At the beginning of each month, I check off the bills my husband and I are expecting: mortgage, water, electricity. Automobile and health insurance. Our cellphones. All normal, somewhat boring expenses. Then I get to the medical debt from my miscarriage, and I need to take deep breaths to center myself.

I have survived this.

I told myself this a few weeks after I lost the baby, when the bleeding finally stopped and life felt normal again. I made it through an entire day without breaking down in tears. The worst of it is over, I thought.

But then the medical bills started to arrive, and I felt like I was losing my son all over again.

In April of this year, I peered at a positive pregnancy test, filled with panic. I wanted a baby, but knowing I was actually carrying a poppy-seed-size embryo that would eventually become a tiny person was an overwhelming thought — especially as I wondered whether my husband and I could afford it.

I’d heard that labor and delivery could cost thousands of dollars, even with good health insurance. My friends with children complained about the bills they received while their babies were still newborns. My husband and I talked about how much we needed to save. We decided to cut back on takeout and skip coffee runs. I started researching car seats and strollers.

Saving money made it feel real — having children was no longer an intangible hypothetical for us; it was actually happening. I couldn’t feel any kicks yet, but we saw the baby wiggling during ultrasounds at my doctor’s office. I almost cried the first time I heard the steady, loud throb of the baby’s heartbeat.

But when I was 13 weeks pregnant, an obstetrician looked at me with sadness in her eyes and told me the baby was no longer alive because of a neural tube defect called an encephalocele, which happens when a fetus’s skull doesn’t fully form. Weeks later, we found out that the defect had been caused by a rare condition called Trisomy 18, and we were also told the baby was a boy.

I was given the option of waiting for my body to miscarry naturally, taking pills to induce miscarriage, or having a dilation and curettage procedure to remove the baby that day. Surgery made the most sense to me — I felt like a walking cemetery, and I just wanted it to end.

I didn’t know, though, that what felt like the least traumatic choice — the D&C that would end my pregnancy within hours — would also come with a hefty price tag. I had health insurance, but more importantly, I was consumed by grief. So the cost was the last thing on my mind.

I spent the days after surgery in a fog, bursting into tears without warning and dreaming about the baby I’d never meet as I cramped and bled. With the help of an incredible therapist and a strong support system, I began to feel like myself again a few weeks after my loss.

But nothing could have prepared me for the shock I felt when I tore open the first envelope and started to grasp how much money I was going to owe. The bills started to arrive in August, two months after the surgery: $1,368 to the anesthesiologist who was present during the surgery; $500 to the hospital; $228.52 for lab work; $1,017.43 to my obstetrician’s office; $1,400 for the fetal autopsy; $273 for the appointment where I found out there was no heartbeat. And the bills haven’t stopped coming.

My health insurance company covered only a fraction of the cost. When I called them to ask why, the representative told me the rest was to be paid out of pocket and they’d apply it to my annual deductible.

I sometimes wonder whether I would’ve picked a cheaper option if I’d known how much I’d owe. Would I have taken pills to induce miscarriage and labored at home — an option that was presented but not recommended by my obstetrician? Deep down, I don’t think it would’ve mattered. I was wrecked by grief and not feeling very pragmatic. I would have likely agreed to pay anything to make my pregnancy end as quickly as possible.

On most of the bills, it lists a missed abortion under the service description, which is the medical term for a miscarriage in which your body doesn’t naturally expel the fetal tissue. That was a regular reminder that something had gone terribly wrong. My body should have known something was wrong and miscarried on its own, but it didn’t. So now the money we had planned to use for nursery furniture is instead being spent on monthly payment plans to various health providers.

And I feel fortunate. We’ve been able to afford the bills, even though we’ve depleted our joint savings account, and we should be done paying off the debt by next summer. This situation hasn’t bowled us over financially, but it’s taught us even more about the profound unfairness of pregnancy loss.

“From a psychological perspective, there’s almost a sense of re-injury or retraumatization,” says Jessica Zucker, a clinical psychologist who specializes in women’s reproductive and maternal mental health. Zucker started the viral #IHadAMiscarriage campaign after miscarrying when she was 16 weeks pregnant. “Receiving these bills and then having to actually deal with them can be crushing.”

One of the lowest moments came when I called a billing office and tried to argue down the fee total. I had a miscarriage, I told the woman on the other line. This wasn’t a planned procedure. She was sympathetic but couldn’t do anything to help.

Zucker says that grief is unpredictable, and a phone call with an insurance agent could make your day much worse. “If they say the wrong thing, that might just throw you into this fit of despair,” she says. “It’s really hard to know when it’s a good time to take this on.”

She suggests asking a partner or close friend to help navigate the billing and insurance headache, and I agree that can help — delegating some of the bills to my husband did make it slightly more bearable. But he’s also still grieving, and dealing with the logistics is hard for him, too.

Eventually, I will try to get pregnant again. If I’m successful, I’ll pull out the onesies I bought during the first trimester and stashed in a closet after I miscarried. And I will start to save for a nursery for a second time. I can only hope that the medical bills I receive after my next pregnancy will be for labor and delivery costs, and that they will feel like a simple nuisance instead of a reminder of the worst day of my life.

Ayana Lage is a freelance writer and former journalist living in Tampa. Find her online at AyanaLage.com.

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