I’ve been trying to write Patrick’s birth story for months now, and I keep getting stuck on two words with which I clearly haven’t made peace. I haven’t been able to talk about the specifics of this part of Patrick’s birth with anyone. It’s the one place I hold a tremendous amount of guilt.
I’m a worst-case scenario sort of girl. I like to think about the ramifications of the worst-case scenario in just about any situation. If I can figure out how to cope with the worst-case scenario, I believe that I can deal with anything in-between. It’s a coping strategy that I’ve clung to a good portion of my life.
When we learned of potential problems during Patrick’s ten-week ultrasound, I was anxious that we would lose him, but I really didn’t let myself think about that outcome. I couldn’t fathom the worst-case scenario, because I didn’t think I could survive it. Instead, I thought of every other thing that could go wrong that I could handle. While the possibility of his death always lingered in the back of my brain, I didn’t let myself go there for long. I needed to hold on to hope, so in that moment, I ignored the actual worst-case scenario.
In this particular situation, my worst-case scenarios included small birth weight, congenital heart disease, and a variety of trisomy diagnoses about which the doctors were concerned. Our maternal fetal medicine (MFM) specialist continually warned that one day we may find no heart beat, but I told myself that he was being cautious, and he had to throw out that disclaimer. In addition, Patrick kept giving us reasons to hope. At one point, our MFM told us that he was starting to think that the baby was just giving us attitude, and Lloyd and I laughed and joked that we wouldn’t know where that came from.
When we had our “second bad ultrasound,” I couldn’t take the unknowns anymore, so we had an amniocentesis, which we really hadn’t wanted. But we needed to know with what we were dealing. I needed to know the worst-case scenario so I could start to plan how we’d cope. While waiting for the results, I went several times into the clinic to hear Patrick’s heartbeat, which I always found so reassuring. We expected to hear the results of the amnio at a follow-up appointment on April 1st. The Friday before, I received a phone call from my OB. She had woken up to the results of the amnio in her email inbox and called me immediately, before she even got into the office.
The amnio was perfect. No trisomy. No DNA explanations for the lagging growth and other problems we were seeing. We were thrilled. This news was very reassuring. I had the calmest weekend I’d had in months. I felt Patrick move for the first time. Losing him was pushed to the very back of my mind. That wasn’t our worst-case scenario. At this point, I was convinced we were dealing with a problem with his heart. On April 1st, our first appointment of the day was with the pediatric cardiologist for a fetal echocardiogram. Finally, we’d find out our worst-case scenario, and we’d make a plan.
Unknown to us, the tech couldn’t find a heartbeat. Perhaps we should have found it alarming that she went to get the pediatric cardiologist after only a few minutes, when we’d been told the echo could take several hours. We had warned her that the baby didn’t like to cooperate for ultrasounds, so as she went to get the doctor, we jokingly asked, “He’s not cooperating, is he?” She smiled and said, “No, he’s not.”
The pediatric cardiologist confirmed the tech’s fear, moved the wand off my belly, and said sadly, “I’m afraid there is no heartbeat.” We had our worst-case scenario, and we moved into planning mode. I was admitted to labor and delivery later that day to be induced. My OB had warned that it could take up to 48 hours for the medication to send me into labor. She also warned that the placenta may not deliver, and they may have to do a D&C. In preparation, we loaded the iPad with movies.
I got my first dose of Misoprostol at 8 p.m. and would get a dose every six hours until Patrick was delivered, or when they decided I needed Pitocin, which we were all trying to avoid. I got my second dose at 2 a.m. By 5 a.m. I was having contractions and was very uncomfortable. I pressed the call button for the nurse to see if I could get something for the pain. She recommended that I go ahead and get an epidural. I didn’t want it to wear off before I actually delivered, and she assured me that the pump could continue until delivery, even if we were hours/days away. She gently told me that this wasn’t the time to be in pain, that I should try to be as comfortable as possible.
My mom and Lloyd went to get some breakfast, and the anesthesiologist came and started the epidural. After the epidural, I was finally able to sleep a bit.
Before my night nurse, Ann, left her shift, she sat with me feeling my contractions. She mentioned that the contractions were steady, and I might only need one more dose of the Misoprostol. She turned me over to my day nurse, Alicia, and we waited for the doctors to finish rounds and administer the next dose.
Around 8:45 a.m., my OB came to check on me. She and Alicia were talking, and she found out that I hadn’t received my 8 a.m. dose yet. She said she’d administer it while she was there. She lifted my blankets to insert the medication, and said, “Oh,” which was startling.
I asked, “What?” somewhat alarmed, and she responded, “I think you’ve delivered.”
I’ve read many birth stories of women who have delivered their babies still, and the birth experiences are as varied as the delivery of live babies. The most common thread, though, is a description of the silence of the room after that final push. When you expect to hear a baby’s cry, the silence is deafening. It’s often described as “slipping silently into the world.”
Patrick slipped so silently into the world that I didn’t even know he’d been delivered. The whole situation seems implausible. How could I sleep through my son’s delivery?
My OB remarked that we needed to remember that I labor quickly so we plan for that when I’m back with a full-term baby. Then she described this as the best-case scenario, because delivery was quick and without any complications. My placenta delivered along with Patrick.
I continued to hear Patrick’s delivery described as the best-case scenario throughout the day, as my mom recounted the story to those who called for updates, to my therapist, to the pediatric chaplain, and to the social worker who came to help us decide on final arrangements.
I’ve spent the past 15 months trying to reconcile the words “best-case scenario” with my experience. Patrick’s death was beyond my worst-case scenario; how could any part of it be described as the “best-case scenario”? I don’t fault those who used the description. I know the meaning was an accurate description. I can know that in my brain, but my heart can’t make sense of it. I didn’t need Pitocin. I didn’t need a D&C to retrieve the placenta. I didn’t have an excruciatingly painful and long delivery. He was born early in the day, so we could spend the entire day with him. It truly was the best-case scenario of the worst-case scenario.
I’m still not sure I’ll ever be able to reconcile how Patrick slipped silently into this world. But it is part of his story, and his story deserves to be written in completion. I will likely forever hold guilt that I slept through his delivery, but it is time to own that part of his story. It is time to write his his story before I start losing bits and pieces of the day we spent with him. It’s the least I can do for my sweet boy.