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Wednesday, February 9, 2011

Blame Game

Today I am 18 weeks and 3 days pregnant.  Last year, on April 5, I was also 18 weeks and 3 days pregnant.  Late that night, I felt a sensation like a water balloon popping and a gush of blood. I was sure my water had broken. First thing in the morning, I went to the midwife's office. The baby's heart was beating away, loud and clear.  She gave me a fern test, which tests for amniotic fluid. It came back negative. My big anatomy ultrasound was scheduled for 20 weeks exactly; she decided to move it up a week - three days from then.

Two days later, my water broke for sure. This time it was clear, and I immediately went to the ER.

Five days after that, Caleb was born.

I'd had very minor spotting at the beginning of the pregnancy, but around 15 or 16 weeks it picked up, and there was bleeding to some degree nearly every day.  I learned later that bleeding like that can be a very typical symptom of cervical changes. I also learned later that the fern test isn't accurate when accompanied by blood and the blood can obscure the amniotic fluid, giving a false negative.

I question everything.  I blame myself, but I trusted my caregivers. I thought they would take care of me and my baby.

Why didn't the midwife tell me, after I'd gone in several times for bleeding, that I wasn't a candidate for midwifery care anymore?  Why didn't I get an ultrasound to look for the source of that bleeding? Why didn't she know that the presence of blood could give a false negative on a ferning test? Why didn't she order an ultrasound immediately upon my coming in with the concern that my water had broken?  In retrospect, waiting three days was completely insane. But I trusted her when she said everything was okay.  Why didn't she consult with one of the doctors at that point?  The midwife practice I was seeing was in a hospital, and shared office space, staff, and the L&D area with both the regular OBs and the high-risk doctors. Why didn't I insist on a second opinion??

I'm convinced that my water broke that first time, and that it broke a second time two days later (the bag can reseal, temporarily or permanently, after breaking).

If I'd gotten an ultrasound at 15 weeks when I started bleeding, would they have discovered that my cervix was shortening?  Would I have gotten a cerclage at that point? Would that have saved Caleb?

If she'd used ultrasound to check on my fluid levels instead of using a ferning test, would she have discovered that my water had broken 48 hours before it broke "for real"? Would I have been admitted to the hospital at that point, given antibiotics earlier, gone on bedrest earlier (when they broke "for real", they put me in the hospital for three days with IV antibiotics and saline solution).  Would the bag of waters have resealed and stayed resealed?  Would that have saved Caleb?

We'll never know if different care would have changed the outcome.  Maybe it would have been the same and he would have died no matter what we did.  But maybe he would have had a chance if I'd been more knowledgeable; if she'd have been more aggressive.

I still believe in the standard of care that most midwives provide for low-risk, uncomplicated pregnancies and births.  I do believe that when I started bleeding at 15 weeks, the midwife should have bowed out of my care.  I do believe that when I was sure my water broke at 18 weeks, she should have bowed out of my care.  I don't blame midwives in general.  I'm not even sure I blame her specifically. I should have spoken up. I should have insisted on an ultrasound. I should have asked for a second opinion. I didn't.  At the least, we share blame. At the most, as his mother, the blame falls on me for not protecting him.

The what-ifs in do nothing but frustrate and sadden me, so I try not to think about them too much.

But please. Be an advocate for yourself and your baby. If something doesn't feel right or you don't feel like the care you are receiving is enough, speak up. Your baby's life may depend on it.


  1. ((hugs))
    As someone who lost a baby at 37 weeks after going in for monitoring more than once, I feel the same way. I share blame with the doctors. I should have pushed for an u/s earlier or they should have ordered one.

  2. Yes, always be an advocate! When I went in cuz I thought my water broke, the ferning test was negative. I walked around for two hours, came back, and they were ready to send me home cuz I had no progress. I asked again to be tested, and it was positive. I knew my water was broken!

    Lara, I've been following your blog(s) for sometime, and I'm so happy to see you are pregnant again. I lost my 2 month old son a month ago, and so many women came to mind when he was sick and dying. You were one of them. Your story made my heart so sad, and now that I'm going through a loss, well, it's just a whole new level now. I'm sure I've commented before when you lost sweet Caleb, but I just wanted to say again that I'm so sorry. Much love and best wishes for your current pregnancy!

  3. Oh Lara, I know these next few days are going to be tough on you as you relive last year and remember Caleb's birth.

    I go through those what if's too and they just kill me.

    I know this time, if I feel ANYTHING out of sorts, I'll be going in. I won't wait like last time with Wyatt. I won't.

    Big *hugs*

  4. It's very brave of you to share honestly about Caleb's birth and your regrets. I say that because I struggle so much with my guilt and pain over Liam's birth, the "what ifs", the crazy notion that everyone (family, friends) blame me and think "how stupid she is for not knowing, for not demanding more care, more intervention." I don't really know how to let it go completely and be free of it and just mourn him and love him without the feeling of blame. Somehow, reading other women's birth stories reminds me how similar we all are and how fallible, unfortunately, and how, no matter if we do everything "right" it just doesn't end up that way. I hate it that I'm not alone and I hate hate hate it that other women know exactly, down to the location of a pin prick, of the pain I feel because they've experienced it themselves. Thank you for bringing me comfort today and reminding me that I'm not alone.

    Congratulations on this pregnancy! brings hope for the future...

  5. I've been having a lot of similar thoughts about Oliver tonight. Tomorrow (well, today now) is the anniversary of his birth and death, and it's impossible not to ask how things might have been different. But I want you to know that you did right by Caleb. You were a great mom. I know how impossible it can be when you have complications in a first pregnancy to even know what's happening. All we can do is trust our caregivers. In hindsight it's easy to think what else we might have done, but I'm sure you remember that in the moment you did the best you could for him.

    It's strange to be pregnant again, because at this point I feel like it can't go fast enough. I'm itching daily to hit 24 weeks, and then get bigger and bigger. I can't wait for you to, either.