23 weeks plus 2 days’ gestation continued

It must have been around 7 a.m. because our midwife Amy came in to tell us that her shift was almost over. We were half asleep. Amy said she was about to take a few days off, and that she would be thinking of us while on leave, and would come to see how we were doing when she returned to work. She wished us all the best and we thanked her for everything that she had done for us. I was very sad to see her go. I’d only known her for one night, but I had gone through more with her by my side than I had done with most people I know. I wondered what our situation would be when we saw her next. I hoped our baby would still be safely inside me.

She left and everything went quiet for a second. I didn’t dream it, then; we were still here at the hospital. The same smell (that hospital smell) was in the air; people were talking and walking back and forth outside the door to our room; cups and saucers were clanging together as the breakfast trolley passed through the corridor; an unfamiliar bed in an unfamiliar room with an obscured glass window. We were still here. The hustle and bustle of a busy hospital ward had begun, and so did the rumblings of a new day. This was our first morning waking up at the University Hospital Wales (UHW), Cardiff.

Soon after Amy left, I started to feel as though I’d been in a fight. My forehead ached, probably because I’d been frowning so much; my eyes felt bruised because they’d been open for most of the night; my back and neck ached due to all the tension; and my throat was sore because I had been swallowing back tears on and off for hours. Still, I sat myself up in bed to get ready for the day; we both did. My husband Dave and I spoke about breakfast, getting clothes from home, which doctors we’d be visited by and what more they’d have to say. It was hard, though, because there was just one thing on our minds: our baby and whether today would be the day that he or she would be born.

That morning I was 23 weeks plus 2 days into my pregnancy. Dave and I had been at the hospital since the previous evening, when we were told by doctors that I was 2cm dilated. This was an enormous shock. I had expected our hospital visit to result in an examination, but I’d assumed it would be precautionary and routine, and that we’d be sent home, reassured, left to enjoy the rest of my pregnancy. That didn’t happen.

The doctors didn’t know whether our child was on the way and they advised that in order to have a much better chance of survival, our baby would need to stay inside the womb until at least 24 weeks’ gestation, when a foetus is considered viable for life outside the mother’s body. I was another 5 days away at this point; 6 days from when I was first admitted.

Throughout the first night at hospital and into the early hours of the next morning I didn’t take my eyes off the clock; counting almost every minute; every second. Time was passing by so slowly: we had only reached 23 weeks plus 2 days gestation. It was torture, and it felt like time could go no slower. Try to imagine willing the clock – time itself – to speed up when what’s at stake is the life of your child, and you have a terrible feeling that the clock – and time – is winning. Imagine the panic that brings. And when the hands on the clock seem to be moving spitefully slow; imagine the anxiety. It was hell on earth. Tick. Tick. Tick. Tick. And I felt like I was losing my sanity.

It was morning now, though; Amy had gone and daylight had appeared. Once I had woken up completely, my thoughts immediately took me to the fact that my baby was still inside the womb. We were well into a new day; well into 23 weeks plus 2 days gestation; not just scratching the surface we had been during the early hours of the morning. The tightening in my stomach had not worsened (if anything, they had settled down); there was no fresh bleeding; the baby was kicking away happily and contented; and he or she hadn’t made an attempt to come out yet. Suddenly I felt more positive. I said to my husband, “it’s a new day Dave and the baby’s still in there.”

With a hopeful exhale he said, “yes, 23 weeks plus 2!” He was obviously counting time too. Our conversations with the obstetricians and the NICU team had been awful, but I went on to say, “as they said to us, “IF” the baby comes out now he or she won’t be expected to survive, but they didn’t say he or she was definitely coming. They said they just didn’t know! Maybe the baby will stay in for weeks yet and everything will be okay.”

There was something about this new day; literally being there in a different light – daylight – that changed my outlook a little, and at this exact point in time we were both more positive. I should point out, however, that all through this journey we’d experience extreme highs and extreme lows. Up and down, up and down, constantly. For now we were on the up.

At some point after 7 a.m. Carmen walked into our room. A smiley, immediately positive influence, she introduced herself to us. Carmen was the midwife who was going to look after me for the next 12 hours, and little did we know that she would go on to have a significant positive impact on our lives forever.

The morning had started to pick up after its slow start; breakfast was brought to the room and although I had no appetite, I knew I had to eat something. I’m the type of person who, when worried, upset or stressed, loses all appetite for food. Many people comfort eat, but I’m the opposite of that. The smell of food made me feel sick, and I had no desire to eat. But even though this was the most worried, upset and stressed I’d ever been, I knew that turning food away wasn’t an option. I had to think about my baby growing inside, and I felt an urgent need to fight against the clock by nourishing him or her to the fullest extent possible before he or she came out. The baby needed food, and so did I.

Carmen also saw to it that Dave had a cup of tea and something to eat. She put those awful white stockings on me; those ones that stop you from getting deep vein thrombosis because you’re not moving enough. I cringed because I hadn’t shaved my legs in forever. It’s said you should always make sure your legs are shaved and that you’re wearing tidy underwear because you never know when you could end up in hospital. Well that’s what my mother says, anyway. It turns out she’s right!

We chatted to Carmen about her life and where she was from, and she asked us about ours; where we lived and worked etc. Talking to her was so easy. Her naturally bubbly persona was a real comfort and her soft voice was a calming influence. She had an incredible ability to almost make you forget the situation we were in. But on the other hand she made me feel so at ease that I just wanted to pour my heart out to her. I wanted to tell her everything that had been discussed during our time here so far; “the obstetricians said this; the NICU team said that; I’m only 23 weeks pregnant; they can’t put a stitch into my cervix in case I already have an infection. La la la!” I could have just completely offloaded, but I didn’t because I knew she already knew what had been discussed.

I should point out that the night before, at the assessment unit, a sample of my blood was drawn, a sample of my urine was tested and a swab was taken from my cervix. We were advised that an infection might have caused my cervix to dilate.

It was still morning when we were visited again by Dr Ali again, the obstetrician we’d spoken to the night before.  During our previous conversation, she’d informed us that it wasn’t clear why I was 2 cm dilated nor why my membranes (amniotic sac) were bulging; and they just didn’t know whether labour would be imminent. She’d informed us that she considered it unlikely that I had an incompetent cervix – a possible cause of early labour – and that an infection of some sort was a possibility. I had asked if a stitch (a suture) could be inserted into my cervix to keep the baby inside, and she explained that this procedure wasn’t an option in my case.
She’d explained that if an infection were present, labour was likely to follow shortly after any surgical intervention. So trying to insert a stitch into my cervix would likely cause me to start my contractions. Avoiding a stitch was a no brainer in that case, I guess. She’d also explained that inserting a foreign body such as a stitch in circumstances where I had an infection could jeopardise my health. Although I understood and agreed with what she said, the frustration of being denied an option to keep my healthy baby inside was unbearable, and the worry was more than I could handle.

But on this morning, the obstetrician seemed different to the evening before; the mood was a little lighter; she seemed more positive and not as tense. She proceeded to ask me the questions you’d expect her to ask: how was I feeling; was there any tightening of my stomach, bleeding, movement etc.; and she seemed pleased to hear my responses. She began to talk about the ultrasound scan that was planned for me later that day. I was confused to hear about a scan, but I let her continue.
Wondering if something had passed me by, (which wouldn’t have been surprising given how stressed I was) I looked at Dave for an explanation, but he seemed equally perplexed. So I asked, “Dr, did you say I’m having a scan today?” “Yes”, she said. (I should point out that it was very briefly mentioned the night before that if the insertion of a cervical stitch was ever a possibility, an ultrasound scan would be required beforehand) and so I asked, “Is it to see if a stitch can be inserted into my Cervix?” “Yes”, she said and proceeded to say, “We hope to insert the stitch but we have to look at the baby and your cervix first to see if this is something that can be done today. There’s no guarantee at this late stage the procedure will work but we will do it if we can.”

“So, I take it that this means I don’t have an infection?”, I asked. “Your test results have come back clear, and there doesn’t seem to be an infection”, she said. Outwardly composed, I thought; “No infection! No infection! Thank God!”

Throughout all of this, the possibility of infection terrified me the most; simply because it seemed to prevent interventions to help save my baby. The doctor spoke to us in a way that suggested she thought we had already been made aware of latest developments, but this wasn’t the case. The first we had heard about any of this was from her; from this conversation. There had obviously been a communication breakdown somewhere, but it didn’t matter to us; we didn’t care because what she was telling us was amazing news.

I was so eager to just get on with the procedure and so I asked, “When? What time? How long do we have to wait?” Question after question; it was as if someone had just poured petrol on to my diminishing fire and I was suddenly raring to go again and fired up. I had been given the slightest bit of hope and I was going to run with it. “So we’ll get you taken down, have a look and go from there. Okay?” I responded instantly: “Yes! Thank you Dr! Thank you for letting us know.” She smiled and left us alone.

I looked at Dave with my breath held and my eyebrows raised; I slowly exhaled. He did the same. There was hope; there was something; some light; maybe this was the solution to our problem. We smiled at each other and the tension seemed to lift for an instant. We felt better, more positive. I mean, we weren’t out of the woods, of course, but maybe something could be done to improve our situation. Even if they managed to keep our baby in for 4 more weeks, or 3 or even 2 weeks, the chances of its survival would improve significantly.
Because there was a possibility of something being done for us, I could breathe a little easier; the helplessness that we’d been experiencing was overwhelming, and if I had heard, “all we can do is wait and see” one more time, I was going to explode.

Dave said, “well, the doctor was far more positive today and that must be something, don’t you think?” I responded, “Yeah, definitely. I thought the same thing.” Everything was going to be okay now; our nightmare was going to end. Everything was already better, and, just like that, I was hungry again.

Carmen was beaming when she heard the latest development. I remember her taking hold of my hand after the doctor left. She looked deep into my eyes and nodded at me as if to say, “we’ve got this!”

(I have a lump in my throat and a little pull in my stomach as I write about this moment. This was someone that we had just met for the first time, and yet she was so very much in this with us; genuinely affected by it all and feeling it deeply. To feel and experience kindness of this level from someone you don’t know is so moving. And we got to experience kindness at this level time and again as our journey moved on. These are moments that will stay with me forever. Some of them last just a second but have a profound effect all the same.)

Stomachs jumping with butterflies, we both prepared for the scan. Dave and I freshened up as best we could, and I put my dressing gown on over my pyjamas. Dave had rushed home the night before to pick up a few emergency essentials. I brushed my hair in an attempt to diminish the “Scary Mary” look that I was rocking so very well and Carmen wheeled me down to the ultrasound room with Dave walking beside us. I had asked about walking over to have the scan, but Carmen thought that I should take the chair, just in case an incompetent cervix was what had caused the problem. I didn’t argue or disagree but I felt a little foolish being wheeled in a wheelchair; especially when I was able to walk. I felt as though I looked vulnerable and I hate that feeling. The idea of being seen in public in my pyjamas made me feel uncomfortable too.

I mean how unnatural is that?! There you are, all pj’d up; the attire usually only seen by your closest circle of family or friends, and there I was being wheeled for quite a distance through the busiest and largest hospital in Wales, wearing Christmas pyjamas (thanks Dave) and those horrendous white stockings, passing people who were all dressed in “day” wear. I’ve only ever given this a second’s thought, mind you, but I’m just reliving the cringe worthy moment now that life is good again, and, to be fair to Dave, I doubt he gave my pyjama choice much thought at the time.

Feelings of embarrassment apart, I was filled with a combination of hope, apprehension and worry. I worried that the stitch may not be something they could offer. So what would happen then? Back to just waiting and seeing again?

Notwithstanding nerves, the journey to the scan was filled with laughter and cheerful conversation. It’s crazy how, when you find yourself in such a hellish situation and you’re given one tiny ray of hope, you go from the depths of despair to euphoria, with nothing in-between. Woosh!!! We were experiencing one of the “ups”. There’s no sense or rhyme or reason to it; your emotions are simply uncontrollable. For a short moment, it felt as if the night before had never happened. Everything was okay; no harm done; no one’s fault; everything would be back on track once the stitch could be inserted.

I remember waiting to go into the room for the scan; Carmen, Dave and I were still chuckling and talking about funny stories. Then my name was called and my heart started pounding. This was getting very real now. My being able to have this stitch was critical for our future, and this was the exact moment that we would find out which direction we were going in: hope or despair. The three of us, now more serious and quiet, walked towards the door and went in.

The radiologist was a young man who hadn’t reached the top of his profession yet, but clearly knew what he was doing. He asked me to lie on the bed and explained all about the procedure and what he was about to do. Although the three of us were nervous, desperately wanting this scan to reveal that a cervical stitch was the way forward, there was still an element of hope and excitement in the room. Dave and Carmen continued to chat away on the seats to my left. I remember the whole experience clearly; the monitor was to my right and I couldn’t really see the screen properly. I was too afraid to try to look.

Dave and Carmen could see the monitor clearly, though. The radiologist put the gel onto my stomach and began the scan. Naturally, the room fell quiet. Everyone was waiting with baited breath for something; anything. Now that the ultrasound was under way I felt a little nauseous because it dawned on me that this man was going to be looking at my child. He was actually able to see him or her. I realise this may sound ridiculous, but, all along, the emphasis on doing the scan was mainly about the cervix. The issue seemed to be the cervix; and not the baby. Then it dawned on me that throughout our hospital stay so far, with all of the sadness and the negativity spoken about this baby’s predicament, no one had yet looked at him or her.

Someone was looking at him or her for the first time since my admission. And that was scary. What if my child had changed in the last three weeks, since my 20 week scan? Maybe a growth had appeared or there was some sort of malformation and this is what was causing him or her to come out. I mean, this probably sounds ridiculous, and makes no kind of medical sense, but what did I know?! I frantically began to wonder about how he or she looked; was he or she in some kind of distress? Was the radiologist seeing something about this child that he didn’t like? Suddenly, I felt a little ill and the temptation to look at the screen took over me. When I did so, I saw my precious child, who looked great. Granted, I’m not a doctor, nor another kind of medical professional, but I could tell that this child looked okay. He or she was moving around nicely; arms and legs moving; head moving; heart beating normally; and I could tell that the radiologist seemed happy with this.

I had been afraid to catch a glimpse of my baby on the monitor because I was frightened that it would make me even more attached to my baby, even though that was impossible. I think I was looking for ways to protect myself against the possible, and impending, worst pain in the world. I couldn’t help it, though, and my eyes took me straight to him or her. My heart ached. Through my mind I sent a message to the baby. It said, “you look so comfortable in there, and I’m glad. You look so happy and content, but I’m sorry that I can’t seem to keep you in; you may be coming out but please try your best and fight to stay in there. We really need you to stay in.”

Suddenly, I realised that this could be the last time that I’d get see my baby alive, and so I looked at that screen for as long as possible. I tried to take in every aspect. The way he or she moved; the profile; the beautifully dainty chin; the little turn up nose; and I tried to focus on that moment, excluding all other things. This moment in time when we were both alive; when we both existed in the world, together.

Time was getting on now and the radiographer was still carrying out the scan. The longer it was taking the more concerned Dave and Carmen seemed. Eventually the room fell completely silent. I wondered why everything was taking so long. What had he seen? Dave, Carmen and I were consumed by fear and suspense. I examined the radiographer’s face for a sign of what was happening: every inch of it; every expression. I studied every pause; and would quickly look to see what he was taking a second or prolonged look at on the screen (not that I would have been able to answer any of my own concerns, but when something’s not right, you know it).

I looked at Dave and he looked concerned. Carmen did too. They had a much better view than me of the screen. The radiographer would say things like, “oh this one’s a wriggler”, and he’d smile and say, “come on little one, keep still for me.” My heart continued to ache. Here was someone speaking kindly to my child, in the way that people do with children. He could do that then because he or she was alive. But that might not be a possibility the next day. He said, “okay, that’s done. I’m just going to get my colleague to take a second look.” “Okay”, I said. He left the room and returned with a female colleague. She was his boss and he sent for her to double-check his findings. He wasn’t gone for long but the conversation and atmosphere between me, Dave and Carmen was awkward; forced.

The radiographer had conducted a thorough investigation, so he cut to the chase when he did the scan in her presence. I wouldn’t say they whispered; there’d be no point in that; it’d be ridiculous seeing as I could literally touch them, but I could tell they found it awkward speaking in front of us. They didn’t want to leave the room to chat because that would have obviously set the panic wheels in motion. And so, here we were again, in a room with professionals speaking to one another in code; a code that we could easily decipher by looking at facial expressions and picking up on the general tone of the conversation.

“You see this?” he said. “Mmm mmm”, she said. “And that?”, pointing to the screen. “Yeah”, she said. I could hear, “cervix” this and “membranes” that, and then she asked, “what’s the gestation again?” He looked at her and said, “23 weeks”. She gave him a prolonged stare, paused and said, “okay, do you want me to have a chat?” He responded by saying, “No, it’s okay.” She left the room and he smiled at me and handed me some paper towels to rub off the gel. He left the room too. The room was so quiet. My baby wasn’t on the screen anymore.

He came back in and said, “okay, Nicola, I’ll hand the images over to the doctors and they will come and speak to you back at the Delivery suite.

He didn’t look me in the eyes when he spoke to me.

And I knew something was wrong.