April is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.
Winter kept us warm, covering
Earth in forgetful snow, feeding
A little life with dried tubers.
- T.S. Eliot, “The Wasteland”
It was in late April when my husband and I joined a club that has far too many members: we lost what we had dreamed would be our first child.
We learned the news while my sister was visiting me in Nairobi, Kenya. The three of us went in to hear the baby’s heartbeat for the first time, filled with happy anticipation. I had honestly not even considered the option that we would be met with literal radio silence, as my pregnancy symptoms had been raging and I felt healthy. And though I had been reading books and articles about pregnancy, and though many of my friends have been pregnant, I didn’t know much about miscarriage.
Tears streamed down my face, unimpeded, as we learned that I had a silent miscarriage. “What do you mean?” I remember asking in an unnaturally high-pitched voice. My fetus, already so loved, had in fact stopped developing two weeks prior. My body had not realized this, and had continued producing the hCG pregnancy hormone, causing me to believe otherwise.
I wailed, loudly. A woman in the waiting room held me by the arms and told me that God will always provide. I tore away from her. We got smoothies. We drove to the OB-GYN office in a daze.
I had read that up to 1 in 4 pregnancies end in miscarriage. In the waiting room, my sister even showed me a passage from Michelle Obama’s autobiography in which she talks about her own miscarriage and pregnancy struggles. But somehow, I never really thought it could happen to me.
At the OB-GYN office, my doctor said lots of words at me that didn’t filter through. Apparently, she talked through the three options for the actual miscarriage. I could try “expectant management,” meaning that I could wait for the fetus to pass on its own. That could take over a month, given my high hCG levels, and I would have no control over the timing or my environment. I could do a surgical abortion, commonly known as a D&C (dilation and curettage), which would require anesthesia and a trip to the hospital.
Finally, I could do a medical abortion at home, which my doctor recommended for my case. I vaguely remember her opening a medical textbook to tell me how to do it and what the risks were. She solemnly sent out for mifepristone and misoprostol, “just in case” I decided to go that route. We paid the receptionist 2,500 shillings for the drugs, or about $25; she would be able to legally procure them with a doctor’s note confirming my “nonviable pregnancy” (abortion is illegal in Kenya in most cases, though the drugs are available to aid with natural miscarriages like mine).
Reading the words “nonviable pregnancy” stung my eyes. This was not how I expected the morning to go.
UUpon hearing the names of the drugs, my mind began wandering. I knew them well, though not intimately, as the most popular method of first-trimester abortion — particularly in parts of the world where the practice is illegal or inaccessible. Compared to surgical abortions, the pills are more discreet and less invasive. Nonprofits like Women on Waves even bring them to women around the world by ship or drone.
Mifepristone, the first drug I was prescribed, decreases pregnancy hormone levels. Misoprostol, also known as Cytotec, induces labor. Taken together in early pregnancy, their efficacy in causing an abortion is over 95 percent. Both drugs are on the World Health Organization’s List of Essential Medicines.
I thought about the month I spent in Brazil in 2014 reporting about abortion, which is illegal there in most cases and deeply stigmatized. Complications following illegal abortions in Brazil are estimated to lead to four deaths a day. I then remembered sitting in a coffee shop with a 32-year-old personal trainer named Raquel, who told me about her experience using the same drugs I had just been prescribed — but under completely different circumstances.
Raquel, whose name has been changed for protection, told me about the time she paced down the aisles of a brightly lit drugstore with her friend Amanda. She spied the pharmacist who could, according to an acquaintance, fix her problem. Her palms were sweaty, and not just because of the tropical climate in Teresina, the northern Brazilian town she calls home. They fiddled with beauty products to pass the time, trying to be inconspicuous as he counseled another customer.
Once the customer left, they walked up to the white-haired man behind the counter. Raquel felt in her pocket for the 250 reais her boyfriend had given her (about $100 at the time). She dreaded to think how he would react if he knew how she planned to spend it.
Raquel opened her mouth to speak to the pharmacist, but nothing came out. Amanda jumped in with some small talk. A few minutes later, she whispered, “Actually, we’re here because my friend is looking for Cytotec.” Raquel kept her head down — she couldn’t bear to meet the pharmacist’s eyes — and tried to hold back her tears.
The pharmacist’s eyes darted around the shop. His voice dropped to match Amanda’s: “Who told you to come here? Are you police officers? Are you reporters?”
Amanda assured him that they had no interest in getting him in trouble; Raquel was just desperate to terminate her pregnancy, as it was her only way out of a bad relationship. Raquel privately thought about how, within a few short months, a drunken kiss at a party had turned into a relationship full of threats and verbal abuse.
She had met her boyfriend while battling a deep depression. “I was fragile, and then he appeared,” she recalled. They started dating, though she quickly realized he often turned to alcohol, which would turn to yelling and berating. “It wasn’t a relationship with love. It was just to have someone to stay with,” she said. She knew having a baby would mean signing up for a loveless and terrifying marriage.
The pharmacist, perhaps sensing Raquel’s anguish, asked Amanda to come to a back room. They returned with a blister pack of six pills. Two were to be taken orally (the mifepristone), and the following day, four were to be inserted vaginally. He said that under no circumstance should Raquel visit a hospital within 24 hours of taking the pills. Doctors would be able to tell she had attempted an abortion and may refuse to treat her — or worse, report her to the authorities.
OOver three agonizing days, I endured two more ultrasounds. The final one, on a Saturday morning, confirmed that the fetus was shrinking and that my body was showing signs of rejecting it.
As we left the office, I tried not to look at the happy pregnant couple in the waiting room. We went grocery shopping for iron- and protein-rich foods. I impulse-purchased a pair of earrings with a moon and star on them, because I remembered an Instagram post that ruminated on the word “miscarriage” and how it sounds like you did something wrong. Why not call it “returntothestars,” to acknowledge that a being existed, and then returned to the stars?
I hated my body. I hated that it had made an inhospitable home for the ball of cells that my husband and I had wanted for so long. I was ready to move on to the next stage of my life, to finally become a mother. In my nine weeks of pregnancy, I did everything according to the book. I took the prenatal vitamins. I didn’t drink. I didn’t eat uncooked egg yolks or soft cheeses. I didn’t even do sit-ups. Why was my body betraying me like this?
At home, I looked at the medicines on my bedside table. I took a deep breath and knew that I had to do a Very Hard Thing.
OOnce Raquel had the pills, the two friends agreed to meet at Amanda’s house that evening. Amanda lived with her mother who, on the pharmacist’s orders, had cooked a simple rice broth for dinner. At 9 p.m., they laid a mattress on the living room floor. Raquel forced a smile as she inserted the Cytotec, unsure of what to expect. Amanda gave her pillows to raise her pelvis, switched off the light, and wished her luck. Raquel lay still in the dark room, and for the first time that day, began to cry as she thought of the decisions she had made. Her friends and family had said that her boyfriend was a jerk — why didn’t she listen to them?
A few hours later, Raquel woke up feeling like she had to pee. Amanda had warned her to not go to the bathroom until she couldn’t hold it, lest the medicine leave her body prematurely, so she waited. Soon, she felt the first pangs of what would build to be intense cramps, far worse than any menstrual pain she’d ever experienced. When she could no longer handle it, she wobbled to the bathroom, sweating profusely. Her entire body contracted and jelly-like blood clots began sliding from inside her into the toilet. Her eyes widened, horrified by the sheer quantity of blood. She muffled her screams, so as to not wake Amanda and her mother.
The cramps continued throughout the night, and she bled well into the next day. The pain eventually subsided. Raquel’s pregnancy was no more.
IIn preparation for the miscarriage, my husband and I cleaned our house, lit candles, and put on music. I texted with a doula and an OB-GYN about what to expect. I decided to finally start watching “The Office.”
Our German Shepherd hobbled upstairs, which he had never done before, due to his old age and osteoporosis. But that day, he limped into our bedroom, put his face on my leg and paw in my hand, and looked me deep in the eyes. He then licked my husband’s nose and finally sat outside our door, as if guarding us. A few hours later, a brilliant blue sunbird flew inside the bedroom, sat on the dresser, and left.
Like Raquel, I inserted the pills and raised my pelvis on pillows. About two hours later, I had the same intense urge to pee. Over the following seven or eight hours, I rode through waves of increasingly intense contractions, in between watching Jim and Pam exchange furtive glances and eating apples with peanut butter.
What surprised me about the procedure was that there was beauty in the pain. My husband was the most supportive caregiver I could have ever asked for, and we shared tender moments throughout the day. We signed up “for better or for worse,” and this was one of the most horrible things a couple can ever endure. I truly believe that this adversity has made us stronger.
I spoke with my sister on the phone, who had reluctantly returned home to New York by then. Every time I felt a contraction stirring, she would distract me with a funny story, like the time one of her students plucked her classroom’s pet fish out of its bowl to take it for a walk.
That night, as the sensations were subsiding, I began to trust my body again. I began to believe the wisdom of this physical body that has served me well for the last three-and-a-half decades. There was most likely something chromosomally incorrect about the fetus that wouldn’t have allowed it to thrive, and maybe this was the least painful way to let it go.
IIn many ways, Raquel’s story could not be more different than mine. Her pregnancy was dreaded, while mine was welcome. I was in a nurturing relationship, while she was in an abusive one. I didn’t have to sneak around to get the healthcare I needed, and I trusted the quality of the information and medicine I was given; Raquel did not have the same luxury. I took the drugs in my own home, while she hid her procedure from her boyfriend, as well as from her deeply Catholic family.
I met Raquel five years after her abortion, and she still remembered that time as a low and painful point in her life. But she had no regrets. The abortion allowed her to leave a bad relationship and rekindle ties with her family, who had not approved of her boyfriend.
Regardless of whether a pregnancy is badly wanted or bad news, its loss is an emotionally fraught journey. As Julia Bueno writes in her gorgeous new book, “The Brink of Being,” “A miscarriage can be a relief for a while but mourned at a later date, just as the desired termination of an unwanted pregnancy can later become a devastating loss.”
I will not pretend to know the depths of Raquel’s anguish, nor will I compare her suffering to mine. I don’t consider my pain to be more virtuous than hers. Our circumstances were fundamentally different. All I know is that we were both relieved to have gotten the healthcare we needed — a relatively discreet pharmacological antidote to our individual personal hells.
And now that we’re both on the other side, I can confidently say that, truly, we are stronger than we know.
