A perfect storm

Last Wednesday, I ran into a mom of one of C. Samuel’s classmates for the first time since we lost Jane. Reflexively, she asked, “So, what happened exactly?” then immediately seemed to regret it, saying “You probably don’t want to talk about it.” I suspect this is the thought process most people go through when they hear our daughter was stillborn.

For the record, I don’t at all mind talking about it.

At the time of Jane’s birth, we knew extremely little. Dr. R suspected a placental abruption: I had no risk factors for stillbirth aside from maternal age; even with the close monitoring that came with going past term, I showed no indicators of an underlying cause; and my labor progressed extremely quickly (a classic sign of abruption). Moreover, Jane came out looking perfect, with no signs of cord injury (the other likely cause for demise of an otherwise healthy pregnancy).

Six weeks after my due date, we went to our follow-up appointment with Dr. R. By then, the results had come back from the dozens of tests performed on me…

The verdict?

Dr. R said that to the best of her knowledge, Jane’s death was the result of “a perfect storm.” I Googled the expression, and found it defined as “A situation where a calamity is caused by the convergence and amplifying interaction of a number of factors”. Sounds about right.

What were the factors converging to result in Jane’s demise?

Dr. R said there were three contributors that we know of, namely:

  • We know that Jane had a small, insufficient placenta, although we don’t know why. Risk factors for this include drug use, high blood pressure, pre-eclampsia, gestational diabetes, advanced maternal age, and infertility. Dr. R said she had looked into the infertility link further, and found that it has only been demonstrated for pregnancies achieved through IVF…so not Jane. The only known risk factor I had was advanced maternal age.
  • Jane had a shorter-than-normal umbilical cord. I’ve learned that the normal range is 35-80 cm, and that Jane’s was 30 cm after being cut. Dr. R freely acknowledged that some may have been lost in the cutting. So definitely on the short side, but not far outside the normal range. She said that a short cord increases the risk of a cord injury.
  • The main vessel of Jane’s placenta contained some “old, organized clots”. Dr. R suggested this may be due to an event that pinched the cord. (More on this in my placental pathology report, reproduced in part here.)

Dr. R suspects one additional contributor to Jane’s death:

  • Dr. R still believes I had a placental abruption. She said she can’t prove it (for example, my test for maternal fetal hemorrhage was negative), but supporting evidence includes my crazy, tumultuous labor (from 1 – 10 cm in less than 2 hours), old brown blood in my amniotic fluid (which was visible upon dilation), and “port wine-colored” blood delivered with Jane in my amniotic fluid.

Would Jane have been okay otherwise?

There’s no way to know if Jane would have suffered from my crappy placenta and blood clots if she had been delivered earlier. She looked perfect at delivery, so…perhaps not.

Was Jane “growth restricted”?

Dr. R said we can’t tell if Jane fit the definition for intrauterine growth restriction (IUGR) or if she was just small for gestational age (SGA).

Was there an underlying cause?

Kaiser did tons of tests on me. All came back essentially normal. I do not have a clotting disorder. I did not appear to have any relevant infection during my pregnancy with Jane. Dr. R promised to send me my test results by mail. (She did, and I summarized them here.)

How could we prevent this from happening in a future pregnancy (assuming we can get pregnant again)?

For any future pregnancy, Dr. R would recommend that I take low-dose aspirin through 36 weeks to prevent clots. (I actually took the low-dose aspirin through the first trimester with both Jane and C. Samuel, on the advice of Dr. Y. Given my test results, she does not currently recommend heparin.) We would do monthly growth ultrasounds, along with additional Doppler scans to check the baby’s blood flow (specifically the cord flow and “mid-cerebral artery flow”). We would do “intense testing,” including a repeat of my blood clotting tests. If anything looked bad once the baby reached viability, we “will act” (that is, deliver him or her early). Dr. R also recommends a scheduled C-section, rather than taking the risk of fetal distress or an accident during labor.

When should we try again?

Dr. R gave me the all-okay physically. She mentioned that some studies suggest that a shorter break between pregnancies correlates with shorter umbilical cords, but she didn’t think the quality of evidence was good. She indicated a desire to talk to Dr. Y more about this.

I’d like to write a longer post on the subject of trying again. Suffice it to say that neither C nor I want to wait long.

Are you going to retire?

Dr. R answered confidently, “Oh I’m going to see this through!” She also shared (perhaps unprofessionally, although I hardly fault her for it!) that she had a dream that we had another, healthy child. I hope her dream proves to be prophetic!

On our way out the door, I handed Dr. R a Thank You card, in which I shared our feelings of gratitude to her, along with a photo of us with Jane:

img_0579

When I got home, there was an email from Dr. R in my Kaiser inbox:

Hi, K and C! I rushed out to catch you but you were too fast and got away. The card was so touching and beautiful! Thank you so very much for the picture. It means so much to me, more than any words can express. I am here for you in any way that I can help. Please feel free to reach out at any time. In peace, Dr R

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14 Comments

  1. I am so glad you are getting excellent care. Your doctor sounds wonderful.

    Reply
  2. Your doctor sounds incredible. I am so thankful you have her. Sending you well wishes.

    Reply
  3. I don’t really believe that our whole lives are planned out for us by some supreme deity necessarily, but I do believe that you were meant to have this doctor to help you through this part of your journey. Thank goodness for that.

    Reply
  4. First off, I am unspeakably sorry you and your family lost Jane. Second, I’ve been reading these posts and wiping away the tears without having a hot clue what on earth to say. So I haven’t. Stillbirth runs in my family and is associated with my reproductive immunological issues so I was terrified of it. As such i wrote a post about it that garnered a comment from a very knowledgeable OB and Professor who has advocated for women to be educated about the significant risk of stillbirth after 37-39 weeks. If you would like I can share the networks he told me about and if you’re on the eastern seaboard and might want to talk to him, his name and contact information. If so – at any point – my blog email is spirit.baby.please.come.home at gmail dot com. Finally, it is nice to know you are getting caring medical care.

    Reply
    • Shoot. It just occurred to me that I only mentioned this in case you plan to try again. Not in ANY way suggesting you did anything whatsoever wrong in trusting your caregivers in Jane’s pregnancy or delivery. Please forgive me if you had even a moment’s fleeting thought to that effect.

      Reply
    • Thank you so much.

      Ironically, before Jane was born I read in the Washington Post (I think) about a meeting where a large number of OBs had come to a consensus that recommending universal induction at 39 weeks would reduce the risk of several adverse outcomes (including stillbirth). But it was such a low probability event, and given what we knew at the time, and how closely I was being monitored, I felt (and still feel) that we made a reasonable, evidence-based decision. I had a C-section scheduled for Monday, the day after I delivered Jane (when I would have been 41 weeks gestation).

      Feel free to send any resources my way. I’ll definitely check out your post!

      Reply
  5. Megan Persinger

     /  October 13, 2016

    sending you love. thank you for your wonderful blog posts. I hope you will consider writing a book someday!

    Reply
  1. Tests | the infertile chemist
  2. When to try again | the infertile chemist
  3. Ultrasound and fire truck update | the infertile chemist

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