Elizabeth Petrucelli

Author, Blogger, Educator

Category: Awareness (page 1 of 5)

#SuicideAwareness

#SuicideAwareness has been circulating the internet over the last year or so. I am sure it has been around much longer but recent events have caused this hashtag to spread dramatically. It’s a great hashtag and is usually preceded by someone asking to post a status that says, “Share this so others can see that someone is always listening,” or something similar.

Honestly, I roll my eyes at this. Before you jump on the hate train, let me explain why.

I have experienced postpartum depression.

I have been in the depths of postpartum depression. It sucks and I don’t wish it on anyone. It was a surprise to me as I had not experienced postpartum depression after the birth of my first baby. 10 years later, following the birth of my second living child, postpartum depression appeared. I didn’t realize that’s what was happening to me. A therapist pointed it out when I arrived to her office, in tears, fearful that what I was about to say meant that my baby was going to be taken from me.

I don’t share this story lightly. I realize this can hurt my career and any future career. I know that in sharing this part of me there will be judgment and that clients may question my abilities. I also want to assure you that postpartum depression or depression for that matter, does not occur in a vacuum and people can be extremely functional with depression. This is why suicide can be so shocking. There isn’t always a sign that can be seen before, sometimes it occurs after an attempt or completion of suicide.

For over five years, I sat with suicidal patients in a hospital. These patients had either attempted suicide or had what is called suicidal ideation (they are contemplating suicide or have had thoughts of suicide but may or may not have a plan to act on it). Twice I sat with patients who actively tried to kill themselves in front of me or my staff.

I empathized with them although I didn’t understand completely how they could be in such despair. They had people in their lives that loved them and they had their own children and families (people who were worth living for). I sat next to one person who had just attempted suicide. I asked them why they felt so deeply that they should be dead.

The emotional pain hurts much worse than any physical pain I have experienced. 

I will never forget that statement. This person explained that cutting off a leg would hurt less right now than the pain they were feeling. I asked many more questions but ultimately it boiled down to this one statement; how to calm the emotional pain so they wouldn’t want to die. I am not saying there aren’t other excuses for wanting to commit suicide, there certainly are but this really struck me. This person had so much going for them.

As I sat in my therapists office, it took me several tries to say these words, “The other day my baby was crying and I wanted to throw him into the wall.” She stared intently at me and didn’t say a word as I blurted out, “Please don’t take my baby away from me.” She smiled and stated that was not in the plan at this time. I felt safe to also share, “Another time he was crying, I just wanted to smother him.”

I was glad that it was a safe place to share these thoughts with her. They were horrible thoughts and I felt extremely guilty and scared about them. I had lost a child a few years before, why wasn’t I cherishing every moment I was having with this child? Then I made one of the most shocking statements, as if what I haven’t already disclosed wasn’t shocking enough.

My husband left his gun on the counter and when the baby was crying the other night, I looked at it and thought, “If I just blow my brains out right now, the crying will stop.” Then I picked up the gun. Obviously I didn’t use it. I picked it up and placed it in the gun locker and locked it away. Then I closed the door to the storage room it was in. Sure I had the key but I had also placed several steps in front of me that may stop me from using it.

There was so much that went into why I was having these feelings. Lack of sleep, a difficult baby, feeding problems which meant sleeping problems (for the baby and me), unresolved grief from the miscarriage, little help at home (an inability to ask for help),  expectations for how my baby should be compared to my last baby, and hormones. What was even more confusing for me was that I was at least five months postpartum. How could this be happening now?

We talked and came up with some plans. I had already had a day where I handed my husband the baby, bawling as I looked at him and said, “I am not leaving you or the children but I need to leave. I need sleep.” My husband looked at me and replied, “You do what you need to do, we will be here when you get back.” If that night away didn’t help me, what would?

When my therapist said to me, “I know you don’t want to hear this and don’t believe it but you have postpartum depression,” I didn’t want to believe it. I couldn’t have depression. People like ME don’t have it. I have a good support system, people who love me, children and family to live for, and very little wants and needs. Plus, I was at least five months postpartum. How could I have “it?”

Ultimately, it didn’t matter, I was in the depths of postpartum depression.

The plans we came up with did not involve medication. I was glad for that and after a few months of therapy, I was feeling so much better. By the time my son was nine months, the fog had lifted, I felt sane again, and I bonded and fell in love with him from that point forward. By twelve months, I was contemplating another child.

Roughly a year later, we were pregnant again but sadly, our son Gus had triploidy and passed away at 10.5 weeks gestation. I processed his loss very well and move through my grief more quickly. I think it really helped having a commendation ceremony/funeral for him.

We had decided that our family was complete and began our journey of utilizing Natural Family Planning (NFP) to avoid having another child. With my age (I was now over 40) and the depression I had experienced, we decided it wasn’t healthy for us to attempt another pregnancy. In Gus’s short life, I had experienced several weird illnesses and was under the care of a GI specialist. This can happen when a woman is pregnant with a baby who has triploidy.

To our surprise, God had other plans for us an in September last year, I became pregnant. Ensuring my mental health was priority and this is something we planned ahead for. I will blog about this journey on another date but it is important to share with you my thoughts on the #suicideawareness and how it may not really be that successful.

It is suspected that a friend and former employee of mine may have committed suicide. There is some speculation on how that happened (not necessarily related to depression) but friends are left wondering how they missed the signs. What signs are those people, who are not experiencing depression, looking for? Are you looking for someone to say, “I am going to kill myself.” How about, “I just want to die.” Or, “I am in the depths of despair.”

What does it look like to you to see that someone is depressed or contemplating suicide. You see, I have reached out in the past and no one noticed. I felt I was pretty blatant in my post. I was really struggling and needed some help that evening so I shared something on Facebook and seven out of 500+ friends of mine responded with a “like.” It was the only way I knew how to ask for help because a person like me doesn’t ask for help. Yet, no one knew. No one saw that my message was asking for help and if they did but did not reach out to me, well…I don’t want to think about that.

So the signs can be there and can be extremely subtle. I am highly functional through my postpartum depression. I smile, I laugh, I visit with friends. I am not crumpled up on the floor.  If you ask me, “how can I help,” or “let me know what I can do,” you won’t get an answer. If you want to help, HELP. Say, “I am going to bring you dinner on _________ night,” or “I will hold your baby so you can take a shower,” or “I am going to pick you up and take you out on _________ night. I have already talked with your husband and he is going to watch the children.” Just help someone when they are experiencing depression. (After I wrote this blog, a friend passed along this article. It has pictures and explains the faces of depression well.)

When I write these down, I see they are familiar. These are some of the same things that can be done when someone is experiencing grief or just had a baby. These are helpful things and when you are doing these helpful things, you are opening the door to conversation, for planning other ways to reduce stress, anxiety, and depression, but most of all, you are showing this person that they are loved.

I see it all the time. “Didn’t _________ know how much we loved them?” Or, “I told them I loved them and that I was here for them but they still are still sad or they still committed suicide.” It might not be enough to say, “I love you.” So it might not be enough to say, “Could one friend please copy and repost? I am trying to demonstrate that someone is always listening. #SuicideAwareness”

Miscarriage and the Flu Vaccine

Several mainstream news sources, to include USA Today, have recently posted articles on miscarriage and the influenza vaccination. Newly pregnant mothers want to know, is the flu vaccine safe in pregnancy? The flu vaccine is recommended for all pregnant women and women are told there is little to no risk in receiving the vaccination during their pregnancy. Yet many vaccinations haven’t been tested in pregnant women. 1 in 4 miscarriage

So let’s talk about it. This is the recently published study by the CDC that shows an increased risk of miscarriage after receiving the influenza vaccination containing pH1N1. The 2017-2018 influenza vaccination looks to have this virus in it. Here are the three viruses for this season:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • an A/Hong Kong/4801/2014 (H3N2)-like virus
  • a B/Brisbane/60/2008-like (B/Victoria lineage) virus

The risk of miscarriage was only looked at for the 1 – 28 days following the vaccine and the woman had to have received a prior influenza vaccine which contained pH1N1 as well. The 2016-2017 influenza vaccine contained A/California/7/2009 (H1N1)pdm09-like virus (I am only listing H1N1).  While the study authors stated that it cannot establish a causal relationship, the association of receiving the flu vaccine during pregnancy and having a miscarriage (SAB) was significant.

What we do know is that pregnant women ARE at a higher risk of contracting illnesses during pregnancy and the flu is one of those illnesses. I used to receive the flu vaccine but as I have aged, I have become allergic to the ingredients in many vaccines. Even if I weren’t allergic, I personally would not receive the flu vaccination, or any vaccination for that matter, during pregnancy. I was pregnant this year and in February, I contracted Influenza B. Not a single person in my family was sick or became sick. I was miserable and I did what I could to protect my baby.

I am not certain where I contracted Influenza B but I do work in a hospital so maybe that’s where I picked it up. My symptoms did not present normally. I did not have a fever at all but I felt very sick, headache, muscle aches, heart palpitations, and I felt like I was struggling to breathe. I put off visiting the ER, mostly because my husband did not want to take me in the middle of the night. In addition, we knew the visit would be costly and that is always a consideration.

It was not easy waiting through the night not to be seen. I couldn’t sleep and honestly, I wanted to be put out of my misery.  Instead of going to the ER, I asked for a walk-in appointment the following morning. When I arrived at the clinic, the doctor was upset I was there and not in the ER. While my oxygenation was fine, I was clearly struggling to breathe. Their concern was that I had been breathing rapidly (over 33 respiration’s per minute) for more than 12 hours and my body would give out and I would “crash.” That was their nice way of saying, die.

I felt absolutely awful but I wanted to avoid the ER so I asked for any testing or procedures they could do in the office. They said they couldn’t test for the flu in their clinic and I would have to go to the ER for that, but they would give me a nebulizer treatment and see if that helped. I did not want to take any medication during my pregnancy but I needed some relief. I was convinced to take the treatment in hopes that it would help and I would avoid the ER.

It did nothing, so we were sent to the ER. I again received an ineffective breathing treatment and was sent home. I was told my blood labs were normal and that my influenza test hadn’t come back but they would call if it was positive. They had no explanation for my illness, other than I must have a bad cold (even though I wasn’t congested at all) and because I was “old” and pregnant, I was responding harshly to the virus. I later learned that my labs were not “normal” but the doctors didn’t believe my labs were indicative of anything.

During the 15 minute drive home, the doctor called my husband to confirm that I had Influenza B. I was surprised they didn’t admit me as my respirations were still horrible but they sent me home with Tamiflu. I hesitated to take the medication. There are no studies of the use of this drug in pregnant women but I needed relief. In addition, I had been symptomatic beyond the 48 hour window for the effectiveness of this drug.

I conducted a little research before consuming the drug. I had immense anxiety over this. I was well into my second trimester and  was passed the gestation where the defects could occur. There were three babies whose mothers had taken the drug who had defects (although some babies were aborted but according to the study, this was not statistically significant). 24 hours after taking Tamiflu, I began to feel relief. By 72 hours after Tamiflu, I was feeling well although exhausted.

I worried throughout my pregnancy that I somehow hurt my baby from the Tamiflu. Only time would tell and a future ultrasound did not show any defects with her heart. Once she was born “normal” I felt okay about taking Tamiflu although it’s still possible she could have been affected but we won’t know until later in her life. So far, all is well with her.

Despite the CDC study, women are still urged to get the flu shot in pregnancy. Why? The reasons cited are to reduce hospitalizations due to complications from the flu, morbidity and mortality, and to pass on antibodies to the unborn baby. This study shows that the influenza vaccine in pregnancy is 91.5% effective in preventing hospitalization of the infant in the first six months of their life (this does not say the infant does not contract influenza). I am sure my daughter has antibodies for Influenza B since I had it.

So what should a pregnant woman do? There is clearly a relationship between miscarriage and having received the influenza vaccination so it would be up to the woman to assume the risk. Do the research, make the decision. I don’t ever recommend just listening to a doctor. I want to be very clear in what I am saying; the doctors recommendation IS important; however, it should not be the only deciding factor. If a woman receives the vaccination and then miscarries, how would she feel knowing that ?

I know I would never forgive myself so I choose not to receive vaccinations during pregnancy and most especially during the first trimester. Only you can decide if it’s right for you. As someone who has experienced miscarriage twice, I worry so much during subsequent pregnancies about losing the baby and anything I can do to reduce that anxiety is helpful. Once the baby is born, I know there are many things I can do to help keep the baby healthy and I follow all those precautions and recommendations during such a fragile time.

Making the decision to receive or not receive the flu vaccine is difficult. There seems to be good research out there to help make an informed decision, although much of it is irrelevant if the baby does not make it to term if the flu vaccine causes miscarriage.

The Struggle to Go In – When Baby isn’t Moving Regularly

I specialize in pregnancy loss. I have been working with women for six years now, in differing capacities as a perinatal loss specialist and bereavement doula. In my childbirth education classes, we review fetal kick counts, fetal movements, and I share that it’s a myth that babies “run out of room” the farther along in pregnancy women get. We talk about being intuitive with the baby and knowing what is the normal pattern for the woman’s individual pregnancy and baby. Each baby may not fit the pattern of X number of movements per hour but if you know how your baby moves and what you can do to get your baby to move, then it’s easier to tell when things are “off.”

If you didn’t know this, as of the writing of this post, I am 30 weeks pregnant with my 5th baby (hopefully 3rd living). Yesterday, I had a scare with my pregnancy and it was very interesting for me to see how my mind was responding to this scare. I know I had been little more anxious this past week but I chalked that up to a few new clients with stillbirths and a few stories that popped up in my Facebook feed about late losses. It had me on edge more than usual and I was listening to baby more than usual on my home doppler. That always brings me reassurance but I had found I needed the reassurance more often.

I was having periods of contractions the last few days as well. These were not typical contractions. My belly was tightening but I was also experiencing cramping and some pressure. Knowing my body, even though they were uncomfortable, I did not think these were contractions that were dilating or effacing my cervix. On Wednesday night though, I was very uncomfortable so I took a bath; which helped for a few hours but then things picked up again.

I decided to try to get some sleep and listened to the baby just before I fell asleep. She had an episode where her heartrate was really high and then dropped but then she stabilized and all seemed fine. Throughout the night, I was not feeling her. I get up often, roughly every two to three hours, because my bladder calls and when I return to bed she usually “tickles” the side I am laying on before we drift off to sleep. I briefly noted that this was not happening.

By morning, I figured my cup of coffee would rouse her. Nothing.

I took my son to his dentist appointment and didn’t feel her at all so we went to the store and I got a donut. The worst kind, a frosting filled, maple iced, long-john. Surely this amount of sugar would get her moving. Nothing.

I wasn’t worried at this point but just noted that she wasn’t moving much. I thought I had felt a few punches earlier so I rationalized that I had felt something but really knew I was feeling nothing.

I sat outside with my youngest while he played in the driveway. It was a nice warm and sunny day. I lifted my shirt to expose my belly; which was something that usually got her moving. Nothing.

After a few hours outside, I returned inside and sat at the table and did some work on my computer. I leaned forward to sort of “smush” her hands because that would usually get her moving. Nothing.

I grabbed my doppler at this point and listened. THUMP, THUMP, THUMP, THUMP, THUMP. Her heart rate was in the 130’s. Normal for her. But she didn’t punch or kick the doppler like she always does. Ugh!

I had to go to an appointment at the church. I figured I would start to contract and get her moving because it was “that” time of day where my uterus liked to pick up and do something. Unfortunately, on the drive there, my uterus was silent, but so was she. As I got closer to the church, I decided to feel for her. She always moves her foot away when I push on it. I located her foot and pushed. Nothing.

When I arrived to the church, I parked and sat for a moment. I talked to her and told her she needed to move. Nothing.

I hummed and sang; which usually got me a kick. Nothing.

Then I located her butt and pushed down on her. I could feel her whole body move down into my pelvis. I felt the pressure of her head on my cervix. Nothing. She was still. I was now worried.

I called the OB office and demanded to speak to someone. I was lucky because they actually transferred me directly instead of “sending a message.” I told the nurse everything I just wrote above and she said I should be seen. I wanted to go to the clinic but it was 3:30 on a Friday afternoon and even if I got there before 4, the doctors wouldn’t be there long enough to read the strip. She said I had to go to L&D. Oh how I wish there were more options with my HMO. It’s very frustrating.

I texted my mother-in-law to see if she was available to watch the kids and went into the church for my appointment. It was quick and I returned to my car anxious about the baby. She wasn’t moving at all. I was going to leave straight from the church but I kept feeling like even though she wasn’t moving, she was okay.

Then all the questions in my mind began.

“She’s probably fine.”
“It’s probably just a growth spurt.”
“It’s going to cost me a fortune to go to L&D”
“I am going to get there and she will move like crazy and then they will think “I” am crazy.”
“It will end up being a waste of time and money to go in.”
“I heard her on the doppler and her heart rate was fine, so she is fine.”
“I don’t want to go and be admitted.”

I am sure there were many more things going through my head. I called my mother-in-law to tell her what was going on. She had texted a few times and called me but I couldn’t respond. She rationalized with me and said everything was probably just fine. We talked for what seemed like, FOREVER. I just wanted her to say I should be seen but I never heard that. I just kept rationalizing and since I was going back and forth, I decided to drive home.

I called my husband on the way home to update him. He didn’t have an answer for me either. He just kept saying that it was probably a growth spurt and she was “tired” because I had been in so much pain the night before.

“What if the cord is wrapped around her and she isn’t getting enough oxygen?” You would hear that on the doppler as her heart rate would be struggling.”
“What if my placenta isn’t working right and she isn’t getting enough oxygen?” Same answer as above.
“What if there is something wrong and I don’t go in and she dies?” There is probably nothing wrong.
“What if…”

All my concerns were shot down, either by my husband or by my mother-in-law. In all honesty, I was shooting some of my concerns down as well. But the back of my mind kept saying, “What is your advice to women who aren’t feeling their baby move regularly?”

If your baby’s movements stop, change, or are concerning to you, be seen!

I couldn’t even follow my own advice. I stress this in my classes. I stress this to women in pregnancy after a loss and here I am…the professional…struggling to follow my own advice. How are women going to follow this advice if I can’t?

I got home and laid down on the floor on my back. Surely this would get her to move? Nothing.

I poked her. Nothing.

I listened to her on the doppler. THUMP, THUMP, THUMP, THUMP, THUMP. Her heart rate was in the 140’s.  She still didn’t kick the doppler.

I grabbed some apple juice and a snack and went outside with my son who wanted to play again. I drank the apple juice and sat on the bed of the pickup truck. I had been talking with my mother-in-law who decided that we would have dinner together and decide then.

It had now been at least 18 hours since I felt any real movement from her and in the next few moments, I felt her move. It wasn’t much, but it was more than she had given me all day. This only began to complicate things more for me.

I had dinner with my mother-in-law and had two slices of pizza and a Shirley Temple. This would also HAVE to get her moving, I thought. Nothing. Nothing for an hour!

It was now after 7pm and I really needed to make a decision. I posted on one of my Facebook groups and every person who responded said to go in. I knew I probably wouldn’t sleep much if I didn’t and I knew that I would question every second of her silence. So, I opted to go in. It was such a tough decision and I didn’t want to waste the money but there was that “what if.”

So here is when things really got crazy for me. In the car on the way there, she started to move. I began to actually feel kicks. I hadn’t felt a single kick all day. We almost turned around but decided to go in anyway. Five minutes on the monitor had her moving like crazy. It was like she was dancing inside me and I was so frustrated that this happened to me and I was now here. She even got the hiccups and we decided she was fine. 12 minutes on the monitor and they said all was good with her. 

It took longer for them to “check me in” and “update my chart.”

They were about to discharge me when they took my blood pressure. It was high. While baby was fine, there seemed to be something else going on with me. It took two more hours, a urine test for protein/creatinine, and blood pressure checks every 10 minutes, before I was able to go home. Diagnosis, I have borderline high blood pressure which needs to be followed up on.

I learned quite a bit though. I learned that even though I know when I am supposed to go in, it’s not as easy as it sounds. I learned that I should have gone in earlier when the decision was technically easier. I learned that it’s not as simple as “go in if your baby isn’t moving regularly.” Now I just need to take all this information and work on a new way to present it.

Was it worth going in? Absolutely!

Pregnancy After Loss – Bargaining

Day 1 - miscarriageWhen you pee on that stick and see the positive, you are elated…usually. Even in pregnancy after loss, there are moments of excitement which appear immediately upon seeing the positive test but it isn’t usually long until the worry and anxiety sets in. It’s almost as if entering pregnancy after loss means restarting the stages of grief.

Bargaining!

We will do whatever we can to ensure this baby will come home. That includes delivering early either by c-section or induction. I’ve been there, begging my OB to induce just so I could bring my baby home alive.

Hiring a doula – Some women will hire a doula immediately after peeing on the stick…as if to say, “there, now the baby HAS to come home alive with me because I hired a doula.” We know this isn’t true, but absolutely feels like this can be a sure way to ensure a living baby at the end.

Testing – Some women have as much testing as possible and others refuse all testing.

Ultrasounds – Extra ultrasounds, one each week or more is another way to “bargain.” If I see the baby more often, I might be able to pick up on something that is wrong earlier and hopefully correct it.

Creams – Progesterone creams or other hormonal treatments can be another way women bargain with the universe to keep their baby.

Herbs – Special herbal remedies were definitely something I explored. I remember trying False Unicorn Root during my pregnancy with Ruby. I just KNEW I would get to keep her because I was taking it. She died only a few weeks after starting it.

Prayer – If I pray more, go to adoration more, attend church more, etc…God will give me this baby.

Heck, I would have hired a drummer to come into my home and drum on a daily basis if that would have guaranteed I would bring my baby home. But we know, nothing can guarantee that.

Sometimes it’s about rituals; appointments at the same time and on the same day of the week.  Or still others have avoidance rituals:

Never returning to the same doctor/hospital/clinic.

Not purchasing anything for the baby until they are here.

Not announcing the pregnancy until very late in pregnancy or not at all.

These are all forms of bargaining. It’s a way for us to feel a sense of control. We desperately need to feel in control. We need to feel that we can do something, anything to bring home a living baby because the opposite of that is so extremely painful we feel we won’t survive again. Another loss feels as if we would surely die.

I think deep down we know that it’s still out of our control but we really need to feel a sense of control so we do things. Things that can confuse others and sometimes even ourselves. It’s not wrong to do these things. Some of them may help but at the very least, they help us feel better and as long as we are not putting ourselves or our babies at risk, then why not?

How Far Along Are You?

early pregnancy testWhen a woman discovers she is pregnant, the inevitable question is immediately asked.

How far along are you?

I will say that we had known for weeks before we shared with a few select people and waited even longer to share with the rest of our close friends and family. Some, were kept in the dark longer. I really enjoyed keeping the secret and once it was out, it was a bit disappointing. The pressure also began. The pressure to be farther along than I was so that this baby would matter if this baby died.

The constant question “how are you feeling?” by the people who knew brought on the anxiety but the question, “how far along are you?,” would stop me in my tracks. I had to think about it for too long. Sometimes adding days or weeks to the gestation, just so the baby would mean something to the person asking.

It’s an innocent seeming question but for someone experiencing pregnancy after a loss, this is a loaded question. In all honesty, it feels judgmental.

How far along are you means, I want to know if you are “really” pregnant.

I assure you, there was a second line on the test, I am pregnant.

How far along are you means, I want to know if you are far enough to in the safe zone.

There is no safe zone.

How far along are you means, is the pregnancy far enough to be a considered a baby yet?

It was a baby from the moment of conception (for me anyway).

How far along are you means, you are trying to legitimize my feelings of grief should this baby die too.

My grief is legitimate no matter how far along I am.

How far along are you mean,s that the farther along I am, the bigger the baby, the more worth the baby has.

My baby has worth no matter how small or early he/she is.

As I get bigger, how far along are you, takes on a different meaning.

I am closer to delivery yet still not quite there. Will I make it with the baby alive?

I know the question, how far along are you, seems innocent. It seems like an inquiry and a supportive question but it’s not. It’s loaded, it’s dangerous.

Because if I lost the baby, I will have lost everything I have already dreamed of with her. Yes, her, because I imagined the baby to be a girl. So I have already seen pink and purple, flowers and butterflies, protective big brothers, dancing and singing, a love of reading, nurturing of a girl, bringing out my girly side, dresses for her baptism, communion and wedding. And, I have even imagined her children. Oh and yes…her name.

Call me naïve, stupid, crazy for even beginning those thoughts but it’s impossible not to. It’s impossible to pretend the baby, her future, doesn’t exist or will never exist. I am already in love. Her father and brothers already love her. And if she turns out to be a boy, we will love him too, just the same. So if this is only an “inside baby,” this is what is lost. It will hurt. It won’t hurt because of how short or long I was pregnant. It will hurt because I have loved and lost.

So when you ask “how far along are you? The answer is, it doesn’t matter. Because I am pregnant and I love this baby.

This is pregnancy after a loss.

Dear Self Magazine: Change on Miscarriage Starts With You

Self Magazine published an article on August 5, 2016 entitled When You’re Having a Miscarriage but Have to Work Anyway, by Zahra Barnes. This article helps bring to light many of the pressing issues women who miscarry face such has social stigmas and having to work through a miscarriage. Many women don’t realize that miscarriage can be covered under FMLA as a serious complication from pregnancy or a serious medical condition. Learn more about FMLA for miscarriage here.

There are many good things about the article which focuses on the miscarriage experiences of Ashley Frangipane (Halsey), who suffered a miscarriage while on tour in 2015 and took narcotic pain killers while wearing an adult diaper while at her work venue. No time to have her miscarriage in the comforts of home or safety of a medical facility, if she stopped working it could have been detrimental to her career. This is an issue many women face.

1 in 4 pregnancies end in miscarriage; roughly 10-25% of recognized pregnancies. The statistics are frightening because most women don’t realize how common miscarriage is until they have one. Women are typically silent about their miscarriages due to cultural taboo on talking about miscarriage. The social stigma is that miscarriage isn’t a big deal and when women do feel different than the stigma of the norm, there is shame in those feelings. Women become silent and suffer in that silence.

When famous women come out to share their experiences of miscarriage, the media reports for them. This helps women not feel so alone and that is very needed. It sheds light on the millions of women experiencing pregnancy loss around the world. Articles such as the Self article can be helpful but there is a hidden message in the article Self wrote. I will tell you what that is.

At the end of the article, the author calls for change in the beginning of her final statement when she writes: “Although it will take some time for cultural attitudes about miscarriage to shift…” But instead of helping to change that stigma, the author actually furthered a common misconception about miscarriage, that it’s “like a heavy period.” The author interviewed Dr. Sherry Ross, an OBGYN who stated that miscarriage will evolve into something like “the heaviest period you’ve ever experienced.”

I wonder if this doctor has talked with her patients or better yet, been there while her patients experience miscarriage. A majority of them would likely not describe miscarriage this way, especially if they held their very tiny baby. As a woman who experienced miscarriage twice, I can attest and confirm that miscarriage is nothing like a heavy period. In fact, I suffered through horrible periods associated with PCOS and hormonal imbalances for a majority of my life and I would take that experience over the labor pains I had with my miscarriages.

Another OBGYN, a male I might add, describes miscarriage to women as “hell.” He then explains that miscarriage can be “really heavy bleeding, really heavy cramping, and generally feeling really beaten up.” Before I discovered that Dr. Jacques Moritz was male, I made an assumption that this doctor had a personal experience with miscarriage and maybe his partner had one but he still minimizes the miscarriage experience. The statements by these OBGYN’s further trick women into believing that miscarriage is “no big deal,” “not a serious medical event,” can be experienced at home or work with little complication, and that miscarriage, “is like a heavy period.”

Doctors and Miscarriage

My book “It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook” shares with you how miscarriage is not a heavy period. It’s rarely experienced that way, yet women are told by their doctors that they will bleed like a heavy period and receive little to nothing more. Nothing to help with the pain that shocks them out of their sleep, nothing to catch their baby or remains in, and no real guidance on warning signs. Women are left to go through this experience alone and uninformed. I often wonder how doctors truly understand the miscarriage experiences of their patients when the majority of women are never seen and their pleas for help and guidance are ignored.

The article wasn’t all bad. I know I focused solely on the statements by these OBGYN’s but when Self Magazine calls for change, they should help create that change by interviewing proper professionals or women who have experienced miscarriage. One statement of particular note was when Penelope Trunk talked about how some women might prefer to go back to work immediately and that “there are basically no wrong choices here.”

This is a very true statement and women need to hear this. While some women couldn’t imagine going to work during a miscarriage, there are others who may prefer to go back to work and neither is wrong. Women who don’t feel they can go to work need to be empowered with information on how to manage that, such as through FMLA. Statements like the ones made by medical professionals, minimize the experiences of miscarriage by the majority of women. Because they are medical professionals, society places more trust in their words than in the words of the women who experience miscarriage.

So Self Magazine, if you want change for women; help make that change happen for women.

The Dark Side

It’s hard to believe that there is actually a dark side to pregnancy loss organizations. At least some of them and to know that a dark side exists, damages trust. At a time when families need love and support the most, some are being turned away and they don’t even know it.

It’s almost similar to comparing losses. Comparing loss serves no one for sure. I was watching the show Scandal, Cyrus had lost his husband and Mellie had lost her teenage son and was still deep in grief months later. Those around her were trying to be compassionate but she was still not dressing and refusing to leave her home months later. The two were having a conversation and Cyrus ends with, “To take a measure is cruelty.”

Mellie: It’s not the same. My child, your husband. It’s not the same.
Cyrus: I keep hearing that. The loss of a child is greater. I resent that, never having lost a child. I resent having to feel like losing the love of my life, the only someone who ever made me feel like I was truly me, is less of a loss, is smaller than your loss. I am now broken. I’m not me. I’m forever changed. I’m undone. A broken heart is a broken heart. To take a measure is cruelty.

Wave Of Light1

Loss hurts. It hurts so deeply but each person’s experience is different and we have no idea of knowing how it is for them. We do know it hurts to compare losses. A family who discovers that an organization will not help them because their loss was not deemed worthy enough, feels rejected.

I had a family in need. They were told they would receive services from a nationally known organization. People constantly refer to this organization and they are a wonderful organization but like others, they have a dark side as well. This family learned it the hard way.

Told one thing by nursing staff yet refused assistance, the family turned to Dragonflies For Ruby for assistance. I hurt for them. I had seen the added devastation to families during their darkest hours, seeking compassion and love, yet being sent away because their child didn’t make the cut. They knew this, because the nurse was tired of families being rejected and she had to share with this family they why.

Most families will never know this. Most families will not be told the reason services were not provided and while that may save them from added devastation, that doesn’t make this scenario right. And this needs to change.

We are screaming for equality in this world right now. There are hundreds, if not thousands of organizations out there trying to ensure that people are treated equally and fairly yet discrimination of our tiniest humans is still taking place. Maybe it’s the culture of death? Maybe it’s another lobby against these tiny humans? Maybe it’s a lack of understanding for the needs of bereaved parents?

I believe it’s all of that plus more but because I believe the best in most people, I will err on the side that it’s a lack of understanding for the needs of bereaved parents. Because this is something that I can wrap my head around and facilitate change. To see that it is a lobby or lumped into the culture of death makes this issue much harder to tackle in my mind.

So what can be done?

We continue to share with others the needs of bereaved parents. Sure, each family might not need or desire the same services and resources and there are certainly differences in the types of pregnancy loss but all bereaved parents need compassion, love, and support. They should not be denied services based solely on disability, appearance, or gestation.

Does this mean that organizations cannot specialize in a particular form of pregnancy loss? ABSOLUTELY NOT! What this means though, is that:

  1. An organization should not pretend to be available for all forms of pregnancy loss.
  2. An organization should provide a resource available to fill the need of the bereaved family when they do not support their form of loss.

Organizations should be transparent. My organization states that Dragonflies For Ruby is a unique service for families experiencing pregnancy loss in any gestation. This implies (in my mind) that no matter how early or how close to term a baby is, the organization will support that pregnancy loss. Could the organization be more clear? I suppose we could list the forms of loss and dig a bit deeper but we are trying to be inclusive and to list all forms of pregnancy loss may accidentally be exclusive.

Bereaved families know very little about what services and resources are available to them. It is important for them to be presented with their options so they can choose what’s best for them. Failing to provide an option based on the assumption they won’t need it or want it, is not acceptable. The option should be presented anyway and let the family choose for themselves.

depressionSo, not only do some pregnancy loss organizations assume that families would not want or “should not want” a particular service, they are actually hurting families and spreading the stigma that certain forms of pregnancy loss are not worthy of grief, that families should feel shame, and are pushing families deeper into grief and pain. This is that dark side. A side that isn’t usually seen and shouldn’t exist. We can’t let it exist. We must create change and not accept these dark sides. Those who know they exist should take action or we are a part of the problem. Yes…that includes me. Because “to take a measure…is cruelty.”

Janet Street Porter, How Shameful of You

A few days ago, I learned that Tana Ramsay (wife of Gordon Ramsay) has suffered a miscarriage. As a perinatal loss specialist who serves families enduring pregnancy loss, my heart hurts for them. Watching how the media is treating them can be both heartwarming and horrific. Here, you can see Janet Street Porter displaying the horrific side.

“I was surprised he announced it so early on to be honest,” she told her fellow Loose Women, Ayda Field, Coleen Nolan and Andrea McLean. 

“I remember thinking, hmm maybe Tana would have wanted to announce the news herself and waited a little longer because the pregnancy would have been quite unexpected.

Janet Street Porter, do you think that Tana was upset that Gordon announced their pregnancy? Do you think that he just took it upon himself to share without her permission. That’s highly unlikely. It’s obvious in the video that he is delighted and bursting to share the great news! Gordon Ramsay announced that Tana was expecting on May 12, 2016 on The Late Late Show. If she is now five months pregnant, this would mean that Tana was at least 12 weeks along.

She was past the first trimester. Past when society deems it okay to announce a pregnancy (which is B.S. by the way). She was considered in the “safe zone” of pregnancy. Pregnancy loss is much more rare at this stage. So I ask you, how long did you expect them to wait? Until they had a baby in their arms? Would it have been appropriate for them to announce then or should they have waited until he was in preschool…well past the time where he could die from SIDS. I mean, after all, if he had died from SIDS, you would be back on Loose Women saying, “I was surprised they told people he had been born.” Maybe it’s just too early to tell the world when a child is born?

When you make statements such as “I was surprised he announced it so early,” you are really placing blame on this family. You are saying that announcing “early” that this is somehow their fault, that somehow they were jinxed, that their age meant this would happen so they should have waited,  or worse, serves them right for announcing so early. Let me tell you, there is no such thing as announcing a pregnancy early! There is just announcing a pregnancy.

Pregnancy Announcement 8 weeks

My pregnancy announcement at 8 weeks

Pregnant families make the decision to announce. They can announce the moment they discover they are pregnant or they can wait to announce but it’s their decision and statements like yours just further the stigma that women and families should wait. What should they wait for? Does it hurt you when a family endures pregnancy loss? I don’t think so.  Families enduring pregnancy loss will still hurt, even if they announce “early.”

Please stop placing blame and shame on families who announce their pregnancy “early.”

Let’s review some statistics. At the time Tana Ramsay’s son died, she was five months pregnant. Do you know how common pregnancy loss is at five months? Between 1-5%! When they announced their pregnancy, the statistics were relatively the same. So Janet Street Porter, they didn’t announce “early” at all. They waited and were at no further risk of their son dying when they announced then when he actually died. He didn’t die “early.” He died in the second trimester!

Janet Street Porter, here’s what you should have said, “I want to extend my condolences to the Ramsay family for the loss of their son [fill in his name].” That’s it. No shaming, no blaming, just condolences. It’s not their fault. You don’t get to say that. You don’t get to say that they shouldn’t have announced the joy of a new addition to their family.

Right now, you should offer the family a meal, compassion, empathy, love, and support for all they are enduring, including their other children because this affects them too. Share that on Loose Women.

Miscarriage App Icon

Love to the Ramsay’s

 

Miscarriages are NOT Heavy Periods

miscarriage in ultrasound room“Miscarriages are like heavy periods.” I don’t understand where this phrase comes from at all. After diagnosis of a miscarriage, many women hear the words, “It will be like a heavy period.” Sometimes the medical professional adds, “And you might see more clots and pass tissue.” There is rarely mention of pain or contractions. Do doctors not understand that some women do not cramp at all during their periods? So now, when a woman who wouldn’t normally cramp during her periods, experiences this crampy feeling, what are her thoughts?

Let me explain. I teach childbirth education classes and we discuss contractions, pressure waves, etc during the childbirth preparation. I prefer to relate the pain of contractions to something they have felt before, menstrual cramps, diarrhea cramps, ovulation pain, etc. It can give a general idea on where they might feel contractions. I also explain that these are functions that do not mean something is wrong.

Because nearly all the experiences of pain we have are signals that there is something wrong.

So, pain = something is wrong.

In the case of menstrual cramps, contractions, etc, pain is not a signal that something is wrong but we don’t typically think of it this way and again, a woman who doesn’t experience menstrual cramps will be confused about what is taking place in her body. So now, this woman begins the miscarriage process and she is cramping (contracting) and now, because all her prior experiences of pain signaled something was wrong, she will likely think that something is wrong. And fear sets in.

Now the woman has fear in a very emotional situation where she is already deeply hurting. When you put physical pain together with emotional pain, the combined pain is off the charts. It can be too much to manage at all.

Now imagine that the medical professional explained the process a bit more. “You will likely bleed heavily, pass clots and tissue (grey, pink, and red), you may see the baby in full form or partial form, and you will likely experience cramping or contracting. If the pain is too unbearable, you may take this medication I have prescribed to you.” Then they add some warning signs, “If you bleed through more than 1 pad an hour, please contact us, if you pass any clots larger then the size of an egg/plum call us immediately or head to the emergency room, and if you see the baby you may put the baby in a bag or box and place them in the refrigerator and then call us.” Then they add even more, “You may begin bleeding more heavily after you pass tissue and this can be a sign of retained tissue. Keep an eye on this and if you feel faint, dizzy, lightheaded, or nauseated please go to an emergency room. If you pass out, someone needs to call 911. This means that you should not miscarry alone and someone should be with you at all times.”

WOW! That is one awesome medical provider!

Knowledge is power and this woman would feel much more confident in her experience even though it is sad and emotionally difficult but at least she knows what is normal and what isn’t. This helps reduce fear and empowers her to take control.

woman-grief-3-labeled-for-reuseBut, miscarriage is treated just like a period. Women believe that “it’s no big deal.” That all the contents that emerge from her are to be flushed or discarded and when the gravity of the situation takes over, she is confused about why she is so sad and if she is worthy of grieving.

She is then silent about her experience and becomes shameful. She fears telling anyone because miscarriages are “like a heavy period” so what’s the big deal? Yet she mourns. She yearns for her baby. If she was in her second trimester, she may have held her baby (some can do this in the first trimester), she may have weeped over her baby and repeated to her baby over and over that she was sorry.

Yet miscarriage is like a heavy period. Society thinks, “Why is this woman so distraught, it was just a heavy period!” These experiences just irk me. This is not okay. Women ARE worthy of grief. Miscarriages are NOT like a heavy period. About the only time a miscarriage would be “like a heavy period” would be if it were to happen extremely early within the pregnancy, often so early the woman may not even suspect she was pregnant. This would be before 5 weeks of pregnancy. Miscarriages after 5 weeks would likely be more painful.

It's Not "Just" a Heavy Period; The Miscarriage HandbookAll of these reasons and more are why I wrote the book, “It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook.” Women should have the information they need to make the best decisions they can when they are miscarrying. They should have the knowledge needed to feel empowered with their choices which helps reduce trauma and improves their coping as they grieve.

Why are so many medical providers causing more emotional trauma and hurt by dismissing this experience as a heavy period? We MUST change this! I want to mention a recent movement in the US to help change this. It’s called Don’t Talk About the Baby. I hope you will join me in supporting them so that this movie can come to fruition. We must stop the medical community and society from telling women miscarriage is no big deal. It is a big deal.

Breaking the silence of first trimester miscarriage.

For Gus

Dear Emergency Departments Everywhere

Dear Emergency Departments everywhere…

STOP SENDING WOMEN HOME WHO ARE HAVING A MISCARRIAGE!!!!!!!!!!!!!!

I really cannot stress this enough. It’s getting very old hearing the words, “There is nothing we can do, go home.”

Is that really all you have to say? Do you really thing there is nothing you can do? Let me explain to you the things that you CAN do because what you are doing is not enough and is definitely nothing. In the end, you are hurting so many more women emotionally and physically. And many of you have no idea that these women are being put at risk and readmitted for complications or seeking care elsewhere.

Here is what an emergency department can do when a woman is miscarrying:

  1. Express condolences. Even if you think the woman is relieved or that this doesn’t matter to her (or to you), saying, “I’m sorry for your loss,” or “I’m sorry you have to go through this experience,” is perfectly appropriate.
  2. Don’t rush. Families do not understand the administrative responsibilities of an emergency department. We don’t know how many people should utilize the room per day to operate at your maximum efficiency. So when you rush a family out of the emergency department, it comes off as you don’t care and that the experience wasn’t worthy of more time, compassion, and attention. And to be honest, your survey responses will be poor.
  3. Don’t send her home. Let’s be honest here, no women should miscarry at home. She is giving birth and is at risk of hemorrhage and other complications but if a woman is going to miscarry a baby beyond 11 weeks, she should have the option of being admitted during the process. And let’s get more serious, if a woman is between 15-20 weeks, it’s insane to send her home to deliver her baby alone. Actually, it’s malpractice in my opinion.
  4. If you have to send me home, send me with information. With how common miscarriage is, of course hospitals would be overrun with women delivering their deceased babies; however, you can’t just send them home with no information. That’s irresponsible and dangerous. Women need to know what the process is going to be like, feel like, and look like. Then they need to know how to manage everything from the pain to delivering the baby, to what to do with the baby. How about you give them a book? Something like “It’s Not Just a Heavy Period; The Miscarriage Handbook” would work wonderfully.  In addition, women should be sent home with a way to capture and preserve her baby. A miscarriage kit by Heaven’s Gain would be perfect.
  5. Present options. What does a woman do with a miscarried baby? Women need guidance. Offer those options. Families can create memories such as photos, prints (even with tiny babies), and molds. Women should be offered bonding and memorial options. If you don’t know about any, learn. Cremation and burial are also options so do not forget to present them.
  6. Offer testing. Women who lose a baby have a desire to know why. Women deserve testing even if you believe nothing will be revealed. If only 13% of families choose autopsy, no one can say with any certainty that information can not be revealed. This should be offered so this is another reason not to discharge a woman to deliver her baby at home. If she has to deliver her baby at home, testing can still be an option. Send her home with a test kit, such as the Anora miscarriage kit.
  7. If you are hesitant to send her home, don’t. Do something. Admit her, run tests, monitor her and the baby (if still alive), and provide options and resources as mentioned above.
  8. If the baby is still alive, do something. Imagine how you would feel like if you were sent home after your water broke or your cervix was dilating, knowing your baby was still alive, and being told there was nothing that could be done by a medical institution. Ever heard of the Trendelenburg position? Or how about an amnioinfusion? Admit this mother! The outcome may not change but you did something to try. Can you imagine the guilt a mother feels when she can’t do anything but everything within her is telling her she should have? Do something! Because there IS something that can be done in this situation.
Photo Credit: Dravas Photography

Photo Credit: Dravas Photography

This information is not hard to present or to find. The problem is, emergency departments just don’t have the information but with how common miscarriage is, they should. This is no different than having information and resources for heart attacks or suicidal ideation. It’s time that emergency departments take miscarriage seriously.

Hospitals do not believe women should be delivering their babies at home. They believe that homebirth is dangerous and all women should deliver within the confounds of the hospital, yet they have no problem sending a women home to deliver their dead baby or their baby that is too young/early for life saving interventions. This makes no sense. The risks you are concerned about are still there but the fact that her baby is dead changes everything and that is just plain sick (and this is just another blog topic).

While the goal should be to stop sending women home to hemorrhage on their bathroom floors only to be transferred via ambulance to the hospital in a fatal condition and to deliver their dead babies at home; your policies aren’t going to change overnight. So start doing this better. It’s imperative that you do. Women’s lives depend on it!

-Breaking the silence of first trimester miscarriage.
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