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Wednesday, June 26, 2019

Miscarriage on a Mountain

My husband and I have piles of gear—snowshoes, snowboards, powder skis, skate skis, tele skis... and a pair of tiny plastic toddler skis purchased just before we started trying to grow our family. Little did we know how much dust they’d gather.

In March 2016, to celebrate my 29th birthday, we pulled our snowshoes from that gear stash, shouldered massive backpacks, and headed toward the Pemigewasset Wilderness, part of White Mountain National Forest, a couple of hours from our home in Vermont. The next morning, the temperature stayed below zero as I forced myself out of the warmth of my down sleeping bag to grab my stuffsack of tampons. My fumbling, frozen fingers annoyed me more than the fact that our first month trying to conceive hadn’t panned out.  

Another couple of months would pass before that TV-commercial-like moment of squinting at a pee-covered stick at 4 a.m. and squealing with joy that we were pregnant. I immediately began to envision us as the outdoor family of three, coveting infant life jackets and purchasing a backpack child carrier off Craigslist. Our unborn baby was on board for my first rock-climbing trad leads and even got to claim seconding a first known ascent of an obscure line in Vermont. We still call that route Baby Bella after her.

Ten weeks into the pregnancy, an ultrasound revealed there was no heartbeat. I was miscarrying. We were heartbroken, grieving a child we’d never meet, but took solace in our medical team’s assurance that there was no reason to believe we’d have any trouble conceiving again or carrying a subsequent pregnancy. So, like taking a whipper climbing or a yard sale down the ski slope, we figured we just had to get up and try again. As the trying got to be more trying, I turned to naturopathy, acupuncture, and even fertility yoga. I missed the casual annoyance I used to feel when my period came. Now I felt a primal desire to raise our own offspring and a deep sadness after every failed attempt.

“Infertility is more common than people realize,” says Dr. Jennifer Brown, a reproductive endocrinologist at Northeastern Reproductive Medicine (NRM), a clinic in Colchester, Vermont, that specializes in the medical and surgical treatment of infertility and reproductive disorders. “Ten to twenty percent of couples of reproductive age struggle with fertility. Most of it is out of the individual patient’s control. It’s medical and it’s biological.”

Clinical infertility is diagnosed after a year without conceiving a viable pregnancy. I hit this pivotal milestone the day I ran a 15-mile trail race, my uterus cramping as my calves screamed. I could run, but I could not hide from my reality. We were going to need some help. “Nobody wants to come here,” says Stephanie Olmstead, a fertility nurse at NRM. “It’s very stressful. I see a lot of type-A people who can control so much in their life, and having a baby is the one thing they can’t.”

For us, after two years of trying, that assistance would mean in vitro fertilization (IVF). Eggs and sperm are combined in a laboratory to hopefully grow into an embryo that, once transferred into the uterus, will (again, hopefully) implant and in nine months become a baby. IVF usually consists of a woman taking medication injections for a week or two to stimulate the ovaries to produce multiple mature eggs, which are retrieved under anesthesia during a simple outpatient procedure. The eggs are then placed in a petri dish alongside sperm, and fertilization and embryo development are monitored for several days before transferring the embryo(s) into the uterus or vitrifying them for a future transfer. Hormone medications are also used to support the embryo’s implantation in the uterus and later, if all goes well, a pregnancy. Worldwide, eight million babies have been born from IVF, and the pregnancy and subsequent delivery rate per cycle hovers at just above 30 percent—not all cycles result in embryos to transfer, not all transfers result in pregnancy, and not all pregnancies end with a baby. But we’d seen our twin nephews born via IVF, so we were cautiously optimistic as we began this medical treatment. 

I woke up from anesthesia after the egg-retrieval procedure and immediately asked my doctor if I’d be able to work the next day. “Tomorrow’s Sunday,” he replied, chuckling, assuming I was too groggy to know what day of the week it was. “I teach skiing on Sundays,” I responded.

Even as I dreamed about someday skiing with my own children, living in the moment was important. In this moment, I missed my class of five-year-olds who were cruising down the slopes without me. I was back at the mountain the next day, my ski pants tight over my swollen ovaries as I tried to take it easy, as advised. Skiing with those kids was a reminder that no matter what, I am able to be a formative part of a child’s life.

Following the egg retrieval, we spent a couple months preparing to transfer one of our precious lab-incubated, vitrified embryos. This meant having another surgery to remove polyps that were found in the lining of my uterus. I spent time drinking craft beer, eating sushi, and going on long trail runs without needing to worry about how it might affect an early pregnancy, since we were on a medically advised break from trying to conceive.

That break ended as summer began, and I hit the hills with a flock of kids again, shepherding campers around the White Mountains as a backpacking trip leader. I traded the tampons in my stuffsack for hormones and syringes—I was finally pregnant from IVF. After my campers were tucked into their tents for the night, I headed to mine to inject a 1.5-inch needle into my thigh to administer pregnancy-sustaining hormones by headlamp. Sometimes the intramuscular injection left my quadriceps so knotted that I’d spend the next morning hiding the limp in my stride.

Six weeks into the pregnancy, I was hiding something else: sheer terror that I might be miscarrying again. As we summited Mount Adams, on July 5, 2018, I noticed an ache in my uterus. The ache turned into distinct cramps, which became particularly worrisome when I headed into the outhouse and realized I was spotting. While we usually tented in more rugged locales, on this evening we were staying at Crag Camp, a cabin perched high on Mount Adams in the Presidential Range. I hate the distraction of cell phones in the outdoors as much as the next person, but I was fortunate to have enough service to sneak into the woods to call my doctor’s office while the kids and their counselor played cards. Over the phone, a nurse convinced me that I was likely fine, as the symptoms had waned, and that what I was experiencing could be a sign of the uterus stretching during a healthy pregnancy. My anxiety, however, had not diminished. I spent a restless night listening to the wind howl against the cabin walls, hoping for the best while overthinking every twinge in my abdomen.

A thunderstorm rolled through the next morning as I packed my syringes and stained underwear while trying to collect my thoughts. If there was one thing I’d learned from my time in the mountains, it was the power of putting one foot in front of the other. There was nothing more I could do but lace up my hiking boots, fire up the WhisperLite, and proceed with our day. I again tried to live in the moment. In that moment, I was still pregnant, I was in gorgeous mountains, and, regardless of this pregnany’s outcome, I was a strong role model for these girls. We proceeded on the hike back to our van without any urgency, singing and joking, hitting the ice cream shop and the swimming hole en route to camp.

The next day, the symptoms returned. I had the day off and met up with my husband at the crag. A lead climb momentarily gave my mind reprieve from my racing thoughts. I could focus instead on the delicate balance of my feet on the slab, on how close my next move would bring me to the anchor. When my feet were back on the ground, though, I realized things had taken a turn for the worse. I stripped off my climbing harness and clothes to squat, making no attempt to hide behind foliage. It was in a beech leaf that I caught the perfectly round, iridescent, pea-size embryo-enveloping sack as it left my body. It was remarkably different than any blood clot, and decidedly dainty—much smaller than my previous loss. We stared at it in shock and wonder before wrapping it in the leaf and laying the bundle to rest near Lost Ledge. We hiked out and drove to the ranger station to call my doctor. I burst into tears as I walked past the stuffed animals in the gift shop—I was devastated I wouldn’t be buying one for this baby.

An ultrasound the next day would confirm our second loss. Lil’ Presi, as we’d nicknamed this baby, after the Presidential Range, would only ever know the joys of backpacking in utero.

Approximately one in five pregnancies end in loss, and I realized I was far from alone in my experience. Janine, a friend and avid rock climber from Vermont, who asked that her last name remain anonymous, lost a pregnancy while camping in Snow Canyon, Utah. Thanks to her outdoor pursuits, she’d always seen her body as a source of strength. She says that after miscarrying, “it was disorienting to feel like my body let me down.”

“A couple of days after I miscarried was the first time I ever onsighted a 5.11a. So that was really reassuring that, OK, my body isn’t totally failing me,” she says. A year later, almost to the day, Janine gave birth to her healthy son. She continued to climb, with her doctor’s blessing and some modifications, for most of that pregnancy.

According to Dr. Brown, miscarriage isn’t a sign of our bodies failing us. “The most common misconception about miscarriage is that the patient did something wrong—they went rock climbing or they were too stressed,” she says. ”Miscarriage is not a person’s fault, they can’t control it. It’s usually something inherent in the pregnancy.”

I was fortunate to have known, going into my second pregnancy, that my physician had no concerns about me continuing most of the physical activities I enjoyed. I know plenty of women, however, who would never have considered backpacking or rock climbing during pregnancy. While I can respect that everyone makes the best choices for them and that everyone’s pregnancy is different, I felt some societal shaming for my active choices. When I drafted an e-mail to some close friends to tell them about our second loss, my husband requested that I make it clear that while I miscarried rock climbing, I didn’t miscarry because I was rock climbing.

If only carrying a pregnancy to term were as simple as avoiding rock climbing. There are so many factors that have to be biologically aligned on a cellular level for a pregnancy to occur and continue that sometimes I think about how much of a miracle it is that any of us are here, with or without babies.

Precisely because of how miraculous life is, during my first pregnancy, I remember walking around thrilled with the secret that I was carrying along with our baby. I didn’t look pregnant yet, so passersby would have no idea why I was beaming. Now I carry the new secret of my grief, and rather than making me smile, those lost babies are the reason I might appear on the verge of tears. We all carry both joy and sadness that is unknown to most of the world. None of us have a path in life without steep grueling climbs, and fortunately, most of us are also afforded those moments of breathtaking scenery and effortless descents. For now, I’ll keep putting one foot in front of the other, despite the uncertainty of where this path might lead.

This author has chosen to use a pseudonym.

from Outside Magazine: All

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