d experienced this loss. I felt deep empathy for them. However, now I know I was oblivious. I was farther from understanding that heart-rending pain than a marathonist is from her finish line at the start of the race (and that’s a four-hour run).

To say that this broke my heart would be a massive understatement. My soul was broken, my spirit was broken, my life was changed.

 A New Year’s Baby

I found out about my pregnancy early on. At five weeks and a few days, I was at the doctor’s office having my first ultrasound. After a brief conversation, he told me my due date was January 01, 2022; I was thrilled. The first day of the year is my favorite holiday and celebrating New Year’s Eve is my favorite family gathering. It fills me with joy and hope and all the goodness in the world.

“Come back next week,” the doctor said.

I thought he meant next month. And so did his assistant. And although I found it odd, amazingly I didn’t overthink it (kudos to my therapist).

Apart from the micro interviews with my doctor, I was reading Emily Oster’s book Expecting Better for the second time and was constantly skimming through the pages of Pregnancy, Childbirth, and The Newborn. Not to mention I received weekly notifications from the Baby Center app. So, I felt relatively covered with my pregnancy information at this stage.

Getting Caught Off Guard

We returned to the doctor’s office a week later, now over six weeks pregnant. While in the examination chair and staring silently at the live image of my uterus on screen, I asked if everything was OK.

“It’s not growing properly,” he said. 

I was six weeks and five days pregnant, and the embryo’s size matched the growth for six weeks and one day—not five.

My mind immediately went to a place of “What did you do wrong?” 

Out of the countless potential problems that I could have imagined, my baby not growing at an appropriate rate, wasn’t even on my catastrophe radar.

And I guess now is a good time to tell you what I didn’t know then, and therefore, didn’t panic over: a slow-growing embryo is a red flag for a potential miscarriage. The team behind this clinical article said it best: “Early first-trimester growth restriction is associated with subsequent intrauterine death.”

When the Lights Went Out

Finding out I was pregnant one week, and learning I was on the road to miscarriage the next, was overwhelming, uncomfortable, and emotionally exhausting. I went to four appointments in three weeks because we needed to monitor the situation closely. The farther the baby grew from its age in weeks, the higher the probability of my pregnancy ending.

Every time I went in for the ultrasound, I held my breath. The phrase “preparing for the worst, hoping for the best” never felt so true. It reminded me of the lady in the thug cat video—she’s observing the mischievous cat whose eyes are fixed on her, but whose paw is getting closer and closer to the glass, about to push it over the edge. I’m sure that like me, she was holding her breath, hoping her cat would spare that one glass from shattering all over the floor. But it didn’t.  

On our next-to-last ultrasound I was closer to eight weeks, and the embryo had ‘grown’ to six weeks and two days now. It was not a good sign.

That was the last time we saw the blinking light-like dot, before it went out for good.

The Aftermath

The best unsolicited advice I can give, should you become pregnant or face a similar situation, is to get informed.   

THERE ARE THREE COMMON PATHS TO FOLLOW AFTER A MISCARRIAGE AT THIS STAGE: 

• Expectant Management: wait for your body to expel any embryonic tissue naturally, a ‘wait-and-see’ approach.
• Medical Management: the doctor prescribes medication to help your body pass the remaining tissue.
• Surgical Management: you go through dilatation and curettage—involving minor surgery (this was my case).

Your doctor or healthcare provider should walk you through any risks and considerations around each option to support your informed decision-making. 

Choosing to undergo minor surgery was the right choice for me. I can’t say for sure, but I doubt that consciously passing any remaining tissue would have strengthened my mental health at that moment.

THE POWER OF SHARING

The first thing I did after the doctor said there was no heartbeat (and after crying my life out) was text my therapist. No one knew I was pregnant. Not our families, not our friends, not our colleagues. And I wanted to tell them. I knew I needed the space to feel, to be, to do nothing, and to see no one. However, I couldn’t disappear from my job, nor ghost my close friends and family.

Being her amazing self, my therapist gave me a simple framework to keep the news short and to hold difficult conversations without oversharing and overexposing myself, while in that fragile emotional state.

So, I focused on three key points: 

• What happened
• How it made me feel 
• What I needed from them

I’ll be forever grateful.

Forever grateful to her for helping me navigate through this turbulence, and to those family members, close friends, and colleagues on a need-to-know basis, who offered their empathy and support via kind words and soul-nourishing messages.

Light at the End of the Tunnel

These are a few things that allowed me to make peace with myself and to experience this grief with enough self-compassion: 

Getting informed. There’s nothing I could have done to prevent or avoid it. According to this review, approximately 50% of pregnancy losses are caused by chromosomal abnormalities. Particularly before 12 weeks.

Choosing the right healthcare provider (for me). My doctor noticed something was off, and acted on it from day one. He was thorough and transparent when explaining our situation and our choices. He answered my thousand questions without rush and was exceptionally empathetic. This was fundamental to keep my mind in the right place.

Respecting my emotions. Even if my loss happened shortly after eight weeks, I should never belittle my pain, nor undermine my experience. Losing a pregnancy is devastating at any stage.

Sharing my experience. I decided what I would share, how I would share it, and with whom. I also talked to women who are close to me, and who shared their own experiences. There’s a healing component in normalizing this conversation and in acknowledging the hurt. I don’t need to hear it will be alright and I’ll have a baby eventually (I have faith in that). I just need you to join me in recognizing how much this sucks.  

Prioritizing mental health, rest, and recovery. Loss is hard. I didn’t just lose a pregnancy. I lost the illusion of a baby, of a child, of our extended family. I lost hope. So, I gave my mind and my body the immediate attention they deserved.

Recognizing that this is not only happening to me. My husband didn’t ‘support’ me. He went through this with me. When it came to feeling the feels, I chose to share mine and he chose to share his. Transparency and empathy helped us connect and ultimately strengthened that unique bond that keeps us together day in and day out.  

Honor Your Needs

Healing is not linear, and loss can look and feel different for everyone. Miscarriage takes a deep toll on our bodies, our minds, our emotions, and our relationships. Consider taking care of yourself by voicing your needs, asking for help, and for the space you need—whenever you need it.