The Girl We Lost

There was a time, not too long ago, when I wouldn't have been able to read an opinion piece called End of Life, At Birth. The title alone would have kept me away. Too liable to scratch away at the scab that has finally begun to harden over my wound.

Written by Dr. April Dworetz, a neonatologist, the piece examines the moral quandary of sustaining life in very premature infants.

Earlier this year, I shared my children's birth stories, on their birthdays. But last month, I let my third child's birthday come and go. She was born July 8, 2009, though she never took a breath.

When my water broke at 22 weeks, 4 days, I knew it was very bad. I knew that where we were living, in the UK, newborns would not get any medical care before 24 weeks gestation. But I also knew that even if we crossed that shaky line, it wouldn't guarantee anything in terms of her health. Unlike the parents of 23-week baby "Miracle", described in Dworetz's piece, Josh and I are scientifically-minded and well-informed; we knew the many risks associated with extreme premature birth.

I knew that babies need amniotic fluid to grow, and that mine was going, fast, along with worrying bloody show. I knew that there was no way to stop the leak, nor to put substitute fluid back inside. But there was so much I didn't know. No one at the public hospital where I was admitted ever looked me in the eye and told me that I was going to lose my baby. I understand, completely, why Miracle's parents allowed their child to be resuscitated. The opposite choice is so shocking, it hardly registers.

Our baby was going to die? But we had just picked up a hand-me-down crib from a friend. Our daughters, ages 6 and 4, had attended the 20 week ultrasound, and were thrilled to learn they would have another sister.

I would have to birth the baby. For some reason, I thought the doctors could spare me from this; rescue me from the baby dying inside me. But day followed day, as my body depleted itself of amniotic fluid, but refrained from going into active labor. I've since learned that it can be hard for a woman's body to go into labor before the hormones are right and ripe. If I had been more comfortable with death, and if anyone had given me frank choices, I might have gone home and waited, however many days or weeks it might have taken, until my body was ready to give birth. But I was not comfortable with death, and no one said a thing.

Also, there was that unspeakable fear hanging over my thoughts: if she, by some unlikely "miracle" made it past 24 weeks, they might put her on machines; keep her alive. And, as Dr. Dworetz explores in detail, there were many reasons to question that course of action, for the affliction she might have experienced, and for our own.

I forbade my daughters from coming to see me; I didn't even speak to them on the phone. It was like a state of purgatory, in which I couldn't explain what was happening, so I chose not to try. After one ultrasound, in which I held my gaze away from the screen, terrified of seeing both the technician's face, and my baby's, I wanted it to be over. I knew that our baby did not have a future, and I felt like I was in hell. I couldn't continue to live until this was over.

I asked for, and was given, drugs to bring on active labor. I had to sign a piece of paper, as technically I was choosing to end the pregnancy. (If I had been in Texas, following the passage of recent laws, my desperate pleas to bring this suffering to an end would have been ignored.)

A neonatologist, the most compassionate and straight-talking caregiver I encountered in my five-day ordeal, told me what to expect. She said that it was possible that the baby would be alive when she was born, but that because her lungs were not fully developed, she would not live more than a few hours. She told me that either way, I could hold the baby.

I gave birth the regular way. Though she only weighed 1 lb. 8 oz., the birth was more painful than any of my three full-term births. There's a difference between pain and suffering, I learned recently in a childbirth educator course. All my births were painful, but with the others the pain was tempered by intention and joy and excitement. This birth was replete with suffering.

A nurse wrapped her in a blanket so only her ashen face was showing. She felt so light in my arms, like a tiny bundle of feathers. The nurse said, "she has your hair."

Though there was no religious obligation to have a funeral or sit shiva, our supportive rabbi helped to arrange a burial in a Jewish cemetery. Though there were family members who discouraged it, I insisted on attending. The day after I was discharged from the hospital, we drove to north London and watched as Leah Naomi was buried in an unmarked grave, full of babies, secrets, and loss.

I noticed that most people in my life didn't want to talk about the baby that had failed to live. Some people never ever mentioned it to me. It was like I had never been pregnant. For whatever reason, it was hard to talk about.

It's hard to write about, too. There was so much guilt, so much second-guessing, as I wondered what I must have done wrong; I felt like I had failed grandiosely as a mother. But that caring neonatologist in the hospital said one other comforting thing I'll never forget: she said that considering the innumerable things that can go awry in the process of growing a baby, the miracle is that they ever come out of the process well and fully-formed.

Dr. Dworetz's piece starts with Jackie Kennedy's loss, which I have thought about a lot: how publicly she was pregnant, and how publicly she was forced to mourn. Pregnancy, for most women, is a time of celebration and joy. What I didn't know, until after, is that loss is an ever-present part of the fragile life-giving process. I had entered the secret society in which women--some friends who had never before mentioned a word--shared stories of their own or their relatives' losses. I attended a support group, where I found out that babies die; not just mine.

As explored in another New York Times piece from this past weekend, trauma is an ever-present part of everyone's life, and our traumas are bound to us. They do not simply evaporate. This one will be with me, always.

Welcome Sunshine, Part Two

Part One recap: 41 weeks pregnant, in hospital. Finally, labor starts picking up. While the details are hazy for me, my lovely doula Jill Fransen wrote an account. Thank you, Jill, both for writing the story and for agreeing to let me share parts of it, here.

When I arrived around 4:00, your dad was there, and your mom arrived in a little while with food for Josh. Your contractions were tolerable as you sat in the rocker. That rocker would be your friend for many hours that night. 

After your folks left we got down to the real business of labor. Your contractions were really quite close and strong. It seems that your labor was a series of rhythms. The rocker was very effective...you would "OM" through the contraction...going inward and being very focused. Then we decided to walk, stopping every few feet as you bent over holding onto the rail. You were determined to just continue to let your body and baby work together. You got in the shower; we listened to Sting, Stevie and some jazz. 

You labored--your contractions were mounting. You were getting very tired...your energy was being drained, and still your dilation was very slow. Things were getting intolerable: from the birth ball, to the shower, back to the chair, slow dancing with Josh, back rubs, foot rubs, hand massages...it all helped, but you were about to hit a wall. What you needed most was rest. Around 10:30 the nurse removed the rest of the Cervidil to give you a break from the piggybacking contractions. Finally around 1:30 in the morning, you got in bed, had a half dose of Demerol, and were able to get some rest. 

Here's what I remember about this part: I remember that the nurse saw me working hard and said something to the effect of, "I don't think you can go on like this much longer." She wanted me to have pain relief, but an epidural was not an option because I wasn't dilated enough (not that I wanted one anyway). I consented to the Demerol because I believed that I was still at the beginning of labor--that it could potentially be another day or two before the baby would be born, and I just didn't see how I could go on for that long. Josh was also exhausted because we'd been up for past several nights with false-alarms.

Josh opened up the couch, I positioned myself by your side, your small hand in mine. We turned off the lights and you got the rest you needed. I have rarely seem Demerol work so perfectly. You were aware of the contraction, only at the peak...you moved around, moaned, then were able to fall back into a restful peace. I did not leave your side as I held your hand and talked you through the peak of each contraction.

What I remember is that the contractions at this point were incredibly strong and hard, and that I couldn't "OM" anymore because I was loopy from the drugs. So I was literally moaning in pain at the peak of the contractions. While the narcotic undoubtedly allowed me to rest in bed (I couldn't have laid down otherwise), it actually took away my ability to concentrate and deal with the pain. I was very, very grateful to have Jill's hand to squeeze during that time.

Then, an amazing thing happened. As you roused during a big contraction, you said something popped--"my water broke." While you weren't particularly happy at that point, it sure put a smile on my face. Within a half hour the nurse checked you and you were 6 cm dilated! Josh woke up; the lights went back up a little...we were on baby alert. You went to the bathroom and sat there for a while. I believe that is where transition took place, because you experienced powerful urges to push. By the time you returned to bed, at about 2:30am,  you were 9 cm. dilated. This now was exactly the opposite of the old axiom: Hurry up and wait! This was, rather: Wait and hurry up! Dr. S. had to be called--you were going to have a baby! 

Now you were experiencing real bearing down urges...almost uncontrollable urges. This was when Josh just shone. He had you concentrate on his face, on his finger, guiding you through those extreme urges to push as we waited for the doctor to arrive.

To explain: the nurse was in a bit of a panic, as the doctor was not there. She told Josh to hold his finger in front of my face and instructed me to blow out the candle...instead of pushing. So, essentially I was holding the baby in due to absence of the doctor. Good times!

You were just amazing as you blew on the birthday candle that was Josh's finger. The urge at that time is greater than any other bodily function; watching you two at that moment I knew you were quite a team. I think the nurse thought she would have to deliver this little bundle...the first time we looked we could see about one eighth of her little head peeking out. So we were very grateful when Dr. S. walked in, sleepy and so beautifully pregnant herself.

Because you had done so much work before; because you had done so much breathing down and letting your baby just descend, you only had to push two or three times, and there she was...in all her glory of girl and red hair.

When Bella was placed on my chest I cried, and Josh cried, and I kept saying, "Beautiful! Beautiful!" because she was.

Isabel Renee

January 30, 2003

3:45 AM

8 pounds, 9 ounces

Bella's Birth Story, Part One

In honor of Bella's birthday: her birth story. It only took me ten years...

About a week before my due date I moved back into my parents' house, where I slept in my childhood bedroom. This was because my Ob-Gyn, Dr. S., was my father's partner, and also the same doctor I'd been seeing since I was eighteen. No one wanted me to have to travel to Long Island from the city whilst in labor. It wasn't half bad having my parents watching over me and feeding me, like I was a child again. But there wasn't much to do other than wait, and being away from home really put a big black exclamation mark over that magical and elusive due date.

When that date came, January 22nd, 2003, I started work on my labor project, an idea I took from the inspirational book, Birthing From Within. I made a birthday cake for my little Sunshine, the name we called her throughout my pregnancy, not knowing that she was a she. If only I had actually been in labor... (We stuck the cake in the freezer and brought it to the hospital after Bella was born, where we shared it with the nursing staff. No awards for me in the cake-decorating dept., I know.)

A few days later, I started having daily non-stress tests (a half hour or so strapped to the fetal monitor) at the doctor's office. At each test, Dr. S. said, "The baby sounds great. We can induce you now, you know." 

Josh and I took a lot of walks, as I was determined to move the baby down and get labor going. It was freezing out, one of those bitter winter weeks, so we found a place to walk inside: up and down every aisle of Target and Best Buy and Home Depot. I thought maybe Sunshine was staying put because it was simply too cold out for babies (or because she was afraid of big box stores).

On day five or six, the doctor's message changed slightly: "Soon it will be time to get that baby out." She stripped my membranes (ow!) and said, "You're really not dilated at all. Maybe a one." What I heard was: Nothing's happening. Your body is not doing what it needs to. That baby is never coming out without our help. 

On day seven, at the prospect of Josh having to leave to go back to work in the city, I gave up. I didn't want to be induced. I knew that inductions with first babies have a higher rate of resulting in Caesarean births. But I was beyond ready to be done with the waiting and to meet my baby. 

When I arrived in the hospital (straight from the doctor's office) for my induction on January 29th, I was already having patterned contractions, which had been happening on and off for days. I hadn't slept well the past two nights, and I was already tired. The doctor inserted a Cervidil suppository, and I had to stay in bed with a large uncomfortable plastic belt around my middle. (Whoosh, whoosh, thump, thump..the sound of that monitor never ending; Josh staring at the printouts because there was little else to do.) "In the morning, we'll start you on pitocin," Dr. S. said. Then, pregnant herself, she went home to sleep.

When the contractions soon became strong, I was very thankful to have my wonderful doula, Jill Fransen, at my side. She encouraged me to ask for permission to walk around, and reminded me to practice techniques to get through each contraction. I had prepared for this. I believed then, as I do now, in the mind-body connection that allows a woman to give birth. I tried to gain strength from my (hokey) piece of birth art (another Birthing From Within inspiration), and reminded myself what I had to do.

I don't have a good sense of the timing or details of what happened next, but lucky for me, Jill wrote a detailed description of the birth. 

Tomorrow: Part Two, Jill's account of Bella's birth.