Let’s get something out of the way first, as I appreciate the post heading here is rather click-bait-y, this isn’t going to be a post that offers easy answers. Yes, I’m pregnant again, and, yes, we’ve made it to 22 weeks so far (and counting…every agonising day and tremulous kick). But there’s been no ‘a-ha!’ moment; no ‘one weird trick’; a consultant hasn’t suddenly been able to pull a wonder pill out from under a sleeping rabbit in a hat. Even so, since announcing I was pregnant for the fifth time a few weeks ago I’ve found that one of the first things people ask me is: what did you do differently this time?
It’s a fair question. After all, it’s exactly what I would want to know, too, were it someone else. As one miscarriage became two miscarriages, became three, became four…I tore through the internet looking for stories of people who’d had successful pregnancies after losses – and what, if anything, they’d done differently when it finally ‘worked’.
So I think it’s only fair that I try to give the question a proper answer. With the major caveat that I am not offering advice or holding myself up as some sort of paragon. For a start, I still feel there is a long path ahead of us and we are by no means out of the woods yet (part of me feels that the very act of writing this is jinxing things, inviting the scorn and spite of the universe as I type).
What’s more, as a general rule of thumb, I try not to dwell on these pages on what exactly I’m doing or not doing in our efforts to bring home a baby. I am not a doctor or an expert in anything (bar Harry Potter trivia or Gilmore Girls plotlines). I also know too well how seductive it can be, in the absence of any other answers or hope, to read the musings of a stranger on the internet about their radical lifestyle overhaul or battery of private medical tests and swallow it whole, as a prescription for success. Believe me, I’ve been there.
The not-so simple answer to what I’ve done differently this time around is ‘some things’ but also ‘nothing, not really’.
I didn’t have any new tests or procedures. And I didn’t make any major changes before we conceived this time. I kept taking the basic (and I really do mean the cheapest of the cheap, supermarket basics range) folic acid that I’ve been taking for the best part of four years. I didn’t change my diet. I am not gluten-free or vegan or vegetarian. I didn’t quit sugar. I ate real, full-fat dairy and (a little) red meat. I still had the occasional take-away and I didn’t worry about whether things arrived in plastic containers (at least, not from a fertility point of view). Unlike in the past, I still drank a little, though not much – probably no more than three glasses of wine or G&Ts a week. I vaguely tried to avoid alcohol post-ovulation, but I was by no means obsessive about it. I think I had a glass of wine the day before I got a positive pregnancy test this time, in fact. I did yoga once a week and carried on running, although I cut down on my miles and stopped signing up for races.
The biggest change – and it is potentially a very big one – was that once I was pregnant, I persuaded our NHS recurrent miscarriage clinic to let me take progesterone this time, on a ‘just in case’ basis.
Previously, all the consultants we’ve seen have been incredibly reluctant to prescribe anything at all, on the basis that all our results have been normal. But I knew that a large-scale, high-quality research trial last year had shown that taking progesterone increased the live birth rate for women who have had more than three miscarriages – in this particular group of pregnant women involved in the trial, 72 per cent of those who took progesterone went on to have a healthy baby, compared to 57 per cent of women in the placebo group (i.e. who were given pills with no active treatment in them). The researchers concluded that this was a substantial and significant benefit. There was a slight benefit for women who’d had one or two previous miscarriages, but the evidence is not as compelling. (You can read more about the trial, which was funded by Tommy’s, here, and the full scientific paper is available to read here).
The specific dose used on the trial was 400mg (as two capsules per day), and women took it up until 16 weeks – so this is what I did, too, starting after our first appointment, at seven weeks pregnant.
Progesterone supplements are not especially pleasant to take. They’re a pessary for one thing, which horrified Dan when I explained that I couldn’t take them orally, that the tablets had to go in my vagina (think cartoon-character eyes-on-stalks on his part, as we waited in the hospital pharmacy). Frankly though, after two general anaesthetics and an interminable amount of internal probing and prodding, a twice-daily encounter with a pen-lid sized capsule of hormone-infused vegetable fat is the least of my worries at this point.
They do make a real mess of your underwear though. And side-effects can include headaches, bloating and mood swings – of course, it’s hard to separate out whether these are caused by the supplement or by the pregnancy itself.
I’ve since learnt that it’s also possible that a bleed I had around the 8-week mark was caused by the pessaries irritating my cervix. This was alarming to the point of psychological torture, given that this was the exact stage our previous three pregnancies have failed, and that the bleeding looked identical to the start of both of my natural miscarriages. For a little over a week, I was completely convinced we had lost another baby and we went to our nine-week scan braced for bad news.
It was only after I’d had time to accept that the little bubbling bean we were shown on the ultrasound screen really was real – after the last tears of relief had been wrung out of me, after the sonographer had confirmed there was no sign of a bleed from inside my uterus – that a quiet anger crept in that no one had thought to mention the possibility of bleeding as a consequence of taking progesterone.
I should probably say, at this point, that progesterone is something I had to ask for specifically. I don’t think it would have been offered to me if I hadn’t. It should also be said that the best evidence for progesterone is in women who have had three or more previous losses and are experiencing bleeding again in their current pregnancy. (Whereas I didn’t get any bleeding until after I started on the progesterone, confusingly).
With this in mind, I was well aware that it could make no material difference to us this time, other than offering a kernel of comfort, knowing that at least we weren’t ‘doing the same thing over and over again and expecting different results’. That much-quoted definition of madness.
My level of faith in the pessaries would pendulum-swing on an almost daily basis, lurching between a near-ravenous belief that the progesterone was all that stood between us and another miscarriage (invariably this would be on days where I’d forgotten to take one of the capsules, or taken it slightly later than usual) and, alternately, a cast-iron conviction that it was making no difference whatsoever, or, at best, was just delaying the inevitable. As I said, there are no wonder pills.
So that was the ‘something’, now here’s the ‘nothing’ part.
When it came to everything else, I tried to remind myself that I’ve done it all ‘perfectly’ in previous pregnancies and things had still gone to shit. And, on that basis, this time, there should be no onus on me to do anything other than the minimum of good pregnancy behaviour.
I carried on using all my normal beauty products and toiletries. I kept painting my nails. I kept an appointment for a facial, booked pre-pregnancy test. (Though I did dodge the hairdresser’s completely until the second trimester, unable to overcome my fear of being sat that close to hair-dye chemicals for any prolonged period of time).
I still ate runny eggs. And smoked salmon. On a very brave dinner out I ordered tiramisu (raw eggs, coffee AND alcohol). Though, to be completely honest, for the first 12 weeks, my diet was largely made up of Tuc biscuits with cheese, salted crisps and peanuts. Salted anything, really. My fruit and vegetable intake took a dive off a cliff, as I felt too sick. I didn’t drink coffee – not at all, not even decaf – until around 15 weeks, but only because even the smell turned my stomach. Make of that what you will.
I did stop running post-test and, on the advice of my teacher, I also stopped yoga for the first trimester. There is no medical basis I know of for either of these decisions, it was purely about managing my anxiety (and from about week six I was too tired anyway).
Another thing I used to beat myself up about after our previous losses was my stress levels: the strain of working 50-hour weeks, sometimes not leaving the office until 9pm or later, and commuting for up to three hours a day. Admittedly, a big chunk of that stress has gone from my life now that I’m freelance. This time round, I’ve had the luxury of making sure I could get enough sleep, rather than dragging myself up for the 7.12 train. But I did still have deadlines to meet, projects to juggle and tax returns to do. And, of course, throughout the whole of the first trimester, I was trying to co-ordinate a complicated house move. So I would be lying if I said I was entirely un-stressed (and that’s even before we account for the stress of believing you could lose this baby too, at any given moment – a whole other post, for whole other day).
I repeat, I’m not sharing any of this as ‘do’s’ or ‘don’ts’. I suspect a lot of my choices were largely meaningless. Instead, I hope this post can function as a sort of pressure-valve for the pregnancy-related perfectionism that can build up after loss. I hope it shows there is no such thing as a ‘perfect’ fertility diet or pregnancy lifestyle (beyond the very basics). I hope it helps quieten that weasly inner voice that likes to shout ‘blame’ at you whenever it can.
I’m aware that a more comforting answer from me, at this point, would have been to say that it has all felt different this time round. That I ‘just knew’. That there were signs. That I was more sick, more tired. But it would be a lie. For the first 12 weeks, I kept trying to read those runes myself. I willed the morning sickness to be worse. Because surely that would mean something. Every so often I’d convince myself that I didn’t remember feeling this bad when I was pregnant before. And then just as quickly I’d recall the piles of ginger biscuits I went through in pregnancy number two. Or the time I almost threw up on the tube, gagging on a stranger’s aftershave, on my way to the scan that diagnosed miscarriage number three.
As I said, there are no easy answers. There is only inching yourself along, cautiously and carefully, eyes as open as you can bear to keep them, on a tightrope across the unknown.