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.