A New Hope

I have a few more experiences to share about what happened after I lost my little girl, but I want to just jump ahead to the present for a little bit. I may go back at a later time and insert another post or two in between.

A few days ago I got another positive pregnancy test. I remembered saying that I was cautiously excited the last time this happened. Well, this time, there's a lot more caution and a lot less excitement.

With my first ultrasound at the Reproductive Endocrinologist's office, at 5 weeks and 4 days, they saw a gestational sac with a yolk sac and an embryo inside it. The sac was measuring on target for dates. But they also saw another collection of fluid outside that sac, which they didn't really know what it was. They said it could be another gestational sac. At this point, I was just talking to the ultrasound technologist who was not familiar with my history. I asked her if she thought it could be a hematoma. She said maybe. She wanted to know why I even asked that question and if I had had any bleeding or spotting since I got pregnant. I told her I hadn't bled or spotted at all, but I was just a little afraid because of my history.

I called my perinatologist with the concern about the hematoma, and he wanted to look at it himself. He had initially put me on enoxaparin (popularly known by its brand name, lovenox), which is a blood thinner. It is supposed to help prevent blood clots in the uterus. But if you already have a clot or are actively bleeding, you have to be taken off it. Otherwise, it can make the bleeding worse. Therefore, at this point, with the suspected hematoma, he told me to stop taking the enoxaparin.

About a week later, he saw me in his office. The great thing about going to his office, as opposed to the Reproductive Endocrinologist or the regular OB, is that when they do an ultrasound, the doctor does an ultrasound himself or herself after the technologist has taken the necessary measurements. So you can get a well formed diagnosis on the spot.

The doctor told me that what I had in there did not look anything like a hematoma. He said that he saw hematomas all the time, and this abnormality looked nothing like one. He thought that it was probably an endometrial abnormality, probably caused by the hormones I had taken for my IUI. He did not seem too concerned about it, and he put me back on the enoxaparin. And asked me to return for a follow up in a week.

With that visit, I was relieved but still somewhat concerned. I had never before heard about endometrial abnormalities like this. I was concerned about it mostly because I did not know what it meant to have such an aberration and what its possible consequences were. But still, I was mostly relieved.

I was completely awed by the miracle of the way the human fetus develops. I was only 6 weeks and 3 days pregnant that day. That actually means that the fetus had only been conceived 4 weeks and 3 days ago. At this very early stage, the ultrasound could detect a heartbeat. It's miraculous and awesome that a tiny being, which is only about as large as a grain or rice, is capable of developing a heart that beats. This was the first time I had actually seen a heartbeat being detected that early. The last time, it had been detected at 8 weeks and then some. (Mostly because that was my next ultrasound after the first one at 5 weeks or so, but still.)

I left the doctor's office with some relief in my mind and with a renewed sense of hope and a prayer in my heart. Dear God, please let me hold this baby in my arms before you hold me in yours.

And Life Goes On

The first few days back from the hospital, I intermittently felt relatively normal and sometimes felt as if something was tearing at my insides. I constantly questioned why this baby girl, who was so loved and so wanted, had to die. She was perfect. She had always been growing on track. Every ultrasound had shown her to be growing normally without any defects.

Medical science has achieved so many wonderful things today. They can put a woman's eggs together with a man's sperm in a petri dish and the egg can be fertilized there. Outside a woman's body, where nature intended for the fertilization to happen. They can also take a baby born prematurely, as early as twenty four weeks of gestation, and put her in a little incubator in an intensive care unit and give her a fighting chance at survival. Such premature babies complete their gestation in the incubators, once again, outside their mothers' bodies. It makes me wonder how long it will be before they can handle the twenty two weeks or so in between and grow babies outside women's bodies all together.

My friends from my online support group sent me a little pot of yellow mini roses. At first, I thought that flowers were the last thing I wanted to see at that point. It was spring, and life was blooming everywhere. Little baby animals, new leaves, flowers of all colors and shapes, and all of it just served to remind me of the life that had just died inside me. It just seemed to be completely against the laws of nature to get pregnant in the fall and to lose the baby in the spring. I put the pot of roses just outside the side door to our house, where I could see them if I wanted to, but wouldn't keep running into them every now and then. I remembered that our neighbors across the street had had a poster on their front door announcing the arrival of their little girl a few weeks ago. Now we had a pot of roses announcing the loss of ours.

The roses stayed in their original pot, which was supposed to be a temporary pot, for a long time. I was not allowed to do any physical activity that would strain my abdomen. And I did not really want to look at them too much. So I put off finding a more permanent spot for the flowers for as long as I could.

A few days after the pregnancy ended, my breasts began to feel really huge and heavy. I had not really thought about this beforehand, but I knew what was happening. My body thought that since the pregnancy had ended, there was a baby to feed. And it was producing milk for that baby. I could just stand in the shower and cry. Some literature said that wearing a tight fitting sports bra helps with the situation, but it felt to me like it was just making it worse. So I just put up with the pain. The physical pain was nowhere near as great as the emotional impact of having a constant reminder that I was supposed to have a baby and that I had lost her forever.

My husband did all that he could to help me out during those initial few days. He did part of the cooking, he rented movies for me to watch while I was home, he ran all errands by himself. But there were days when he felt low and was very expressive about it. And there was nothing I could do or say to make him feel better. You would need to feel sane and composed yourself before you could do something to make another person feel better. His outbursts of emotion just served to make me feel even worse and even more helpless. I have always been somewhat introverted and felt even more uncomfortable than usual about sharing my feelings about the loss with him.

After I had been at home for a few days, my husband and I both thought that I needed to get out of the house, go out for short walks or trips to the grocery store, just to see if I felt like I had the stamina to go back to work. The first day I tried to go out for a short walk, it was still somewhat chilly outside, so I put on my coat. It was the first time in a few months that I was able to button down all of the buttons on my coat. Something like that would have been a very happy occasion in another day and age, like when I had been trying to lose weight. Not that day. Not in the least.

Long ago, when I was too young to actually understand something like miscarriage, I read a story in a women's magazine written by a woman who had experienced miscarriage and she wrote about how strange it is that we mourn the death of those who have lived a long and full life, but nobody really holds funerals or memorial services for babies lost to miscarriage. A life that had a lot of potential. A life that ended even before it began. A life that could have been something great. I can completely relate to that emotion now.

My husband spoke to a priest about a small prayer for the baby we were supposed to have. He said we didn't really need to pray for the soul to rest in peace, since the soul doesn't even enter the body that early on. But we could do a prayer for the baby anyway. The doctors also do not think of this being as a baby at this stage, they think of it as a fetus. It's a baby only after it has the capability to survive outside the womb. Maybe they are right about that, but you can't help believing that life had begun when you had seen the baby move around and heard a strong heartbeat on all the ultrasounds and you had even felt the baby move inside your belly.

The Hospital: Day Two

I asked the nurse for a second dose of the pain medication and the nausea medication at about three in the morning, about five hours after the first dose. Things did not get quite as bad this time round, because I asked for medication fairly quickly after I began to feel discomfort. And because the doctor had already put in the orders for the medication, it was already available for me. The nurse did accidentally drop the vial of nausea medication and had to call housekeeping to clean up the broken glass, but other than that, things seemed to be going relatively smoothly at that point.

A resident doctor came by to check on me at about the same time and asked how I was doing. I told her I was doing fairly okay since I had been getting medication and the bleeding seemed to have slowed down since that afternoon. Of course, none of it changed the fact that I was there to end my baby's life, but I did not say that to her.

At half past seven in the morning, the night nurse's shift ended and the other one, the one who had met me when I had first been wheeled into the surgery floor, came back. To me, that was an indicator that I was that much closer to getting it all over with and going home. I had nothing against the night nurse, but I thought that I would not have to see her again because I was not going to stay that long.

The day nurse asked me how I was doing. I told her I was feeling better under the effect of the medications. She said I could take a walk down the hallway if I wanted to. I told her I was feeling rather weak because I had not kept any food down since the previous morning. And it was rather uncomfortable to move around with the IV. Every time I moved my left hand, even while still in bed, it hurt where the needle was. She said she would get me a hot pack for my hand. She also got me a hot pack for my abdomen. It had been more than four hours since the last time I took medication, but I had rather mild cramps and did not feel the need for more pain killers at that point. The warmth from the hot pack was rather nice and comforting.

The nurse told me that it would probably be around one or two in the afternoon when the doctor would send somebody to take me to the operating room. But the doctor would come by in the morning to check on me, she said.

The day shift resident doctor came in to check on me. Two senior doctors from the department of Maternal Fetal Medicine at that hospital came in later in the morning. They told me that my doctor was not yet in but they worked with him and wanted to know how I was doing. I told them that I had started getting cramps and bouts of nausea pretty much as soon as the doctor was finished inserting the laminaria he was using to dilate my cervix. The doctors told me that the dilation can sometimes have that kind of side effect, even though it is very gradual dilation.

I had a few moments to myself before my husband came back. I knew he would come in around eleven in the morning, to avoid getting caught in early morning rush hour traffic that was usually rather heavy, with so many people trying to get into the city for work. I took those few moments to say a prayer to God and ask for his forgiveness, and to talk to my baby for the very last time and ask for her forgiveness. I wanted her to know that we had made this decision only because we loved her and did not want her to suffer all through her life. We did not want her to live a partial existence. We did not want her to live just for the sake of living. I told her that we would always love her and that we would hold her in Heaven.

She was moving vigorously inside my stomach, like she always did when she was hungry. I felt so helpless at the fact that I could not give her anything to eat. I wanted to ask the nurse if we could possibly give her something to eat. I cried because my baby did not know, but I knew, that her hunger and discomfort were soon going to be relieved in a very unexpected way.

The nurse pulled away the blinds from the window and pointed out how beautiful the day was. I think every mother hopes that the day her child is born is a beautiful day. But for it to be a beautiful day when you know your child is going to die just makes things that much more painful and harder to deal with.

My husband came in soon enough. I don't know if he was actually feeling better or just trying to be strong for me, but he put forth a more cheerful exterior that day and it put me in a better mood. At that point, it was just a long waiting game, not knowing when the operating room would have an opening for me.

I had expected to be called in towards the later end of the time range that the nurse had told me. But to my surprise and relief, a man with a stretcher came by for me at a little past one. He wheeled me to the preoperative area. A nurse met me there and asked some basic questions about drug allergies and whether I was prone to motion sickness. I told her I was very prone to it. She wrote down my husband's cell phone number so they could get in touch with him once it was all over. The anesthesiologist also came by to introduce himself and talk about the anesthesia. He told me that he would start the medication through my IV to put me to sleep, and once I was asleep, they would put in a mask through which I would breathe in a different medication to keep me asleep. I would also get some stronger pain medication during the course of the procedure. The most common side effect of the anesthesia, he said, was that patients often felt nauseous afterwards. The next most common effect was a sore throat, which was caused by the medication I would be breathing in through the mask. The sore throat, if it happened, should be mild and short lived. I no longer cared if I got nauseated and threw up a few more times, although I did not say that to him. I had had a lot of that kind of thing and was somewhat used to it by then.

The anesthesiologist changed my IV drip from the fluid to the anesthesia. The IV hurt again. I did not know what to expect, if I would fall asleep gradually or suddenly, or how long it would take. I just tried to relax. The doctor came in for a few minutes and asked how my night had been. I told him it had been rather unpleasant and uncomfortable. He asked if I had been bleeding a lot. I said no, I had not bled much since I had last seen him, the previous afternoon. But I had had some bad cramps and nausea. He said he was very sorry to hear that.

Very soon afterwards, they wheeled me towards the operating room. I was a little surprised to see that they were wheeling me in while I was still completely awake. I had no idea how long it would take me to fall asleep, but I thought I should have been feeling at least somewhat drowsy by then.

I had never seen an operating room from the inside before. I saw that they had some big lights, which would probably be quite bright when turned on. The gurney that I was supposed to be lying on during the surgery was rather narrow. The was a clock on the wall that I was facing, and it read half past two when they brought me in. The nurses lifted me up and moved me on to the gurney, and just as I was trying to get comfortable on it, I fell asleep. Completely.

Next thing I knew, it was a quarter past three on the clock in front of me and the anesthesiologist was telling me to wake up because the surgery was over. The first thing I noticed was that my belly had shrunk. I became a little misty eyed and stroked my belly a few times. I also noticed that my throat was a little scratchy, but I had been told to expect that. The anesthesiologist asked how I was feeling. I told him I felt okay, except that my throat felt a little sore and I had a bit of pain in my right upper thigh, near the joint where my thigh connected to my torso. The nurses took me to the post operative recovery area and left me in charge of one nurse there. The nurse gave me a blanket that had been warmed up in something that looked like a toaster oven. She covered up my abdomen and upper thigh with it. That felt really nice and helped relieve the pain. I told her that the bed I was on was probably too short, because my feet were hanging off it. That was probably another reason why my thigh was achy. When I bent my leg or turned to my side, it hurt less. She called another nurse to help her move me on the bed so that my head would be farther up on the bed and my feet would not hang off it. I asked her if I was bleeding a lot, because I felt rather wet. I had no idea if I was even wearing a pad or even an underwear at that point. It turned out that I was wearing both, and the pad did not have a lot of blood on it, the nurse told me. But she changed it for me anyway, to help me feel drier. That was the first time in my life that someone else had changed a pad for me. I hoped that that kind of thing would not have to happen again, that I would never be so dependent on other people again.

The nurse said that my bleeding appeared to be slowing down, but my heartbeat was too fast. I could feel it, my heart was beating furiously in my chest. It seemed to her that I was somewhat dehydrated,and she increased the dosage on my IV fluid. I cringed in pain. "What hurts?" she asked. "The IV?"

"Yes," I told her. I added that it always hurt when someone changed anything with it.

A little while later, she told me that my heartbeat seemed to be coming down and I was probably ready to go back to my room. It was about half past five when she changed my pad one more time and sent me back to my room.

My husband was waiting for me in the room. I greeted him with a big smile, much more cheerful than I had been in many weeks. I was just so relieved, at that point, to just get rid of all that physical pain and discomfort that I had been going through all through the pregnancy, and especially during the last two days. I may be a terrible person for thinking this, but I did feel a strong sense of relief at that moment, relief because I was no longer physically in pain and relief because it was all over. Throughout the pregnancy, I had constantly worried and wondered about whether or not the pregnancy would end on a happy note. My mind was finally free from the heavy load of that worrying.

The nurse brought me some ice chips in a cup. She said I could crunch on those for a while, because it would not be the best idea to start eating right away. I felt a lot better chewing and sucking on the ice chips than I had felt in a long while. My mouth had been feeling extremely dry and rather uncomfortable. The nurse finally took the IV out and that was also a huge relief. She measured my vital signs again, and she said my heartbeat was still somewhat fast. I told her the nurse downstairs had told me that it was probably so because of dehydration, but I was sure it was stabilizing, because I could no longer feel my heart beating furiously fast. She said she would need to talk to the doctor and brought me some apple juice and crackers to snack on in the meantime.

The doctor who had performed the surgery had spoken to my husband immediately after it was over, and he had told him that it had all gone very smoothly with no problems. The doctor also came by my room to see me and to tell me the same thing. He also said that he hoped to see me again soon, with happier news.

Because of the elevated heart rate, they wanted to check some blood tests to make sure I was okay before letting me go home. The nurse said that they would ask for the blood work results stat, which meant that they would probably get them back in an hour or an hour and a half or so. By this time, it was basically time for the day nurse to go home but she still came in to draw my blood and then to read and explain my discharge instructions to me. There was still a chance that they would keep me there another night, if the blood work results were of some concern, but everyone was basically hoping and assuming that I would get to go home that night.

I asked the nurse if I was allowed to shower that night after I got home. She said yes, I was, and added that it would certainly feel good to take a shower after all that I had been through. I agreed, I had not had a chance to take a real shower in two days and I badly wanted one. Because my surgery had not involved any stitches, I was allowed to shower normally that night.

It was already well past time for the nurse to go home but she still wanted to finish what she was doing. My husband asked if it was okay for him to bring me something to eat. She said I could eat if I wanted to. He said he would run down to get something from a sandwich shop that he knew was just around the corner from the hospital, and where he had gone for his lunch. I told him I did not want to eat any meat, because I did not think my stomach could take it at that point, but I would be willing to eat a sandwich with vegetables and sour pickles. We ate while we waited for the blood work results. For the first time since I had been there, I noticed that there was a TV in my room and I turned it on. For a few minutes there, it began to feel like a very normal evening at home, watching TV and eating dinner together. My husband had been rather willing to wait until after seven in the evening to go home, because that way, we would avoid traffic, but he and I both began to get rather restless when the clock showed half past eight.

The evening nurse, whom I had not expected to see again, was back to measure my vital signs again. She did say that my heart rate seemed to be stabilizing.

It was a little past nine when the resident doctor came in. She asked how much bleeding I was having at that point. I told her it was not much, I had not changed my pad in almost four hours, since the recovery room nurse had changed it and sent me back to the room. And there was not a lot of blood on that pad either. The doctor thought that was a good thing. She said that my blood work was stable and my heart rate was also stabilizing, so I could go home. I was very relieved to hear those words. I basically jumped out of bed and changed out of the hospital gown into my own clothes as quickly as I could.

The nurse asked if I needed a wheelchair to get to the car. I told her I was feeling much better physically than I had felt while coming into the hospital, and I was definitely able to walk now, if I had walked then, with all the pain.

We had to stop at a pharmacy to fill my prescriptions on the way home. There were three medications, including a pain killer, which was just ibuprofen. We did not buy that one since we already had some at home and I may or may not actually need it. There was an antibiotic and another medication which was supposed to help contract my uterus back to its normal size and to keep me from bleeding too much.

By the time we got home, showered, and got into bed, it was close to midnight. I fell asleep almost as soon as my head hit the pillow, because I had had an almost completely sleepless night, the previous night at the hospital, and two very long days. The most rest I got while in the hospital was probably in the forty five minutes I was asleep in the operating room. I was just glad to be able to shower in my own bathroom and sleep in my own bed once again.

The Hospital: Day One

On Monday morning, I got out of bed a little after my husband had already left for work. I went to the bathroom and saw that I had had hardly any bleeding during the night. I did not realize it right then, but in the few minutes that it took me to brush my teeth and wash my face, my pad was completely soaked through. I was a little scared but I thought that I should watch the bleeding for a little while before calling the doctor's office. The first thing they ask when you call them about a bleeding episode is how long you have been bleeding and how frequently you are changing pads.

The bleeding seemed to have let up soon afterwards, and I decided I could relax and wait for my appointment, which was scheduled for the next day. But it came back after an hour or so, again filling up a whole pad in a matter of minutes. And then it apparently stopped again. When it came back a third time, I decided to call my husband and then the doctor. Most of the bleeding I had had until that point had been dark red, brown or almost black colored blood. This was bright red, and it was quite heavy. I was hoping and praying that the bright red blood was a sign that the pregnancy was ending naturally. I had thought all along that if it ended of its own accord, I would find it easier to accept the loss and to be at peace with it.

I first called my husband and then my OB's office. They asked a few routine questions and then told me to go to the nearest emergency room. I told them I did not want to go to a place where they did not know my case history and where I did not know the doctors. I wanted to see a specialized doctor whom I knew and trusted. The nurse asked me to hold while she consulted the doctor on call. A few minutes later, she told me to call the office of the doctor who was supposed to do my D&E later that week. So I did. I called his office. They also put me on hold while they talked to a doctor. Then they told me to come to the hospital and go to the labor and delivery floor. The doctor would meet me there and analyze why I was bleeding and if he needed to move my surgery up. I asked if they thought I should pack an overnight bag. They said they really couldn't say whether or not I would need to stay overnight. I just threw some extra pads and extra pairs of underwear into my handbag and called my husband. He said that he was on his way home and he would take me to the hospital. This hospital was a rather long drive from our house and I was thankful to have him with me for the drive and for what was to come after it.

It was close to 2 PM when we arrived at the hospital and neither of us had eaten any lunch by that time. We went to the labor and delivery floor and waited for a nurse to show me where to go. The nurse who met us in the waiting room and led us to the triage area was very friendly and warm. She led me into the triage room where there were three beds separated by curtains. This was where women were brought in when they were in labor. The doctors and nurses would then see how far along their labor had progressed and then decide whether to send them back home or wheel them off to a labor room. I did not want to be among such women at a time like this. But thankfully for me, the other two beds in the room were unoccupied. It was just me, my husband and the nurse in the room. She paged the doctor and told us that he was on his way.

The doctor came in shortly and introduced himself to us. Once again, he said that he was sorry that he had to meet us like that. Then he went on to explain what he was going to do. He said he would do an ultrasound and also examine my cervix to see if it was dilated at all, and to see how much I was actually bleeding. I told him that I did not think I was bleeding much right then, but the bleeding came in bursts. He asked if the bleeding I was experiencing then was different from what I had been experiencing until then, through the course of the pregnancy. I told him that I had had darker blood until that point, but I was seeing more bright red blood that day.

He did an ultrasound and said that there was still a heartbeat. He mentioned that he had thought that I was possibly bleeding because the baby had died, but that did not seem to be the case. Since that had not happened, it was likely that the placenta had ruptured and was causing the bleeding. He said that he saw practically no fluid around the baby. He also said that he thought that termination was the right decision in this scenario, because my health would be at risk if I continued the pregnancy. I could develop a serious infection and suffer large amounts of blood loss. And the baby would not develop functioning lungs.

I wanted to scream and tell him that he was not helping me by telling me that there was still a heartbeat. But there was something about his demeanor that made me feel more relaxed than I had been in the last few days. I was getting the feeling that I was going to stay at the hospital until my surgery happened, and I did not like the idea of staying overnight at a hospital. I had never done that before, and I did not want to do it now. Even so, I was relatively relaxed and calm in the doctor's presence.

He examined my cervix and said that it did not seem like I was bleeding too much right then, but I may be bleeding more in general, since I had said that I was bleeding in bursts. Given that information, he wanted to move up the termination procedure. He said that if I wanted to go in for labor induction, they could probably start that right away. If I wanted the D&E, he would start the dilation almost immediately and put me on what they call an "add on" list for the operating room for the next day. That would mean that they would fit me in whenever they could find a free slot in the operating room, but it would probably happen some time in the late afternoon.

I asked him how long it would take to deliver if they induced labor right away. He said that it could take up to thirty six hours. I asked him if going through labor now would make it easier for me to go through labor again, when I actually had a full term baby. He did not think so, because the fetus at that point was very small, lighter than a pound, and a full term baby would be much larger and would weigh around seven pounds.

I asked if he thought that the risk of infection or damage to my reproductive organs was greater with either one of the two procedures. He assured me that he and his team would take good care of me and the risks would be very minimal either way. He would write me a prescription for an antibiotic which I would need to take for about a week after the procedure was done. He emphasized that he wanted to make sure that I was taken care of properly, so that I would refer all my friends to him. I said that I hoped I would never have to refer anyone for something like what I was going through. He agreed, he hoped I would not need to refer anyone for this kind of thing, but for other things.

I asked if he would want to keep me in the hospital for another night after delivery, if I chose the labor induction route. He said, "As much as I like you, I don't think I need to keep you here after you deliver." Basically, with either procedure, they would monitor my vital signs for a few hours and as long as they seemed to be normalizing, they would let me go home a few hours later. I liked the way he was trying to keep the mood light by throwing in some humor.

I also asked him if he thought I was at an enhanced risk of a hematoma and related complications with a future pregnancy. He said he did not think so. He would have said that there was an enhanced risk if I had been a smoker or if I had been taking recreational drugs, but not otherwise.

He left us alone for a few minutes so that we could talk and decide which way we wanted it to end. He said that unfortunately, he could not give us the happy ending that we wanted, but we had to make the decision about how we wanted it to end. That was a matter only of personal preference, because he would make sure that things went smoothly either way. He also added that since I had gone through so much bleeding and pain, he was confident that I could endure either process.

When he came back, I told him that I still wanted the D&E. I did not want to see the baby and experience labor, I was not so sure that I could deal with that emotionally. He said he understood, some people did prefer that. He told the nurse to insert an IV needle into my wrist so that she could draw blood for some preliminary blood tests through it, even though they did not need to give me fluids through IV just then. They planned to start that at midnight, when I would need to stop eating and drinking, but it would be easier to draw the blood through that one needle and minimize the number of times I would be poked at. She asked me if I was right handed or left, because they generally preferred to insert those needles into the hand that was not dominant.

Once the doctor left, the nurse patted my hand in a warm way and said that she would have chosen a D&E too. It was rather reassuring. This was the first female medical professional who had spoken to me about this. The male doctors had been saying all along that an 'advantage' of labor induction would be that my husband and I could see the baby. I did not understand how that would be an advantage. The reason why all of this was so difficult and painful was that we had begun to bond with the baby, we had begun to think of her as a real person, we had started thinking of names for her, I was feeling her move, and we were starting to get to know her. She was real. Actually seeing her and delivering her like a real baby would make her that much more real and deepen our bond with her that much more. It would be so much more difficult for us to get over all of this and move on. My husband and I had talked about it and he agreed that he did not want to see the baby. The doctor asked us later if we wanted to take the remains of the fetus with us or if we wanted the hospital to take care of them. Both my husband and I were very certain that we wanted the hospital to take care of them.

The doctor came in and had me sign some consent forms. I asked him how long he thought I should take off from work and relax at home. He said that I could possibly feel well as soon as the next day, and two weeks would be a very long time for me to just sit alone at home with not much to do. I saw his point and figured that I would take maybe a week's time off.

He started out with the dilation process, explaining everything he was doing as he was doing it. He cleaned me cervix with a disinfecting liquid containing iodine. He injected a local anesthetic into my cervix. I hardly felt that. He did say that I probably would not feel it, since there were hardly any pain nerves in the cervix. Then he opened up my cervix using a speculum, just like he would do for a pap smear. The speculum opening up was the most discomfort I felt. He inserted some thread like things called laminaria into my cervix. Those were actually going to dilate my cervix. He was putting in a number of them and asked me to inform the nurse on call if I saw any of them come out, on toilet paper or on my sanitary pad.

They were going to keep me in the hospital until the next day, when the surgery would actually happen. The doctor expected that I could possibly experience a lot more bleeding or pain and did not want me to need to rush back during the night. He said my cervix was pretty soft and he would not need to dilate it twice, so he could just do the D&E the next day and send me home that evening. He told me that I needed to be aware that I could go into labor because my cervix was dilating, and that I should inform the nurse if I felt any contractions.

Once he was all done, the nurse asked us if we wanted something to eat. That was when I realized that it was about half past four in the afternoon and I had not eaten anything since breakfast. They had prepackaged deli style lunches in their kitchen, which came with a wrap or a sandwich, chips and a few other things. I could only eat a little bit of the wrap, but I ate some chips and maybe a granola bar or something that came with it. In the middle of eating, I felt like I was going to throw up. No big deal, I thought. I had felt like throwing up any number of times during the pregnancy but had never actually had any vomiting. So I just sat there on the bed for a few minutes and tried not to look at the food. But the feeling seemed to be stronger and more persistent than usual, so I went to the bathroom. And it seemed to me that everything that I had just eaten came right back out.

The nurse came back to check on me a few minutes later and asked if I had eaten. I said yes, I had, but I just threw up everything I ate. She said she was really sorry about that. Pregnancy hormones and dilation can cause that kind of thing sometimes.

The nurse informed us that I was going to be moved to the surgical floor, where I would probably be more comfortable because I would not have to be around women who were having their babies or had just had them. I certainly appreciated the thought. I had not seen any such women the whole time, except for one woman who was signing in when I had just signed in and was waiting for the nurse. And she had arrived at the hospital by herself and did not appear to be in active labor. But she was evidently close to her due date. I had, however, heard babies crying a few times, but that was all.

I began to develop severe cramps in my lower abdomen. Now I had had almost equally bad cramps during the course of the pregnancy, with most of my bleeding episodes, but I had not taken any medication to help with those. I had always tried not to take any medication when I was pregnant. Even ones that were supposedly safe for the baby. I always worried that there could potentially be some side effects for the baby. But now I wanted medication. I wanted something to help with the pain. I was still very nauseated, but I went to the bathroom a few more times and nothing came out. I did not think there was anything more in my stomach that could come out.

I got up from the bed and walked around the room and that seemed to help with the pain a little bit. The nurse told me that a room was being cleaned up for me on the surgery floor and she would take me up there as soon as it was ready. She said her shift ended at half past seven, so she would be the one to take me up there. The nurse taking care of me over there would give me medication for the nausea and pain once I was in the room.

It was a little past seven when she actually took me up to the room. The nurse who greeted me over there was also close to the end of her shift, but she said she would get me settled in before she left. She was probably about fifty years old, and she reminded me of the nurse at the RE's office who had done the IUI for me that cycle. The one who had taken care of me when this life inside me had begun. And now this nurse was going to take care of me as this life was ending.

The nurse told me that they often got patients on that floor who had problems with their pregnancies. They always preferred to keep such patients on that floor rather than the labor and delivery floor, so I was not an unusual patient for them at all.

We were on the twelfth floor and the room had a huge window from where I could see the city lights. It was a great view, but I was in no state to enjoy it. There was a patient bed and maybe three comfortable chairs, but there was no place where my husband could have slept comfortably if he wanted to spend the night. I told him that he should go home and get some sleep because it had been a long day and he would need his energy the next day as well.

There was also no place to shower. There was an attached toilet with a bathroom sink, but no place to shower. I had been asked to shower with a special surgical cleaning soap the night before and the morning of the surgery but there was no place to do it. We had bought that soap but we did not bring it with us to the hospital, so they would have to come up with both the soap and a place to use it in, for me.

The nurse informed me that the doctors were putting in the orders for pain and nausea medication for me and I would get those soon. They would also start the IV fluids when they brought in the medication because I had been throwing up and was probably beginning to get dehydrated. I was still allowed to eat and drink for another four hours or so but it did not seem like I could, so I would have to be on IV fluids soon.

Shortly after I got into that room, I threw up again. I did not know where any of that stuff came from. I had not eaten anything since the last vomiting episode and it had seemed like I had thrown up more than I had eaten at that time.

Shortly after that second vomiting episode, the nurse who would be taking care of me that night came in. She had heard me throwing up. She asked how I was feeling. I told her that I was in a lot of pain and very nauseated. She went away and came back shortly with the medications. Now I had had the IV needle in my wrist for a few hours, but it had not really been used, except to draw a couple of vials of blood right when it had been inserted. It hurt badly at the site where the needle had been inserted when the nurse first used it to give me some nausea medication. It hurt again when she switched it over to the pain medication. She said she would be back after a few minutes to switch it over to the fluids, once I had received the appropriate dose of pain medication. The dosage was controlled electronically, and the electronic gadgetry was plugged into an electrical socket. She showed me where she had plugged it in and told me that I would need to unplug it each time I wanted to move about, and then plug it back in when I came back.

She told me that I was allowed to get the pain and nausea medication again four hours after the initial dose, so I should let her know if I wanted it then. She also wanted to keep track of how much I was bleeding and how much urine I was making. I thought that was rather gross, and not something I would want to keep track of for another person, but presumably, she would have known what she was in for when she signed up for a career in nursing. She put something called a 'hat' on the toilet to measure the amount of urine and I was to call her each time I changed a pad and to let her look at it before throwing it away.

She brought in a solution of the surgical soap and a few towels and washcloths and helped me clean up using those. It did not make me feel clean and fresh like a real shower would have, but it was something.

The pain killer began to take effect pretty quickly, and I was just beginning to feel comfortable when the device made a beeping sound to signal that it was done with the recommended dose. The nurse came back in to change the IV over to the fluids I would need to keep me from getting dehydrated. And the wrist hurt again at the point where the needle was.

My husband stayed with me until quite late that night, but eventually agreed that he needed to go home and get some sleep. I did not get much sleep that night. I could not get too comfortable in the hospital bed and I also needed to get up every so often to change my pad. Just getting up to go to the bathroom that was ten steps away was an ordeal, I needed to unplug the IV, wheel it along, go to the bathroom, wheel the IV back, plug it back in, and call the nurse and tell her that I just changed a pad. That was quite enough to make me feel completely awake each time I woke up. I hoped my husband got some sleep that night, because at least one of us would need to be well rested to face the day that came next.

Loss

When I needed to travel overseas for my brother's wedding, I had wished that I would get pregnant before that. Now I wished I had not been pregnant at the time. The doctor I saw after the subchorionic hematoma was first detected on my ultrasound seemed to be very sure that I had brought on the hematoma by taking on the stress of travel and that of attending a wedding. I had asked almost every doctor I had seen in the States about her theory, and none of them thought there was any credibility in what she had said. I believed them and trusted them more than that particular doctor, but during some low moments, I could not help wondering whether there was any truth to what she had said. It goes without saying that the few days after the first low amniotic fluid diagnosis were the very lowest point, not just in my entire pregnancy, but the lowest point I had ever hit in my entire life.

I prayed that our little baby girl would forgive us for making this decision. I prayed that she would understand that we made the decision only because we loved her and did not want her to live a life of pain and suffering.

I am normally not very religious and do not see a lot of value in prayer, but this was an event of life changing proportions. It made me value life in a new way and to appreciate the fact that we are alive. It also made me see that, all too often, we humans fret over things that are too little to think about at all. This kind of event puts a lot of things into perspective and makes you realize what is important and what is not.

I prayed to God and told Him that I knew that He would take better care of my little girl than I ever could, but the next time around, I just wanted one chance to try to prove myself.

After my visit to the hospital that Friday, I went home to wait for a phone call to find out when I would have the procedure, and where. I received a call from one of the nurses at the hospital where I would have my surgery, asking me a few medical history related questions. She also asked about any medications that I was taking. I told her I was just taking my prenatal multivitamins but was going to stop taking them, because I saw no point in continuing to take them. She said that was the right thing to do, because they did not want me to be taking any supplements containing Vitamin E for forty eight hours before the surgery. She said that they were still looking at operating room availability and I should expect a call later that afternoon about specific dates and times.

A short while later, I got a call from the doctor who was going to be performing the D&E. He introduced himself and then said how sorry he was that he had to meet me for something like this. I did not expect to hear that kind of genuinely sympathetic statement from someone who performed these procedures all the time. It made me wonder why the perinatologists I had been seeing until that point had not been more sympathetic, more human, even though I had thought earlier that I understood why they needed to be detached.

The doctor briefly explained to me how things would happen. Because I was at a late stage in my pregnancy, he wanted to see me not once, but twice before the actual surgery. He wanted to dilate my cervix on the day before the procedure and on the day before that. The entire process would not involve any cutting up. There would be no scalpels and no sutures. Everything would be done through the cervix. The disadvantage of that would be that the fetus would not come out in one piece and that I would need anesthesia. I asked if he would use local or general anesthesia. He said general. I was glad about that, because I did not want to see or experience any part of the surgery. He said that I was scheduled for surgery on Thursday and his office would call me shortly afterwards with exact times. Thursday was a little later than what I had been hoping for, but I understood that if he wanted to see me twice beforehand, the earliest it could possibly happen would be Wednesday. I just wanted it done that very minute. The waiting, knowing that the baby was still moving inside me when we had decided to terminate, wearing maternity clothes, all of that was very hard for me during that time.

His office called me later and gave me appointment times for Tuesday and Wednesday and the time for the surgery on Thursday. They told me to arrive an hour and a half before the scheduled surgery time and to stop eating and drinking after midnight before the surgery. Those were probably the standard instructions for all their surgical patients. The nurse told me that I would probably be with them for about five hours on the day of surgery, including the preparation before the surgery and the recovery afterwards. I would need to have someone who could drive me home that evening. That person would not necessarily need to be at the hospital the whole time, they would just need a phone number to call once they thought I was ready to go home.

I had never before had any form of surgery or any form of anesthesia. The doctor had described the dilation that he would do beforehand, and even that involved anesthesia. That would be local anesthesia injected in my cervix. It was a strange thought for me to imagine something being injected into my cervix. I had never before even heard of something like that. But now, after all the phone calls from the hospital, the actual fact of the matter began to set it. I began to think about the actual procedure, and it scared me. Of course I knew that lots of people have surgery every day and almost all of them come out of it just fine, feeling better than they felt going in. But I could not help being a little nervous.

I began to notice a decrease in the amount of fetal movement I was feeling each day. That made me feel like the pregnancy was just not meant to be, and it was going to end tragically sooner or later. I had feared the worst but hoped for the best all through it. I had been terrified with every bleeding episode and relieved with every ultrasound that I had had, until the two most recent ones. I had always wondered, always been uncertain, nervous and worried about what the outcome was going to be. As heart wrenching as this whole process was, it put an end to all the uncertainty and stress, both physical and mental, that I had been dealing with all this time. I am not trying to minimize the value of my little girl's life, but with all the unbearable pain of losing her, there was a strange sense of relief that I felt from time to time.

Through the weekend, I could not do much other than cry. My husband cooked some food for both of us, and I was mostly taking it easy. I could not decide whether it was easier to deal with the pain when we were together or when he was at work or out somewhere else and I was at home. When we were together, we were there to hold each other and wipe each other's tears. But when one of us teared up, there was nothing that the other could say to make the first person feel better. We just ended up holding each other and crying with each other. Neither of us had experienced this kind of grief before. It was so overpowering and so mind numbing that we did not know what to do or say in those initial few days. My husband had lost his father fairly recently, and his father had been quite young at the time of his passing. Even so, his passing did not disrupt the natural order of things. He passed away after his parents did, and before his children. Our daughter was going to die before us, and that goes against the natural cycle of things. My father in law had lived a full life and had made both his sons into mature, grown up people who could take care of themselves. Our daughter was going to leave us, and take with her all the dreams we had for her, a whole lifetime full of potential, years and years of what could have been. Maybe she could have been an artist, a writer, a doctor. Maybe she could have been the doctor who gave the world a better understanding of subchorionic hematomas and found a way to actually treat them. We would never know what potential her life would have held.

In the movies, often, when a person is crying on the inside, it happens to be raining outside their window, or they happen to be caught outdoors in the rain. It happened to be raining outside my window a lot during those few days too.

I prayed to God to forgive me for whatever it was that I had done to deserve something like this. I prayed that I would get a chance in the future to hold a child of my own while I was still on this Earth.

Down into the Abyss

For the duration of the ride home after that visit to the hospital, I could not think or say anything. I was not crying any longer, but I was also not doing anything else. My husband said that we needed to call our families. I knew that he was right, but I did not want to do it right then. I wanted to have a little more time to absorb the news and compose myself before I passed it on to anyone. But my husband seemed very anxious to call, so I gave in.

My mother seemed unexpectedly calm and composed on the phone. Either she was too shocked to react appropriately or was being calm for my sake. She kept telling me not to worry, because things would turn out fine either way. Even if we had to go through with the termination, she figured it would set us back by a year or so at most. I do not know if she was trying to be practical or if she was being pessimistic, but she always seemed to be almost certain that we were going to have to let our baby go, in all the conversations I had with her during the three days or so that we had in which to make our decision.

As I would discover during the course of my journey, a lot of people will try to console a person in a situation like this by telling them that they will have another baby very soon. That may or may not be true, and nobody, not even the most specialized of doctors, really knows how long it will take to conceive another baby after a loss. But that is not the point. The point is that when you are twenty one weeks pregnant and you know the gender of the baby, you have a pretty strong bond with that baby. You do not want another baby, you want that one. I thought of my little girl as a real person at that point, not as a fetus, like the doctors referred to her. I felt her moving inside me all the time. I knew she moved more when she was hungry. I knew she moved more during long car rides and train rides. We had started thinking of names for her and I was trying to imagine how each of our picks would sound with my husband's last name. I knew she liked to hear her father sing and was probably trying to dance to his off key notes. We had bought a crib and some other things for her. She was a real person, and making a decision to end her life should not be something that we, as mere mortals ourselves, should have to do. Only God should make that kind of decision.

I shared the gist of the situation with my online support group. None of them had ever been faced with a decision like this, and none of them had ever experienced a pregnancy loss when they were that far along in the pregnancy. Even so, they were very supportive and they were all praying for us.

I also left a message for my RE's nurse asking if their office had anything to say about the situation and if they thought I should see someone else for a second opinion. The nurse called me back that afternoon and said how sorry she was and that she would have the doctor call us back herself later in the evening, when she was done with her patients for the day. I was rather touched when the doctor called me and expressed genuine sympathy and spoke to both my husband and me for a few minutes. She did say that she could not comment on the situation since she had not practiced obstetrics in twenty years, but I thought it was really nice of her to call and put in a few sympathetic words. She spoke highly of the doctor whom I was supposed to see on Friday, and the other OB whom we had seen on Tuesday after the initial diagnosis at Maternal Fetal Medicine. She said that she would want to see me back in her office about a month after I had the procedure so that we could talk about how my husband and I could build our family.

I knew that we would not want to actually start trying to have another baby just one month after the procedure, but thinking about it did take a little bit of the edge off the pain. I had asked both the doctors I had seen on Tuesday about whether or not I was more likely to have another subchorionic hematoma, now that I had had one. Both said no. But I was still a little apprehensive about the subject, and suddenly beginning to wonder if I would ever be able to carry a pregnancy to full term. I still hoped and wished that this particular baby could miraculously be saved, but I had to begin to accept that it would probably not happen.

I had always thought that this baby was a fighter, one who had been conceived when my husband thought that he had not given me the last dose of medication and the egg would not be mature enough. One who had been growing normally and moving about in my belly all through the terrifying episodes of pain and bleeding that I had had. She had to be very special and strong just to be conceived by us, a couple who had been trying to conceive a baby for so long without success. She was too special and too strong and had come too far for her to give up now, or for us to give up on her.

My husband and I read a lot of things about our situation on the Internet. Deficiency of amniotic fluid, or oligohydramnios, can be caused by a number of different reasons. The doctors were almost positive that the reason, in my case, was amniotic sac rupture, but they could not prove their theory and they did acknowledge that fact. Another reason could be that the baby's kidneys were not working properly, so the baby was not producing enough urine. The doctor at Maternal Fetal Medicine had said that that was unlikely, because the kidneys appeared to be normal on the ultrasound. Another reason could be maternal dehydration. This had not come up in any of the discussions at the hospital. But I was reading accounts of other women's experiences on the Internet and saw that some of them had increased their fluid volume by drinking about two gallons of water a day. I could not imagine how I would drink that much water. My average daily consumption of water was close to half a gallon, or sixty four ounces. That was the minimum amount recommended by Weight Watchers, and that was what I tried to get in on most days. I had been drinking maybe an extra eight ounces a day since I had been pregnant, but two gallons a day seemed unimaginable. I decided I would strive for at least one gallon a day, and try to get as much rest as possible and hope that it would help. Of course, it was hard to imagine getting too much rest if I was going to be drinking that much water, because it would probably lead to frequent visits to the bathroom.

It turned out that drinking all that water was not as difficult as I had imagined. I was able to drink just over a gallon that first day. And I did not need to go to the bathroom quite as frequently as I had thought either. I was hoping that that meant that the water was helping to build the amniotic fluid.

My husband called a pediatrician whom we were supposed to see that week for a prenatal appointment. We had to cancel the appointment, at least for the time being. That particular doctor asked for a copy of the report. He wanted to see it in case he could be of any help. We had the hospital fax it over to his office. The doctor personally called my husband to say that he knew some neonatologists who we could talk to if we wanted. But he did think that the prognosis was poor. The way he went out of his way to speak to us, when we were not even his patients and had just about lost hope of being his patients in the near future, told us that we did not need to interview pediatricians the next time around, when we did actually need one. We had found ours.

We knew that if I could keep the baby inside until twenty four weeks, my doctors would put her in the neonatal ICU (NICU) whenever she was delivered and then the neonatologists would do their best to save her. But we also knew that while there was a fair chance that a baby delivered at twenty four weeks could survive, a baby delivered that early had a very high risk of developing severe disabilities, both physical and mental. We read literature on what kind of problems were commonly seen in babies delivered between twenty four and twenty eight weeks. We found that there was a high chance that, even if our baby survived, she would not be able to lead a full, happy, independent life.

The bigger factor in our case was that most of the medical literature on outcomes of premature births was based on the assumption that the pregnancy had been more or less normal until then. We knew, however, that my amniotic fluid levels were very low at twenty one weeks. The doctor did say that the fluid had probably gone down very recently, since the baby had been growing normally up to that point. Even so, even if she had been growing normally until twenty one weeks, she would not develop quite as normally from twenty one until twenty four weeks. Her lungs, kidneys and some other vital organs would only be as well developed as that of a baby delivered at twenty one weeks. That would give her almost no chance of ever being able to breathe on her own.

We had to admit, slowly and steadily, that unless the fluid levels miraculously went up, our baby would not be able to live on her own, without life support equipment. Even if she did survive, it would mean being in the NICU for about four months, which would be a harrowing experience for all three of us, and then coming out of the hospital with disabilities that would keep her from living a full, happy life.

We wanted a happy existence for our daughter. Not one where she would always be dependent on us or medical personnel for everything that she needed. And we had no parenting experience until then. We had no clue how we would take care of a normal, healthy child, leave alone a child with special needs.

As difficult and painful as it was, we decided that if the fluid levels remained low, we would decide to terminate. We wanted to raise a happy child. We did not want to bring a child into this world just so that she would exist for the sake of existence. We wanted to bring a child into the world so that she would get to see and experience all that is beautiful about this world. We did not want her lying in an incubator at the hospital with tubes and needles all over her. We wanted her to be the happy toddler in the frilly pink dress toddling around our yard.

That is not to say that we felt happy or even comfortable or at peace with our decision. We just thought that it would be the best thing to do, for her and for us. We did not want to give her a partial existence. But we were still heartbroken beyond what words can describe. Until then, I would always get excited when I felt her move inside me. Suddenly that movement was another source of pain. Heart wrenching emotional pain. If I accidentally opened a drawer housing things that we had bought for her, tears welled up in my eyes. I had stopped taking my metformin pills at about ten weeks into the pregnancy, but I was still taking the prenantal multivitamins. Each time I even looked at the bottle of pills, I questioned why I was taking them and why I had been taking them for so long. I questioned why I had worked so hard to lose all that weight before trying to get pregnant. I questioned why I had exercised so much will power over my cravings for unhealthy foods. I questioned why I had been avoiding all kinds of food items that were not recommended for pregnant women. I had worked so hard, tried so hard to eat healthy, avoided soft cheeses, sushi, pasta dishes with wine sauces, unpasteurized dairy products, food with too much sugar or too much fat, food with artificial sweeteners, and for what? For a long time, I had been exercising, taking long walks, if nothing else. During the pregnancy, I had been asked not to exercise or lift anything heavy. I had been avoiding all of that. To what end?

I just felt angry at the Universe, at God, for doing this to me. I wanted to eat all kinds of junk food that I had been avoiding for so long. I just wanted to eat, sleep and cry.

I did not want to talk to anyone about it. The ladies in my support group were great, but a lot of people, especially people who had never had any major problems with having babies themselves, sometimes said things that made me even more upset. They would just keep harping on the fact that we would have another baby soon. I did not want to hear that. A friend of mine told me that he just did not know what to say, except that my husband and I just needed to really take care of each other. I told him how much I appreciated his honesty in telling me that he did not know what to say. Most people who had not been in similar situations did not know what to say and I wished they would just come out and admit that.

I was drinking as much water as I could, getting enough physical rest and hoping for the best outcome for me and my little girl. But I never had a moment of mental relaxation. I was constantly worried and anxious.

On Friday, my husband and I drove to the hospital again for an appointment that, we knew, was mostly going to be an exercise in futility. We passed by the daycare center where we had already made a down payment for our baby and he became really emotional at the sight of it.

At the hospital, even though we had been hoping for a miracle, we were prepared to hear the worst. The ultrasound technician was mostly unaware of what was going on and proceeded to scan every part of the baby like she would do for a routine ultrasound. She even asked us if we knew whether we were having a boy or a girl. It took a lot of willpower for me to not scream at her and tell her that we were here to find out if we were having a baby at all.

She said she would just do some measurements, she would not diagnose anything. The doctor would be in shortly to do that. The doctor we had met at the last ultrasound had mentioned that there was a chance that, when we came in for our next ultrasound, our decision would have been made for us and there would be no heartbeat. I had been praying that either the fluid levels would go up or the heartbeat would stop on its own, so we would not have to make this kind of a decision. It was evident, however, that there was still a heartbeat.

The doctor came in, and scanned my belly himself. He said that he saw very little fluid in there. We asked him what he thought we should do. He said he thought we should terminate. He added that it was easy for him to say so, because he was not emotionally involved in the process. We had to make the decision for ourselves, because we had to live with it.

He seemed quite sure that my membranes had ruptured. He said that in twenty five years, he had only seen one case where the membranes re-sealed on their own. He remembered that one case because it was so exceptional. But he had seen a lot more cases where the mother got a serious infection and suffered some damage to her reproductive organs. He had seen one mother die and one come very close to death. The baby is not going to survive, he told us in no uncertain terms. There is a much greater risk of damage to your own health.

We asked him if there was an increased risk of recurrence of a hematoma with a future pregnancy. He said that once something happens in nature, there is sometimes a slightly elevated chance that it could happen again. We asked if there was something we could do to prevent it. He said there wasn't. We asked how soon we could try again. He said that we could start as soon as I started ovulating again. He asked if I had become pregnant easily the first time. I said no, we had tried for a long time and done some IUIs. In that case, he said, we should definitely not wait too long before we tried again.

We asked him about his recommendation for which procedure to choose for termination. He said that if we decided to induce labor, we could be waiting for a very long time because the labor can take as long as thirty six hours. And the nurses would be checking my cervix frequently, so there was a higher risk of infection. A D&E, on the other hand, would be over in about half an hour. With the labor induction, the advantage was that they could run pathological tests on the fetus to see if they could find any genetic abnormality. But he was confident that they would not find abnormalities. All the problems I had had were pointing towards placenta related issues.

He did reiterate that there were only three doctors in the entire state who could do a D&E at a late stage of pregnancy. Two of them were associated with larger hospitals, one was at a freestanding clinic. The OB's office would probably try to get me in with whoever could see me the soonest, but given a choice, it would always be a better idea to go to a larger hospital for a procedure like this.

After the appointment, we were supposed to meet the OB whom we had met after the first appointment on Tuesday. He was as grave and serious as he had been the first time. He had come in earlier than usual to see us before his first engagement of the day, which was a surgery. He was dressed in operating room scrubs instead of the white coat he normally wore.

I told him that we had decided that we wanted to terminate and that I wanted a D&E. I did not want to see the baby. I did not want to become any more emotionally involved with her than I already was. That would just make it that much harder to deal with everything and move on. It seemed like the procedure would be perfectly safe if performed by a person experienced in similar procedures. And I knew that the OB-GYN office was going to set up the appointments for me, so they would make sure of that part.

He said he would ask his office to set it all up for me. Meanwhile, I should call them if I had any questions. I would also need to call them if I experienced heavy bleeding or severe pain. And I should continue to take my temperature two to three times a day and call immediately if it went above a hundred. He wanted to see me back at his office about two weeks after the procedure to make sure that I was recovering normally.

On my way out of the Maternal Fetal Medicine office, I asked the woman at the front desk to cancel my next regular appointment, which was in about two weeks' time. She asked if I wanted to reschedule it. I just wanted to cry right then and there.

We stopped by the OB-GYN office to make sure that they had the correct phone number in their records, and to add my husband's number to their files, just in case they could not reach me. I also asked them to cancel my next regular prenatal appointment and to set up another one in about three weeks' time (I figured that would be about two weeks after I would have the procedure) for a follow up.

We also stopped by the RE's office. Interestingly enough, that office was just across the hall from the Maternal Fetal Medicine office. It was almost as if they expected patients to shuttle between those two offices all the time.

We asked if my nurse was available to speak with us for a few minutes. She was not. The front desk staff asked if we wanted to write her a note and then they would give it to her. We wrote a note thanking her and the doctor for all their support and kindness. I saw a lady with a little baby in a stroller in that office and I could not help myself, I just began to cry. I found it annoying and also somewhat inconsiderate when people brought their children into the RE's office with them, into a waiting room full of people who were trying to have children. Possibly, quite a few of those children were living success stories of the Reproductive Medicine Center, but I did not like it when people paraded their children in front of others like us who did not have any. Until that point, it had just annoyed me. That particular day, it upset me beyond words.

Roller Coaster

The day before I was supposed to go in for my ultrasound for analyzing whether or not my baby had spina bifida, I started bleeding again. It was noticeably lighter bleeding and significantly less pain than I had been experiencing until that point. It was still worse than a normal period, but I could move about with the pain and did not find myself worried about how I would drive all the way to the hospital with all that discomfort.

I met the genetic counselor before I had the ultrasound. She asked me a few questions about family medical history on both my and my husband's side of the family. Then we talked about the fact that there was a real possibility that the AFP test could have been inaccurate because of the bleeding that I had had. She also talked about something called 'echogenic bowel' in a fetus. That is a bowel that appears to be bright on the ultrasound. It is another indicator that something could possibly be wrong with the fetus, but it can also happen when there is bleeding during pregnancy. She told me that she was telling me about this so that I would not be too alarmed if they saw something like that during the ultrasound.

The counselor informed me that in general, about ninety percent of spina bifida cases are detected on ultrasounds. Since my odds for the disorder were currently at one in six hundred, if there was nothing abnormal detected during the ultrasound, the odds would go to one in six thousand. Then I would no longer be considered to be at a high risk for spina bifida and they would just continue to monitor me regularly to make sure that the baby was growing properly.

I did not feel like the discussion with the genetic counselor had been of too much value to me, but I knew that they were required to have this kind of discussion with a patient who had had abnormal test results. I also knew that I had signed myself up for this kind of discussion when I had chosen to have the tests done. They had given me the option to avoid doing the tests, and I could have taken them up on their offer.

I went in for my ultrasound a few minutes after the conversation with the counselor was over. This was a technician I had seen a few times at the RE's office, but I had not seen her in recent times. She seemed only vaguely familiar to me but I did remember her name. She scanned every part of the baby's anatomy, just like all of the other technicians had done at all of the other appointments I had had at Maternal Fetal Medicine. She said that the baby's spine looked normal and did not seem to indicate spina bifida, but the doctor would do the actual diagnosis on that. I asked her if she thought the baby was growing on track. She said that she thought so. I asked her if she could still see the hematoma. She could. I asked if it was any smaller than before. She said it was hard to tell. I was rather confused by that response. Until that point, all of the technicians had given me exact measurements, down to the millimeter, on how big the hematoma was.

And then came the moment I had been waiting for. The technician asked me if I knew what I was having - a boy or a girl. I said no, but I expected to find out with this scan. She said that it looked like a little girl in there, but the doctor would confirm that.

As she pointed out the baby's arms and legs and belly to me, she used the phrases "her arms" and "her legs." That was the first time anyone had used a gender specific pronoun for my baby. I also saw my baby moving her arm, as if she was waving to me, although obviously she had no idea at that very young age about waving to someone. But in those few minutes, I felt very connected to her, more than I had felt so far. Suddenly I was able to visualize her as an actual baby in my arms or in a crib, now that I knew she was a girl.

I was happy beyond words to hear that I was going to have a girl. I had always, always wanted a girl. After the technician left, I spent a restless few minutes in the room, waiting for the doctor to come in. The doctor came in and introduced herself. She went over the facts that I had had an abnormal AFP test and some bleeding shortly before the test. She agreed that the test could have been thrown off by the bleeding, but said that there would still be some concern about whether or not the baby was growing normally and that they would want to monitor me every three weeks or so. No big deal, I thought. I had been seeing them about every three weeks until that point anyway. I was basically used to all the frequent appointments at this point.

She looked at the baby's spine and pointed out that the baby was lying on its back, so it was hard to see the spine, but from whatever she could see, there seemed to be nothing abnormal. She asked me if I knew whether I was having a boy or a girl. I told her that the technician had said that she thought it was a girl, but wanted her to confirm. She agreed that she saw a girl in there.

I asked her about the hematoma. I told her that, at my last appointment, I had been told that it was clotted and healing. She said that it was clotted, but even after it clots, it has to go somewhere. It has to either be reabsorbed into the body or bleed out. This one was positioned right above my cervix, which was a position from where it was more likely to bleed out than be reabsorbed. That did make sense to me, but it did not put my mind to rest or put an end to the worrying.

Even so, I was beyond excited when I left the doctor's office that morning because I knew I was having a girl. I was growing less worried about the bleeding because it was lighter than it used to be and it did come with less pain, and the doctors did seem to think that it was healing.

The bleeding slowed down to just spotting later that day, but it did not stop completely like it had always done in the past. The spotting continued for a few days and then the bleeding became slightly heavier for a few hours, and then went back to spotting again. This pattern kept itself up for the remainder of the pregnancy.

A week later, I had an appointment with the regular OB. These appointments had generally been uneventful. She asked me how I was doing with the bleeding. I told her that I had been spotting all week, with some heavy bleeding in between. She said that she would need to listen to the baby's heartbeat with the Doppler. She listened, and I listened too. The heartbeat was strong. The doctor said that it sounded really good. It was good to hear that, and to actually hear the heartbeat too.

The doctor told me that it was okay if I wanted to just put up with the bleeding at that point, since I was between nineteen and twenty weeks then. But once I got to twenty three or twenty four weeks, I would need to come in immediately as soon as I saw anything more than spotting, even a moderate flow. She said that at that point, the baby is considered viable and that they would want to do everything they could to try to keep the baby inside, and if not, to get the baby out safely and into the neonatal intensive care unit (NICU). Until then, if I had bleeding that was actually signalling a miscarriage, there really wasn't anything that they could do about it.

I did not like the idea of delivering my little girl at twenty three or twenty four weeks. I knew that babies born that early did not fare too well, even in the very best, state of the art NICUs. But it was somewhat reassuring to know that I was getting close to the point where my baby could, potentially, survive outside my body. It was a milestone in the pregnancy, and every milestone meant that I was getting closer to the end of the pregnancy and closer to actually holding my baby in my arms.

At this point, the baby seemed more real to me than ever before and I could actually imagine giving birth to her. I started feeling safe and secure with the prospect of having a baby and told my brother and his wife and a few of my close friends.

I was really bonding with my baby at this point. Once we knew we were having a girl, my husband and I started thinking about names. It was easier to visualize her as a little baby and as a toddler in a cute pink dress. I was also feeling movements more frequently. I got to know that she moved about more when she was hungry, like early in the morning when I had not eaten in a few hours. She also moved about more during long car rides and train rides. She either really loved those rides or completely hated them.

One time, my husband was singing loudly and a little out of tune for no particular reason except that he was happy and the baby started moving about really vigorously. I told him she was excited to hear him sing and was probably trying to do a little dance in there. He tried to feel my belly but he could not feel anything. He kept asking me when he would be able to feel the movements. I told him it would probably happen around twenty three or twenty four weeks. We were about to find out very soon afterwards that we would never get to that point.

We had scheduled our childbirth education classes for my second trimester, since that is the time when a pregnant woman is supposed to feel the most energetic and comfortable. We had a labor and delivery class scheduled as an all day session on a Saturday. I noticed that most of the women there were around seven or eight months pregnant. I was a day under twenty one weeks and still wearing one of my regular tops with maternity pants. Sure, the top was a little stretchy, but I could not have worn it if I was as far along in my pregnancy as most of the other women over there. I was due in early August. Most of the others there were due in April or May. Until that point, I had been concerned about whether I was showing and whether I was visibly pregnant enough for people around me to notice. That was the first time I was conscious of the fact that I was not really showing.

The Monday following that class, we had a child safety and infant CPR class in the evening. We attended both of these classes gathering information that we thought we would use in the near future. We spoke to the nurse who taught the CPR class about a different class that we were supposed to attend the following Monday. She said she would probably be teaching that one too.

We also started looking at pediatricians and made prenatal appointments with a few of them so that we could get to know them and see how well they fit in with our needs and expectations. We also assessed a few day care centers and actually zeroed in on one and even made a booking deposit.

Three weeks after the ultrasound where I had found out the gender of our baby, I was supposed to go in for another ultrasound just so that they could follow up on the baby's growth and make sure she was growing normally. They were still concerned that she could possibly have spina bifida and the disorder tends to restrict the baby's growth in utero. As it happened, that ultrasound was the day after our infant CPR class.

I was spotting the whole time since the last ultrasound that I had had. I had had a couple of episodes of heavier bleeding as well, but those had been less painful than they used to be. The bleeding had also been lighter. All of that made me feel hopeful that the hematoma would be smaller, almost gone, the next time they got to look at it.

This ultrasound was scheduled for quite early in the morning, and my husband did not have any meetings on his calendar that morning. So he decided to go with me to the hospital. This was the first time he was accompanying me to a pregnancy related doctor's appointment, barring the one we had gone in for when we were traveling internationally. I had told him about how you can see all the parts of the baby's anatomy on the screen, and how I had once seen the baby waving at me. I had told him about how, during one ultrasound, the technician kept saying that the baby was moving all over the place and how I thought that the baby had definitely taken after him in that regard. He was excited and looking forward to seeing all of that on the screen for himself.

My husband had asked me how long these appointments were expected to take. I had told him that the technicians generally spent about fifteen minutes scanning the baby and then the doctor would come in and talk for five or ten minutes. I told him that the technicians generally pointed out everything, arms, legs, head, belly, even kidneys, as they went along.

That particular day, the technician scanning me said that the baby was curled up in a little ball and it was hard to see her anatomy clearly. She pointed out the head and feet, but not much else. She left the room in a bit of a hurry. My husband asked me why she had left so quickly and why she had not really shown us anything. I said it was probably because the baby was curled up in a position where it was difficult to see anything much. But my intuition told me that it was because she thought there was something very wrong but did not want to scare us unless she was absolutely sure. The only way to be sure would be to have a doctor come in and cross check what she was thinking.

The doctor came in soon enough, thankfully, so we did not have a lot of time to worry and wonder about what was going to happen. He came in and said that the technician had had some concerns. That was my worst fear come true at that point. What was to come after that was something I had never imagined or thought about and therefore, never feared.

The doctor scanned me himself and said that what he saw there was very little amniotic fluid. He said that I should come back the next day or within the next few days to see if the fluid was increasing. If it was not increasing, he said, then we would have to talk about our "options."

I was a little too confused to react at that point and did not really know what to say. My husband said that we should probably talk about those options right then.

"What are our options?" my husband asked.

"Well, termination," the doctor said.

The doctor went on to explain that without adequate fluid, the baby's lungs cannot develop. If that does not happen, the baby can never survive outside the womb. He said that the fluid could possibly be low because my amniotic sac had ruptured, which is to say that my water had broken, or that the baby was not getting adequate nourishment through the placenta. He said that I had had an elevated AFP marker, which probably meant that something was wrong with the placenta.

I pointed out that everybody had agreed that the elevated AFP was probably because of the bleeding that I had had. He said that it could possibly have been because of that, but the AFP was very significantly elevated and should not be so unless the placenta was not functioning properly. He also mentioned that the sac could possibly have ruptured because of the blood clot that I had had. I said that I had been told that it was healing and that it was positioned right above my cervix. He said that even if it was above my cervix, it had to have been formed elsewhere. The source was somewhere else. And that source could have caused other problems. It had probably been healing, but subchorionic hematomas were "poorly understood". I asked him how big the hematoma was then. He said he could not really see it, but that was not the biggest concern at that point. The lack of fluid was a much bigger concern.

My husband said that we thought that once you were in the second trimester, this kind of thing was not supposed to happen and that was why we had told a lot of our friends and family. The doctor agreed that they usually did not see problems this late in a pregnancy. He was fairly stoic about it. I know he had to be detached and needed to avoid getting emotionally involved with his patients' problems. He was a high risk OB and he probably saw patients go through difficult pregnancies all the time. If he became emotionally involved with all of them, he would probably be spending most of what he was making in paying a psychiatrist's bills. Or he would have to quit what he was doing or risk going insane. But even so, it seemed extremely odd that a person talking to me about something so heartbreaking for me would show no emotion at all. He said a rather cursory "I'm sorry," but that was about all.

I asked him what kind of odds he would give me at that point. He admitted that the probability of things improving was much lower than not. I asked why he thought that the fluid levels could go up suddenly if I came in the next day. Should I not wait for a week or so? I was thinking that I should wait for a month, but I managed to say only a week. He said it would be okay to wait until Thursday or Friday. It was a Tuesday. But he pointed out that we should not wait too long, because I was already twenty one weeks and two days pregnant and that the State law did not permit terminations after twenty four weeks. The longer you put off the termination process, the harder it gets. He meant that it gets harder to do it physically, because the fetus keeps getting bigger and stronger. But I don't think I knew at that point how hard it would be emotionally. I was still in denial, and still hoping against hope that things would turn out fine. But I had to admit that the odds had never been stacked against us before. I had had difficulty getting pregnant, but the doctors had never said that it would not happen. They said it would take time, but it would happen. I had the hematoma and I had a lot of bleeding, but the doctors said that, more often than not, things turned out fine in cases like mine. This was the first time somebody was telling me that things were more likely to not turn out fine.

The doctor asked me if I had seen any one particular doctor at Maternal Fetal Medicine more regularly than the others, or if I felt more comfortable with any one of them. I told him that I had had three appointments before then, and had seen three different doctors. He was the first one I had seen for a second time. He said that I should feel free to make an appointment for Thursday or Friday with whoever I wanted to see and get a second opinion from. He understood that this would be a big decision for us and pointed out that he and the others in his team did not take it personally when a patient went to someone else for a second opinion. He added that I should probably also talk to my regular OB if I felt more comfortable with her and wanted to take her opinion as well. He pointed out that we should definitely not make any decisions based on just one ultrasound.

He asked me if I felt like I had been leaking fluid and if I suspected that I had broken my water. I told him that I had been spotting constantly since the last ultrasound and had been wearing protection all the time, so I would not have known if I was leaking fluid. Since he could not eliminate the possibility that I was leaking fluid, he informed me that if I were, it could possibly lead to an infection. Such an infection could have potentially serious consequences for me. I should take me temperature at least once a day and call them or come in immediately if the temperature rose above a hundred degrees.

I asked him if I should go about work and other activities as usual or take it easy. He suggested that, until the next appointment, I be on what he called modified bed rest. That basically meant lazing around for most of the day but not necessarily being in bed all the time and being allowed to get up for short periods of time. He asked if I was allowed by my employer to work from home. I told him I was not. He said that I should just take a few days off, and if my employer gave me any trouble, I should call his front desk staff and they would send a letter to my employer. I told him I did not think that would be necessary for only three or four days off, but thanked him for offering to do it.

As soon as the doctor left the room, my husband and I just hugged each other and cried. We stood there crying for a few minutes. Just when I thought that things were beginning to look up and just when I felt like I was really going to have a baby, hope was snatched away from me.

I made an appointment to see the more experienced doctor whom I had seen before, the one who was the Director of Maternal Fetal Medicine, on Friday. My husband asked for a copy of that day's ultrasound report. We would need that in case we wanted to get a second opinion from someone who was not associated with that particular hospital.

My husband and I walked over to a different wing of the hospital to visit the OB's office. I told the lady manning the front desk that I had a rather complicated situation and wanted my OB's opinion on it. I asked if there was an appointment available for Friday after the morning's ultrasound. She looked at her computer for a while and said that there wasn't, but if we were willing to wait for a few minutes, she would go in and see if the doctor could see us right then. So we thanked her and settled down to wait on one of the couches in their waiting room. A doctor's assistant came by for me shortly afterwards and took me to an examination room. She said that she thought I might be more comfortable waiting there, rather than in the waiting room full of pregnant ladies. She did not actually say the last part about the waiting room full of pregnant ladies, but it was clearly implied and I thought it was rather considerate of her. She said that she had read the report and it basically just said that I needed to follow up later that week. I had not actually read the report myself until then, so I had no idea what it said.

The assistant was trying to catch hold of the doctor on call that day, who was a doctor I had not met until then. I was not sure that meeting such a doctor would be very valuable to me, but I trusted that all of the doctors in that particular facility would be good at what they did. As it happened, she could not find the doctor on call, but a different doctor was available. This particular doctor was the Chair of Obstetrics and Gynecology at that hospital and he was the doctor I had originally wanted to see when I first got pregnant and had a chemical pregnancy. He was the reason I was seeing doctors at that particular hospital in the first place.

This was probably the most experienced OB-GYN at the hospital. He was just looking over my reports when the medical assistant led us into his office. He introduced himself, even though he did not need to, and then said how sorry he was that he had to meet us in such a situation. There was genuine concern and sympathy on his face. That was in stark contrast with the way the other doctor had reacted to the situation. It was nice to see that he actually cared. Not that it made a difference to the situation one way or the other, but it was nice to see that the doctor was also human, just like us.

The three of us sat down around a small round table in his office. The doctor said that he had looked over my reports and understood that the doctor at Maternal Fetal Medicine had talked to us about termination. We said yes, he had, and asked him if he would recommend the same thing. He answered in the affirmative. He reaffirmed how the baby's organs, especially the lungs, would not develop properly without enough fluid in the amniotic sac. He did also say that we certainly needed to come back for a follow up ultrasound and make a decision only after that, but we needed to understand the situation. I asked if the fluid level was still low on Friday, could they possibly do anything to fix it? He mentioned that some people had tried injecting saline solutions into the sac, but it just did not help. There was a bigger risk that I would develop an infection because of the leaking fluid and an almost zero chance that the baby would survive.

He went on to talk about what our options would be if we did decide to go in for a termination. They could either induce labor, in which case I would deliver the baby like I would have delivered her at full term if things had turned out differently. Or they could do a Dilation and Evacuation (D&E), which was a modified D&C, modified to accommodate the fact that I was quite far along in my pregnancy. Some people, he said, preferred the labor induction because they felt that it was closer to the natural way and also because they wanted to see the baby. At the mention of getting to see the baby, both my husband and I teared up.

I asked about risks involved in the procedures. He informed us that with either procedure there was a small risk of bacterial infections, but I would be given antibiotics to counter that risk. With the D&E, I would have to make sure that the person doing the surgery was experienced in performing such procedures at a late stage in pregnancy, otherwise there was a possibility of damage to my uterus and other fertility related organs. That could impact my ability to get pregnant in the future. He emphasized that their biggest concern at that point was my health and my future pregnancies.

I asked about recovery times for each procedure. He said that it was usually only a couple of days for the physical recovery, but most women took about two weeks off, but that was more for the emotional recovery.

He explained that with a D&E, I would have to see the doctor a day before the actual procedure and he would use a certain substance to dilate my cervix. There would be no cutting up for the actual procedure, everything would happen through the cervix. The fetus would not come out in one piece with this procedure, which would make things difficult if we wanted a pathological analysis done on the fetus.

He also told us that there were only three surgeons in the entire state who did that kind of procedure at late stages of pregnancy. His office would arrange things for us if we decided to terminate via a D&E. He himself did similar procedures up to about seventeen or eighteen weeks into a pregnancy. But if we decided to go the labor induction route, they could do that at that very hospital for me, possibly as soon as the same or next day after we made our decision. Either way, the risks were very minimal and he and his staff would make sure that I got the best care and every precaution was taken to ensure my safety.

We asked him how long after a termination we should wait before trying to conceive another baby. The normal recommendation is to wait until two normal cycles have passed, he said.

We left the hospital that day with a completely unexpected load of information in our heads, heavy hearts, tears in our eyes and a very difficult decision to make.