I had been at the post-natal ward only a few hours, before finding myself back at the delivery suite. It was around 4 am. The mucus plug had presented itself; the tightening in my stomach had become more frequent; and following an examination, I was found to be 4 centimetres dilated. I was 23 weeks pregnant. 23 weeks plus 4 days, to be exact.
The fear that our baby could be born prior to 24 weeks gestation (before viability) had become reality, and the hope that my previous 2 cm dilation did not mean the immediate onset of severely early labour, had been dashed. Even through our darkest moments during our 3 night stay at the University Hospital Wales, there were always moments of hope to occasionally counteract the terror.
How so? Well, doctors couldn’t say for certain that our baby was on its way, and even though I had been 2 cm dilated, no further changes seemed to have occurred in a number of days, and that had to count for something. But now things had changed. It was time. Our baby was coming. There was no more need for counting minutes, hours and days. Or so we thought.
I wondered how long this labour would last. I desperately hoped our baby would not be born until sometime after 10 am, so that he or she could receive the full course of steroids to mature the lungs. (The course of steroids was reluctantly offered by doctors; this reluctance was because I was still only 23 weeks pregnant.) If born before 24 weeks’ gestation, our baby’s chance of survival was a devastating 20%, with half of those that survive suffering with moderate to severe disabilities.
I had received the first steroid injection, but for our baby to receive the full course, a second injection would be required. The second steroid injection is administered 12 hours after the first.
Lying in a different bed in a new room, it all started to become very real. It was very dark outside, and inside the room, things began to get busier. The vibe began to change from how it had been throughout the duration of our stay. It had changed a number of times actually, but this felt different.
We had had the completely unexpected conversations about our unborn baby’s prospects of survival; conversations which required us to listen when what doctors had to say was so utterly heart breaking, they’d hang their heads in sadness, visibly affected by their own words. And the conversations with midwives were also difficult, after they attempted to help us understand what we had heard. We went through the excruciatingly slow wait when the baby didn’t seem to be coming, and all staff routinely popped in and out doing their thing; asking us questions, answering our questions, and making the kind of routine checks they would make for any mother and unborn baby.
Yes, the waiting game during this period was hell on earth because we desperately wanted our baby to stay inside the womb and doctors simply didn’t know if he or she would, but at least the little one was inside the womb. But now the medical staff had their game faces on, and a lot of preparations began to be made. “Game faces” meant that the worst case scenario – birth before viability – was coming true. It meant heart break in its truest form; and it meant our lives were going to change forever, and probably not in the way we had dreamed about. I could almost hear the fat lady singing, and what a terrible sound it was.
Midwives popped in and out to discuss matters, examine me, bring things in and take things away, but the midwife looking after me for the most part was a lady called Victoria (I think).
Then things got quieter; much quieter; and it was just me, my husband David and Victoria in the dimly lit room. At this point it felt as though we were just being left to it. I don’t mean neglected, by any means; we were left in the capable hands of a midwife, and others were occasionally in and out and only a few feet away, if necessary. After all, this was the early stage of labour. I don’t mean it in a critical way either; I just mean it seemed as though it was thought we needed as much privacy as possible. And why would that be? To give us space during this miserable time; time for nature to take its course.
It was just so very sad. We were two people who had tried to conceive for such a long time and who were completely ready and prepared to become parents. I had to put my body through a great deal of sacrifice in order to conceive. I was required to stop taking a drug called methotrexate, (administered to keep rheumatoid disease at bay) six months prior to trying for a baby because methotrexate would most likely kill an embryo or foetus. Not taking methotrexate and having to rely on less effective medication for three and half years, took its toll on my body and had a dramatic effect on my general health. It wasn’t easy on my husband either, but together, we were committed and determined to becoming parents, so we just took the sacrifice on the chin. During my pregnancy, I had done everything right. I didn’t eat anything I wasn’t supposed to; didn’t take too much caffeine; I went to every single consultant and midwife appointment and really took an interest in the general pregnancy dos and don’ts. Not that I thought for a second that someone else was more deserving to be in our position if they hadn’t taken as much care as I did, but I just couldn’t understand how we had got there and why we were going through that. I couldn’t understand how, when we had sacrificed so much to have this baby, things could fall apart so far down the line and in such a tragic fashion. I never said as much, though.
Victoria was a red headed, bubbly lady and was very pleasant. She explained that she wouldn’t be taking care of me for very long because the shift changes were not far away. She apologised for that. It was a very strange situation, really; each member of staff behaved differently, as they were bound to, being different people. Some were very smiley, trying to keep spirits up, up to the point where you could almost forget that this wasn’t going to be a happy occasion; others found it a little harder to hide their sadness and pity.
Dave was sat to my right; very close by. He was calm and composed but underneath it all he looked like a deer in the headlights. Petrified. With puffy eyes, woken from sleep, he provided the right amount of lip service to try and make everything seem less tragic and to minimise my sadness, even though he felt it in equal measures. He worried about me and my health, both mental and physical; an added worry to that of mine because I couldn’t care less about what happened to me. If it meant my baby surviving, I’d have risked my own life in a heartbeat. He listened to what the professionals had to say, he supported me and just did everything he could to make this situation as bearable as possible. This hurt my heart because he was going through it too. He was so brave. There is no better partner to have by your side. I am lucky.
I chatted away with Victoria (apologies if this name is incorrect) and even smiled with her. She had such a knack of occasionally enabling you to forget the hell you were in, which sounds insane, I’m sure. Maybe forgetting the situation was possible because that’s what the brain wants: to forget, to escape. (Gas and air really helps with that too by the way.) But then the wave of realisation would come back and there would be silence.
We talked about her family and how some women can get a little “away with the fairies” when receiving gas and air, and how funny that can be. I actually initiated this conversation because I was paranoid I was embarrassing myself. I was even chattier than usual (I can hear those of you who know me, saying, “ha! Impossible!”) and I remember talking about some really random things. I remember thinking, “God, does this woman think I’m speaking shit?”
She mentioned that the NICU team had been asking when delivery was likely and that she’d told them she didn’t know.
Victoria explained to us that she was going to check the baby’s heart rate. She placed the equipment onto my stomach – and there was nothing to hear, just a fuzzy sound. My own heart beat so frantically with fear that I’m amazed it wasn’t picked up through the monitor. She stayed quiet, moving the probe over my stomach, with an intense look of concentration on her face and the room fell silent. Had it already happened? Had our baby passed away? There was this swishing and swirling sound, and she informed us that this was the sound of the placenta. “But where was the heart beat?”, I desperately wondered. She said, “ah there it is. Hear it?” But all I could hear was the continuing sound of the placenta.
This didn’t fill me with confidence, because I expected, just like all the other times, to hear the heart beat loud and clear. But she said, “nope, that’s fine, there we go.” Just as I was reluctantly about to take her word for it, there it was! Thumping away – a healthy and happy heart. Although I felt an enormous sense of relief, hearing the heart beat as it did, also pushed me into a deeper level of sadness, just when I thought it wasn’t possible to sink any lower, in my already truly miserable state. Inside me, even at the point where my body was evicting our child, was a healthy baby; and hearing this perfect heartbeat was evidence, or a reminder, of that. To think how things were going to change for him or her was tragic.
In the dimly lit room, Victoria said, “do you have your phone? Lots of parents like to film their child’s heartbeat prior to the birth, to keep as a memory. It’s a nice thing to do.” That maybe the case, but we knew why she was encouraging us to do it; because she thought it likely that this would be the last time we’d ever hear it. The last piece of evidence; footage of the moment in time that we were parents to a living child. I knew it: Dave knew it. His face instantly filled with sadness. He became very quiet and in an attempt to make this moment seem more normal, like there was no hidden meaning behind it, I continued to chat and say things like, “it’s really fast isn’t it, the heartbeat?” Victoria smiled and said, “yes.”
It was after 5.30am and the tightenings were quite clearly contractions by then.
At around 7am, Victoria said that her shift was coming to an end. She wished us all the best and with a big smile on her face, she said that when she comes back to work, she would be checking up on us by looking in the book to see where we were and what had occurred. I thought, “hopefully, the baby will still be alive and fighting hard.”
Around the same time, Angharad introduced herself to us. She was my new midwife. I remember studying every inch of her face because I knew she was going to be the midwife present when our precious baby came into the world. So I wanted to remember at least one person (in addition to us) who was going to be in the room when our baby was; who would know he or she existed; even if she only remembered for a short while. Angharad was lovely. She was very warm hearted and comforting. She spoke Welsh, which is my husband’s first language, and so naturally he immediately felt at home with her.
I remember Angharad, just like Victoria before her, writing things down, every time there was some kind of progression (it seemed). It wasn’t long before the contractions started to get even stronger and there was less time in between them. There wasn’t much time in between at all, actually.
During a contraction, the pain down below was completely in the front. It was intense and burned terribly. It was weird: I’d never been in labour before but I knew exactly why I felt so strange. It was because the amniotic sac was intact, robust and pushing up against me. It didn’t seem at all ready to break. I mean, why would it? It was young. The best way to describe how it felt, is that it felt like I hadn’t had a wee for a very long time, and, as a result, the pressure was unbearable. Gas and air helped a little, of course, but it also made my mouth very dry. I remember desperately sucking on the pipe.
Because I had gone from abdominal tightening, to contractions, to severe contractions, with very little time in-between, I didn’t have much time to prepare myself mentally. I didn’t know whether I was coming or going. The contractions had gotten so bad that Angharad said, “Nicola, these contractions seem to be getting stronger now, do you need something more for the pain?” And oh so casually, I said, “oh no, I’m OK, thanks.” “Ok”, she said. “You let me know if you do, though, because I can easily give you something stronger.” “Yeah OK, thanks”, I said. I don’t know why I do that. Why I always need to show that I’m fine. Whether it be mental or physical, I don’t know why I can’t admit that I need help sometimes, and, more importantly, why I don’t even recognise when I need help.
As far as pain goes, I’m used to living with it on some level every day, because I have rheumatoid disease. A day in my life can range from discomfort to severe pain, to pain so acute and intense that it can leave me bed-ridden and visibly bent out of shape. I know I have a heightened pain threshold, but it doesn’t mean that I don’t feel pain and so I carried on with the gas and air in agony.
This was my first labour but it didn’t feel right. It felt that my body was working against itself. The natural fighting against the unnatural. As much as my intact amniotic sac didn’t want to break, and the amount of grief that that caused me, I was willing to go through the pain for days if it meant the baby would stay in the fluid and inside my body. I kept hearing in my head the words of the NICU doctor a few days before, “everyday counts. Every day that your baby stays inside the womb is vital; its chances of survival will increase.” So, even though the amniotic sac wouldn’t break, I was OK with that, despite the pain.
I made a move to get up to go to the toilet, and said to Angharad, “I need to wee really badly.” She said, “hang on Nicola, let me get you a kidney bowl, don’t get off the bed.” I said, “oh I don’t think that will be big enough; I really need to go.” She said, “you probably don’t need to go that much; it’s most likely your bulging waters making you feel as though you do.” Not convinced, I said, “is it because you think the baby could come out?” She said, “it could happen.” She handed me the kidney bowl, and terrified after what she had just said, I took it from her. There I was, on the bed, with people in the room and my dignity in tatters. Labour will do that to you. Angharad was right. As desperate as I felt to wee, not a drop came and so I lay back down in so much discomfort.
At some point, Dr Ali entered the room, accompanied by another doctor called Khadijah. They both sort of crept in really, as if to suggest they had been there for a while, not to alarm me, it seemed. For those of you that don’t know, Dr Ali is one of the doctors that we had a number of conversations with during my three night admission at the hospital, prior to this point. She was one of the first, if not the first, of the obstetricians we spoke to; the person who informed us of our predicament. She advised us what my 2cm dilation may or may not mean; she was the one who answered our first bout of questions; she was the doctor who informed us that it didn’t seem like I had an infection, and that the insertion of a cervical stitch may have been a possibility. So when she walked into the delivery room, the sight of her familiar face made me feel relieved and her expertise made me feel more relaxed; until I realised that her presence meant that I was getting closer to giving birth. I could feel that I was, of course, but her presence was clarification.
Dr Ali was sat to my right when talk of putting a cannula into my hand began. A very friendly midwife, unknown to me, asked Dr Ali if she wanted to do it but she declined. Jokingly, she replied, “no, it’s ok, I haven’t done it for a while, I don’t want to make her bleed, you can do it.” The three of us laughed. The midwife proceeded to put the cannula in and I ended up bleeding quite a lot anyway. We joked about this too.
The fact that I had not yet been given magnesium to protect my baby’s very immature brain bothered me. It had been on my mind the entire time. I remember magnesium being talked about during our very first conversation with the NICU doctor three days prior, so I asked, “when will you be giving me the magnesium? I haven’t had it yet.”
The situation was progressing so rapidly that everything seemed rushed. It seemed as if it was a case of, “right, let’s get this magnesium in her quick.” The magnesium affected me instantly, as the midwife said it would. The second it started going through my system, I felt a tingling sensation, almost like pins and needles, and I felt light headed. I didn’t like how it made me feel, but it wasn’t about me, it was about my baby. It was about his or her incredibly immature brain and giving it the best chance possible. I remember looking at the bag of magnesium hung up to my left and willing it to go down quickly; willing every last drop to get into my system in time. The anxiety made my toes curl at times. My memory is a little unclear on this; however, I’m certain that my baby didn’t receive all of the magnesium.
I really liked Khadijah. She was just lovely. She was young and vibrant. That may sound a bit odd, talking about a person being vibrant during such a tense and unhappy time, but I could just feel that that was how she was. She had a smiley face; the type of person who smiles with their eyes. I was glad she was there.
During a contraction, I’d push so hard. I didn’t want to because I wanted so desperately to keep my baby inside, but I couldn’t help it. Not wanting to but not being able to help it caused me so much anxiety.
Through the monitor, the baby’s heart beat remained strong and healthy and it gave me hope. It was a constant reminder that he or she was doing well.
Soon, it got to the point where there was no time at all between my contractions. A minute, maybe less. Angharad was amazing; Dr Ali and Khadijah too; advising me and supporting me throughout. Then, an almighty contraction came, and there was a very loud pop. In fact, I’d go as far as to say it was a quiet bang. The contraction had burst the amniotic sac in the most dramatic fashion, and the water literally flew across the room. No exaggeration. It travelled without dispersing, until it hit the wall and floor. How it never hit Angharad, I’ll never know. I remember thinking, “what the hell was that?! Well that must be normal, it must happen all the time,” and then I saw Angharad’s face. She stood there, with wide eyes, and hands raised to shoulder level, wide apart from her body; her mouth was open, while she surveyed the area around her. She was astonished, and I thought, “oh, ok then, that’s obviously not normal.” Angharad quickly got some towels and started to wipe the floor, using her feet, while reassuring me that everything was OK. Then she left the room, to get some more towels, I assumed. It was still pretty wet in there.
As soon as my waters broke, things took a turn for the worst. The baby’s heartbeat began to drop. Imagine hearing the sound of a healthy foetus’ heartbeat; the speed of it; the pattern. A sound, that because of its healthy rhythm, had very much become background noise; but then, in an instant, it dropped dramatically and didn’t stop slowing down. As its strength faded, it felt to me as though the sound of it was getting louder and louder. Bellowing out that this human being was in trouble.
It seemed to me that inside the water, our baby was happy and healthy, but as soon as he or she was in the womb without his or her comfort blanket of fluid, and in such an instantaneous fashion, he or she went into some kind of shock and started to struggle in the blink of an eye. The shock theory hasn’t been confirmed by the medical profession, of course, it’s just how it seemed to me, having witnessed it all play out. It’s the only way I can describe it. It was as if in the absence of fluid, he or she didn’t know what had hit him or her.
Dr Ali turned to me and very softly said, “the heart is very weak.” These are words that will haunt me forever. She was preparing me for the worst. She, fairly, wanted me to accept that this baby’s chances were looking very slim, or even non existent. With the heart rate continuing to drop as it was, it didn’t look as though the child was going to be born alive. I remember thinking, “I have got to get this baby out before the heart stops beating all together.” I knew that if he or she was born without a heartbeat, that would be it, game over. This child would be born before viability, so a resuscitation attempt would not be made. I had to get the baby out alive if I wanted him or her to be given a chance. The next step now was to deliver the baby quickly. I then had to hope that he or she would survive the delivery.
I pushed with everything I had. Don’t be fooled into assuming that just because a baby is tiny, delivery is automatically easier than it would normally be. I’m sure there have been premature babies that have just dropped out, but that is often not the case. Khadijah was the one assisting me with encouragement at this point but then Dr Ali stepped in and took over. As I pushed again, Dr Ali began to encourage me. She was brilliant from the start but all of a sudden she started to get fired up. It seemed that now she could see I might get this baby out in time, she had gone from accepting its fate to being completely in the moment; in fight mode herself. “Go on Nicola. Push! You can do it.” Seconds later, our baby’s tiny foot made it’s entrance into the world. A breech birth, feet first, our baby was born.
Shortly afterwards, Angharad returned to the room. She must only have been gone a matter of minutes.
Our baby was immediately taken to the corner of the room and Dr Ali looked me right in the eyes, and said, “you are a very brave girl, Nicola, a very brave girl.” Eyes full of tears, I said, “thank you.” For me, those words meant everything. It was confirmation that I had done all that I could; that I was right to push our child out as fast as I could; and that I was right to want to give him or her a fighting chance, even at the last possible second.
Dave asked Dr Ali, “is the baby dead?” She pursed her lips and with raised eyebrows, she nodded gently, as though to suggest she thought so.
High on gas and air, I watched calmly as they rushed the baby over to a table that was equipped with the tools needed to attempt resuscitation. It was as if I was watching a film. I obviously knew what had just happened; I knew the baby was mine; and I knew the seriousness of the situation; but it was as if my panic and anxiety buttons were stuck. Something wasn’t connecting in my brain, so I just lay there, looking on. Gas and air, combined with shock, didn’t allow me to connect the dots. Dave on the other hand was completely “with it” and clearly traumatised by what had just unfolded. Our baby, in the corner of the room, was laying there lifeless, and still he held my hand, continuing to support me, dignified and selfless.
I caught my first glimpse of our child when they took him or her away from my body to be placed on the table. I couldn’t believe my eyes: he or she was severely bruised and his or her back was towards me. His or her head and right arm lay in-between the doctor’s thumb and index finger, and the doctor’s little finger was wrapped around his or her back. This human being was the smallest thing I’d ever seen.
The baby, my baby, was on the table. It seemed like ages, but it probably wasn’t, and I wondered where the NICU team were. As I was about to ask, a woman rushed to the door. It seemed to me that there was some confusion in the room, because even though she rushed to the door, she casually walked into the room and found a spot to stand in. Our child was so small that this lady couldn’t see him or her laying on the table, so someone shouted, “the baby’s there!” She then rushed over to assist. Everything happened so quickly that a crash call to the NICU had to be made. Certain NICU team members would probably have had to drop everything and just come running.
Seconds after this lady’s arrival, the rest of the NICU team followed behind her, and they took over the room. One of them was the NICU Doctor who visited us during my three night stay at the hospital. He was the doctor who provided us with the dire statistics about the survival rates of 23 weekers; the doctor who opened our eyes to the reality that we were in and the doctor who wanted to know whether we planned to have the baby resuscitated at birth. Even though his face couldn’t be associated with happiness and positivity, seeing someone familiar to us, was comforting in a strange way.
There were so many doctors and nurses surrounding our baby; working on him or her for what seemed like forever. The baby was completely silent, which we always knew was going to be the case because his or her lungs would be far to immature and weak to enable him or her to cry. A baby of this gestation wouldn’t be able to breathe unaided for long, if at all, so crying would be out of the question. Having been warned this would be the case didn’t make it any easier though – the silence was deafening. You know when you watch these TV programmes about giving birth? And how an episode can become overbearingly tense and dramatic because the new-born hasn’t made a sound for a few seconds? And, the tension is so much that you hold your own breath until the infant cries? And how you feel such relief when you hear the cry?
Well, imagine that tension when it’s your own child, and there is no cry, and the seconds turn into minutes; many, many minutes of silence; and all you have is the hope that when doctors turn around to you, they say, “resuscitation was successful.” It is agonising.
Angharad was present at the table when our baby was being worked on. Dave turned to her and, in Welsh, he asked about the sex of our baby. She looked at Dave with a face full of sadness and replied, “merch fach.” I know what that means, but I couldn’t hear properly, so I asked, “what did she say?” “It’s a little girl,” Dave replied.
As soon as those words left his mouth, he broke down. That was it; the moment where he couldn’t be strong any longer; where he had no choice but to release the contents of his broken heart. You see, we always knew deep down that I was carrying a girl. We both had a feeling. We were so sure; to the point where, during my pregnancy, we referred to the baby as ‘she’. We never officially found out whether we were having a boy or a girl but I just knew. A mother’s intuition, perhaps. We would have been happy to have a boy or a girl; after trying to conceive for so long, we just felt incredibly blessed to be having a child. All we asked for was a healthy baby. However, if it were possible to choose, Dave would have picked a girl. He sat there to my left with tears running down his face, with his shoulders jolting uncontrollably and I tried my best to console him. Knowing our baby was a little girl made things all the more real, all the more personal, and it provided a more specific picture of the life we were probably never going to have.
It wasn’t long before Dave wiped his eyes, took a few deep breaths and got himself together.
We held hands as we watched them all in the corner working on our child. It seemed as though the person trying to intubate our baby was having trouble doing so, and so the NICU Doctor I keep referring to took over. I watched their every move. My memory tells me that the room was chaotic. There must have been at least 13 members of staff in there, all doing their thing.
Through it all, I remember concentrating on this specific NICU Doctor and being completely amazed. To us, he is God. Seemingly unfazed by the chaos; and completely in the zone; he worked his magic on this incredibly small human being. He managed to get enough oxygen into her lungs to bring her heart rate back up again, and he managed to intubate her; how he managed to do so is something I’ll never understand. Her life; and ours; rested completely in his hands and the hands of his NICU colleagues too. Imagine that type of pressure. I can picture him now; the intense look of concentration on his face, and I often think, “thank God for him; for people like him. For the people who possess those type of skills and that type of intelligence. Where would we all be without them?”
The doctor had finished doing his bit and I held my breath. Had their efforts been for nothing, or had they been successful? Did he manage to resuscitate her? I didn’t know at this point. I could see them preparing to move her from the table, putting her into a plastic bag to keep her warm as her skin was incredibly thin. They put her into a transport incubator and I could only assume they had achieved what we had wanted them to achieve, for now.
The doctor turned to me and nodded. He explained that their resuscitation attempt had been successful. The relief I felt was incredible and I exhaled loudly. I was too afraid to get too excited though. I told myself, “ok, that’s the first hurdle out of the way.”
I was informed that our baby would be taken straight to the NICU and it would likely take them approximately 3-4 hours to try and stabilise her. We would be told when we could visit. What they couldn’t guarantee was that she could be stabilised. So when we visited our daughter 4 hours later, we didn’t know whether they would be continuing her care or not.
We were advised that our baby was born in poor condition. So poor that my obstetrician had thought she was dead. She was born at 23 weeks gestation, without having received the full set of steroids for her lungs; lungs that hadn’t yet progressed to the stage where they had released natural surfactant. She was born without having received the full dose of magnesium for her brain; she was severely bruised, with a heart rate so faint that it only beat 55 beats per minute; so when the NICU team wheeled the transport incubator to the bottom of my bed, for us to catch a quick glimpse of her before they took her away, the NICU Doctor looked at me and said, “the odds are not good.”
Having misheard him, I asked, hopefully, “the odds are good?” “Not good”, was the reply. My heart sank. Mishearing him like that had made my heart pound with hope, but hearing the cold, hard truth, made me feel as though I had been body slammed to the floor.
Just as he clarified that her odds for survival were not good, she moved her leg. She lifted it right up in the air and brought it back down again. It wasn’t a twitch, it was a slow, solid movement. Her leg was all I could see as she was so tiny. She had gone from being barely alive; her body so small that labour could quite easily have killed her; but now, after a lot of assistance and oxygen flowing into her lungs via a ventilator, she had found the strength to move like that. I knew she was a fighter. I nodded to the doctor in acknowledgment but thought, “naaah. You’re my hero Doctor R, but you’re wrong .”
They all left the room, leaving me and Dave behind, and made their way to the NICU.
To everyone in the room that day – Angharad, Dr Ali, Khadijah, the NICU Doctor and the incredible NICU team with him, and anyone else I have missed – thank you. This blog is dedicated to you. You gave our daughter the safest and best start possible in life and we will be eternally grateful.