Six Minutes

Even though we just met, I know that look on your face.  I know it all too well.

I know what lies behind that expression: a desperate struggle between a wild, unsubstantiated hope and raw, unhindered fear.  Let  me tell you, a hundred years could pass, and you still couldn’t be ready for what’s going to happen.  I know, it’s not something you want to hear yet–but it’s something for which I must prepare you, because it’s going to happen soon.

I know how hard it is for you to even consider the likely outcome of this situation, so I’ll give you a bit of padding from this unpleasant reality for now.  After all, it’s the baby that wasn’t even supposed to be possible–and not to mention, it’s the holidays.  And I know that in order to keep yourself together, to some extent, you need that mental distance between your head and the facts, at least for now.

I know what your boyfriend is trying to do.  I know he’s trying his best to prevent this.  Most men like to fix things, not talk about them, and that’s his mode at present.  But this is one problem that neither of you made, nor can you fix.  He talks about telling your child one day about how hard you had to fight to keep him or her alive, and I struggle to keep my expression neutral, knowing that he speaks of a scenario that is never to be.

Nonviable.  It’s one of the harshest words I know.  And at this point, it’s a waiting game of the worst kind: will the contractions pick up again, in spite of the magnesium?  Will your already thin and dilated cervix dilate more?  Will baby come tonight?  I’m your nurse, and quietly, despite your talk of being here for another six weeks, I know, but I won’t say it.  Not yet.

Those contractions are looking meaner in these early hours.  I strap the toco to you and gel up the fetal heart monitor as you talk about the magnesium–when does the bag get changed?  Will the new bag work better?  I know you don’t want to hear the mag isn’t working anymore–your body is losing the battle to keep this baby inside.  A weak cervix and angry uterus are going to end this little life before it begins.  But I tell you anyway, gently, because you need to know.  You need to be somewhat prepared for what is going to happen, because as far as I can tell, it’s probably going to happen soon.

Oh, that’s a beautiful sound–the happy heartbeat of an 18-weeker.  He or she is moving, that’s for sure–that was a direct punch to the monitor!  A thumping rhythm in the 140’s–steady, strong, perfect.  It’s a good moment in the span of our time together, and I let you relish fifteen minutes of listening to that sweet sound for the joy of seeing your face light up and for fear that it’ll be the last time you hear it.

Magnesium is nasty, I know.  It makes you feel like crap, but you’re one of those wonderful women who would walk on nails to save her baby.  And you’re taking this drug like a champ.  So we’ll do the dance between morphine, Zofran and mag, hoping that the first two drugs will temper the effects of the latter and that between the mag and the morphine, you’ll somehow get some sleep tonight.

But sleep is not to come.  The contractions pick up and you notice you’re bleeding–bloody show, a sign your cervix is dilating even more.  As I draw up another dose of morphine, I know the bitter tears in your eyes as you try to accept what’s going to happen.  And believe me when I tell you that they will sting more than any tears you’ll ever cry again, but they’re tears that must be cried if you ever want to stop crying.

The morphine isn’t touching the pain this time.  I was afraid of that.  I stop the magnesium, pull off your IV lines and BP cuff, disconnect your SCDs and remove the monitors.  I check your cervix only to find out you’re dilated to 7 and fully effaced.  The truth is unavoidable at this point: the jig is nearly up.  I have gloves in your room, the charge nurse on standby, and the doctor in house.  We’re ready.  You look up at me and ask how much it will hurt.  We discuss your pain, what to expect in terms of baby, and what you want done with baby when he or she gets here.  They’re questions you’re not prepared to answer and never will be, but not to worry–I’ll guide you through this.

It’s time.  You’re about to come off the bed as I pull on sterile gloves and place a finger just inside your labia, feeling the strange squish of an unruptured bag of water.  Seconds later, I guide the bag out slowly, making sure the birth is controlled and atraumatic.  The charge nurse and I work quickly through the layers of the slippery bag, and in a matter of seconds that feels like years, another nurse hands us the scissors.  One, two, three, four layers later, the water breaks and the amniotic fluid parts to reveal your 18-week-old baby.

I scoop her fragile form up in a blanket and the charge nurse grabs a stethoscope, listening to that tiny chest.  The third nurse cuts and clamps the cord.  It’s a girl, we tell you, wrapping her up and placing her in your arms.

Baby is hanging on, but she won’t be for long.  The doctor arrives and the charge nurse tells him about the birth quietly.  I watch your daughter, just as awed as you are, as her tiny hand finds yours and grasps one of your fingers with five of hers.  The charge nurse steps in several times to listen for her fading heartbeat.  Finally, six minutes later, she tells us the inevitable: baby is gone.

Those bitter tears are back as we quietly go about our duties, ensuring you’re recovering as well as possible from the birth.  Your boyfriend, who has been distant, comes near for a look at baby, and together, you begin to marvel at her perfect little body, her unopened eyes, her tiny lips and nose and fingers.  Will we ever know her eye color, you ask?  No, I reply, her little eyes are still fused shut.  But chances are, she could hear your voice and she could feel your touch for the six minutes she spent with you on earth.

About an hour and a half later, I take baby and make footprints, handprints, foot impressions, and fill out keepsake a birth certificate and crib card.  A tiny knit hat and cloth diaper are hers to wear and keep.  I bundle her up and bring her back to you.  You take her as warmly and gladly as any mother accepting her child, and for the rest of the night, she, as in the first 18 weeks of her life, will have no other cradle.

It’s morning and I have to go.  I know how hard the next year will be, and when I stop in to say goodbye, we talk about it.  While it will be a long road ahead, in talking with you, I sense that you are well-equipped to navigate the process of mourning and loss.  I encourage you to let yourself grieve, be aware of the anger that will occasionally engulf you, and be ready for the mood swings that will come out of nowhere over the next 12 months.  It will get better, I promise, and though it will be difficult, you and you alone will remember the best parts of this child: her life within you, her kicks, her movement, the changes of your pregnancy.  She is uniquely yours to love and to remember, and no one can take that from you.

After we have parted, I think about the night we spent together and everything I had told you.  I know so much–more than I wish I did.  And yet, there is one very simple question that even I cannot answer.

Why?

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2 thoughts on “Six Minutes

  1. I am a new grad PP RN with aspirations toward L&D. I delivered my first pregnancy, twins, at 23 weeks, and had PTL with both subsequent pregnancies at 28 weeks, all three with the heinous mag sulfate. I can’t thank you enough for being there for “them” (though I know it’s more than one patient). It shaped my entire life and I’d never have thought of being an L&D nurse before that experience. (((hugs)))

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    1. Thank you for your comment and for sharing a bit of your experience. There are times when having personal experience with loss and/or some of the complications that can accompany pregnancy can make it hard to work in the field and with women who are experiencing the same things. However, I’ve always found that in the long run, while those shifts are far from easy, my own experience has enabled me to better relate and provide an almost intuitive care for the women and families I guide through those times of loss, grief, and anxiety. All the best as you continue in PP and work toward L&D! You sound like you’ll make an awesome nurse, wherever you end up!

      ~Sophie
      (CWAS)

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