Thursday, February 23, 2012

From positive to negative, Part 1: All of the damage, none of the joy.




From Positive to Negative: What to expect after pregnancy loss.

Part 1: 
All of the damage, none of the joy.


Hope deferred makes the heart sick . . .
 (Proverbs 13:12)
A positive pregnancy test doesn't just tell you that you have some new, crazy hormone in your body that is causing a ridiculous amount of nausea, weepiness, and an altered personality.

That positive pregnancy test is a promise.

A promise that, in your near future, you will hold a baby in your arms. Not just any baby.

Your baby.




When that promise is broken through miscarriage, stillbirth, or ectopic pregnancy, it's not just your pregnancy status that changes -- you change. Sometimes, those changes feel scary and are unexpected. Sometimes they are temporary. Sometimes they are permanent.

And each one can leave you reeling, wondering when -- or if -- you will ever feel "normal" again.

Two months out from my loss, I can tell you I continue to evolve week after week, day after day, and sometimes, hour after hour.

I have felt absolute despair that I would never find a reason to smile or laugh. I've had hope that a day will come that won't be consumed by my loss -- and at the same time, feel terrified for the day  that I would forget my baby. I have struggled with feelings of utter worthlessness. I have questioned God, my faith, my family, and everything I normally hold near and dear.

If you have lost a baby during pregnancy, you can probably relate. There is nothing natural about losing a pregnancy, nothing normal about losing a baby. And your body, your heart and your soul know this and will react very tangibly to your loss.

In this series of posts, I hope to expose what happens physically when you lose a baby, what you might experience emotionally, and helpful ways you can try to piece your life back to a "new normal."

Part 1: All of the damage, none of the joy.

First, a disclaimer. I'm not a medical professional. (And I do want to stress that it is important you find a trusted OB/GYN or midwife during your pregnancy loss experience.) I'm just a girl who went through an ectopic pregnancy and likes to read lots of books. Lately, those books have been on pregnancy loss. I've also been talking to lots of people about their pregnancy loss experience.

I've used those resources to try to capture a list of what to expect following a loss. This is not an exhaustive list. Everybody reacts in a way that is unique to them and their situation. And your experience will depend, in part, on how far along you were in your pregnancy.

But this list is for those of you who have never been through a loss, and wonder what the "big deal" really is. And it's for those of you who have experienced a loss, and wonder if anxiety attacks, crazy cycles and insomnia are all normal. (And the answer is, yes.)

Your postpartum body. As someone who has had a live child, I can tell you that postpartum brain and postpartum body are not fun to deal with. But at least with Madelyn, I had a baby at the end of it. With a pregnancy loss, you have all of the damage and none of the joy.

You may experience excess baby weight that you will have to work hard to lose. You may lose hair. (My hair came out in clumps in the shower after my daughter, Madelyn, was born). Depending on how far along you were, your skin can take up to a year to go back to pre-pregnancy state. You might retain fluid, get constipated and have a hard time peeing. (Or, you just might pee a little bit every time you laugh, cough or even so much as blink your eyes). You might have hot flashes and night sweats just like you are in menopause.

Your belly might still be swollen. I've read it can take up to 6 weeks for your uterus to return to it's normal size. Because of swelling from my surgery, I had to break out maternity clothes only after my loss. Looking more pregnant after my loss than I did while I was actually pregnant felt like a cruel joke.

Stretch marks and scars (if you had surgery) are a constant physical reminder to your loss that don't go away. (But both do fade over time.)

Mommy brain. We all joke about it when we're pregnant: "The bigger my belly gets, the smaller my brain is." We can't remember simple things like, "Now why did I walk into this room?" after brainlessly wandering in (and out) of that room three times in a row. Then there's the inability to finish sentences, remember names, or talk of anything but baby.

The bad news is, that mommy brain can continue for weeks after you've lost your baby.

I remember going back to my work, and forgetting things I was supposed to bring, saying all the wrong things, and forgetting people's names. And this was three weeks out. Often our very deep feelings of grief can exacerbate mommy brain. It's hard to know where grief begins and postpartum brain ends.

Still feeling pregnant. As the hCG hormone drops in your system (which can take weeks), you might actually still feel pregnant after your baby is gone. For over a week after my surgery, I struggled with morning sickness -- even more so than when I was actually pregnant!

You might also feel pregnant because you are in denial. Sometimes, I look at my belly and wonder why it's so flat. This isn't what a 16-week bump should look like, I think. And then I remember, I'm not 16 weeks. God hit the stop button at 7. And that's as far as I'll ever get with my baby. Your brain is super powerful, and can make you feel baby kicks that aren't there, get sick when you aren't pregnant, and have mood swings just like before you lost the baby.

Late and irregular cycles. After the pregnancy loss, it will often take weeks for your cycle to resume. When it does, the duration and intensity of your cycle might change, and it may take time -- even months -- to normalize.

(Just an important note -- when you miscarry or lose the baby, the associated blood is not considered a period. When your doctor tells you to wait a few cycles before trying again, you do not count the time of bleeding during your loss as a cycle.)

Your body might not register the loss of your baby. Or your body might recognize the loss, but is unable to pass everything on its own. When my body recognized that the baby wasn't viable, it did try to miscarry. It shed my uterine lining in what appeared to be a miscarriage. However, my baby was in my fallopian tube, not in the uterus. My body's attempts to "resolve" this pregnancy were incomplete. After my tube ruptured, I needed emergency surgery to remove the baby, the blood I lost, and my placenta.

You might need a D & C, or medicine to help get things started or finished. I will let a licensed medical professional give you advice on these procedures -- just be aware that you may need outside help. Each intervention comes with its own risks and side effects that, physically and emotionally, will add one more layer to get through in your healing.

Your body might let the baby go naturally. Pregnancy loss is the passage of a child leaving your womb in a condition in which the child cannot live. Often, that comes with lots of blood, and lots of pain. It can happen over hours, days or weeks. Your cervix will need to open. For women who lose the baby very, very early, it may feel like it is just a really bad period.

For those further along (as in, at least 6 weeks gestation and on), the pain can be anywhere from uncomfortable to excruciating. Many people do not understand that women who miscarry babies still labor and deliver, even if they are technically "miscarrying."

There is often a lot of blood and a lot of pain involved.

We all know how there is nothing that gets a woman to talk like bringing up delivery stories. I feel that women who miscarry have that same need to talk through their experience. Passing a baby is very physcial, and can be a painful and traumatic experience.

Sex . . . What sex? Some people have a change in sex drive after a loss. I know I did. I researched this, and came across many reasons: You might associate sex with conceiving a baby. You might be struggling to be vulnerable with your spouse. Your hormones might be causing vaginal dryness, making sex uncomfortable. You might be upset at using contraception.

I don't think I ever put together why I didn't want to have sex. Maybe "mommy brain" was keeping me from thinking of my issue in a cerebral way. Whatever the reason(s), I didn't care if I had sex ever again. EVER. In fact, if it didn't take sex to make another baby . . . my husband might have been very unlucky indeed!

In time, I did warm up to the idea again -- but only with much prayer and much patience from my husband.

Just a note -- many doctors do recommend waiting the normal 6 weeks before resuming sex after losing a baby. Discuss with your doctor when it is safe for you to resume having sex.

Postpartum depression and grief. Postpartum depression is a hard one because many of the symptoms are considered normal in grief. According to one source, here are the symptoms of postpartum depression:
  • Agitation or irritability
  • Changes in appetite
  • Feelings of worthlessness or guilt
  • Feeling withdrawn or unconnected
  • Lack of pleasure or interest in most or all activities
  • Loss of concentration
  • Loss of energy
  • Problems doing tasks at home or work
  • Significant anxiety
  • Thoughts of suicide or death
  • Trouble sleeping
From what I have read, it is normal to want to die to go be with your baby. What you need to be alarmed about is if you actually start making a plan. If you find yourself planning your death, please get help. You can call the suicide hotline at 1-800-273-8255.

While symptoms of grief and postpartum depression overlap, please be aware that some depression is caused by chemical imbalances in your brain. Those imbalances are going to make your grief that much harder to walk through. Please discuss with your doctor and/or counselor to see if you might benefit from anti-depressants to address these imbalances.


Mood swings. Surviving the loss of your baby can feel like riding an emotional roller coaster without a seat belt. You might feel up one moment, down the next . . . and all you can do is hang on for the ride and hope that the next bend won't be your demise.

I'll be discussing much more about the emotional aspect of pregnancy loss in Part 2 of this series. But our physical experience very much informs our emotions, and those emotions can change day-to-day . . . moment-by-moment.

You might start to feel better one day . . . then crash the next. Or, one moment feel very accepting of your situation, only to see a commercial for diapers and lose it. Feeling out of control emotionally is very normal. Give yourself grace as much as you can as you try to survive this crazy ride.

Let's talk boobs. After having Madelyn, milk production hurt. My boobs were engorged, and it was NOT fun. Making milk is hard enough when you have a baby to suck it out. I don't even want to think of how hard it is to lactate with no nursing baby on the other end.

Since I had an early loss, I did not have to suffer through milk production and engorged breasts. I can imagine that it is very painful, emotionally and physically. There are additional complications such as mastitis that can arise.

A friend of mine has shared that if you do have a stillbirth, or late miscarriage, your doctor can prescribe medicine that will prohibit lactation.


However, she also shared that some women have found pumping their milk to donate to others therapeutic. Allowing lactation and pumping can actually help minimize postpartum depression, and can help your uterus to shrink more quickly.


Lactaction is pretty complex. But if you have never lactated before, a simplified way is to know that demand increases supply. Pumping tells your body there is an increased demand, and you will produce more milk. However, if you do lactate and don't release the milk, you can come down with mastitis, a very painful infection in your breast.

Again, this is another issue where it's important to talk through all your options with your doctor to come up with the best plan for your health and comfort.

One more note on boobs -- even if you don't produce milk, you may notice that your boobs actually get smaller than they were pre-pregnancy. Most people believe that your boobs shrink as a result of breastfeeding -- but the truth is, it is the pregnancy itself  that causes your breasts to get smaller.

You might have trouble sleeping. Or trouble staying awake. My insomnia began the day we found out something was wrong with our pregnancy. For someone who has a history of a sleeping disorder that minics narcolepsy -- this is really a feat.

I am still struggling with insomnia. (I am writing this post at 3:30 a.m. . . . and it's pretty normal these days to stay up till 4.) I have found melatonin to help, when I'm willing to take it. Sometimes I WANT to stay up because it's my only time to process my feelings (and write) without the distractions of a 3-year-old.

I also had times, though, when I didn't want to get out of bed, and wanted to sleep the day away. Sleep changes -- whether sleeping too much or too little -- is normal, although it can be frustrating. My counselor strongly urges me to do the best I can to get 8 hours of sleep. She reminds me that I will grieve, and just function in life much better, if I am giving my mind and body the rest it needs.


You may experience changes in your appetite. You might want to eat more, especially if you know you are an "emotional eater." You might do what I do in depression and lose your appetite completely.

If your appetite is affecting you physically -- you are gaining too much weight, or losing too much weight -- please check in with your doctor.


As we go through the physical changes of losing our baby, it is important that we take care of ourselves as best as we can. If you can't take care of yourself, allow someone else to help -- whether that's having others bring you meals, hiring a sitter (or family member) to watch the kids so you can nap, or finding a helpful doctor or counselor that can walk alongside you.

When you lost your baby, what physical aspect was hardest to deal with? What surprised you the most?


A few links I found helpful:

http://pregnancyloss.info/

http://www.babyzone.com/pregnancy/labor_birth/photos_postpartum-body/3

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/

2 comments:

  1. As far as the milk production goes....there are medicines your dr can prescribe to stop milk production. Especially in the case of a stillbirth, this is important otherwise you'll get very full breasts at about day 3 and no way to get that milk out without keeping your supply going. Pumping will tell your body to make more milk. I have read blogs from moms with a stillbirth that chose to pump and donate their milk for a time. For them individually it helped with the healing emotionally and physically as pumping/nursing helps shrink the uterus and helps with postpartum depression. If it were me, I have no idea what I'd do :(

    ReplyDelete
  2. Thanks so much for sharing. I edited my post to include your suggestions. I should have done more research on options in case of lactation before posting, but I hope that your insight will help others.

    Thanks again!

    ReplyDelete

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