Sweet Heloise; Pretty in pink.
Hope. Heloise's entire life was one of hope. At the beginning of our pregnancy, a friend send us a frame for an ultrasound photo. On the frame are written the words "Image of Hope". This is Heloise through and through. We were all so hopeful for her; every doctor, every hospital staff member, every friend and family who knew. Again, a freak accident of nature took another child; another of our children. Heloise was our fifth child - born on her daddy's birthday. Our hope was that she would live a long life. Eventually, we had to adjust our hopes, but we are not ever devoid of hope. Even now.
We entered Heloise's pregnancy fully prepared. In early September 2001, I underwent a unique procedure called, a Trans-vaginal cervico-isthmic cerclage. This is a permanent buried stitch, like the rare and formidable abdominal stitch, but surgically placed via the vagina rather than the abdomen. It loops through the ligaments on either side of the cervix, holding the cervix closed. It is intended to remain permanently in place through several pregnancies. We fell pregnant the following cycle, our due date being 15 July, 2002, with a planned Cesarean section scheduled the end of June. We hoped that with the aid of this cerclage, we would deliver a full-term baby.
All was going extremely well, with only a short episode of bleeding at around 12 weeks, the cause of which went unknown. We carried on, following our protocol of limited activities and rest. I ate well, rested much, and never lifted a finger. Kieron did all the work. We hoped our efforts would make a difference.
To the right is an image from Heloise's 12 week scan.
At our 18 week ultrasound we learned that my cervix was doing something unexpected, something called "beaking". This is when the cervix begins to open at the top. For us the beaking occurred just down to the point of the cerclage, leaving me with 2.5 cm of cervix, still a good length. I went onto complete bedrest as a precaution. Since this cerclage has never before failed, our perinatalogists were very confident, assuring us that it would remain secure. We hoped the cerclage would hold as they said.
We had another ultrasound at 19 weeks and were totally stunned to learn that my cervix had pushed the cerclage down so far that I only had one cm of intact cervix left! Everyone was completely shocked. No one had ever seen this happen before. I was immediately admitted to hospital on complete bedrest with the expectation of remaining for the entire length of my pregnancy. After much deliberation with our perinatalogist and the Professor of Gyn and Obstetrics, we decided to have an emergency abdominal cerclage placed in a valiant attempt to save our baby. I went in for abdominal surgery two days later. We spent those two long days wondering why, why, why a cerclage that has never failed before in over 15 years of use, would fail for us. We had such faith in this technology. Such hope. We had every reason to be. And yet, here we were. Inconceivable doesn't begin to describe our thoughts...........
Above: Heloise, sucking her thumb during her 18 week scan.
The emergency cerclage was successfully placed, although it was quite difficult to do. The risk we faced with the surgery was the rupturing of my membranes, hastening the immediate delivery and death of our baby. But........ doing nothing would also mean delivery and death of our baby. We decided we had to try. My membranes remained intact throughout the surgery. We felt hope. Everyone did.
Two days later, my membranes ruptured on their own. Infection is the usual culprit for ruptured membranes. In our case, my membranes may have been caught between the two stitches, although we can't know for sure. Regardless, they ruptured and it seemed the end was near. We were very angry. Our child was going to die! And we didn't want our child to have to go through labour and delivery only to be labeled a "miscarriage". A baby is not issued a birth certificate unless they are 20 weeks gestation and beyond. Our baby was as much a person as anyone else is considered a person. But we were 19 weeks and 5 days. I asked the doctor on call to please make sure everyone understood our position on this. Please. She assured me, everyone would. I hoped she was right.
That night we asked to see Father John, the hospital priest, hoping he could bless our baby while she was still alive. He came and right away revealed himself to be a unique individual. I told him I was very angry and he asked me where I felt that anger. I put my hand on my chest and said, "Right here. It hurts right here." He was very interested to know more. I told him how angry I was about everything. I even told him about how much I hated Christmas cards. I told him how much it hurts to get cards from people who never even mention our children but go on about how great their year has been, sending these cheery, upbeat messages to us. I used to love Christmas, now I dread it because I know it will be a time when our pain is overlooked by others who want us to be happy (for them). His response: "Fuck em. Burn the cards. Do it!" Father John speaks his mind! I had to laugh, I was so grateful. He told us that what we were doing, right now, talking and sharing, was what he considered true fellowship. He then blessed us as a family.
The following day, both cerclages were removed. Because our rescue cerclage could be the source for infection, our doctors had to perform another abdominal surgery to remove the stitch they had put in just days before. Without any cervical support, delivery and death for our baby seemed inevitable. Our doctor thought about delivering our child during the surgery, but instead followed an instinct that told him to refrain. We hoped we could go on with ruptured membranes.
Following the surgery, I didn't go into labour. We waited the night out. Nothing happened. The next day. Nothing. Days passed. I did not go into labour. With each passing day, our hope would build. I wanted to know, are we more likely to make it because we are 48, 60, 72, 84, 96 hours etc. passed the rupture? Unfortunately, our doctor said no. Leo explained: it is like walking across a lake of ice - just because you get halfway across doesn't mean you will get all the way across. We just have to take it day by day, step by step, and not get caught up in thoughts of the other side. But how can one not think about the other side. We hope our daughter lives...........
We lived in limbo for 3 weeks and 4 days. Bedrest is horrible when one doesn't know from hour to hour what may or may not happen. I filled the time with lots of books and puzzles. Father John visited everyday. Leo visited everyday. I talked on the phone. Kieron and I watched T.V. I tried to sleep at night. I tried to eat my meals but the food was tasteless and horrible. To be presented with unpalatable food when one is trapped is excruciating. Luckily, Kieron brought me nice things to eat. Every day brought us closer to the possibility of making it. But knowing that so much ground still needed to be covered is like a cruel prison sentence. Also, Imogen's anniversary was approaching. Imogen had died the year before on 14th March 2001. Any plans we may have considered in her memory were now not going to happen. To make it beyond this day was my short-term goal. I hoped that our baby would not be born on Imogen's day.
Above: Our friend Catherine came for a visit.
On Imogen's anniversary, towards the end of the day, I began noticing some sensations in my lower abdomen. This activity didn't seem like contractions, but it also didn't seem benign. These could either be the result of an irritable uterus or they could mean labour. As the evening wore on, it became more and more clear that the latter was likely. I'll never forget how Leo's face fell when I told him about the uterine activity. I knew by that look that our chances had just been dashed for Heloise. We had fallen through the ice. I hoped it was not true.
There is no way to describe the feelings we had over this night. One year prior, we had held Imogen as she died. And now another child was going to die on almost the same day. How does one prepare for inevitable death? We both alternated between blank resignation to rushes of tears to bursts of anger. I could still feel Heloise rolling around inside. Lying in my bed, knowing that this perfect child was going to die because there was nothing that anyone could do to save her is a torture beyond any other. I hoped that somehow she knew how hard we had tried.
The next day, the contractions had subsided. We could only hope. I hoped that this meant we could carry on. But, in the early afternoon, I spiked a high fever. Delivery became imminent. I was pumped with antibiotics which brought my fever down, and once a room was free, we were transfered to Labour Ward. Our hope changed from hoping our baby could make it, to hoping that our baby could be born alive so that we could spend some time with her.
Our friend Parveen kept us company while my labour progressed. We listened to soothing music and talked. I remember the afternoon light, low in the sky, shining in through the side window - so reminiscent of Imogen's last day the year before. Thinking back, it all seems so incongruous to be so calm, so resigned, knowing that in only a few short hours, someone very special to us was going to be dead.
Above: Karin and Parveen during labour.
What one needs and what one wants are quite often not the same thing. Once in the final stage of labour, I needed to focus entirely on pushing, which was the antithesis of what I wanted - to keep Heloise inside. How does one push a child out, knowing that by doing so, she would die..........My hope changed again. I hoped that I could follow through with this horrible nightmare with dignity. I hoped that we could have a labour experience that was meaningful. I hoped that Heloise wouldn't suffer pain. I could not cry the tears that my heart was shedding. I hoped that I could one day.
After seering pain and hard pushing, she came out in a swoosh. No hearttones. Dead silence. As still as a stone. Leo handed Kieron the scissors, quietly asking, "Would you like to cut the cord?" Kieron has never had this opportunity - our children before Heloise were wisked away as people worked to save their lives. This time, our child was dead. There was no life to save. For the first time we could leisurely do all the things that most parents do when their child is born, only without newborn sounds, without "congratulations", without fanfair. Nothing. I hoped we could be with our daughter peacefully.
Leo gently placed Heloise on my chest. One of her arms was folded across her body, the other under her chin. She had a sweet smile on her lips. I was so so sad that she had died. We knew she had been alive earlier in the day, but now she was not. She was gone before we had the chance to say goodbye. Another little girl...... so delicate and sweet with a smile on her face. I felt so sorry for her, for us. She died. It was all wrong. It was not her time, yet the failure of our stitch made it so. How can this stitch, this inanimate object, be what decides the fate of our child? I felt overwhelming betrayal. I hoped that she knew our love. Above: Heloise with her smile, shortly after birth.
Shortly after the placenta delivered, I began to have trouble breathing. I just couldn't quite fill my lungs. The doctor on call came in to check me and didn't seem to have much input on this. I didn't feel much confidence in his knowledge. I stayed in bed, wishing that I felt better so I could get up and be with Heloise; to bath her, see her, hold her, walk with her, take her outside. Kieron and Parveen took turns holding her. Both of them were so proud of her. Kieron cuddled his special birthday girl, admiring her pretty face.
My breathing became worse. I started to have a lot of trouble lying on my sides. I just couldn't catch my breath without pain. Something was wrong, I wondered if I was having a panic attack. It seemed that with each breath, I was increasingly less able to breathe. I didn't understand this at the time, but my blood pressure was extremely low. Our doctor, Leo, was called back to the hospital, along with the obstetric physician. Heloise was placed in a cot and set aside while everyone tried to assess my illness. Kieron tried to hold the oxygen over my nose, but it was so closterphobic I kept pushing it away. I wanted to die from the pain of it, but hoped that I didn't.
The obstetric physician quietly explained to me that I had septicaemia, a dangerous and deadly blood infection. The septicaemia had caused my blood vessels to dialate and leak, filling my lungs with fluid. The reason I couldn't breath was because I had pulmonary edema. They planned to take us upstairs to Intensive Care where I was to be placed on a ventilator called: Bipap. A mask was strapped onto my head, pushing oxygen into my lungs, forcing the fluid out. Because my blood vessels were leaking fluid, my blood pressure had plummeted. I was placed on IV antibiotics and an IV gel-like fluid meant to stablize my blood pressure. I could see Kieron talking to Leo in the hallway. I wondered what he was saying. I hoped that Kieron wasn't afraid. I hoped that Heloise wasn't alone and forgotten.
Above: Myself with Heloise, shortly after birth.
The Bipap was very hard to endure. I had to sit in a chair for 3 days straight because I was much too uncomfortable to lay down. I never slept during this time. My body filled up with fluid from the IV, so much so that I could not bend my knees or ankles. It was exhausting and painful and worst of all, I was too tired to be with Heloise. When I did see her, she had changed, disappeared. I felt so cheated of even the simple, comforting gestures we had with Imogen and Soren after they died. We at least got to be with them immediately and clean them up, dress them and wrap them in a cozy rug. Heloise was still bloody from her birth. She had not even had a bath. I felt as though I had abandoned her; she looked so unloved.
Sheila, the social worker, helped us make hand and footprints, and clay imprints. It was important to us both to spend time with Heloise in the ways that we had with Imogen and Søren. I didn't want to miss out on her, just because I was sick.
Above: Myself, Sheila and Heloise, doing her footprints.
Kieron and Sheila set up the bath. Finally Heloise was going to be bathed. A few of the nurses came by to watch and take some photos for us. I was even able to help a little. Kieron bathed Heloise himself, carefully sponging her delicate skin. I love watching him bath our babies, they fit so effortlessly into his gentle hold. He has a relaxed, attentive way about him that I've always loved. He cares for our children so beautifully.
It was a peaceful, quiet afternoon. I hoped that I would be able to remember this time forever.
Above: Kieron bathing Heloise.
Slowly, day by day, I got better. The fluid retention lessened and I was able to walk around more. It seemed the better I felt physically, the worse I felt emotionally. One afternoon, our obstetric physician visited to find me sitting with Heloise, sobbing, struggling through an emotional meltdown. The night before, a new mother had been admitted to Intensive Care. She had her baby in her room with her and the baby cried often. It was so hard to hear that living baby knowing our Heloise would never again live. Our physician reminded me that this mother was ill too and needed to be looked after, just like me. I wondered if this mother knew about us. I hoped she recognized her fortune in having her child alive, with her.
Our physician suggested that I might be ready to go home. This was a dreaded moment. I had been in Hospital for 4 1/2 weeks. During this time, I had had two abdominal surgeries, had gone from having really high hopes, to having these very hopes crushed, to then suffering terrible illness. And now I would have to go home without Heloise, severing our ties, ending this time where I was recognized as Heloise's mum and Kieron was recognized as Heloise's dad. Now it was back home to our apartment where people would avoid us in the halls, scurrying away to hide behind closed doors. No one will mention "what happened", no one will acknowledge Heloise. No one will even ask us her name. I knew this was how it would be because it has been like this for all our babies. It is awful to know so well how hurtful people can be. I hoped that we could endure it. Again. Somehow.
We were still able to go up to the hospital to be with Heloise, but it wasn't the same as having her down the hall from our room. Kieron made several special trips to be with her on his own. With each of our children, we have bought a special story book that Kieron reads out loud to them. Soren was read Winnie the Pooh, Imogen was read The Wind in the Willows, and Heloise was read Peter Rabbits Giant Storybook. As I recovered at home, Kieron spent time with Heloise.
Above: Kieron spending time with Heloise. The hospital had a lovely little pink dress and bonnet for Heloise to wear. These clothes mean so much to us as they are an indication of the respect and care offered to us and our family.
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