Tuesday, October 30, 2007

So I wouldn't forget...

(I wrote out the entire course of events of my pregnancy end and Zachary's death. I compiled it all right after Zachary died and e-mailed it to an e-mail account set up in his name for James and I to journal into. I knew with time my memory would fade, and the details of something so important shouldn't be forgotten. I'm sharing my experience now with the world. I was 22 weeks and one day pregnant when Zachary James was born and died, and the cough I mention is one I caught over Easter.)

We had gone to Galveston, TX. on Thursday, April 19 for a "babymoon" -- a little mini-vacation for the family before potential protective bedrest and before baby arrived. When we got to the hotel, I passed a large clump of mucus, and continued to pass mucus over the next several days. We assumed it was just normal cervical mucus, but in excess because I had a hard and deep cough and had been sitting upright for long stretches of time while travelling. There was no blood in the mucus so we did not believe it was the mucus plug.

Sunday night after we returned, my cough worsened and I considered going to the ER because I was in so much pain and struggling to breathe. I was very concerned for the pregnancy because I had pressure in my lower abdomen from the cough, but talked myself out of it because I thought I was being too fearful or paranoid.

Monday morning there were two specks of blood mixed with the same mucus on my morning bathroom tissue. No pain really, and minor random contractions. Stayed home to take it easy.

Tuesday morning there was one speck of blood on morning tissue. Slightly more pain and a few more contractions -- one minor one about every 30 minutes beginning at 7:30 AM. Called the OB for a cervical check, though I believed still I was being paranoid and nothing was wrong. Was seen at 11:30 AM with membranes bulging and was sent to the hospital right away.

At the hospital, I was given Mag Sulfate and other muscle relaxants, along with antibiotics. Was catheterized and left in Trendelenburg (head down, feet up) for the afternoon and night in the hopes that the membranes would retract back into the uterus. We were unable to get the cough fully under control, and it worsened as sinus drainage flowed downward in that position.

At 6:00 AM, I was taken to pre-op for a final check before an attempt at a rescue cerclage. Sono reveled that the membranes were bulging further out into the birth canal. A manual exam showed anomilies on my cervix that were the tears as my cervix was ripping through the MacDonald cerclage that was in place. We had the option of returning to the room for bedrest indefinately without attempting toreclose the cervix, but we had already been advised that that would leave us open for a very likely infection that would end the pregnancy and could likely damage future fertility. The other option we had was to proceed to the operating room to try to manipulate the membranes back into the uterus with the aid of an inflated Foley bulb and then stretch the cervix back over and restitch. That was the option we chose.

The attempt was unsuccessful. The membranes would push out around the Foley bulb and would not retract at all. In the operating room, I was told there was nothing more we could do to repair the cervix, but that I would be kept stable on bedrest for as long as possible. I was nearly 2cm dialeted with the cerclage in place and they couldn't determine if the cerclage was broken at all, though it was clear I was tearing through the stitch. I was cleaned up and sent back to the room after recovery. The cough was still very violent.

I returned to the room on a gurney at 9:30. I was shifted back to my bed and as the nurses were getting me arranged and hooked back up to monitors, my water broke. We thought that was it -- that we would be required to delivered within 24 hours -- but were told by both nurses and doctors that we could remain in the hospital on bedrest for up to 2 1/2 months provided there was no infection or no additional cervical change. I was not having contractions and had been given antibiotics to stave off infection. I was allowed to eat and overall felt pretty fantastic physically, though terrified and troubled emotionally.

At about 11:00 AM the chief neonatologist came to our room to talk to us about the likelihood of premature birth because of my incompetent cervix and PROM. He advised us that ethically the hospital would do nothing to rescusutate a baby born between 22 and 23 weeks, which is right where we were with our little one. Between 23w0d and 24w6d, they had a fairly good rate of viability, but a 50/50 chance of a decent quality of life. With boys, that chance was even lower. At 25 weeks, the success rate of viability was about 85% with minimal long-term complications (like ADHD or dyslexia, etc.). We were encouraged to make a decision about care for our baby before birth. We decided we would choose Hospice or comfort care for a baby born before 25 weeks, though we had the option to retract that decision if the baby was beating the odds. We prayed against the odds that we would have a successful bedrest and that our baby would remain in utero until he was safe. We also prayed that we wouldn't have to make the decision whether our baby would live or die.

After the doctor left, I really had to go to the bathroom. I had been on a liquid diet through the night, and had the urge to have diarrhea. The nurse helped me to the toilet, but as I heard amniotic fluid trickling into the toilet, I couldn't bring myself to let anything come out -- including a BM. I was so afraid it would be a baby coming out. I stood to return to bed and as the nurse was attempting to empty my cath bag, I felt lots of low pressure. I think it was then that baby moved down.

I returned to the bed, had a friend in to visit and was served lunch. We joked about how I would be there for weeks and never be able to go to the bathroom. Then we talked in seriousness about using the bedpan and even resorting to enemas, if necessary. My doctor came in to round and I talked to him about the same thing. He advised me to do what I needed to do -- he preferred the bedpan, but allowed me to the toilet if I had to use it.

At about 2:30, both James and my friend left me to beat school busses home. The plan was that James would go home, meet Matthew, clean up and then bring more things to me within about an hour and a half. After my company left, I tried to use the bedpan, but could not get past the idea of pooping in my bed. The nurse came to help me to the toilet again. As she was attending to me, she noticed a great deal of bloody show. She checked my cervix to be sure nothing new was happening, and determined my cervix was still at 2cm dialated. In the bathroom, I was able to have a BM with no abdominal pressure. However, when I returned to the bed, I had lots of pressure when sitting and was leaving blood everwhere.

The nurse helped me get into the bed and as I shifted one leg in, she noticed something and quickly jumped up to pull the Code Blue button. Within literally ten seconds there were ten people in my room. The cord had prolapsed and was hanging out of my vagina. My doctor was there in an instant, I was back in Trendelenburg, and I think an entire hand was inside of me attempting to push that cord back into the uterus. They were running around prepping for birth, but I asked if we could wait until James got back. The doctor hesitated, but then said this would be where they would be rushing me out for an emergency C-section, but since there was no hope that our little boy would survive, we could wait until he returned. This was at 3:00 PM. I couldn't remember anyone's telephone number at this time of craziness and crisis, but fortunately both James and Mom called me at that precise moment and I was able to have them come back. The doctor had them wait to even move me to Labor and Delivery until James arrived. He ordered an epidural for me to be administered right away. By this time, I was beginning to feel regular contraction and the pain of my cervix pulling through my cerclage.

James and Bub arrived at the hospital about 3:40, with Mom right behind them. They took the time to explain briefly to James what happened, and I relayed what I wanted done with Bub to Mom as she waited for another friend to arrive to pick him up. At that time we wanted the children kept nearby because we anticipated a very quick delivery and thought it would be a good idea for them to see the baby. I was transferred to Labor and Delivery, and by the time I was there, contractions were stronger and more painful and I was groaning and crying with the regular pain and tearing. Things were moving so fast.

The nurses got me situated and the anesthesiologist arrived to administer the epidural. He inserted it in one location -- pushing the catheter up into my spine -- and I had enormous pain in my left hip, so he took it out to start all over again. I still have a bruise at that site seven days later. He aadministered another epidural and within moments, my physical body was no longer in pain, but I was even more brokenhearted. I shouldn't be doing this -- not for many more weeks. I was terrified. I had given birth before to Gracie at 36 weeks, and I remember feeling unsure about the experience, but never terrified. Excited, but nothing like this. At that moment, there was nothing more that I wanted more than holding that little baby in. Because of all the nerves and stress and the liquid diet that I had been on for a couple of days, along with the epidural causing me to lose the muscle tone in my lower half, my bowels began to let go. I had the forethought to tell the nurse what I thought was coming, so we were able to place bedpan after bedpan to catch what was coming. For a normally very private person, this humiliation magnified an already horrible day.

Once the epidural had fully taken effect the doctor returned with his retractors to remove the cerclage. He discovered that the cerclage had remained fully intact when we thought it had broken, and that thought I was dialated to nearly a two with it in place, the dialation was strictly from the tearing of my cervix. He told us then that there was no pulse remaining in the cord and that our son would be born still for sure. I was dialated to a three. Cytotek was insterted at 5:20 to promote continued dilation and to bring on stronger contractions, and we were left alone to wait and weep.

It was in the delivery room that we had to choose a name for our son. We had joked about that for the two weeks that was what were going to have to do. We had been told about six weeks earlier that our baby was a girl for sure, so we had chosen a name, painted the room, purchased clothes, and told all of our friends. Two weeks later, my perinatologist advised us that our "daughter" had a penis -- we were having a son. It was an odd transition. We had been nearly 9 weeks pregnant with what we thought was a girl, and had lost the baby 35 days before my last menstrual period with this pregnancy. Knowing that we were having a girl was in some ways like getting a second chance. When there was a little penis present after all, it was immediately like losing the other baby (Ainsley) all over again.

That sense of disappointment in the change was very short lived -- we were so excited to be having a son. James was especially proud. He was the first and maybe only one in his generation to have a biological son. He was responsible for carrying on his family name. As we packed away the girl clothes we had purchased and prepared and begin washing and hanging little blue sleepers and overalls with ducks and trucks on them, we were both so ready for the end of summer when our baby would be here.

James had the laptop running, as we had just sent an update to our family and friends of our situation. There had been phone calls for two days about the events unfolding, but information was incorrect in some loops and imcomplete in others. We wanted everyone to know for sure what was happening and how they could pray for us in the time of our most desparate pain. With the laptop open, we began searching fervently for a name. We had thought we had at least 14 more weeks, but we knew now we were lucky if we had four more hours. Having a name before he left my body was the most important thing at the time. We used the search engine at www.babycenter.com and searched by meaning. My first meaning choice was "bitterness," but I immediately knew that was not my heart towards my son or my God, so any name with that meaning would not be appropriate. We decided to choose a name whose meaning would bring honor to God, and after searching through all the letters, the name Zachary was absolutely perfect and right. Zachary means "Remembered by God."

For me, this name had such significance because this baby is so important to us. We have dedicated our lives and our finances and nearly all the reserve strength we had to growing our family. We had such hope for Zachary -- as a son, as a brother, as a precious addition to our family. We celebrated every roll, every bump, every kick. Morning sickness excited us. I outgrew clothes with pride. We dreamed of our days with our baby and waited happily for the days that we could "complain" of how sleepless our nights were. I literally dreamed of clutching my newly born child to my breast and singing God's praises even before the birth process was complete. Losing our little one at this time or ever was our absolute worst fear come true. We knew as his life ended that people would rally around us, but the day would come that the busyness of their lives would overtake them. We knew that the flowers and the cards and the phone calls would stop coming. We knew people would forget, but God would not forget. He would not forget how we had prayed for this child. He would not forget how we longed for him. He would not forget all that we had done to ensure his safe arrival. God would not forget the bitter tears we wept, or how we relied on Him for even the strength and will to breathe when we didn't know how we could even survive the pain.

With a name decided upon, we had friends and family in the room. We made small talk and had American Idol on in the background. We pretended we were interested in anything else other than the overwhelming knowledge that the son of my womb had died and that we would never know his voice, hear his laugh, watch him sleep, teach him to walk, or help him pray. A little after 7:00 and another coughing fit, the cord prolapsed further. At 9:20, I was due to have another placement of Cytotek and the nurse said she would check me then. I was worried I wouldn't last that long. I could feel baby parts moving down and out. About 8:30, our friend Richard arrived with some food for James who had eaten very little in two days. We visited until around 9:00 when my nurse and her trainee returned to check me and insert more Cytotek.

The trainee was first to check me. She felt around with a puzzled look on her face and relayed in the most business like fashion that all she could feel was cord and feet -- no cervix. My heart broke further and my fear level rose. She rechecked me and felt around and around. She said she could also feel only cord and feet, no cervix, but that sort of progression was way too fast, so she would note that I was dialated to a five or six in the Nurse's Report. She said if I wanted to go ahead and push, the baby would probably come on out. I told her there was no way I was going to do that. My husband wasn't in the room, my doctor wasn't in the building, and there was no way I was going to do this without them -- that the last thing I wanted was to end up in some sort of crisis situation with nothing but a nurse and a trainee in the room. Zachary was coming out breech, and I could foresee the head getting stuck. She said she'd go then to call the doctor, and my family and friends were invited back into the room.

Back to the small talk until I coughed about five minutes later and felt something else come out. I asked my company to leave the room again and had the nurse come back. She lifted the sheet and said she saw a foot. She asked me again to push, and I again refused. She said we didn't need the doctor there to deliver, that he could just follow up. I reminded her I was paying his bill and he would be there. There was still the risk of Zachary's little head getting stuck, and the risk of me needing a D&C after delivery, or worse -- the risk of me hemmoraging and moving to a very dangerous place very quickly as I had done with the loss just six months before. I then discovered she had not yet called the doctor as she said she would. She left the room to have him come back to the hospital.

James was brought back into the room and the nurses began to prepare for the delivery. As contractions were coming faster and harder, they rechecked my vitals and removed my catheter. I gripped the bedrails and breathed through the pain and fear and prayed that my doctor would get there quickly. I was positioned with my legs folded open so Zachary's body could move slowly through the birth canal as we waited -- so his little arms and body parts wouldn't be harmed by me tightly holding him in.

The doctor arrived about 10:05 PM, took a peek, and began to suit up. I thought back to when Gracie was born. Dr. Harman took his time then thinking this new mommy would take a long time to push and he had just gotten his gloves on when she flew out of me. He caught her by an arm and a leg, and I don't think his surgical gown had ever even been tied. How many times we have laughed over these five years about the sight of him fumbling to catch her. What a sweet and joyful memory. Now here we were again -- my body expelling a baby and a doctor lingering at the dressing table. One glove was on, Zachary was moving down, and all I could do was shout, "Hurry!" His glove popped, my legs were settled in the stirrups, and I was told to push. I couldn't do it. In that split second I thought it may have been much nicer to have let them do a C-Section on me, but then I remembered how I had prayed that if my child should die, to let him die after 20 weeks so I would have the privilege of delivering his body. This delivery was a gift to me. When I realized that, I found the resolve to give birth to our Zachary James. With one half-hearted push and one with determination, his sweet little body left mine.

As the doctor lifted him away from me, I thought I saw his arm move. I asked if he had moved, and the doctor said, "No honey, he's already gone." The umbilical cord was cut and he was carried over to the warming table. James stood at the end of the bed crying not knowing what to do until I asked if he could see the baby. Of course he was allowed to, but we were new to this situation and we were in shock. The baby's nurse was buzzing about her normal duties when James asked why the baby's chest was moving. The nurse said it wasn't, but James insisted it was. My immediate thought was, "Oh God, save my baby," even though I knew nothing could or would be done with him at only 22 weeks. The doctor had just finished attending to me and left me there to confirm that our Zachary's heart was indeed still beating. I asked if I could have him before they washed him or did anything to him -- I wanted those moments of life. The nurse hesistated until the doctor said, "Give that baby to his mama." Then the doctor ducked his head and left the room.

We held our sticky little baby and kissed him and touched that beating little baby heartbeat until it stopped at 12:12 AM. We then allowed the nurse to clean him and dress him to protect his paper thin skin from our hands and from the touches of our loved ones who came to mourn with us. It was amazing how quickly he became cold and the skin on his little hands began to blister after his heart stopped beating. Watching that rapid degeneration made us decide to not have our children return the following morning to say their goodbyes. They are both still so young that we were concerned that what they would see with their eyes would scare them, and we opted to share some lovely photos we had taken instead. Our friends and family left, and we kept Zachary with us until 2:30 AM when the nurses became insistent on my post partum care and the physical pain was just too much to avoid the pain pill and stay awake any longer. We had them take him away.

The following morning we thought we wouldn't see him. We had a lovely, beautiful picture of what he looked like and felt like. We were concerned of losing that sweet image in our minds if he had indeed deteriorated further. After we made arrangements that morning with a local funeral home to have his little body cremated, the nurse mentioned he had been kept in a room nearby. James asked how he looked and we were told he really looked pretty good. We decided to have him brought back to us, and I'm so grateful that we did. That next morning provided more of a sense of closure than the night before ever had. After having given birth and then sleeping, it was all too easy to convince myself that it had just been all just been a bad dream. To have my dead baby back in my arms jolted me back to reality and forced me to begin to truly grieve the loss of what I had had and what never would be.

My doctor came that morning at 9:00 AM to check me and release me, but I refused to leave until I had the opportunity to complete the birth certificate information and until we were able to physically hand our child's body over to the director of the funeral home. (We didn't specifically demand the director -- that's just who was on his way.) In this storm of chaos, we wanted some degree of control. We were allowed to do what we needed, and were respected in our efforts.

As for where I am now, I am struggling. I find such hope and peace in God's Word and have a confident trust in the knowledge that He has a plan for me and had a plan for Zachary, and that this entire situation was not a surprise to God. He knew long before Zachary was ever considered or conceived that this would be the course of his life, and the manner of his death. I believe that God will provide me with the strength and comfort to survive this unimaginable pain. I have hope that God will restore me Himself -- that He will knit back together the broken pieces of my hurting heart.

But I struggle because I don't understand how this could ever be good or be turned to good. I don't understand why it seems like we always have to be the example or the family from which lessons are learned. I struggle because the desire of the heart of our entire family is to grow and have more babies, and I don't know how God intends this to come to be. I really, really wish I had my baby back, but more than that, I wish I had a sense of being settled in the way things were and not consumed by this heartache.

3 comments:

  • Amy

    I am honored that I was with you that night, and I am honored that you opened the window to your soul in this entry and I got to look in. You are a treasure.

    Zachary is indeed Remembered By God, and he will always be remembered by me.

  • Anonymous

    Thank you for posting your experience. It is very much like mine. I delivered my little one at 20 weeks after his chord prolapsed.

    Without God, I don't know how poeple get through this...

  • Renae

    I read this last night, but with tears in my eyes I couldn't think to type. I'm sure this still hurts, but I pray God's peace will fill your heart as you think of Emmanuel- God with us.

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