Trigger warning: This post written by my wife, a nurse, contains imagery depicting stillborn babies.
October is pregnancy and infant loss awareness month. This is a topic close to my heart because of friends I have known that have suffered losses and also because of my time as a labor and delivery nurse. There is in the public a general lack of awareness of how common miscarriages and stillbirths really are. As taboos about breast cancer, prostate cancer, depression, and mental illnesses have faded in recent decades, the silence surrounding pregnancy and infant loss has remained startlingly resilient. The waves of grief associated with losing a child affect not just the parents, but concentric circles of people expanding outwards like ripples on a still lake.
I have taken care of many patients who have lost their children from as early as fourteen weeks pregnant all the way up to thirty-eight weeks. Viability, meaning the age a baby can survive outside of the womb, is typically around twenty-four weeks, but accidents can happen at any point in the pregnancy. My shifts caring for patients whose babies were in danger or had already died were always challenging nights that left me wrestling with God over the question of why.
In order to raise awareness, I will tell you about two of those nights, which were admittedly not the most agonizing. There are some babies whose names I can only bear to whisper in my prayers.
One night I am caring for a patient who has come in with cervical dilation due to an incompetent cervix. She is only twenty weeks pregnant, three to four weeks or so from any reasonable definition of viability. We want to do a rescue cerclage, a risky procedure in which a surgeon sews the cervix shut with a needle and thread. Unfortunately her bag of waters is bulging through the cervix and the risk of the doctor breaking it with her needle is too high to try the procedure. If the water breaks it’s instant game over at this point. It’s left to me the nurse to try to get her bulgy water to go back in by the morning when they will try the procedure. I am giving her a medication to reduce the amount of amniotic fluid and hopefully take pressure off the swelling bag of waters. I put her bed in reverse trendelenburg, a position in which the patient’s bed slopes downward with her head lower than the rest of her body. It’s a desperate attempt to get gravity to help us take pressure off the cervix.
I don’t let her get up to the bathroom.
I don’t let her eat in case she needs urgent surgery.
This girl is only twenty-one years old, just a young thing herself. We the nurses all know that at any moment her water might break and the baby could come right out in the bed. We deliver those babies ourselves; the doctors don’t usually make it in time. By nine PM the doctors go home, the residents lie down for a nap. They know it’s in the hands of God now and only time will tell what will happen. I sit at her bedside for a long time but eventually realize that I do need to go down the long hall to the nurses’ station. I have other patients to see and much paperwork that needs attending to. I check on her hourly, each time finding her lying still in the dark, on her head, with her eyes wide and terrified.
“Are you ok?” I ask, tentatively.
“Yes.” she says with a whisper
“Do you need anything?”
She hesitates, and with a gulp says, “…No.”
I go back to my duties.
Occasionally her call light goes off and I’m suddenly aware of just how LONG the hall is. My stomach drops and dread wells up. I reason with myself not to run; It upsets the other patients. I won’t make any difference anyway. What could I do? Even if she is laboring, even if she is calling to say, “My water just broke.” I force myself to walk, admittedly with an extra skip or two, praying the whole way, Please God, not this time. Don’t let it be the baby coming out this time. Not now. Just a little longer.
“Can I have some ice chips?” She asks timidly, as cool relief floods through my veins.
I don’t know what else to say.
The minutes tick by slowly. Midnight becomes two, then three and four. These are the darkest hours of the night. Each one that passes is closer to the morning when her ultimate fate will be revealed. Will the water go down? Will her cervix be the same, changed? I gather the supplies I will need to prep her for surgery in the morning. I hope against hope that she will make it that long.
Just get to the cerclage.
I think back to a few weeks ago when a resident’s hand slipped and punctured the bag of waters during one of these procedures. It’s a known risk. It happens. But how do you go on after that?
I shove the thought down.
By the time the morning comes my eyes are red and dry and my hands are shaky, but I give report with a renewed energy. As I see my day shift colleague round the corner my heart soars. We made it through the night and the baby is still in, though I don’t yet know what the morning cervical exam will reveal. The oncoming nurse looks at me through bleary eyes having just woken up herself. I explain the course of events with a certain feeling of accomplishment. Med times, surgery prep, and a spot on the morning operating room schedule are all relayed. She doesn’t share my excitement and replies with short “Mmm hmm, yeahs” that indicate she is skeptical about the prognosis.
Two days later I return for another shift and my patient is gone. She got her cerclage and was discharged home to wait. Until her baby is viable there is very little else that can be done so we don’t keep the patients in the hospital. I know that risks are still high but I feel satisfied knowing I did the best I could for her and that she is a few days closer to that mark. I sit down at the nurses’ station with a sense of peace.
Yet as I begin to take notes for the night the peace is broken by a sharp shriek coming from one of the nearby rooms. That’s the cue for all the available nurses to rush in to help. I dash into the room, the same room I had spent twelve agonizing hours going in and out of just two nights before. There in the bed is a woman. Her face is contorted in pain. The nurse looks concerned and begins to report in low monotone the basic facts we helpers need to know to assist her.
“She’s twenty weeks along and just got here a few minutes ago. Abdominal pain for about an hour is getting worse. The resident is on her way to check her cervix.”
We all begin to swarm around. Someone starts an IV line while another nurse holds her still. She is thrashing and crying out and all the while her husband is cooing to her, trying to calm her down. She is murmuring prayers in Hindi with an occasional English, “No, please” scattered in. The charge nurse is trying to get pieces of health history out of her, allergies, past pregnancies. The husband has to interrupt his hair stroking to answer the questions she can’t hear over her own voice. He tries to soothe her, growing more and more insistent that she must try to get it under control, but with each contraction her yells get louder.
“It’s ok, sweetie. The doctor is coming. She will be here any minute. Try to lie still. I’m here with you.” He tries. Then, finally in anger, “WILL YOU PLEASE JUST STOP? JUST STOP! JUST SHUT UP!” We nurses trade raised eyebrows. We know how painful this kind of loss is for fathers as well.
The resident rushes in the room and checks her cervix. She has begun to dilate but maybe we can stop it. Her membranes are bulging but maybe we can get them to recede enough to do a rescue cerclage. As she explains all this, my hands fumble with a bag of antibiotics. We will give these over night along with pain medications and other meds to make her bag of waters shrink. We settle her into reverse trendelenburg and she drifts off into a Dilaudid slumber. I go back to report and start caring for my assigned patients, being sure to tell her nurse to call if she needs help.
It’s about an hour later when her call light goes off, shortly followed by the emergency light pulled by her nurse. I rush back into the room where I can immediately see that that patient’s water has broken in the bed. She is crying out again and the resident is suddenly there too.
“I’m sorry, there is nothing more we can do…” she starts to say, but is interrupted by the poor mother in her agony, her English bursting out in a wild desperation,
“NO! NO! I WANT THIS BABY. I WANT THIS BABY!”
Her husband asks if we can get her an epidural and we try to call the anesthesiologist. He doesn’t make it in time. When the baby comes out the resident hands him to me in a small blanket and I take him over to the warmer. He fits in the palm of my hand but he is perfectly formed. And he is alive. My first instinct is I have to call the NICU. But I know that will do no good.
The father’s anger has broken down into grief. He tries to choke out some words, “Is there anything you can do?”
“No, I’m so sorry. Your baby has died.”
It’s a lie! I hiss in my mind. But then I look down again and I see that the little arms and legs have grown still. There is no heart fluttering under his dark translucent skin. He never took a breath.
I know that after about a day this mother will be discharged home and many people will never know that she ever even was a mother. At twenty weeks, halfway through her pregnancy, it’s likely that she may not have told many of her family members, friends, and coworkers. Perhaps you know a woman who you don’t know is a mother because her child never left the delivery room.
Later in the night I am assigned a labor patient to admit. She has a doula with her and four or five family members. I am fairly certain she is not actually in labor yet but it takes time to figure these things out. She asks if she can get in the Jacuzzi tub, which I agree to, but she becomes irate when I explain that she can’t use bubble bath.
“It can clog the jets and ruin the tub.” I explain.
“But it’s on my birth plan!” She yells back at me, rolling her eyes. “I need my aroma therapy bubble bath!”
“Yes, I’m so sorry but it just won’t be possible tonight.” I say. Her husband glares at me. Her doula glares at me. Her posse of grandparents glares at me. My cheeks are burning hot with anger but I smile sweetly and offer her some relaxing music to listen to instead and a back rub.
There is a hard passage in Romans chapter nine that says,
“But Rebekah’s children were conceived at the same time by our father Isaac. Yet, before the twins were born or had done anything good or bad – in order that God’s purpose in election might stand: not by works but by him who calls – she was told, ‘The older will serve the younger.’ Just as it is written: ‘Jacob I loved, but Esau I hated.’ What then shall we say? Is God unjust? Not at all! For he says to Moses, ‘I will have mercy on whom I have mercy, and I will have compassion on whom I have compassion.’ It does not, therefore, depend on human desire or effort, but on God’s mercy.”
And then further down in the passage,
“But who are you, a human being, to talk back to God? ‘Shall what is formed say to the potter who formed it, ‘Why did you make me like this?’ Does not the potter have the right to make out of the same lump of clay some pottery for special purposes and some for common use? What if God, although choosing to show his wrath and make his power known, bore with great patience the objects of his wrath- prepared for destruction? What if he did this to make the riches of his glory known to the objects of his mercy, whom he prepared in advance for glory?”
If you have ever lost a child, I want you to know how sorry I am. Know that there are many out there who bear your sorrows with you. We nurses never forget you or the faces of your children. We hide them in our hearts and pray for them and you. There are some out there who may have never told anyone at all about their loss, because of the taboo or because of the grief.
Know that Jesus sees your sorrow and He shares it.
To those of you who like myself have been blessed with healthy pregnancies and births, please don’t take it for a given. Be aware that you have, for reasons only God knows, been given the riches of his glory. Your precious children are the objects of his mercy. For it is not always so.