Born Too Soon

I used to watch sports and say, “Can you imagine making a living…playing a game? How awesome is that!” Yet I do believe that my job is infinitely cooler. I get the privilege of playing a role in the most important and transforming time of a person(s) life!! I get to see a life enter the world and see that little person take their first breath, see their mother for the first time…help introduce them to the world! It’s truly magical…and it’s what I call my “job”. That word seems like a joke to me…it’s not my job, it’s my life…and my honor.

However, as wonderful as my job is…I also, unfortunately, have had to play a role in some family’s worst day ever as their nightmare unfolds. This is the part that people don’t even think about when they think of what I have chosen to do for a living. I don’t blame them…I don’t want to think about it either! But the reality is there – not all stories have happy endings.

(the following is shared with permission from the generous family)

Monica was 22 weeks pregnant when she started having some spotting. This was her first pregnancy (they had an adopted son already) and I was only her doula – this was a planned hospital birth. She called me unconcerned and just to let me know. I advised her that at this gestation that was not okay and not necessarily normal and she needed to call her doctor who would want to see her at the hospital. This is exactly what happened, so I met them at the hospital.

When I got there, Monica was already in her room waiting for the doctor to arrive. The nurse said that the doctor would come in, do a “spec exam” (where we visually look at the cervix with a speculum) and would “confirm if what I felt is what I felt…”

I asked her what she thought she felt…she just shook her head and walked away. That worried me and got me on ‘high alert’. I explained to Monica what was going to happen, that they would use a speculum, etc. I also went into detail about what would happen if she was effacing or dilating this early because things would happen quickly and I wanted her to understand what might happen.

The doctor came in, inserted the speculum as I peered over her shoulder…and we both saw her 100% effaced and 3 cm dilated cervix. My heart sank into my stomach and I looked up between her legs to see the mom looking down for my reaction – unfortunately, my face told her everything and she began to cry.

She was immediately hooked up to Magnesium Sulfate, put in a position so her head was lower on the bed than her feet, and we prepared to helicopter her out of this hospital (that doesn’t have a NICU) to a hospital a few miles away that is prepared to deal with such complications.

cervix with cerclage

The next 2 weeks were a roller coaster…she continued to dilate despite multiple medications until she was 5cm dilated with membranes bulging almost to the vaginal opening. A VERY talented perinatologist used a foley catheter bulb to push the membranes back up inside the uterus and put a cerclage into her cervix! An amnio was performed which showed that there was a low level bacterial infection in the amniotic fluid. Monica was put on antibiotics.

Then her water broke. I had been at the hospital absolutely every free moment I had throughout these 2 weeks – riding the ups and downs with her. The goal at this point was to get to 24 weeks, get to a point that we might be able to save the baby. At 23 weeks and 5 days

cerclage seen at top

another amnio revealed the infection remained – and fear for the mother’s health caused them to decide that they had gone on as long as they could. It was time to get the baby out.

The removed the cerclage and began Pitocin. Very soon after, the terrified mother requested and received an epidural. The fetal monitor was not used – and I think that was very hard on everyone. (the baby had a very very low chance of survival…but if they saw signs that the baby was in trouble on the monitor then they would be obligated to perform a cesarean on a 23 week uterus for a baby that it was not likely to help…endangering the mother’s future pregnancies.)

And we waited….until she was fully dilated. And this brave mother began pushing. A tiny little head, much too small to be born, came into view. Monica cried as she pushed her tiny daughter out, unsure if she would be born alive or dead.

As soon as the baby was out I saw her wriggling…I said to Monica, “Look down! She’s out…look at your daughter, she’s beautiful…” Monica looked down between her legs as she whisked her teeny baby over to the warmer to intubate. As they lay her down into the warmer, I saw that she was trying to cry…so I said to Monica, “LISTEN! Can you hear her…listen!!” The entire room became silent and nobody moved…and a tiny little ‘mew’ snuck out. Upon hearing her daughter, Monica sobbed…and that signaled the room into life-saving mode once more.

Almost 15 minutes they worked to intubate this little girl…but they finally got it in. Monica got to kiss her hand before they put her into the incubator and wheeled her up to the NICU.  She was weighed….1 pound 2 ounces.

Monica birthed her placenta 4 hours after the birth…a tiny placenta that represented a fraction of what it aspired to be. The baby was hooked up to all of the machines and bells and whistles in this state of the art hospital….and she fought.

Monica's hand with Jackie

On the second day they performed a cranial ultrasound that showed bleeding…this was worst case scenario. That was the news they feared, and they now knew that she wasn’t going to make it. They called me in the middle of the night with the news that she would be gone soon and I rushed down to the hospital. They were still in the NICU…all the wires had been unhooked so that mom and dad could spend her last bit of time loving her. The neonatologist observed, monitoring occasionally, waiting for the baby to pass. We all cried…holding her….until finally the neonatologist listened to the baby’s chest, looked at me, and shook her head ‘no’.

I leaned in to the parents and said words that were physically painful for me to say…”She’s gone now.”

Me holding Jackie

We spent the rest of the evening with her in a ‘family bonding’ room, holding her, dressing her, grieving her. She was born September 11th, died September 13th, and was buried September 18th.

I will never forget baby Jackie…she may have only been in our lives for 2 days, but she will effect me for the rest of my life.

**FOLLOW UP**

A year later I would attend the birth baby Jackie’s beautifully full term brother, followed by their sister! Beautiful births that I was honored to attend. I am grateful to the family for allowing me to be a part of their lives…and grateful to Jackie for the many gifts she gave to us in her too short time in this world.

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