Tuesday, August 11, 2009

Sierra's story, part 1 - the beginning of the end

At the end of the last post, I set myself up to tell Sierra's birth story...but I have to start farther back in time than that. The story begins with an ultrasound - a normal ultrasound showing a healthy baby (or so I thought). At 17 weeks and 4 days, we went for the "big" ultrasound. Everything looked good, the baby was measuring just right for gestational age, and we made the happy discovery that Austin's prediction that he was getting a little sister was accurate!

This ultrasound had been scheduled a bit earlier than the typical 18 to 20 weeks because we were planning another one to look at the heart in detail at 22 weeks - a fetal echocardiogram - and my midwife knew I wanted to try to minimize the little one's ultrasound exposure, or at least spread it out over time. The echocardiogram was because my husband's brother died of a heart condition no one knew he had, there was a (fairly small) chance it was genetic, and we (my husband especially) needed the reassurance that the baby's heart was okay.

The day after the 17 week ultrasound, I got the results of my AFP test and learned the AFP was elevated. This had happened with Austin, too, and he is fine, and besides, we just had an ultrasound the day before that turned up no red flags. So I wasn't very worried. Elevated AFP is a marker for open neural tube problems and the doctor had looked carefully at the baby's skull and vertebrae during the ultrasound.

However, when we went back for the next ultrasound, at 22 weeks and 4 days, I mentioned the AFP test and the sonographer assured me that she would check the baby's spine again. I relaxed, still not concerned and looking forward to seeing my baby again. She squirted the gel on my belly, began moving the transducer around, then asked casually, "Do you think you've been leaking fluid at all?" Ummm...I don't know. Maybe a little. There were actually a couple of times I'd wondered about that, but I never needed pads or was aware of any gushes of fluid...Why? I asked her, is it low? "Yes, quite low." Oh. I still wasn't that worried. She looked around a bit more, then went to get the doctor. When she left, I looked over at my husband. The concern in his eyes made me wonder if I should worry, too. He asked me what the low fluid meant and I said I didn't know. The doctor came in then and started looking and taking measurements. The sonographer, understanding something we didn't yet, took the somewhat antsy Austin out of the room in search of stickers, crayons, and paper. The doctor then said, "I do see two things that concern me..." Two? "The fluid is very low and the baby hasn't grown the way we would expect. She looks normal and healthy, but is likely not getting what she needs to grow and produce urine." Amniotic fluid at this stage is mostly baby pee. Turns out elevated AFP can also be a marker of placental problems and everything was pointing that way.

Austin came back into the room about then, with his art supplies, and the rest of the conversation was punctuated by him applying stickers to my shirt and my bare belly. The doctor talked of the baby's increasing demand on the placenta, then said if the baby could make it to 25 or 26 weeks it would probably be best to deliver her at that point. Until then, all we could really do was watch and wait and have ultrasounds weekly (so much for minimizing exposure...). As dire as this sounded, I still clung to optimism. She didn't say the baby would necessarily die, just that she would probably have to be born very early. It seems a bit ridiculous to me now, that I was still as hopeful as I was at this point, but when it is your baby, you hold tight to any bit of hope.

The next week I had a visit with a midwife and a follow-up ultrasound at the midwives' office. Still no change in the fluid. The midwife was honest about her concerns and told me as gently as she could that this situation was usually "ominous" and I should see a maternal-fetal medicine specialist at another hospital - in fact, I should probably transfer my care to them, to this larger hospital that had the NICU that my baby would require, should we decide to deliver her. The midwife then looked at me and said she wanted to give me a hug but maybe I didn't want her to upset the control I was (barely) holding onto. I decided I wanted the hug anyway. I can't stand the thought of losing this one too, I told her through the tears. My last pregnancy was a loss and now this... "I know," she said, her hand still on my shoulder and sadness in her eyes. "We just have to hope this little one can hang in there long enough."

Monday, August 10, 2009

An introduction, of sorts

I am a mother. Whether of one or two or three is in the eye of the beholder, I suppose. This much I know: I've held three in my womb, and hold three in my heart. I've given birth to two, and hold just one in my arms now, just one who walks this earth beside me.

* * *

My first pregnancy brought me a sweet baby boy, now a lovely, boisterous, almost-3-year-old. My last two pregnancies combined have totalled 40 weeks - but haven't resulted in a baby I can bring home. One ended at 13 weeks, the other at 27 weeks and 5 days. The latter ended just over five weeks ago - she should still be in my belly. Most mornings I stand in the shower and think, "only me in here," looking down at my slack, empty, slowly flattening belly.

I miss her so much, my little Sierra girl. Two weeks ago we camped on the beach, a couple hours from home. I wrote her name in the sand and watched the waves erase it almost immediately. I wrote it again, then walked away from it as her big brother Austin ran playfully ahead. It felt a bit like birthing her lifeless body, then leaving her at the hospital...