Ectopic pregnancy… and a pandemic
A junior doctor shares her story of ectopic pregnancy, miscarriage and a pandemic.
When it comes to pregnancy loss I feel like an imposter. My pregnancy was never planned. It would never have fitted comfortably into my life. I suppose I was lucky that I never had to make a decision about whether or not I would keep my baby. But that didn’t make it any less painful.
It’s odd. My memories from the time are pretty scarce. Sometimes my boyfriend reminds me of something we watched, or spoke about, and I have no recollection of it. I wonder if that’s a defence mechanism. Luckily, I wrote a diary. It’s difficult to read but I’m glad I have it.
I was in my final year studying to be a doctor. The Covid-19 pandemic had hit and we medical students were off placement, waiting at home for hospital work to start early. I had started to bleed on the exact day my period was due. But, unlike a period, this bleeding went on and on. In retrospect, I’m not sure how I thought it was “just a period”. The pain from my womb contracting was deep and made me feel sick. Blood was literally dripping out of me.
But — I had an IUD in place so there was no way I was pregnant.
When I did eventually take a test the line was faint but definite. So was the next one. I was shocked, but relieved that my body had seemingly made the decision for me. Despite this relief, the next morning I woke up early and cried. I have never felt sadness like it. My body ached for a baby.
At one point, I wrote in my diary that I didn’t want the bleeding to stop — “because then I know it’s all over”.
Because of the pandemic my boyfriend wasn’t allowed into hospital with me. So I lay there, half naked, bottom in the air, with a probe inside me. This was another thing I was learning — just how violating these investigations could be. I felt as if my body wasn’t mine. The sonographer didn’t talk to me and I had to keep asking what was going on.
Eventually she found something on my right fallopian tube. As a medical student, I knew straight away that this meant an ectopic pregnancy. This was made even more likely by the fact that my copper IUD was “perfectly” in place. Knowing so much about medicine did not help. I was terrified.
Ectopic pregnancies are taught as clinical emergencies that can be deadly when missed. They happen when an egg is fertilised and, rather than making its own way down to implant into the uterus lining, it implants somewhere else (most commonly the fallopian tube). It can be caused by many things — scarring from STIs, endometriosis, structural issues. Often we never really know the cause.
Rarely, IUDs fail and allow sperm to pass through and fertilise an egg in the fallopian tube. When the fertilised egg gets to the end of the fallopian tube and is unable to implant into the womb lining because of the IUD, it instead implants into the fallopian tube. There, it forms an embryo, which rapidly divides. Sometimes the embryo is reabsorbed by the body, but other times it can grow until it eventually ruptures in the tube, causing severe internal bleeding and even, sometimes, death. Fallopian tubes are not built to stretch. Women with imminent rupture will have bad one-sided abdominal pain. In this scenario often the only form of treatment is surgery to remove the (or parts of the) fallopian tube. This is what I was most scared of.
Luckily for me, the embryo was very small on my scan. My pulse and blood pressure were normal and I was not experiencing any one-sided pain. I had a blood test that showed that my BHCG (pregnancy hormone) was quite low. So I opted to “watch and wait” and hoped that my body would reabsorb the embryo.
Time seemed to pass differently in those weeks. I continued to have regular blood tests, which showed that my hormone level was going slowly down. But at the same time as waiting for the hormones to go down, I was waiting for signs of imminent rupture. I never appreciated before how regularly the stomach hurts slightly without us noticing. I would lie in bed, feel a slight twinge in my right side and suddenly be terrified I was about to die. My boyfriend was terrified too.
I had another scan — this time with a sonographer who actually spoke to me and made me feel safe. Luckily, my embryo hadn’t grown anymore but the doctor explained to me that it would be too risky to wait any longer and that I should instead have treatment with methotrexate. Methotrexate is an injected medicine that acts as an anti-folate drug. Folate is used by rapidly dividing cells, and this is why pregnant women are encouraged to take folic acid in the early stages. Methotrexate blocks this and so would stop the growth of my embryo.
I remember trying to comfort myself in the room while waiting for the injection, asking the nurse, “surely my risk of rupture is now low given how small it is”. She helpfully (not!) replied that she had seen women rupture with “tiny” levels of hormones. She then left me alone for at least 40 minutes before giving me the — unexpectedly painful — injection in my bottom.
Life continued in a weird timeless way. I moved to London. On my birthday, I had my blood taken and the nurses sang happy birthday to me. I went for more scans, and tried desperately to stop my legs shaking. The new London hospital used a warm probe — how odd, I thought. At one point, I wrote in my diary that I didn’t want the bleeding to stop — “because then I know it’s all over”.
During this time, I was in regular contact with my friends and family. Two of my friends brought me chocolate and dinner. They drove me to and from hospital appointments when my boyfriend was away moving our stuff into our new home in London. They waited for hours in car parks. They sat with me while I cried. I’m not sure how I will ever repay them.
Eventually, I got the call telling me that my BHCG had dropped. A few more weeks later and it was finally zero. I wasn’t sure how I felt. Relieved I suppose. But after the hyper-vigilant fear of dying came the grief, which I really wasn’t prepared for. After all, this was a baby I’d never planned for or wanted.
But something changed when I found out I was pregnant. I wondered if it was a boy or a girl and what colour eyes it would have had. It affected my sleep for a long time.
The fact that it was half my boyfriend, who I love so deeply, made it even harder. We would speak about it often (we still do). It’s something we share and I do feel grateful for the connection it’s given us.
I wonder how different my experience would be if it hadn’t been during a global pandemic. I certainly would have had more support. There was, however, something strangely comforting about not having to see anyone or do anything. I could hide away in my little cocoon.
Towards the end of the summer, I sat in a park with my friend and cried about it. I tried to stop myself and she asked me why. I said that if I didn’t stop, I could continue crying forever.
My ectopic pregnancy is something I have to learn to live with. But I am okay with that. Since starting work — a new chapter — I feel far more able to do this. If anyone asks me whether I worked as a doctor during the first wave of Covid, I tell them I had an ectopic pregnancy instead. Everyone I’ve told (except one!) has been incredibly kind and understanding. I like to think I’m helping to remove the stigma surrounding pregnancy loss, one little bit at a time.
The pregnancy is something that will always be a part of me… and I want it to stay like that. I do take comfort in knowing that I am a part of the collective and unspoken pain that is womanhood. It makes me feel connected and it makes me feel powerful.
