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.

How Fragile We Are

This morning as I was scrambling through the morning get-the-kids-out-of-the-house routine, I heard a story on the radio about how the horrific Boston bombings, like other previous terror events, remind people about the fragility of life.

There I was, filling lunch bags, making tea, spreading spreads on toast, and rushing, rushing as usual, as I peppered my girls with the regular old questions: Did you brush your teeth? What about your hair? Go to the bathroom? Pack your backpack? Bring your book? Hurry, hurry, I said. We're running late.

And in the midst of that most mundane chaos, the radio reminded me that a father in Boston lost his eight-year-old son on Monday, while his wife and daughter's lives hang in the balance. Almost two hundred people, though they survived the blast with their lives, will forever after live with different bodies than they had before that moment.

On Monday, maybe an hour or two before the bomb exploded in Boston, I sat at lunch explaining to a new friend what it was like to be in downtown Manhattan on 9/11, because she asked. It doesn't come up often. For many of us, that experience of watching our city burn, of breathing the smoke and seeing the photos of the missing collect on lampposts and bus stops, is like a barely-healed wound. We try not to pick at the scab.

I told her that I decided that day in 2001, when I was 26 years old and had barely started a new career in publishing after a gear switch out of academia, that I wanted to have a baby; that I didn't want to wait until I was older. Because how could I be sure that I would be around in some unknown future? That's what 9/11 felt like to me: a cliff that the world almost fell over. The end of time.

The year that would follow held yet more difficulty for my family. That winter, Josh's sister Nina was in a traumatic car accident in which she lost her left arm.

Returning on the train to NYC from visiting Nina in the hospital in Boston, I sat next to a psychologist researcher doing work on trauma. (Or maybe I dreamed that I did, because the coincidence seems too strong to be true. But sometimes, this is exactly how life works.) He told me that trauma equals loss and that the loss can take many shapes: a person, a limb, or even a state of innocence. Healing from trauma involves acknowledging and mourning the loss. And it takes time.

I wish those amputee victims in Boston could talk to Nina now, and see all the ways in which she has reclaimed her self; how she has fought to be the powerful and capable person that she is, even without the arm that she was born with.

Some people argued after 9/11, as they always will, that it is futile to bring children into a violent world. But there's a difference between being aware of fragility and giving up hope.

I became pregnant with my first child in the spring of 2002, within months of both 9/11 and Nina's accident. That baby was, for me and Josh, a source of healing.

Yes, I am reminded this week, yet again, that life is fragile. That although it may feel that way sometimes, getting my kids ready for school--like most of our daily stresses--is way less than dire. But let's not let the horror in Boston take away our hope. Sending thoughts of healing and strength straight up 95 North...

Move Over, Birth Trauma. It's Time for Joy

This post is for a friend who is in the final days of pregnancy with her third child. She is tired, 'over it', and ready to meet the kid already, both emotionally and literally, as she is nesting up a storm. She's trying to be patient (compared to how I was at this stage--ready to stand on my head if it would get that baby out). She's worrying about names, about childcare, about having space and time for all of her kids. All of that is to be expected. 

What concerns me is that she's scared about the birth.

Unlike first-time moms, she's not frightened of the unknown. She not worried about her friend's horrible labors, or a birth she saw on TV, or a co-worker's fright-filled tales. She's scared because of her own first two births. She's scared because she doesn't want another broken tailbone and dozens of stitches like she had with her first baby. She's scared because she doesn't want an emergency Caesarian birth with prolonged pain and difficulty breastfeeding, like she had with her second baby.

Birth is many things: emotionally wrenching, painful, joyful, ecstatic. But it shouldn't have to be traumatic. I could sing this from the rooftops. There's too much birth trauma out there, and too much denying of women's emotional and physical pain from their births, as women are told they should be happy they have a baby. Period. Women are constantly told that the experience of birth doesn't or shouldn't matter. 

But the experience does matter. Growing and delivering a baby is an overwhelming, life-altering experience, second only, perhaps, to raising one. 

Here's my message to my friend:

You are a beautiful, wonderful, capable mother to two terrific kids. You will soon be all that and more to your third. You have the power to birth your baby. I believe in you. You are strong, and you are brave. Surround yourself, in these final days of growing your wonder baby, with people who will remind you of all of these things. When you are in labor, remember that you only need to get through one contraction. When that one is over, you'll have a break. Just focus on one at a time. When it's time to deliver, stand or squat or lean. Protect yourself and your tailbone by getting into a good position for that baby to emerge, no matter the size. I pray that you will both be healthy, and safe and happy. I pray that this will be the birth you've been waiting for. 

And as I said to you, on learning that you were expecting this child: the first is a biological necessity, the second is fulfillment of a plan, and the third is pure joy.