I'm An OB/GYN. But I Didn't Understand Why Early Miscarriages Were So Devastating — Until It Happened To Me
In our new Realtalk series, we're sharing personal stories about fertility and family planning. We hope they offer support and inspire honest conversation about an incredibly tough topic.
As a maternal-fetal medicine specialist, I deal with all things pregnancy — the good, the bad, and the complicated. As a result, I've diagnosed many women over the years who have had a positive pregnancy test but never had a pregnancy develop. It's what's called a "chemical pregnancy."
It's a hard condition to explain to patients, but I tried my best. In most instances, the woman would be completely heartbroken. The tears would flow, and denial would set in. Ultimately, acceptance would come, followed by a discussion on what to do next.
I have to admit, though, I never really understood why it hurt so badly. Yes, the pregnancy test had been positive, but the pregnancy was very early (usually just four to six weeks). There was never a fetus and never a heartbeat; a “real” pregnancy never developed.
Nevertheless, I consoled. I explained. I explained again. I double-checked for her. I sometimes thought to myself, “How could someone already be so attached to something that never really was?” I always tried to be as understanding as I could possibly be, despite not really knowing what they were going through.
In fact, I only finally understood after it happened to me.
I truly know now why some of my patients react the way they do. I understand the heartbreak.
My Positive Pregnancy Test That Wasn't
After I got married at age 39, my husband and I waited a few months and then started to try to become pregnant. Because I was 39, I immediately tried ovulation prediction during the first cycle. I took an early pregnancy test (about five days before my first missed period) and just like that, I was pregnant! We were shocked, yet thrilled. It was wonderful.
I went to my OB about a week later where the pregnancy test was again positive. Yet the ultrasound only showed a thickened lining of my uterus and no discernible gestational sac, no fetus, and no heartbeat. I wasn’t worried, though, because I knew it was very early, so we made a plan to repeat the ultrasound in a week.
Over the next several days, I started having some pregnancy symptoms, but then they quickly went away. I knew something wasn’t right.
Sure enough, I started my period just shy of six weeks. My “wonderful” didn’t last very long.
After having seen this with so many of my patients, I was convinced I would handle it like a champ. I was so wrong. I was devastated. I cried. I cried a lot.
I couldn’t explain to myself all of the things I had explained to my own patients — what was happening, why it was happening, and most importantly, that everything would be okay.
Since I had already made plans to fly home to see my family in Kentucky the next day, I went. But I couldn’t even talk to my mom or sister about it. Even more, my husband was out of town on business and wasn’t there during this painful time. Dealing with this alone for the first 36 hours was awful. I cried on the way to the airport. I cried during the flight. I was completely heartbroken. And I finally understood.
What You Need To Know About A “Chemical” Pregnancy
The best way to explain a chemical pregnancy is that it's a very early miscarriage that occurs shortly after implantation, or within a week or so of the first missed period — even before a fetus has the chance to develop. It's also called “early pregnancy loss” or “early pregnancy failure."
Many women who experience a “chemical” pregnancy are actively trying to get pregnant, as I was, and take a pregnancy test the day of or even a few days before the first missed period, in anticipation of conceiving. As a result, they have knowledge of a positive pregnancy very early on. On the other hand, a woman who isn't actively trying to get pregnant may simply have a “late” period and never even know that she in fact had a “chemical” pregnancy.
It's believed that around 70 percent of early pregnancy losses are due to “chemical” pregnancies or early miscarriages. A woman of advanced age is more likely to experience an early miscarriage, and the rate increases significantly in women after age 40. I was 39 years old and trying to get pregnant for the first time — so age was likely a factor. Other possible contributing factors: maternal diabetes, significant maternal medical conditions, an unhealthy lifestyle, or hormonal abnormalities.
Because a “chemical” pregnancy, or early miscarriage, results in a late period, nothing else usually needs to be done. But some obstetricians may choose to do follow-up tests on the pregnancy hormone levels until they are undetectable, as my obstetrician did for me.
What I Learned From My Experience
The most important thing for me to realize, I think, was that it was not my fault. There was nothing I could have done to prevent this from happening. For me, the only real risk factor was my age, a reality that I had no control over.
I also had to allow myself to grieve a loss that for most women is truly devastating. I did lose something — something that was going to change my life, and my husband’s life, in the best possible way. I lost something that was going to be “ours." I lost our “what could have been."
I truly know now why some of my patients react the way they do. I understand the heartbreak. I encourage anyone who is having a difficult time to talk about it. I think it's safe to say — and statistics prove — that there is someone in your life who has experienced the very same thing.
In the future, I will take more time to grieve with my patients. I'll feel what they feel on a different level. I'll explain again and again, and I will double-check.
Most importantly, I will understand.
Dr. Shannon M. Clark is founder of the pregnancy and fertility site BabiesAfter35.com.