the appointment that changed everything

A long overdue post...

Shortly after I found out that I was pregnant again at the end of April, I decided that really wanted to work with a midwife during the pregnancy and birth, and John agreed. Pregnancy had become so medicalized for us--charting, OPK's, clomid, prometrium, betas, monitoring of hormone levels. This was nothing like what I had anticipated or wanted pregnancy to be for me, being so measured, calculated, and monitored. After three miscarriages, I was beginning to lose faith in my body's ability to carry a baby and give birth. I felt broken and damaged. I thought that using a midwife would help me get back to experiencing pregnancy the way I had envisioned. I wanted to have faith again. I wanted to trust the process. I wanted to work with someone who would view me as healthy, capable, and whole.

John and I decided that we felt the most comfortable with a hospital birth (as opposed to a home birth or a birthing center). In Virginia, midwives cannot actually deliver a baby in the hospital, so, in addition to working with our midwife, we would be working in conjunction with an OB practice. The midwife had advised that we would have our first prenatal appointment in the OB's office, and that we could see either the OB or the nurse practitioner. Our first appointment would consist of a physical exam, blood work, and confirmation of the pregnancy through hearing the baby's heartbeat on the doppler or through ultrasound. About 4 weeks after our first prenatal visit at the OB's office, I would see the midwife at her private practice for the first time. At this time, we would talk about the rest of my care, including how often I would see her versus the OB. After our 7 week ultrasound where we saw our baby's heartbeat, the RE released us from his care, and I called to set up our first prenatal appointment. It was a significantly longer wait to see the OB, so I decided to go ahead and make our first appointment with the nurse practitioner.

On June 12th, John and I went for our appointment. I was 10 weeks pregnant. When I originally set up the appointment, I thought I would be going alone, as John had a work meeting that he didn't think he could reschedule. Thankfully, it worked out that he could be there with me, and for this, I am forever grateful. I can't imagine experiencing what came next alone.

We met at the office, and had to wait for what seemed like forever. I was getting impatient and irritable, and just wanted to go home and take a nap. Finally, it was our turn. We followed the nurse practitioner to the examining room. She asked me a few questions, and then I undressed for the physical exam. The exam was difficult and painful. She used the fingers of one hand inside my vagina as her other hand pressed firmly on my abdomen. She said that my uterus was tipped very far backwards--to the point where it was resting against my backbone, and that this made getting a measurement of my uterus very difficult. After applying even more pressure, she concluded that my uterus was hard, enlarged, and definitely pregnant. She explained that at this point, with me being 10 weeks along, they would normally try to find the baby's heartbeat using a doppler. Since my uterus was tipped so far backwards, she thought that we certainly would not hear the heartbeat, and she told us we would go ahead and get an ultrasound to take measurements of the pregnancy. I dressed and we waited in the exam room while the ultrasound machine warmed up.

After seeing the heartbeat at just over 7 weeks--a strong, quick heartbeat, and experiencing increasing pregnancy symptoms, I was starting to finally relax into this pregnancy. All of my other miscarriages had happened so much earlier. Having made it to 10 weeks, I really thought everything was fine. I was excited for the chance to see my baby again, to see how much he had grown in 3 weeks.

We came into the ultrasound room, and the nurse practitioner said that at 10 weeks it is generally possible to get a good view of things through an abdominal ultrasound. She warned us that the extreme retro-version of my uterus might make it more difficult to see the baby, but she though we could at least try. I was thrilled to transition away from vaginal ultrasounds, which were always extremely uncomfortable and even somewhat painful. I raised my shirt, rolled down my pants, and they rubbed the cold gel on my lower stomach. She did a quick scan of my belly, but then said that she didn't think we would be able to get a good view, and she said we would have to do the ultrasound vaginally.

I undressed from the waist down, still thinking that everything was fine. I was disappointed to have to have a vaginal ultrasound, but I was still excited to see that little heart thumping away. A few minutes later, a nurse came in and said that she would be performing the ultrasound. I thought this was a little odd, but she assured us that she had performed many, many pregnancy ultrasounds during her days.  Looking back, it seems very strange that the nurse practitioner didn't come back in to perform the ultrasound. I think that there are two possible explanations: either she thought that everything would be fine and that it would be no problem for an experienced nurse to do the ultrasound, confirm the pregnancy was viable, and take measurements to determine my due date. OR that from the quick abdominal scan, she got a sense that something was wrong, and she went to call my RE's office for more information.

The nurse inserted the wand into my vagina, and positioned it to get a good view of my uterus and our baby. I was squeezing John's hand incredibly hard, but at this point, it was simply because of the discomfort of the wand's position. In this particular ultrasound room, there was a monitor next to the exam table, but there was also a television mounted to the wall directly in front of the table. I was staring hard at the screen in front of us. At first, everything looked fine. The baby was significantly bigger than he had been during our last ultrasound. She moved the wand around, silent. I was scanning the screen, looking for that little flicker of his heart beating. But I didn't see it. John and I exchanged concerned glances, and our grip on each other's hand became even stronger. In that moment, I think we both knew. We had so easily and quickly seen the heartbeat during our last ultrasound. There was no flicker on this screen. From the reading I had done, I knew that at this point, the baby should be moving around quite a bit, even though these movements are not felt by the mother for several more weeks. Our baby was quite still.

The nurse was still silent, and kept moving the want around, looking for a different angle. At this point, I said that I didn't see the heartbeat, and asked if I was missing it. In a sad voice, she said that she also did not see a heartbeat, that she had been looking for different angles in case she was missing it. I don't think she took her eyes off the screen to look at us. She took some measurements, and the baby measured 9 weeks, meaning that he had died about a week before. She pointed out a line on the screen that she said looked like was the placenta, and that it had separated from the uterine wall. The nurse said that she wanted to get the nurse practitioner to come and take a look. She removed the wand, and we waited for a few moments. At this point, the reality of what had just happened was really sitting in, and I became very upset.

The nurse practitioner entered the ultrasound room. The wand was inserted again. She took a quick look, and said that she too did not see a heartbeat. She told me to get dressed. I stumbled back into my clothes. She came back in a few minutes later and said that they had called my RE's office, and that they knew who I was right away, that everyone in his office loved me. It seemed like a bizarre thing to say. She then said that they could go ahead and schedule my D&C, or that I could come back in a couple of days for a repeat ultrasound. I was in shock. I said that I just wanted to leave. As John and I were leaving, they nurse practitioner called out to us, "Don't you want your pictures?" The first thoughts in my mind were, "Why would I want pictures of my dead baby?" John went back and got the ultrasound pictures. Later, I was very grateful to have them.

We had driven to the appointment separately, so John asked if I was okay to drive. I said that I thought I was, and we both left to make our way home alone. After pulling out of the parking lot, I immediately called my mother. She answered the phone, and from her "Hello," I could sense her excitement about receiving an update on her grandchild. I felt like I could barely speak, but I must have said something that made sense, because she said that she was on her way to our house.

John and I arrived home about the same time, and I collapsed on the bed, sobbing and incoherent. After a few minutes, we talked about what to do next. John suggested calling the RE's office. I told him that it was after hours, and that we would have to wait until morning. He suggested that we call anyway and speak to the doctor on call. So we did. The doctor called us back in a just a few minutes. I explained what had happened at the appointment. I can't remember exactly what he said, but it must have been the right thing, as this is how I remember it. I do remember that he told us to come into the office first thing the next morning, and that we would certainly see which ever doctor was available for a repeat ultrasound. The rest of the night is a blur of tears and confusion and anger. I called my boss to let her know what was going on and that I would not be coming in the next day.

The next morning, I called the clinic, and they told us to come right on in. Almost immediately, we were taken to the ultrasound room. My RE came in, and we told him about the visit the previous day. He looked at my file and at the pictures from our last ultrasound. He came over for the ultrasound, inserted the wand, and moved it into position. There was my uterus, our baby, but sadly, no heartbeat. He looked and looked, but the heartbeat was no where to be found. At some point, he commented that the baby had grown so much. In his words, I could hear genuine sadness and disappointment. I got dressed, and we met him in his office.

We told him again about the appointment the day before, and I told him what they had said about scheduling the D&C. He was upset that they had not encouraged me to get a second opinion. "You always get a second opinion," he said. He told us that he was glad we had called last night and that we had come in right away this morning. He said we did the right thing. We talked about what our options were. He said that he suspected that there was a chromosomal abnormality in the baby, that this was usually the case when there is a fetal death after observing a strong heartbeat. I asked about waiting for my body to miscarry on its own, and he said that he recommended a D&C for two reasons: 1) so that we could have a karyotype performed on the baby's chromosomes and 2) to hopefully save me from the long, drawn-out and painful miscarriage that was likely to occur after a late 1st trimester fetal death. John and I quickly decided to have the D&C done. The RE said that we could either have the doctor from the OB practice that we were in yesterday perform the D&C, or he could do it. There was no way I was having some doctor that  I had never met perform the D&C, so I asked him to do it. I could tell that he really didn't want to. He even said something about the other doctor being "quite good at them." I again said that I wanted him to perform the procedure. You can read more about the D&C here.

Thinking back on this appointment, it seems even more bizarre than it did when we were living it. Did the nurse practitioner see something during that quick scan of my belly that gave her an indication of the state of my pregnancy? Why did the nurse perform the ultrasound? Why didn't they at least have the OB come and take a look? I feel angry for the way we were treated, angry that the nurse practitioner didn't even have the doctor come in for a second opinion. I feel angry and shocked that she offered to schedule a D&C on the spot.

I also feel really sad that our experience at this practice may prevent me from working with this particular midwife during my next pregnancy. The midwife doesn't work with any other OBs, and right now, I can't see myself going back into that office again. And, with us now having a higher chance of another baby with Down syndrome, I'm not sure who we will want to provide our prenatal care. I don't know what feels right anymore.

Comments

[oneliner]

Such a sad day. I couldn't go back there,either. And why did they need you to decide right there...on the spot..seconds after you received such devastating news...i mean, really?
Do they not realize that you were in shock. was the scheduling that important?
I'm so, so, sorry that you had to go thru such a loss of such a precious little boy. What a reminder that this is an awful universe sometimes.

[soralis]

I am so sorry that you had to go through all that. I can't belive the OB never came and saw you either.

Take care

[soralis]

I am so sorry that you had to go through all that. I can't believe the OB never came and saw you either.

Take care

[Womb in waiting]

Oh Nikole, your story made me cry for you & John & for lucas too. The story of my second miscarriage was exactly that story except we were at 9 weeks & the baby measured at 8 wks & 2 days, so a week earlier. I know that pain of seeing no hearetbeat, & the staff being strange & it all feeling like a dark nightmare....it is awful...I so hope you never have to go thru that ever again....you have experienced enough loss, more than enough, if only our universe worked in that fair way....im thinking of you & sending you loads of love me xx

[skm]

Nikole I'm so sorry you and John had to deal with those people. I think folks in the medical field need to have sensitivity training once a year or something. My friend used a midwife/doc combo recently. Want me to find out who it was? Perhaps there's another option.

[MoMo]

Nikole....I am so sorry you had to go thru all this...my heart was breaking reading your story. Thinking of you.

[Jill]

Oh, Nikole, I'm so sorry that you had to experience this nightmare. I wish with all my heart that things could have been different for you. It's such a heartbreak to see only stillness on an ultrasound screen where you previously had seen your baby's heartbeat. It's devastating.

[stephanie]

Nikole-What an awful day, I am so sorry you ever had to experience that. It is great the nurse reminded you about the pictures. I did not get any after my first miscarriage, and I really regret that.

[mandolyn]

I am truly sorry.

My husband and I were in separate cars the day we found out, too. I'm still not sure how I drove home in one piece.

I don't understand how non-compassionate people end up with the jobs that they do. It really makes all the difference when you deal with someone who sincerely cares. Do they not offer Compassion and/or Empathy 101 in med school? Why does that have to be hard?

[Alli]

I'm so sorry you and your husband had to go through that. I cried as I was reading that post because it so perfectly describes the confusion and incredulity that goes through your mind when it's happening. I can relate. {{hugs}}

[Ornery]

Thank you for having the courage to share such a painful memory with all of us. Like Stephanie, I'm very glad that you got your ultrasound photos. I refused to take mine and regret it to this day. I so wish I was there to give you a hug, to cry, to grieve together.

[Ella]

This must have been so hard for you to write and so painful to share, yet also very cathartic. You really capture the moment through your writing so honestly and perfectly. A lot of us can sadly relate to this. I really hope the worst is behind you and that soon you are on your way to building the family you so deserve. I also hope you find a new doctor that you are comfortable with. You should'nt have to go through such unsympathetic medical care.

[Kath]

Dear Nikole, thank you for sharing this.

It's so, so sad.

[SaraS-P]

I am so sorry that the news was delivered so poorly. I think medical staff so often messes that part up because they feel awkward delivering bad news. So, they avoid the patient or become cold and detached or just rude. It makes the experience so much more painful. You have had enough pain. I hope that your future care, whoever it may be with, is much better. You deserve it.

[sube]

Sigh. The pain doesn't ever really go away, does it? Sending you a big hug.

[Jennifer]

I'm so sorry Nikole. I totally get the annoyance with insensitive doctors. With our first miscarriage the ER doctor decided to tell me I had a missed miscarriage while I was on a gurney in the hall. While he was a good twenty feet away. Basically shouting it at us.

But I am glad John got the pictures for you. I only got u/s pictures with the first miscarriage since it was the only time we got to 12 weeks. The husband thinks it's weird I keep them but with the recurrent miscarriage issue they may be the last baby pictures I ever get.

Keep getting all your anger, frustration, and sadness out. It helps your sanity. And I've got my fingers crossed for the both of us come September.

[Emily]

Oh Nikole, I'm so sorry this happened to you, life is just not fair is it?

Thank you for sharing your story, I hope it has helped you in some small way by writing it down and getting support from your online friends.

Take care,
Emily

[Ersza]

This is exactly the story of my miscarriage. Strong heartbeat at six weeks. Went into ten week appointment with no signs or symptoms that anything was wrong. My doctor tried to hear the heartbeat, but couldn't. "Probably because your uterus is retroverted." Waited an uncomfortably long time for the u/s machine to arrive and get warmed up. Became increasingly anxious. As soon as she put the wand in, I could see that the baby was dead and there was not enough amniotic fluid. Nine weeks.

Here it changes. My doctor waited while I dressed, then embraced me for a long time. She gave me tissues, and then left me to cry with my husband. She came back again, and offered to send me to the radiology lab for a better ultrasound. I knew I didn't need it to be sure, so I refused. Then she counseled me that a natural miscarriage would be safer for me since she doesn't like recommending invasive surgical procedures unless they are necessary. However, if I wanted a D&C, here are phone numbers, they are done on Tuesdays and Thursdays, yadda yadda. After the doc was done talking to me (and she was SO kind) a different nurse came in to give me a shot of rhogam. I got a long hug from her while she told me that she had been "in my chair" twice. I received much sympathy and kindness on my way out. I am forever grateful.

I am so sorry this is not the experience you had. I would definitely not go back to that office for any further care. I do believe the nurse practitioner abandoned you. Most certainly with her experience she quickly figured out your baby had passed, but she should have invested the time to see things through with you, not run off to do whatever. My doc told me they get about three miscarriages a week, there, so I think they so sometimes forget that it's not "routine" for the woman who is suffering one. I know it's late, and it's not the same, but I am sending you a huge, long, hard hug that you needed that day and didn't get. I cried and cried, probably for about 24 hours straight. So sad.

[agness]

I'm so sorry Nikole. I cried for you, your DH and your baby as I read your post. Thank you for sharing it.

It reminds me of my first two pregnancies, though I'm sure it was worse. Especially my first one, everything was supposed to be okay now (after infertility), I felt soooo pregnant, my body wasn't going to let go.

But you had that added encouragement of the heartbeat -- but that was your little angel baby and you got to witness his life even that much more. I know you are probably aching about it, I see the sadness in your posts but admire your optimism as well. I think of you often.

((hugs))

[N]

Thank you for sharing this horrible story with us. I am so so sorry that you had to go through this and hope you never ever have to again.

When looking at myself - the woman that for the heck of it can'g get pregnant, I can only say that I am so gald that I didn't have to go through this horrible experience. You are so strong!

Hugs over the ocean!

/N

[Amber]

I am so sorry Nikole, that you had to go through all that you did. It simple stinks. I wish your experience would have been less painful. Heck, I wish it wouldn't have happened at all, but if it had to, I wish it would have been somehow less painful.
My thoughts are continuously with you.
Hugs,
Amber

[Serenity]

I have no words to describe how very sorry I am that you had that appointment. Your story made me cry for you, John, and Lucas.

Much love to you, Nikole.

[Zee]

I'm so sorry, Nikole. So hopeful and then all of a sudden so devastated. There may be a feeling worse than that, but I can't think of it now.

[Momma Bee]

Just wanted to let you know that I've been thinking about you, and sending healing thoughts. *hugs*

[Sunny]

Hearing your story totally sounds like mine. I felt like I was swimming and underwater. It was painfully slow. I can't get the imagine of our baby, the first image of our alive baby with a heart beat or any of it out of my mind.

I am so sorry you had to go through this.