Perfectly Imperfect
Written by McKenzie Ruff
I am a perfectly imperfect mom of two perfectly imperfect boys. Sometimes, I daydream about what my days would look like if I were childfree. Slow mornings, drinking coffee and reading in bed as the sun rises. Hours spent preparing elaborate, delicious meals that I’d slowly enjoy while talking with my husband about current events. Long hikes in the mountains on the weekends. But other times, when my husband and our two boys and I are all snuggled together, watching a movie and eating popcorn out of the bowl I ate popcorn out of as a kid, I am blown away by the fact that my entire world can fit in one corner of a couch. My family makes me feel happy and whole.
But our family hasn’t always felt this complete. My husband and I started trying to get pregnant for the first time when we were in our late 20s. At first our approach was casual, I went off birth control, and we figured we’d see what happened. After about 9 months of that approach without success, my doctor suggested we run some tests, to see if there was an identifiable problem. I’ve never had regular periods off birth control, so she figured it was worth looking into. We started with an ultrasound to look at my uterus and ovaries. The test results showed two potential issues – an increased number of follicles on my ovaries, indicative of polycystic ovarian syndrome (PCOS), and bicornuate uterus, meaning it appeared my uterus was shaped more like a heart than an upside-down triangle. She said the PCOS could make it harder for me to get pregnant and the bicornuate uterus could make it harder for me to carry a baby to term. Not great news. But, the results weren’t conclusive for either diagnosis, so the doctor recommended additional testing. She referred me to see a specialist, who would inject a special dye and take x-rays of my uterus. They could only do the test after I had a period, and since my periods are irregular, my doctor prescribed Pitocin to induce a period. As almost an afterthought, she also suggested that I take a pregnancy test before taking the Pitocin, just to make sure I wasn’t pregnant.
But our family hasn’t always felt this complete.
I went home and called my husband in tears, afraid that we’d never have a baby. Then, I went to the store, filled my prescription for Pitocin, and bought two pregnancy tests. I went home and took the pregnancy test and was shocked when I saw it was positive. I immediately did another test… also positive. I experienced such a range of emotions. I was thrilled to be pregnant, but also frustrated because I still had lingering fears about the pregnancy, whether I’d actually be able to carry the baby to term, and because I was pregnant, I couldn’t do any further testing to confirm either diagnosis. Overtime, I settled into the pregnancy, as my doctor reassured me that she didn’t see any signs for concern. In October of that year, we delivered a healthy baby boy.
After our first son was born, we were adjusting to being new parents and having another baby was not on our radar. We were sleep deprived and overwhelmed. Then, when our son was around one and a half, we got pregnant again. This time there was no trying involved. In fact, we were actively not trying to get pregnant again, except for one night when we forgot. You know, sometimes you just get carried away. When I found out we were pregnant this time, my emotions were complicated. I felt so irresponsible about getting pregnant when we weren’t financially or emotionally ready to do so. I also felt like my baby was still such a baby, and I wanted more time to bond with him, without having to share my attention with a sibling. But, after our first pregnancy, I also loved the idea of not having to try to get pregnant again and we had always wanted to have two kids. So while it felt a bit too soon, in the bigger picture it seemed like we were on the right track. We started sharing the news with family and friends, and I scheduled my first ultrasound appointment.
At the ultrasound appointment, they didn’t detect a heartbeat and told me that the pregnancy was not viable. They explained that we could either go home, and wait for the pregnancy to end naturally, or they could do a procedure at the doctor’s office to terminate the pregnancy called dilation and curettage (D&C). They said we needed to decide quickly, because they had limited appointments that day for the D&C procedure. It was a Friday, and they didn’t recommend waiting until Monday if I wanted to have the procedure because of the possibility of having to go to the ER over the weekend if I started miscarrying naturally. I like control, and I didn’t like the idea of waiting for the pregnancy to end when we knew that would be the ultimate result. I had the D&C procedure the same afternoon. To be completely honest, I felt a lot of relief after the pregnancy ended. I didn’t think we were ready for a second baby. I felt sadness too, because I had started to imagine what this unplanned future of ours would look like, but more than anything I felt relieved. I went back to work a couple of days later, and we moved on.
At the ultrasound appointment, they didn’t detect a heartbeat and told me that the pregnancy was not viable.
Later that year my husband and I left our son with his Nana and went to Europe for two weeks. We bought a new house. My husband was promoted at work. Life went on, as life does, and we were content as a family of three. When our son was about three years old we started to think about getting pregnant again. Because my doctor was never able to definitively diagnose me with PCOS or bicornuate uterus, I wanted to circle back with her to pin down a diagnosis. I wanted to understand what was happening with my body, and I also wanted to know if there were things I could be doing, based on any diagnoses, to improve my chances of a second successful pregnancy. What ensued was frustrating to say the least.
I should start by saying I loved my doctor. She is a compassionate, caring, open-minded, and flexible person. She always heard my concerns and trusted that I was the expert on my body. She was willing to run tests when many other doctors would have told me to just keep trying. The problem, particularly with PCOS, is that there is no definitive test to diagnose it. Rather, there are criteria that doctors look for, and if enough of the criteria are present, they will sometimes make a diagnosis. Many of those criteria weren’t present for me, which complicated things. They did another ultrasound and ran bloodwork. The ultrasound actually ruled out bicornuate uterus as a diagnosis, which was good news, but my doctor was still not sure that I had PCOS, and because they didn’t have a clear diagnosis there also wasn’t a clear fix. There wasn’t something specific they could tell me to do to increase my changes of getting pregnant or carrying to term.
The problem, particularly with PCOS, is that there is no definitive test to diagnose it.
I spent months exploring every option – things friends suggested, things google suggested, whatever. I did regular acupuncture, I went on a dairy free, gluten free diet. I drank less alcohol. I took supplements. I had lots of sex. I took ovulation tests. Finally, after about six months, we got pregnant again. I was thrilled. We were more secretive this time, only telling our closest family and friends, because we were still hesitant after our miscarriage. I was nervous about having another miscarriage, but my doctors were also not telling me that there was any reason for concern. So, I was cautiously optimistic.
About six weeks into the pregnancy, I started to have some pain in one of my fallopian tubes. I called the doctor and they suggested coming into the office for an ultrasound, just to confirm that everything was okay. At the ultrasound appointment everything looked fine. They were unable to detect a heartbeat, but they said it was still early, so no cause for concern. They scheduled another ultrasound appointment a few weeks out. Unfortunately, the result was the same at that appointment. They weren’t able to detect a heartbeat, and the baby was much smaller than expected.
That appointment was on a Monday, and on Friday of the same week we were supposed to fly overseas for a family vacation. Again, on the heels of hearing that the pregnancy wasn’t viable, we had to decide whether to let the pregnancy end naturally, or have another D&C. We had moved since my first miscarriage, so I was seeing a new doctor this time around, at a clinic closer to our new home but part of the same practice group as the clinic where I had the first D&C. The new clinic only did D&Cs in the hospital, with the patient fully anesthetized, and they couldn’t schedule an appointment until Thursday – the day before we were supposed to leave for our trip. I hated that a vacation was dictating our schedule, but there was also a lot of emotional baggage tied up in the trip (we were going with my mother, who was terminally ill with cancer) so we didn’t want to miss it either. Instead of waiting until Thursday to have the procedure done under anesthesia, they called over to the clinic where I had the first D&C done, where they are able to do it without anesthesia, and asked my prior doctor if she was available that same day.
She rearranged her schedule and did the procedure at the end of her workday. I am still so thankful for her and for all of the doctors and staff at both clinics who were so kind and compassionate. My first doctor, the one who did both D&C procedures, was from Holland, a country we were planning to visit on our trip. During the procedure we talked about the tulip fields and the best museums to see in Amsterdam. Despite the circumstances, it was lovely in a way. It was all very human. We hugged after the procedure, and I haven’t seen her since, but I think of her from time to time with so much gratitude.
I physically recovered relatively quickly. My emotional recovery was slower, but I was also very distracted with day-to-day life. We moved forward. I met with my doctor again, from the new clinic, when we were home from our trip and she suggested that I try taking Letrozole, a medication used to treat breast cancer which they’ve also found to be helpful for women with PCOS who are trying to conceive. She wrote me a prescription and told me to take the medication when I had my first period after the miscarriage. I remember her saying that she was hopeful I’d be pregnant within one cycle. I was very skeptical that it would happen that quickly.
Shortly thereafter, my period came, I took the medication as directed, and kept track of my cycle with ovulation predictor kits. My husband and I also just tried to have sex every few days. I didn’t want to rely too much on ovulation predictor kits, because I’d been warned that they’re less reliable for women with PCOS. When my period was roughly due to start (my periods were still not super regular) I took a pregnancy test, but it was negative. I waited another week and still hadn’t started my period, so I took another test. Very much to my surprise, it was positive.
She wrote me a prescription and told me to take the medication when I had my first period after the miscarriage.
I was so happy to be pregnant again, but after my last two pregnancies I was also extremely anxious about whether I would lose the pregnancy. I spent so much of the first weeks of my pregnancy worried about what would happen, whether it would last. I would constantly assess how I was feeling, worried that if I wasn’t feeling miserable, it meant the pregnancy wasn’t viable. When I wasn’t worried about not feeling sick enough, I was also feeling pretty darn sick. It was a miserable cycle. I cried to so many people in our inner circle, telling them I was pregnant, but that I was overwhelmed with anxiety about whether it would stick.
Honestly, of all the emotional ramifications of both of my miscarriages, this period of time was by far the most difficult for me. So much so, that I told myself if this pregnancy ended in miscarriage, I was done trying to get pregnant. I just couldn’t go through the cycle of trying, getting pregnant, feeling sick, being anxious about the outcome, and then losing another baby. It was too much. As we walked from our house to the doctor for my first ultrasound appointment, I remember my husband suggesting that maybe I should reduce my hours at work, to help manage my stress if I was pregnant or if I wasn’t and we were going to continue trying. I didn’t have the heart to tell him I was done trying. I figured we’d see how the appointment went and go from there.
I didn’t have the heart to tell him I was done trying.
At the ultrasound appointment I told the ultrasound tech that I was nervous, that this had gone badly for us twice now, and she said she’d seen that in our records. I think she was probably as nervous as we were. After what felt like a while, she confirmed that she was able to hear a healthy heartbeat. The baby was a healthy size and everything looked great. The tech and my doctor confirmed that it looked like a healthy pregnancy, and there was no cause for concern. My pregnancy was uneventful, and in March of 2020, on the precipice of a global pandemic, I delivered a healthy, happy, 10lb baby boy.
I’m so glad to have the trying-to-get-pregnant phase of my life over and my entire heart goes out to women who are still in that phase and are struggling. The feeling that your family is incomplete is unbearable. But, if you ask my six year old, he’ll tell you that our family was quite complete when it was just the three of us, that his brother ruined a good thing, and that I worry too much. The reality is that we, and our families, are all perfectly imperfect, always, even when we’re struggling.
