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:

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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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What happened next

After we arrived at triage and learned that our baby had no heartbeat, the hours and days that followed felt like a string of unpleasant and unanticipated decisions:

Decision 1: Vaginal versus cesarean delivery?By that point, my contractions were averaging about 2 minutes apart, so we knew our baby had to come out. Our first impulse was for a C-section. I was in a lot of physical pain, and the thought of pushing a lifeless baby out of my vagina sounded unbearable.

Our doctor – Dr. R – expressed her complete sympathy and support if I preferred to go with the C-section…but, she recommended a vaginal delivery. Dr. R explained that she really didn’t want me to have to go through recovery from surgery, and that we would most likely want to try for another child, which would be easier without two C-sections under my belt. She also promised to do everything to make me comfortable for the delivery.

We were fortunate that this was ‘our’ obstetrician, the same one that had seen me through this pregnancy. (With Kaiser you typically get whichever OB is on call, almost always a complete stranger.) Coming from anyone else, I’m not sure we would have listened. We certainly weren’t thinking about another baby at that moment, and I really really wanted the baby out immediately.

We told Dr. R we would go with her recommendation.

Things moved quickly after that. Shortly after telling us that our baby had no heartbeat, Dr. R checked my cervix and said I was about 1 cm dilated. Two hours later, I was fully dilated and feeling the urge to push…but still waiting for my epidural.  Dr. R’s best guess as to what had happened to Jane was either a cord accident or placental abruption (my wildly progressing labor supported the placental abruption hypothesis). With placental abruption, there is a serious risk of the mother bleeding to death, so we had to wait for my blood tests to come back before they could place the epidural. Eventually we got the results from both blood tests, and the nurse anesthetist showed up to place the epidural. Once it took effect, I became completely numb from the waist down, which was fine by me. (I’m pretty sure Dr. R told him to use the ‘adult elephant’ dose.) We did a few pushes, and then Dr. R got called away to an emergency C-section.

Decision 2: Whom to tell, and when?

C was the first to make this decision; he texted my mom, so she could try to get on an earlier flight. Then he texted his parents, his brother and my sister at our house, and they immediately drove to the hospital (leaving C. Samuel and the dogs at home with my sister-in-law). At some point he also told our friends S and Q, his business partner, and several other friends. Late Sunday morning, I shared with my local group of infertile mamas first, then texted the rest of my close friends over the course of the next few days.

This decision prompted another: When to let our family come in from the waiting room to see us? I didn’t want them in the room while I was in excruciating pain. But after the epidural was working, Dr. R’s emergency C-section opened up an opportunity to visit, and we welcomed our family back into the delivery room. We all hugged and cried together. My contractions had slowed way down, and the epidural was also making me sleepy, so I closed my eyes and rested for a bit while they were in the room.

Eventually, Dr. R came back from surgery, our family returned to the waiting room, and I continued to push Jane out – two pushes per contraction, one contraction every 5 or 10 minutes.

At 2:00 am precisely, I delivered our sweet Jane into the world. Seeing her beautiful face prompted a new wave of intense grief. C and I took turns holding her and gazing at her. I rocked back and forth with Jane, cradling her and singing James Taylor.

You can barely hear the ‘S’ at the end of James. Doesn’t it sound like he’s singing “Sweet Baby Jane” instead?

Our families came back in, and they each held her, and C and I held her some more. We examined her fingers and toes and arms and legs and back and bottom. Every part of her was so beautiful and perfect.

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We let the nurses weigh and measure her. She was so tiny! Only 5 pounds 8 ounces, and 17 1/2 inches long.

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We all took turns holding her until about 5 am, when we started dozing off and were afraid of dropping her. And so we sent our family home, and asked the nurses to come in and take Jane away.

Decisions 3 and 4: Photographer or no? Visit from a priest?

Some time early that morning a social worker came. She asked a series of questions, including whether I wanted a volunteer photographer from a charity called Now I Lay Me Down To Sleep to photograph Jane, free of charge. C and I said yes.

She also asked if we had a religious preference. I told her I was Catholic and she asked if I would like a priest to come and bless Jane. I said yes.

C’s family showed up with C. Samuel, followed by my sister with my mom, who came straight from the airport to the hospital.

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It was such a comfort to hold our precious little boy

The photographer arrived next and the nurses brought Jane back into our room for photos.

They had dressed Jane in the outfit I had brought to the hospital to take her home in: a sweet little onesie with gold letters that spelled “little sunshine”, the same striped leg warmers that we brought C. Samuel home in, and a pair of tiny socks. Everything was huge on her.

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The nurses had cleaned Jane up a bit, and rubbed some citrus-scented lotion or something on her, which I didn’t mind. She still looked perfect everywhere except for her lips, which had turned a crimson color. And she was so cold. When she was born, Jane had been warm – the temperature of my body – and she had slowly cooled off in the three hours that we held her right after. But now she was much colder – the temperature of the refrigerated room where they kept her tiny body. The cold had also turned her cheeks and arms a sweet shade of pink.

The photographer came in and photographed Jane in the hospital bassinet, and in my arms, and with C, and his parents, and his brother, and my mom and sister, and with her big brother, C. Samuel.

Then our dear friends S and Q (you may remember them and their generosity from this post or this one) arrived and cried with us some more and held our little Jane. Eventually we sent Jane back with the nurses.

C’s business partner came next. He had come straight from church in his suit and tie, and the nurse supervisor mistook him for the priest.

The priest came then, and the nurses brought Jane back into our room for the blessing. Fr. Danny said a prayer and sprinkled holy water on Jane’s forehead, and we cried some more and everyone held Jane again.

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Decision 5: When do I want to check out of the hospital?

As soon as possible.

As much as I hated to leave Jane, I had no desire to stay in that room any longer than absolutely necessary. The nurses mercifully had not transferred me to the postpartum unit to hear the cries of other peoples’ living babies, but since I wasn’t interested in staying another night, they also didn’t transfer me anywhere else. So we were still in the small delivery room where I had delivered Jane. C and I. And C’s parents, and his brother and sister in law. And my mom and sister. And S and Q. And C’s business partner. And the nurse. And our rowdy 2-year-old who had no idea what was going on. It was getting crowded.

I just wanted to go home and grieve in (semi) privacy.

For uncomplicated vaginal births, hospital policy was to let me check out as early as 12 hours after delivery…if I could pee on my own. This proved to be more difficult than I anticipated. While I was able to walk to the bathroom and sit on the toilet three hours after delivery (a stark contrast from when I had my C-section), I was unable to squeeze out more than a few drops during that bathroom visit, or during the one around 8 am. The nurse ended up having to reinsert a catheter just so I could empty my bladder (a process that was markedly more unpleasant sans epidural). Fortunately, my bladder eventually ‘woke up’ from the elephant dose of epidural meds, and I was able to pee on my own twice before 2 pm Sunday, at which point the nursing staff approved me to go home.

I changed into my clothes. Our entourage, including our friends M & M, who showed up just as we were packing up, gathered up all of our things and started down the hall. And C and I held Jane, and said our tearful goodbyes before making our way to the car.

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Saying goodbye to Jane before checking out of the hospital

Decision 6: What to do with Jane?

This decision – actually, this series of decisions, spread out over the next several weeks – proved the hardest for us. C and I were totally unprepared, the funeral home and cemetery staff seemed ill-suited to dealing with infant death, and each decision felt simultaneously rushed and high-stakes…I’ll save it for its own post.


See also:

Decision 6: What to do with Jane?

Decision 7: What to do for Jane’s funeral?

Decision 8: When to return to work?

Decision 9: How to memorialize Jane?

Sad news

I am so sad to share that Jane Margaret was stillborn on July 24 at 2 am. At 41 weeks pregnant, I was excited to go into labor naturally Saturday afternoon, but when we arrived at triage that evening, the doctor could not find a heartbeat.

We are at a loss, since everything looked great at the OB appointment and NST on Friday. Our doctor believes that I had a placental abruption, which combined with blood clots in the placenta deprived Jane of oxygen.

We held her for about three hours after delivery, and several more times before I checked out Sunday afternoon. Jane was beautiful. A full head of dark brown hair. My nose and fingers. A skinny little thing, under 5 1/2 pounds and 17 1/2 inches long.

We have been surrounded by family and friends, and have been holding our little C extra tight these past three weeks. (Have three weeks really passed?)

Here are some pictures of our sweet Baby Jane. I’m sorry if they are hard to look at.

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