“Let’s take a peek, shall we?” I was 10 weeks pregnant with our second child. I pulled up my shirt and unbuttoned my pants, exposing the long, horizontal scar from the cesarean birth of our daughter, Guthrie. Under the florescent lights of the small examining room, my doctor rolled the wand over my belly. “Your uterus is very low. We’re going to need a vaginal ultrasound.”
My body stiffened. Minutes later, with a thin, pink paper draped over my lap and a cold rod inside me: “Your baby is measuring a bit smaller than we’d expect.” My doctor’s hand landed on my right thigh, a movement driven by muscle memory from delivering this news before. “I’m having trouble finding a heartbeat.”
In silent miscarriages — occurring in around 1 or 2 percent of all pregnancies — women don’t experience symptoms of typical miscarriage like bleeding or cramping. In fact, I still felt pregnant. I was nauseous and bone-tired. My body was playing a trick on me: Even though the fetus had died, my placenta continued releasing hormones.
My doctor outlined three choices: Wait up to two weeks for my body to naturally miscarry, take medication to make my uterus contract and expel the pregnancy, or have a surgical procedure under general anesthesia called a D&C. Whatever I decided, I wanted to wait for my husband to travel from Alaska, where he works as a pilot, back to our home in Oregon.
It was early March. Outside, a cold rain fell, leaving thick drops on the windows. I lay in bed, my spirits lifted by the honey aroma of a daffodil bunch on my bedside table. My brother and his wife entertained Guthrie. They swooped in from their home a three-hour drive away after I called to break the news. (Two weeks earlier, Guthrie let the cat out of the bag that I was pregnant to my brother on FaceTime when she exclaimed excitedly, “There’s a baby in my belly!” My brother paused, then said: “Oh reeeally? Are you sure the baby is in your belly?”)
In bed, I reflected upon the decade my husband and I have been together. I wondered, if I could, would I change our path, insert building a family earlier into our timeline? We met in our early 20s. We spent the next decade doing what many in our generation are doing, growing careers and exploring ourselves deeply. Months after we took vows, we bought a crate and chew toys for our new puppy, not furnishings for a nursery.
The rate of miscarriage rises along with an expecting mother’s age: According to a 2000 study of more than 600,000 women, the risk of fetal loss is around 10 percent in your early 20s, around 20 percent at age 35, and around 80 percent at age 45. I am 36. I used to scoff at statistics regarding older first-time mothers. Whenever anyone mentioned advanced maternal age, I’d roll my eyes and change the subject.
When my husband arrived home, the growing fear of what I had to go through physically overshadowed the emotional toil of losing a child. I chose the medication route. Six hours after inserting four white round pills inside me, I began contractions, slow at first, then strong and punishing, every 10 seconds. I experienced transition, the most difficult part of birth. I sweat. I screamed. I vomited. The effort ended with the passing of a 6-inch, liver-colored gestational sac into our downstairs bathroom toilet.
Four days later, I woke to daggers in my lower abdomen. An ultrasound confirmed a small amount of tissue remained. A few hours later, I drifted from consciousness under the gaze of a freckled, sincere-eyed anesthesiologist. Surgery was performed, tissue removed.
Women can miscarry at any age. It has for time immemorial come with the unpredictable territory of giving birth. But to feel impermeable to the fact that my chances of miscarrying increased as I got older left me flat-footed when those statistics became my reality. As older mothers, we also face the increased risk of having a baby with genetic disorders. Given these risks, we’re offered a wider range of prenatal genetic testing options than younger mothers. This type of testing forces us to confront complex moral and ethical decisions that, as a generation, I don’t believe we’ve debated enough.
If I could do it all again, would I change our family trajectory? I only have to hear my daughter’s soft voice to answer that question. And there are many potential advantages — gathered wisdom and financial resources, for example — to being older parents. But open dialogue in our society about the realities of advanced maternal age may help parents navigating these waters make more informed decisions and feel less alone in the process.
My doctor advised us to wait two months before trying again. As time passed, my husband and I questioned whether or not to have another child. I wasn’t sure I could go to bat again. Physically, I felt healed but the emotional wound of a miscarriage festered. An afternoon building sandcastles on the beach with Guthrie delivered the balm I needed. Our family of three didn’t feel chaotic enough. The magnitude of the ocean made the fears I was holding onto seem small in comparison. Last week, our unborn child’s heartbeat resounded around the same examining room I’d heard silence in six months before.