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PAILS of Hope

One More Try: Pregnancy After Multiple Losses
by Maribeth Doerr, Cubby Moderator
At the tender of 19, I experienced my first loss. My son, Andrew, was stillborn due to complications of placenta previa, premature rupture of the membranes and chorioamnionitis which nearly took my own life. I heard all of the usual platitudes like, "you're young, you can always have more children." I just wanted my Andrew!

After struggling with some infertility, I finally conceived and three and a halt years after losing Andrew, i delivered a 9 lb. 13 oz boy, Mark Adam, nine days overdue. My world shattered again as he was born with severe asphyxia and died 5 1/2 days later. My subsequent pregnancy had failed. Sadly, I experienced two confirmed miscarriages (and a few D&Cs where I asked the hospital not to tell me it I was pregnant thinking that what I didn't know wouldn't hurt me. It was the logic of a bereaved parent). I was told that my chances for carrying a baby full term were very slim. The chorioamnionitis with Andrew, the emergency cesarean with Mark and the D&Cs had taken a tremendous toll on my reproductive organs, not to mention my mental health.

I felt like a failure. My self-esteem was virtually non-existent. I decided I needed to chart a new course for myself and with lots of determination, I began a new life. I married a second time to a wonderful man whom I knew I could lead a happy life with even if we couldn't have children. We decided to give it one try thinking that perhaps with time, my body would have healed somewhat. We prayed the doctors were wrong.

When I conceived, I was thrilled and terrified at the same time. Since it had been nearly four years since Mark had died and three years after my last miscarriage, my family was excited. With this child being my husband's first and the first grandchild for his family, they had the attitude of every newly expectant family - no fear, everything will be fine. Unlike my previous pregnancies, the morning sickness was manageable. It was easy, without the constant vomiting, to ignore the pregnancy. I didn't show until nearly 20 weeks so no one really knew for quite some time. Mentally, I was pregnant while at the doctor's office but nowhere else. Underneath this calm exterior was a frightened ninny. Luckily, my doctor was able to see through the charade and made himself and his staff available to me whenever needed. I was told by his nurse that I could come in any time to listen to the baby's heartbeat. They truly understood my fear and rather than pooh-pooh my feelings, they tried to work with them as much as possible.

At 20 weeks, I had an ultrasound to verify gestational age, check placental placement and look at the cord as much as is possible with an ultrasound. This was to alleviate fears about my prior disasters. Up until this point, I had had a relatively uncomplicated pregnancy (imagine that!). The tech said the placenta looked low but thought it was from having such a full bladder which was pressing on the placenta making it look lower than it was. I went to the bathroom, and she rechecked. The placenta was still low, a partial previa. The tech tried to quickly reassure me that 50% of women having ultrasounds at 20 weeks have a low-lying placenta and that 95% of those placentas rnigrate upward in the next ten weeks. This meant nothing to me; I had already lost one child from complications of placenta previa. My seemingly "routine" pregnancy went out the window.

Due to my history, I was immediately placed on restricted activity/modified bedrest and no sexual activity. We lived in a small condo so household duties were minimal anyway. My husband had his own business so he would leave early in the morning and be back mid-afternoon - about the time I would feel claustrophobic. He took over the housework and cooking and generally spoiled me rotten. He made healthy meals, and I have to credit him with my moderate weight gain of 22 pounds at the time of delivery at 37 weeks (and the baby weighed a healthy 7 lbs, 5 oz.) It was important to eat as healthy as possible since placenta previa babies tend to be a little small for gestational age - unlike my baby! Since I hadn't experienced any bleeding episodes, I started to wonder if the placenta really had migrated upward. I had bled heavily for weeks before Andrew's death. Could it be possible that this baby would make it? What if I did go to term and another cord accident happened - or something else? Could I handle it yet again?

At 30 weeks, the ultrasound was repeated. Sure enough, the placenta had migrated - but DOWNWARD instead of upward. It was nearly a complete previa with another ten weeks to term. My bedrest was more restricted vvith no driving or unnecessary walking. I was to try and avoid being in positions that would increase the pressure on the placenta that covered my entire cervix. I was educated on the signs of pre-term labor and an emergency plan in case of hemorrhage was devised. Throughout these calm preparations, my fear intensified. I simply couldn't see myself with a baby. I couldn't think past the delivery room. We didn't prepare anything for the baby other than picking out names.

When my doctor felt the baby was big enough, we scheduled a cesarean. I had very mixed emotions about having an amniocentesis to check lung maturity since I had lost my first baby hours after an amnio. Rationally, I knew that the amnio didn't necessarily cause his death as I had so many other complications, but it was a risk I didn't want to take. I understood that just because my baby seemed to be a good size for a 37-weeker didn't mean his lungs were fully mature. However, the bigger the baby grew, the more pressure was placed on my vulnerable placenta risking dangerous hemorrhaging. After weighing the risks, my doctor felt the baby was safer outside than in (and I agreed!) so the section vwas scheduled without the amnio. I had had an emergency cesarean with my second delivery and had a vertical incision so because of my history and with a transverse baby and placenta previa, a cesarean was the only alternative.

The big day finally arrived. It felt odd going to the hospital without being in labor. It was almost like we were going to Sears to pick up a catalog order. I remained fairly calm until I had the spinal and hyperventilated when I realized I couldn't move my legs. I made a fool out of myself but the anesthesiologist gently explained to me that if I didn't calm down, my husband wouldn't be allowed in and they'd put me to sleep. He gave me some oxygen which helped tremendously as I consciously took deep slow breaths. The nurse asked me about my other babies since it was obvious from my scar that I'd had a previous section. I explained what happened with Mark's delivery, and she kindly monitored the baby's heartbeat right up until they started the surgery. (Mark's heart stopped while they were prepping me for a section after 12 hours of labor. He suffered severed asphyxia probably from cord compression and died at 5 1/2 days.) She gave my husband a copy of the heart monitor tape taken just minutes before the baby's birth, and it's a prized keepsake!

Eric Robert Doerr was born wrth a lusty cry at 1:00 p.m. on June 17, 1987. He was difficult to deliver because he was transverse; his shoulders came out first. I felt like I was on another planet as I watched the NICU staff tend to his needs (standard procedure during a cesarean birth). Could this crying wiggling baby really belong to me?

My husband joined me in recovery after taking Eric to the nursery. He told me about the excitement in the waiting room when our relatives and friends saw Greg and Eric in the nursery. Because I was the only one in recovery (and somewhat of a celebrity as the lady who finally had a healthy baby after 8 1/2 years and 4 losses), the nurse said she'd call the nursery and ask if they'd bring Eric to me since I hadn't gotten to see him yet. They all knew my history and how very special this baby was. As Greg and I glovved, we heard the nurse on the phone say, "is someone coming down to tell the parents?" My heart skipped a beat before beating frantically, and Greg's face went white. The nurse came over and looked quite distressed. She explained that Eric was having trouble breathing - more than is considered normal after a cesarean birth - and his color wasn't good. He had been taken to the Neonatal Intensive Care Unft (NICU) for observation. I was devastated. We had had five minutes in the recovery room to gloat over our success and once again, another baby was in trouble.

Since Eric had been born without the benefit of labor and had difficulty coming out from being transverse, he had aspirated a large amount of amniotic fluid and meconium. We have no idea what caused the passage of his meconium. With each minute, his breathing was more labored, his heartrate faster, and his color bluer.

After getting settled into my room, I experienced an anger that was incredible. After so many losses, after watching one of those babies die in the NICU, after a difficult pregnancy, another baby was struggling to live. As much as a part of me expected it, a larger part couldn't believe it was happening yet again. Wasn't it my turn to have a healthy baby? I decided right then that there would be no more pregnancies. I would not put myself through this pain again.

I saw Eric in the NICU about six hours later. He was in an incubator with tubes and wires everywhere. You could tell how hard it was for him to breathe. I asked to leave five minutes later. The oxygen hood covering his head looked too small. I imagine that such equipment is normally used on preemies. I was so nauseated. The sight was too familiar - the smell, the temperature, the lights, the gown I had to put on and the benedine I had to wash my hands with before I could go in. It was as if the horror of Mark's birth and death in the NICU had just happened yesterday rather than 4 1/2 years earlier. It was too much for my fragile emotions. I jusi couldn't allow myself to bond with another baby who was struggling to live.

The first night I was awakened several times with progress reports and frightening news. I had to sign consent forms for invasive procedures to my son's little body. Finally, after 24 hours, they said he was improving and would probably be just fine. I didn't see Eric for 44 hours after that first visit. I still just couldn't believe I'd bring him home. The neonatologist came to my room and bluntly said that Eric NEEDED his mother. They had put a sign on his incubator that said "minimal handling only - keep lights low, voices soft and touch only when necessary." It seemed that he screamed at the slightest stimulation.

A few hours after this lecture, I made my way to intensive care. Eric was sleeping in his incubator with the oxygen hood over his head, his breathing still labored. The nurse said I could hold him, and my first reaction was to run. Since running was out of the question after just having surgery, I plopped into the rocker where she placed a beautiful sleeping baby in my arms. Greg kept the oxygen hose close to Eric's nose and he just slept in my arms. Where was that neurologically immature baby who screamed at the slightest stimulation? The nurses were whispering and smiling. They had assumed Eric was going to scream when they moved him, but he didn't. He continued to sleep. Greg and I stared at him and decided he didn't look like an "Eric." We had named him after Eric Clapton so I guess I thought we'd have a "mini-Clapton" but he just looked like a slightly jaundiced sleeping baby with tubes and wires stuck in his body. After what seemed like a precious few minutes, the nurse felt he needed to be back in his temporary home." After the equipment was adjusted, I got up to leave. Eric finally opened his eyes and looked at me - really stared at me - then blinked and nestled down for more sleep. The nurse said she was sure he knew I was his mother.

At my next visit, the "minimal handling only" sign was gone from Eric's incubator. The nurse said he had calmed down so much after I held him that he wasn't as hyper-reactive to their handling. I couldn't believe it! They had just begun oral feedings and the nurse helped me attempt breastfeeding - and Eric and I started getting acquainted.

It was very difficult to go home without him. Once again, a long heartbreaking ride home without a baby! But Eric did come home - a healthy, still high-strung, but precious baby. I'll always remember our first night home. When I got up at midnight for a feeding, we nestled down on the couch with just the light of the aquarium to guide us. As I looked down at him, his beautiful turquoise colored eyes were staring at me very intently as it to memorize my face. As I gazed back, I swear I saw a bit of a smile. We had done it!! We had a baby in our home to make our lives sweeter.

At my six week check-up, Greg and Eric came with me. Greg sat with his new son in the waiting room during my examination. After being thoroughly chastised by my doctor for not bringing them into the room, he ran out to get his latest success story. As the doctor picked Eric up, his eyes sparkled. He showed him off to each of the nurses and secretaries saying that this baby was nearly nine years in the making and very special. Our doctor's joy made us feel even more proud (if that was possible)!

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We've come a long way since Eric's birth. Our bonding was a little delayed but it happened. We survived four plus months of uncontrollable crying due to his neurological immaturity, surgery to remove a tumor from his thigh, the terrible twos (which weren't that terrible), his first day at preschool, a broken leg, still more tantrums, his first day of kindergarten and most recently, the chicken pox. Today he's still considered high-strung (I prefer to use a more positive term such as spirited), but we've learned to accept that it is an important and special part of his personality. It makes him very aware of his surroundings, bright and curious. His latest concern is why aren't toothbrushes called teethbrushes since you brush teeth not tooths.

Eric is quite a joy to everyone who knows him along with his little brother, Chad, (whose pregnancy and birth is quite another story!). I'm forever grateful that Greg and I took that plunge for one last try (and ultimately another try). It was a long hard road but worth every bit of the anguish. I've been truly blessed!

Copyright March 1993 by Maribeth Doerr

PS (April 2001) . . . Eric is now (gasp!) 13 years old, and he's still "spirited," bright and curious . . . and stubborn. It's hard to imagine that he is 13 already, because the years have flown by so fast. It's been a joy to watch him grow and now mature. He's taller than I am now, his voice cracks frequently, never gets full even though he eats constantly, is an honor roll student, was a starter on the 8th grade basketball team this year, and no one makes me laugh the way Eric does. I'll never forget his early beginnings because it makes me cherish him even when his stubborn teenage-ness makes me crazy. But it certainly is nice to have these "normal" parenting challenges!

Maribeth

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