Looking back.

I've been thinking lately, about my reproductive issues. Thinking about all the mistakes that were made with Gabriel, and thinking about how all of this technology wasn't enough to save him when the humans controlling it still made mistakes. Thinking about how that might change someday, or not.

It made me think about that which lead to Gabriel's premature birth - the ectopic pregnancy that preceded it. People who were around back then may remember the weeks of anxiety over that pregnancy as it was never normal. A dropping temp, spotting, a full period and positive pregnancy tests that persisted beyond the period. Beta tests indicated a likely chemical pregnancy, and home pregnancy tests indicated a persisting pregnancy.

Beta after beta followed, always increasing, never normal. No question about a baby in the future, but a big question about what the hell was happening. At 7 weeks, a pelvic scan was totally normal. At 9 weeks, the 'pregnancy' - now a growing fluid filled cyst attached at the internal os of the cervix was found. I was given options - methotrexate being the preferred option. A d&c was offered but counseled against as an older method that required surgery and may or may not fully remove the cyst/pregnancy and carried a higher risk of damage to the cervix (which was inevitable, as the pregnancy had already damaged it, though we didn't know that then). Methotrexate it was. It worked to stop the growth and encourage my body to do the rest. All together, I spotted or bled for 3 months. It was an awful time.

I remember being shocked by the diagnosis, since I had dismissed ectopic pregnancy as a possibility because of the clear fallopian tubes in the seven week scan. The odds of an ectopic pregnancy occurring outside the tubes are very small (hence the common name 'tubal pregnancy'), and for a cervical pregnancy the odds are 1% of all ectopic pregnancies.

This happens so rarely that there aren't good retroactive studies done for it, so causation is sketchy at best.

The advent of methotrexate being used to stop growth in pregnancy has been life-altering for women with ectopic pregnancies. It provides a non-surgical option for ending the pregnancy, which can better preserve a woman's fertility. While surgical options are much improved with the advent of mini-laprascopy, there is always a risk of damage. With cervical pregnancies, the chances of damage are greater, because it requires manual dilation (which can weaken the cervix)and curettage in the cervix (which can cause problems like what I have). Back in the day, the most common end to a cervical pregnancy was a hysterectomy caused by excessive bleeding. The abnormal bleeding I experienced - while not excessive - is perhaps the biggest sign of something wrong, and I was lucky it seems. Though without modern technology, who knows what would have happened? That group of cells just stuck around and continued to grow and expand.

Would I have died? Would I have had a hysterectomy? The odds are that if I survived the experience - and there is no guarantee the further back into history we go - then it is unlikely I would ever bear a child to viability because of the damage. That damage was dismissed and undetected by our modern means of medicine (by 2 doctors and a midwife and a clear ultrasound days before) until I lost my child. A cerclage should solve many problems (if I ever conceive again, which somedays, looks doubtful at best), and p17 shots, restricted activity and close monitoring should solve the rest. Options unavailable to me not that long ago.

I don't yet know what all of this means when put together, not really. I guess that I'm grateful to live now? Even when I'm not? I wonder sometimes what might have been, what is another dimension or plane or timeline in which all of these possibilities are realities. Before, I've only imagined myself holding Gabriel and loving him, watching him grow. But there are other timelines, ever divergent, in which Gabriel is never conceived because that ectopic ended in hysterectomy. Or in which Gabe isn't conceived because I had a d&c after Chickadee and waited the necessary cycle and the ectopic wasn't conceived. Another child was, a girl sometimes, sometimes a different Gabriel. In some branches of this mystical life, Chickadee lived and is beginning the first steps of potty training and toddling after Jonah. Back and back and back and around and around and it has all of it happened and none of it been. Of course, even if life works that way somehow, the one I'm living presently is all that matters.

Perhaps trying to assign meaning to it is laughable; these things simply are as they are. Considering them beyond that is an exercise in futility. I do think though that I'm still processing that pregnancy. It was so long, so abnormal, so filled with angst and then that doctor was so awful to me, and then it was the drama of watching the numbers decrease, and when to try again and then . . . Gabriel. The effects of that pregnancy are far-reaching, and still being fleshed out. I wonder if I'll ever feel that my body hasn't betrayed me.