The Painful Silence of a Silent Miscarriage

When I turned 40 a couple of months ago, I enjoyed a few potentially foreseeable surprises: a beautiful dinner with my family at one of our favorite restaurants, an adults-only night out with my husband at a dimly lit speakeasy, an afternoon at a comfortable spa, and to top everything off a surprise party!  I’d never had a surprise party, and when I walked into our apartment feeling loose and relaxed because of the massage I’d just had, I was so excited to see the festive decorations hanging from our living room ceiling and to hear my family and friends yell, “SURPRISE!”  Within minutes of arriving, I was handed a glass of champagne and began to flow from one easy conversation to the next.  It was perfect.  The next day, as I thought about the details of my jam-packed birthday weekend, I was a little sad to know that all of the surprises were over and that it was time to resume normal life.

That is, until a week later, when I was confronted with a surprise I had not foreseen: a positive pregnancy test.  It was a Monday morning at 4:30 am.  My period had not been quite right for the past week.  I finally succumbed to the nagging feeling I’d been having and took a pregnancy test I’d buried deep in one of my drawers a few days before.  While waiting for the result, I put the test on the white rug in the bathroom, sat on the toilet seat, clutching my bent legs to my chest and rocking back and forth.  It didn’t take long for a strong positive sign to appear in the window.  “Oh shit, oh shit” is what I said, continuing to rock back and forth.  My stomach was in knots.  I had just turned 40.  I had three daughters.  My husband and I weren’t planning on expanding our family.  My mind fast forwarded to the responsibilities another child would bring.  We are making it work in NYC with three kids – not an easy thing to do for a middle-class family – but did we have the resources we’d need to take care of someone new?

That morning was the beginning of a fast-moving and emotionally charged roller coaster ride that hasn’t quit for the past six weeks.  Within days of the positive pregnancy test, I was being told by a doctor that the pregnancy probably wouldn’t end well – I had gotten an early ultrasound because I suddenly saw a lot of red blood and the ultrasound detected a tiny gestational sac in the uterus surrounded by an amorphous hematoma.  The blood clot looked like the wavy shell of a giant oyster closing in on a little pearl.  I left the doctor’s office and walked back to work along 2nd Avenue in a daze.  Seeing the tiny sac in my uterus made me feel something.  There was a little boo inside me.  All of my girls had started out that way.  I rubbed my belly through my shirt and moved slowly.

Sure enough, two days later, I started bleeding.  A lot.  I passed a big blood clot and studied it before dropping it into the toilet.  Was the sac inside it?  I took a sick day from work and assumed it was officially over.  Within a week, I had found out I was pregnant and had miscarried.  That was pretty efficient.

Yet as the days wore on, I felt more and more pregnant.  My breasts were sore.  My appetite increased.  I gagged when I scrambled eggs for my girls.  After lunch every day, I felt tired, like a zombie.  At the next ultrasound, which was performed simply to confirm the miscarriage, a miracle: we saw a teeny tiny heartbeat, and the blood clot was completely gone.  The sac was still there, and it was developing.  The doctor said, “I can’t believe this, based on what we saw before, but this appears to be a viable pregnancy.”  There was a second sac in my uterus – undeveloped, potentially a “vanishing twin,” the doctor said.  Maybe the blood clot had formed because that sac was not viable, but there was still something inside me, and I could feel that my body was working hard to nurture it.

I had felt fear and trepidation when I first learned that I was pregnant, but as time passed my emotional landscape changed.  Sure, I was still scared about our financial future.  We count every dollar every month, and we were going to need more dollars.  But with this potential new life I was beginning to fantasize and hope: I imagined cradling a newborn baby again, something I haven’t done in almost four years, pinching baby toes and gently rubbing baby cheeks; I looked forward to breastfeeding; I wondered if we might have a boy – he would have Stephen as a middle name, for my father.  I looked at my girls and imagined what life would be like with a fourth child.  Roxy wouldn’t be the baby anymore.  Our home would be even noisier.  Gigi’s Facetime conversations with her friends would be punctuated by an infant’s cries.  Simone would be old enough to help me take care of the baby.

As my thoughts about the future got more and more involved – every pregnant woman I saw represented what I would look like months from now, every mother carrying a baby in a front carrier symbolized the future me on my afternoon strolls during maternity leave (maybe I would take four months off instead of three…) – my body started to change too.  Even though it was early, I had done this before.  My lower belly started to pop just a little.  My pants became tight, and I wore loose-fitting shirts to disguise what was happening.  My husband and I decided that we wouldn’t tell many people that we were pregnant.  In 2011, before our youngest daughter was born, we lost a pregnancy to trisomy-13 at thirteen weeks, so we knew enough about the risks to want to wait.  But I still kept fantasizing.  And my husband started to think about possible names: “When we saw that heartbeat,” he said, “I figured it was meant to be.”

Two days ago, on a beautiful Friday afternoon, I reported to the doctor’s office for a third ultrasound.  I sat in the waiting room with my eyes closed.  What a pleasure it was to rest in the middle of the day, when my body is usually begging me to get into a ball under my desk and fall asleep.  The technician said, “Stephenson,” and I eagerly bounced out of my chair and followed her into the examination room.  The temperature wasn’t exactly right.  She took a minute to adjust the thermostat until we suddenly felt the cool air rushing through the ceiling vent.  Just as the technician began the examination, I thought I saw the familiar flicker of a teeny tiny heartbeat, but then I lost it.  Maybe the technician had to get closer and focus again.  I could see that the baby had gotten bigger – I recognized the shape of the body and the oversized head.  The technician stayed quiet and moved like lightning: taking measurements of the baby, my ovaries, my uterus.  Meanwhile the fuzzy form of the tiny baby stayed in my view – I noted that it was perfectly still, and I squinted to see the heartbeat again.  Suddenly the technician was done, and she said that she’d be back with the doctor to discuss the results.  I sat alone, waiting, and literally talked out loud to myself.  I said that it could go either way.  Had I seen a heartbeat?  The baby had clearly grown.  Maybe the technician moved quickly because everything was so routine.  Or maybe not.  The doctor came in and said that she wanted to take another look.  My stomach sank.  “Did you see something funny?” I asked.  “Yes, that’s why I want to look again,” she said.  “Can you tell me what you’re looking for?”  I smiled.  “Not yet, give me a minute,” she responded.  The ultrasound image appeared on the screen.  I asked, “Is it a heartbeat thing?”  “Yes,” she said.  “I’m sorry.”  “How long ago did the heartbeat stop?” I asked.  “Sometime last week.”  A silent miscarriage.


With that, all of my recent hopes and fantasies burst into a million pieces.  There would be no fourth baby.  No afternoon strolls during maternity leave.  No baby toes or cheeks to pinch.  No breastfeeding.  This was a familiar feeling.  When the doctor told us in 2011 that the 13-week ultrasound had revealed a catastrophic brain deformity, indicative of a chromosomal abnormality, that pregnancy abruptly ended too.  Was this really happening again?  In the back of my mind, I had acknowledged all of the risks of this pregnancy over and over.  I was 40.  The pregnancy started with a massive blood clot.  We had a history of early pregnancy loss.  But I thought that the odds were probably in our favor.  I thought that this surprise pregnancy, this baby that had miraculously survived a giant, threatening hematoma and that was taking its beautiful, exhausting toll on my body, was meant to be, just like my husband had said.

Now I am no longer pregnant, but the silent, still fetus is still inside me.  My body doesn’t realize what has happened yet.  Maybe I’ll start bleeding within the next few days, or maybe I’ll have to have surgery to officially remove the pregnancy.  Like I did in 2011: it was one of the most traumatic experiences of my life, as I lay wide awake in the procedure room, tears running down my cheeks, while the doctors manually opened my cervix with some kind of metal contraption (I felt like I was in labor while they did it) and then removed the “pregnancy tissue” from my uterus with what sounded like a vacuum cleaner. I am stuck in cruel limbo, knowing that my pregnancy has ended but carrying the remains of what could have been inside me.  My pants are still tight.  I don’t want to eat when I am hungry: the baby deserved to be fed and taken care of, but do I?

I have chosen to write about this today because I haven’t been able to talk about it.  This is a little ironic, because for months now, through my grief work, I have been talking about the importance of telling the truth about death and talking openly about loss and making yourself vulnerable with others when you are struggling with grief.  All of that is hard to do when most people in your life don’t know what you’ve lost and don’t realize that someone is gone.  Early pregnancy loss is uniquely hard, because only a few people in the world have been touched by the life that might have been.  Only a few people have started imagining a real body, a real baby, and what it would feel like, what it would look like, how its being in the world would change the rhythms of life and love and family.  This is all about the future, and not everyone can or should feel the pain of losing a fantasy.

I am sad, but I will be okay.  I am lucky because I have three children, a supportive partner, a life full of interesting challenges that we all bring to each other.  There is plenty of work to do, and plenty of precious moments with my girls for me to savor.  Each of them is a miracle, and I see that today.  I saw it last week too, but somehow today I appreciate it more.

But there was someone else, someone new, inside me whose heart stopped beating last week.  I will never see or touch this new person.  I will only remember what I imagined could be for him or her, and for me.