Answers

 I was so anxious this morning on our way back to the hospital for my postnatal appointment. It’s not just that the hospital now has traumatic memories for me, but I was worried about being surrounded by pregnant women who were blissfully unaware that I, too, was recently pregnant like them but that I had to leave my baby there with strangers only hours after he was born. We arrived early and had a cup of tea and talked for a while about how we felt, what we expected, and went over our list of questions again to make sure we hadn’t missed anything.

I reported to reception at the pregnancy clinics and within two minutes my obstetrician had come out to collect us so that we did not have to sit with everyone else in the waiting room. I was so bloody relieved as even just walking in there and seeing everyone and their pregnant bellies sitting around was enough to make me lose my breath in a panic. Dr Fiona Cullinane is the obstetrician who saw me on the ward, and who saw me today. She will also be the doctor who looks after me through any future pregnancies, even though we now live out of The Women’s catchment area - she said that she will pull strings to do so for us. She is an Irish doctor, with a lovely lilting accent and a kind, expressive face. She has shown us nothing but kindness and compassion, whilst at the same time delivering horrible news. She is a specialist in the area of pre-term birth, having set up the Preterm Labour Clinic at the hospital. I’ll write more about that later.

We spent a full hour with her going through the results of all the blood tests, placental analysis and the post mortem results (we did not consent to a full post-mortem, believing Max had been through enough, but we allowed them to conduct an external examination and a chromosomal analysis which required only a skin sample). She really seemed to ‘get’ what we’d been going through and was able to pre-empt a lot of our questions before I even had a chance to ask them. She began by asking me if I’d recovered physically, if the bleeding had stopped, and if I had any pain or discomfort. Everything settled down very quickly after the birth so I had nothing to report. She also made the effort to ask Leslie how he had been coping which I thought was very good of her.

She was very thorough going through all the reports with me. They were very clinical and full of terms and descriptions I had never heard of so she explained it all to me the best she could. The good news is that Max himself had no abnormalities and was a perfect little boy, as I already knew. He was a ‘well preserved male infant with body weight and measurements consistent with 23 weeks gestation…no abnormalities identified’. In fact, Max was a fantastic size for his age. He was 682g and the 50th percentile for his gestational age is 578.2g and the 95th percentile is 731.7g. Must be all the bananas I ate giving him lots of energy for growing big and strong! His cause of death was determined to be as a result of ‘extreme prematurity’, which of course was no surprise.

I say that this was good news in the respect that it meant there were no obvious abnormalities which may have indicated more sinister problems in my ability to grow and carry a baby. In another way it was heartbreaking to hear that there was nothing wrong with him as it makes it so much more difficult to make sense of why he had to die. In some ways, if he’d had a chromosomal problem or disability I would be able to understand that what happened was my body’s way of ‘righting a wrong’ or whatever it is people say. I would have been able to reason with myself that perhaps he would have had a hard, painful life and so it was for the best. Now, though, I have to come to terms with the fact that I had a perfectly healthy, perfectly developing baby boy who would have arrived safely had something in my body not triggered pre-term labour. In short, I guess, I feel like my body failed him. I know people will tell me this is not true, and maybe I know that it’s not, but I can’t shake the feeling.

I was very anxious that there would be no answer as to why I started contracting. The doctors told me that in 50% of cases their is no attributable cause. It turns out there was a reason though there is still much uncertainty associated with the diagnosis. Basically, the report found that ‘it is likely that preterm labour and delivery have been precipitated by infection and/or haemorrhage although the exact contribution of each of these factors is unknown’. The placenta showed what is called Early Acute Chorioamnionitis and a recent Marginal Haematoma.

As I understand it, chorioamnionitis is a general term for bacterial infection of the amniotic fluid, membranes or placenta. Bacteria ascent from the vagina and break through the normal barrier at the cervix to gain access to the amniotic cavity. It is the most common cause of premature labour, causing approximately 25% of preterm births. It is often caused by treatable conditions such as bacterial vaginosis or group b streptococcus. The problem is that in some cases (such as mine) it is a subclinical or ‘silent’ infection that has no symptoms therefore you do not see it coming and do not have the chance to treat it with antibiotics.

It is diagnosed in three stages. I had Stage 1 Early Acute Chorioamnionitis which means that the infection was still probably in its first 12 hours and was confined to the decidua, which I think she said was the maternal side of the placenta (trying to decipher her notes!) At any rate, it had not yet spread to Max. They found ‘a heavy infiltrate of neutrophils’ (white blood cells) at the ‘chorio-decidual junction’. In response to infection, these white blood cells migrate up through the chorion and amnion, which are placental membranes, and infiltrate the placenta.

I was incredibly relieved to find out that I had not caused this to happen. I have spent many sleepless nights since Max’s death obsessing over things I think might have caused it. I remembered accidentally eating some pre-prepared salad at my sister-in-law’s house. Maybe I gave myself listeria. There were one or two times that Les was not home and I had to change the kitty litter. Maybe I got toxoplasmosis from my beloved cat. I took two medications regularly during my pregnancy. Maybe I poisoned my own baby in trying to make myself feel better.

At the same time, I’m so angry that my baby died because of something as ordinary-seeming as a bacterial infection - something that is entirely treatable. It seems so senseless and such a waste. In an ideal world, the obstetrician said, they would screen all pregnant women for these bacteria much earlier in pregnancy, but they can’t screen every low-risk woman for every single thing that could possibly go wrong. I understand this, but it still hurts. My baby didn’t have to die. This didn’t have to happen.

Because it is preventable, though, and they now know that I am at risk of preterm labour, hopes for a future successful pregnancy are relatively high. There is no reason to suggest that it would recur, and I would be under careful monitoring to ensure that it did not. Speaking odds-wise, I now have a 15-20% chance of having another premature labour, which is higher than a normal woman’s chances (which are 5%). I asked her that if you had to experience a premature labour what would be the ‘ideal’ time to have one (ha ha, as if there is one!) and she said that anything after 26 weeks would be good as baby’s lungs are much more developed then.

In a future pregnancy I would be managed, as I mentioned, by the Preterm Labour Clinic. Here, they see you weekly from 14 weeks gestation. Each appointment you have a transvaginal ultrasound and a swab to test for the bacteria. They are also chemical ‘markers’ that are released into your body when your cervix starts to thin or dilate. They are able to pick these up and predict with great accuracy whether you are likely to go into labour in the next two weeks. If your cervix does start to shorten or change, they treat you with progesterone pessaries which have apparently revolutionised the treatment of premature labour. They don’t know exactly how it works but it is thought that progesterone helps to ‘quieten’ the cervix and discourage it from getting up to no good.

Fiona said that this clinic have really good results and that she has high hopes that she will see me get to take home a healthy baby in the future. I now have private health insurance and I asked her if there was any specialist I should see, or if I’d be better off under private care. She said absolutely not and that the Preterm Labour Clinic is the place to be as no other hospital is as equipped to deal with complicated pregnancies. I felt happy about this as throughout my whole pregnancy and labour I experienced such wonderful care from the doctors and midwives there. Admittedly, the admin staff could do with some customer service training, but those things aren’t as important.

She said there is no ‘ideal’ time to have another baby - that there are no physical reasons to wait, but just if and when you feel courageous enough to try again. I am terrified of ever being pregnant again but I know that we will want to try again at some point. I want a baby more than ever since I held Max in my arms and felt what it was like to be a mother. In fact, I want a million babies and this is saying something as I was always sure I just wanted one!

That’s a consideration for a much later time, though. Right now it’s still early days and my arms still physically ache from the pain of not being able to hold Max in my arms. Right now I don’t want any other baby except the one that is already rightfully mine, and I think I have still not really come to terms with the fact that I’m not pregnant anymore and that he will not be coming in March. It is so easy to convince myself that what happened in November was a bad dream and that everything is still OK. I should be on the homeward stretch of pregnancy now. I should be attending my antenatal classes on the 15th January. I should be finishing up work a month after that. So many plans that will not come to fruition. So much more that needs to be planned to take their place. What I do with myself and expect of myself in 2012 is still to be decided and I could use with some direction; some kind of sign from the gentle hand of ‘fate’, if such a thing exists, of how to go on with my life in the absence of my son, because I certainly cannot see a way right now.