Hey Jude — Regrets of Those Left Behind

Recently, I spoke to someone who’d lost her brother in a truly tragic way. Our conversation was surprisingly candid giving the sensitive nature of his loss; he took his own life following a struggle with “issues”. Pained, she said that she regretted not doing more…not forcing the issue, not insisting he get lock-and-key treatment, for a moment, I really didn’t know what to say.
My instinct was to comfort her with clichés such as, “Oh, no dear, there’s nothing you could’ve done,” and, “You did your best,” …the kind of stuff I heard after we lost Jude 19 months ago today. Did I do my best? Was there nothing I could’ve done? Are we truly victims of cosmic design? No, we aren’t.

At the same time, I could understand how and why she felt the way she felt. When someone we love passes away in a tragic manner, we inevitably feel some kind of culpability; the question of “what if I had” ever looming in our minds. Certainly, I don’t think there’s anything she could’ve done that would’ve changed anything, but I can understand that there will always be the question of “if I had”….

When my inadequate response to her reflection was, “I can understand how you’d feel that way, but…” she lobbed the question back to me and asked, “Well, don’t you feel that way about Jude?”

I considered the question, and the answer is yes, I do. Even though by all accounts, I did the “best” I could, was it enough? Did it change anything?

A significant aspect of my reconciliation and coping with Jude’s loss has been the conviction that Jude’s loss was an act of God; as a human, I cannot overpower acts of God. And so I cope. I realize, it’s a little more technical than that. Jude was a brilliantly healthy pregnancy. He was active –so active, that Christmas Eve before Christmas Day and then Boxing Day when he left us. We were on the monitor at the hospital when his heart stopped; they weren’t worried…at least not so worried that I wasn’t shuttled to USA Women’s & Children’s to deliver a preemie who would have obstacles but who would be born alive.

A little less than a year ago, I uncovered evidence that supports that possibly low blood pressure among other factors (read, the perfect storm) led to Jude’s passing. Scientifically, I attribute his loss to a nearly undetectable yet possible phenomenon in which the fetus doesn’t receive adequate nutrition and oxygen through the cord and well, you get the idea. I don’t want to think about it.

Anyway, I digress. I do have questions, regrets…things I’d have done differently had I known then what I know now.

–I’d have gone to USA Women’s & Children’s on the way back into town on 12/26, bypassing my doctor’s office visit and the related hospital that is, while fine, doesn’t have the resources of the University’s hospital.

–I’d have slept on my back less frequently. After having had Lillianne and followed all advice to a T, I realized much of the pregnant mommy rhetoric that’s out there is overly-cautious. The occasional back sleeping wouldn’t hurt anyone, but now I’ll always wonder…with my low blood pressure (I’m hypotensive while pregnant) and the occasional back sleeping, which inhibits cord flow…what if…?

–I’d have sat less often. I’d already determined to quit traditional work to work from home and stay with the kids after we had Jude. I was working full-time, taking care of Lillianne during my lunch hour, and then burning the midnight oil to establish enough of an income as a writer and part-time college professor to make the shift. I sat a LOT.

–I’d have gained less weight. As a result of all of the sitting and the total lack of personal time, I also gained more weight, and I was less fit. At best, I walked a few miles early in the pregnancy. After daylight savings, the most I walked was from my car to my office. I wasn’t fat comparatively, but I was 155 lbs by the time we lost Jude at 33 weeks, which was over my delivery weight for Lillianne.

–I’d have gone in on Christmas. I’d have pushed the issue when I was at my in-laws and doing things I never do to get the baby to move…drink a soft drink, eat a sandwich, lay on my side, lay on my other side…look, when you’re scouring the Internet for advice on how to get the baby to move and the baby’s not moving, go directly to the best ER with a NICU. Just…go. I realize that had I done this, chances are, I’d have been sent home and Jude’s heart would’ve quietly stopped without me hearing it. As it is, I did hear it, and I’ll always wonder if I’d have gone sooner to the more advanced hospital…what if….?

I could live in bitter regret for all of these things, but I don’t because I can’t resent what I didn’t know then. Did I really think that Jude was in danger of passing away? Well, not at first, but then when I thought he might have his cord wrapped around his neck, of course I was very scared and moderately comforted by his occasional movements. These were my anxieties when we were already driving back to town, so at that point, I guess it was moot. Also, he’d scared me earlier in the pregnancy, toward the end of the second trimester, when he went almost a day without moving only to start kicking up a storm at about 10:00 p.m. when I started working on some assignments I was anxious to finish.

So, did I do the best I could? Perhaps at the time I did. In hindsight? No, of course not. Jude’s not here; he’s in heaven. The same can be said to the girl who’s brother took his own life. Did she really think that he was on the course he was on or did she perhaps just think that he had some issues but he’d get through it? I’m inclined to think the latter as the response when it did happen nearly five months ago this August 8 was that nobody could’ve expected…or believed…nobody really thought it would happen. Will she always rack her brain for what she could’ve done differently? Probably, but who wouldn’t?

Regret and wishing is a casualty of tragic loss, and for those of us who survive it, we really shouldn’t be so hard on ourselves, even though I know part of us always will be.

 

Dear Jude, 

I’m sometimes so conflicted not only because I’ll always wonder if I’d acted differently if things wouldn’t be different, but also because I’m so thankful to you for giving us Eilie, and as you know, I truly believe I wouldn’t have Eilie if not for you. She’s so happy…a radiant little ball of cuddles and joy. I know you meant for her to make us happy, and she does, but I want you to know that I’d have been so overjoyed to have you here, too. I miss you so much, and I feel bad when I don’t get to write to you as often as I think of you, which is daily. You’re my baby boy…my special boy. I love you, sweet boy. Give our family in heaven a hug for me and keep an eye out for us on Earth.

You’re my shining son.

Love,

Mommy

Hey Jude — Billie Jean

The women of my grandmothers’ generation were iron clad. These women endured under the direst of straits and in the worst of times and emerged 70-plus years later smiling and most likely wondering what we were so upset about with our video games and our Lisa Frank notebooks and our Saturday morning cartoons.

My father’s mother, full German, was raised in Ulm and Berlin during and after WWII. She and her family were not Nazis. In fact, they were sympathizers to war victims and often gave away food and resource to help those without. Tried for treason among other things, her parents suffered substantially during the war. Post-war, well, it’s likely to assume that my Oma’s elementary school days were consumed just being thankful you had food and a roof.

My mother’s mother, full southerner, was born in Tupelo and lived throughout Mississippi, Arkansas, and Tennessee before settling in Mobile. I knew her as Memaw. Her name was Vonnie Lillian Opsal. She had dark, auburn hair and blue-grey eyes, plump cheeks and thin lips, and a figure for days. The plaque over her grave says she was born in 1912, but that’s a lie. She was born in 1915; I have the erased and re-scrawled documentation to prove it. No, she lied about being born in 1912 so she could marry at a scandalously ripe teen age to a guy named Curtis.

I like to envision she and Curtis were young lovers…full of innocence and stupidity, like most sweet first love. They were kids playing house and the reality of adulthood swooped in like a thunder strike. Shortly after marriage, Vonnie got pregnant. She was a married ingénue in the late 1920s, and she was pregnant. Curtis had a job with the railroad. It wasn’t much, but life was good. At least they had real love.

When he left for work in the morning, Vonnie was already in the kitchen, barefoot, swollen with child, her flush belly swaddled tightly with an apron. She and Curtis kissed. She smiled warmly as her dear husband left for work, already anticipating his return, as brides do.

He never returned. Curtis was killed in an accident at the train yard. The news he was dead was more damaging than if she’d been clubbed. The oxygen in her lungs compressed, and she couldn’t breathe. He would never come home. She was dizzy. Never would she hug or hold or kiss him again. Lights flashed. Gone forever; dead. A bright light and then nothing.

Time elapsed like a dirge and, then, it was time. The baby. She was there, at the hospital. Then came the twilight sleep, and when she awoke, “I’m sorry ma’am but your baby was born still.” No, she heard the baby cry, but years later, she swore she did. It was a girl, she was told. She never saw or held her baby girl, who she called Billie Jean, and she never believed –not fully—that the baby had died.

I grew up with a wisp of the story of Billie Jean in my ear, and it was never from my Memaw. This story descended to me through my mother. Memaw was a woman of her generation. You didn’t dwell on these losses. You didn’t let them cripple you. You sucked it up. You had…responsibilities. Except, really, she didn’t. She was on her own, bound by loss, my Memaw, at such a young age. A dead husband and a still baby. I regret that I was never able to ask her and to hear her side of this (likely) defining aspect of her life. My grandmother, Vonnie, was my favorite person, truly. The woman effervesced; she lived, and was she ever inspiring.

Her other two children, mom and Aunt Linda, came nearly 13 years after Billie Jean. Their father was an alcoholic and an abusive husband, and Vonnie went toe to toe with him like it was her job. She worked in a restaurant on Mobile’s Dauphin Street that she later purchased. It was called The Home Kitchen. Yet still later, she remarried a seaman who was often deployed. Unconventionally, not only was she a divorce, but she also never begged or groveled or needed a man. My mom’s stepdad never paid child support, and Memaw never sought it. The woman had scars as deep as gashes, but you’d never have known it. The only indication I ever got was when I was a toddler, and she persistently advised to “never let a man take advantage of you.” She was like a ship, ironclad. Made of steel. She deftly sliced through turbulent waters, and if it compromised her an iota to do so, only God would know it.

Having lost Jude, I realize that being destroyed from the inside-out doesn’t defeat you. It imbues you with resolve, a fervor to thrive and survive. I’ve been reduced to ashes on more than one occasion; though, losing Jude was and is still the most significant trauma of my life. Sometimes I wonder if I fully “get it”, but I can’t worry about if I do or don’t or if I’ll have a nervous breakdown one day. All I can do is polish my armor and be a fighter like our grandmothers were. That which does not kill us makes us stronger. Of course, it does more than that. It defines us. I miss Jude with a passion every day, and lately, I’ve talked about him to many people. I still have my time that I’m cry and when I’m sad, but when I talk about him…I’m just happy. How does such a harrowing loss become a source of joy and strength? I mean it when I say that only God knows and that God is indeed mysterious in his wonderful ways

Aside:

My Memaw was a blessing to me. When I was born in 1983, “Billie Jean” was the number one song in the nation. It’s really more of an irony, but it’s sentimental to think that my departed Aunt Billie Jean was already looking down on me from heaven and that she is holding my Jude and singing in his ear, “Hey Jude….”

 

Jude,

It’s been 17 months since you left me, and you’re still so much a part of me and so real to me. I’m sad that I don’t have new pictures to share of you or to see how you’d look at Eilie’s age. She’ll be four months tomorrow. Four months. Hard to believe. She’s such a happy baby. She smiles all of the time, and boy, I bet you’d have smiled, too. Like a champ. I saw a baby at the park today. He smiled at Eilie. He had brown eyes, too. All I could think was how much he reminded me of you. You’re so loved, darling, and you’re so missed every day. I love you now as much as I loved you the day you were born. I love you forever and for always. You’re always my baby, and you’re always with me. You’re my joy, my baby boy. Keep heaven warm for me.

Love, Mommy

Hey Jude – One Second

For two months, I’ve neglected to post something on Jude’s site. I assure you, it’s not for lack of love or remembrance of my baby boy. I think about him all of the time; Jude Bear still shares our bed at night. In fact last night, I put him between Lillianne and Eilie who were snuggled in our big bed with us and thought that Jude Bear is about the size of my baby boy who would never grow or age another second. The idea of a second is one that I’ve thought of a lot in the past two months of being unable to properly put my feelings into words.

 

It was an unassuming Tuesday when at 7:24 I woke to a missed call from Sean; the call came in at 7:22. He never calls. I thought and pushed to redial.

The story spilled out and I was drawn into what can only literally be described as a living nightmare. Someone close to Sean had taken his own life only a handful of hours before. My nerves pricked, and I repeated, “Oh my God, oh my God,” as if the mantra would somehow reverse the reality and I could wake up for real.

This man, someone I admittedly barely knew, is someone’s son, husband, father, and brother. He was expecting a son. He was so much to so many, and in one moment, one second, his saga on Earth ended.

 

My mind swirled around the circle of grief as I thought of his mother, wife, and sisters. I imagined their pain. His mother, I could somewhat relate to; it’s an inexplicable phenomenon of loss and grief when your baby precedes you in death. There’s nothing that can prepare nor is there anything that can explain how and why you can wake up each morning afterward and step out of bed.

Her loss, I felt, was the more substantial for many reasons because even though I could relate, I couldn’t imagine. After 36 years, you feel like you’re safe. After your baby is born, you feel life your baby is safe. Your baby will do what babies are supposed to do…they’ll live their life, find happiness and fulfillment…their smile will be the last thing you hopefully see before your own life ends one day.

Of course, with Jude I learned that there’s no such thing as a safe time. You’re guaranteed nothing…not after the first trimester…not after the second…not even after that baby is born or can no longer stumble into sharp corners or can no longer choke on grapes…. It’s not a reason to be fearful, but it’s the truth. I’m sure at no point when in 1979 she looked at his gummy baby grin and dark eyes that she envisioned that baby would only have 36 short years to be heard and to be embraced. I’ll admit that even though Jude’s loss was so much less painful, the fact that I don’t have any memories to sustain on makes me feel sad and empty. Respectfully, none of it’s fair.

His wife…I could only imagine. I’ve woken up to a text from Sean almost every day since 2008. He’s the reason I look forward to 5 p.m. I get excited about the weekends because he’s usually here. The idea of not looking forward to those things is painful. More agonizing, I think of my babies asking for daddy…missing daddy…wondering when daddy will get home. Lillianne is almost three. Most mornings, the first words out of her mouth are, “Where’s Daddy?” and I get to say, “He’s at work, but he’ll be home soon.” Of course, then I think of us with Eilie; how many times have I said, “Look! Look!” because she smiled or lifted her head up or was making a cute face? I text Sean dozens of photos almost every day because our kids do something funny or adorable. I would miss sharing those sharable moments with the only person who cared about them as much as I did. So for his wife, my heart continually breaks.

When I thought of his sisters, I thought of my brother…the only person who uniquely shared my lifetime of memories and secrets. He’s the only other person who truly understands what life was like in our house. They were supposed to be able to raise their own children together, support each other through life’s pains and triumphs as they had when they were younger. The sibling bond is special, which is why I hurt so much for Lillianne after we lost Jude. She lost the best friend she never knew she had. Even though Adam (my brother) and I aren’t as close as we used to be nor do we talk as often as we should given our proximity to each other, I wouldn’t be complete without him. I mean, we shared more than a house and parents for the most formative years of our lives….we shared a womb; we share DNA. We’re (in some ways) the same person. If he’s not here, part of me isn’t here, which is how I feel about Jude as well, and it’s why I’m often sad for Lillanne and Eilie.

 

We drove out of state to attend the funeral…showing up felt like the least we could do and at the same time, it was the only thing we could think to do. A friend suggested that we do or say what we wanted when we lost Jude. For me, the answer was nothing. I didn’t want anything. I didn’t want to make conversation. I didn’t care about food. I was shell-shocked, but in hindsight, I appreciated the people who showed up one way or the other (physically or with calls, cards, and flowers).

 

I looked at him before the funeral Mass started. He looked peaceful. Surreal. A clip show of photos played on the other side of the room. A lifetime was being conveyed in a series of photos. He was athletic. Spent summers with his family at the beach. Posed for the camera in tee shirts and shorts like every other dorky kid from the ‘90s. He smiled infectiously in every image; he was harmless. Sweet. I met a person I hardly knew in a series of photos…probably the person his mom and sisters remembered best.

Too soon, the slideshow ended, and the Mass began. The finality of the closed coffin seemed to make it more real. I’m never ready for the coffin to close; I wasn’t ready for Jude’s coffin to close. During Jude’s wake, Sean was by his side, holding his little hand; I was only a few steps away, but I wasn’t next to my son. I somewhat regret that. I also regret never seeing his eyes or dressing him. I honestly wasn’t sure what I was allowed to do with him; he was mine, after all, and at the time, when we were in the hospital, holding him and brushing my hand across his cold cheek seemed like enough.

The guests took their seats at his Mass. His daughter’s attire was entirely apropos for the sad occasion; her innocence was highlighted profoundly by her purse. It was a little pink toy-like purse as though it wasn’t really her father’s funeral…just a morbid game of dress-up. I started to cry.

As children will often do during church, mine became restless, and I slipped out with Lillianne; we heard the rest of the Mass from the foyer. Sean soon joined us as Eilie was also getting restless, and we heard the remainder of the Mass from there.

After, we stood and watched –almost intrusively, like voyeurs of grief—as the family entered the foyer. He came first followed by his very pregnant wife then daughter and mom and grandma and sisters in turn; arms tenderly outstretched to one another, providing support and simultaneously reaching for it. A cloth was ceremoniously draped over his coffin. I clutched at Sean’s elbow, weeping for them…for him…for them.

 

During the procession to the cemetery, I flash-backed to Jude’s procession and had an outburst of emotion. I cried unrelentingly for a few moments. I was reminded of that chasm of pain that literally engulfs you when you have a loss so significant that you can’t even fathom it. It’s the kind of loss that your mind has to do absolutely wondrous and incomprehensible things to facilitate coping. It’s the kind of phenomenon that reminds you that there’s a higher power and a purpose. It’s the kind of thing that you realize, wow… I can…survive this un-survivable devastation and life can…have purpose.

Within the past year, I recalled reading a fascinating piece about a survivor of the atomic bomb in Hiroshima. It was riveting to say the least. Regardless of how you feel about the war, the first-person narrative of what they experienced was profound to hear of. And it reminds me that I’m not the only one who’s loved and lost so deeply. It’s something I’m reminded of often; in fact, just as with the story of this very important and wonderful and special person, I’m the least-suffering of anyone who has ever suffered, I feel.

Perhaps that’s because I know such mercy and grace, and I’m really thankful for that. Maybe I don’t know how badly I could or should have it, but I just…don’t. I don’t have it bad. I tell people all of the time that I’m blessed. I know I’m blessed. It’s not because Eilie is here, either. I’m blessed because I’m a child of a loving God.

Yes, I suffer, and I know pain. The world suffers, but there’s something beyond that. Have you ever seen people rise up in the face of pain and adversity? Band together? Overcome hatred and anxiety and stereotypes because they just had to help someone? I feel like that’s the point of pain…it helps us to be human and to become our best selves while having faith that it really will somehow all be okay.

To this family who suffered such a loss, I love you all so much. I don’t know where you are as you walk through the valley of the shadow of death, but know that we love you. Know that I love you. Know that your boy is holding mine in heaven, and that they are bringing one another joy. Know that we are here to bring you love and joy and peace and hope and prayers. Life isn’t always fair, but at least we can say there’s always love. We love you.

 

Related: On March 9…a day after (wow) a blogger shared this piece via Mental Health America: ”Open Suicide Letter.” I read it March 21, and it was –still is—profound insight.

 

Hey Jude – Somewhere Over the Rainbow

I’ve always liked the expression that life is stranger than fiction because it is. In fiction, scenarios are contrived. If you want it to, love conquers all; the boy gets the girl; the bad guy gets what’s coming to him, and the good guy wins in the end. In reality, life is dirtier and messier. Bad things happen to good people; some bad people never get their just desserts. Life can seem unfocused and random at times, which is why many people believe that events in life are purposeless.

Without saying that everything happens for a reason, I believe it’s possible to find meaning in most things. Losing a baby, losing Jude, wasn’t one of those things I was going to try to find meaning in beyond what joy Jude had, has, and continues to bring to my life. You see, when someone suggests to a grieving mother that she lost her baby for a reason, there are very few conclusions she can and will arrive at that don’t lead her to conclude that she’s a terrible person.

After we lost Jude, some very well-intended people suggested that perhaps it was a wake-up call for us, which I reasoned if I needed such a powerful “wake-up” call as losing a baby that I must be a terrible, horrible human being completely unfit to so much as breathe the same air as everyone else; however, I realized that though well-intended the suggestion (as it aimed to give some purpose to the nightmare of suddenly and without explanation losing Jude), it wasn’t accurate. Pain and punishment aren’t doled out to bad people just like riches and rewards aren’t doled out to good ones; this was something that our priest talked about during church on Sunday and is something that we –humans—struggle to understand.

Thus, I was content to accept that no special meaning or greater purpose had to be attached to Jude’s perfect life. He was pure, innocent, and he was love; there didn’t need to be more to it.

When we became pregnant with Eilie five months after losing Jude, I knew their due dates (Jude and Eilie’s) would be close; you’d think it would’ve been difficult when I found out that Eilie’s gestational due date was February 11, 2016 one day and one year off of Jude’s gestational due date of February 12, 2015. It was even more ironic since Jude’s scheduled C-section would have been February 11 as it’s my mom’s birthday. I took the situational irony with a raised eyebrow and a grain of salt.

After all, Eilie and Jude wouldn’t come close to sharing an actual birthday; Jude was born still on December 26, 2014; Eilie would hopefully spend at least six more weeks in utero to be born on February 4, 2016 at 39 weeks.

Like her brother, Eilie was scheduled to be delivered via C-section. Other than my copious anxiety during her pregnancy, everything relative to Eilie’s development and pregnancy was perfect (this is the actual word that my doctors used). I did a weekly non-stress test with my regular OB and a weekly biophysical profile with my high-risk doctor. Toward the end of the pregnancy, I sheepishly told Dr. B. that, “I felt bad seeing a high-risk doctor with such a healthy pregnancy when there were women out there (with losses) with real problems (in their pregnancies).” He kindly told me I was right where I needed to be.

On Tuesday, January 26, 2016, thirteen months after losing Jude, I wrote my monthly letter to Jude. That afternoon, I went to see my regular OB. Like clockwork, I was hooked up for the non-stress test. After a while, my doctor’s nurse came in and said, “Now, I don’t want you to freak out….”

“I know,” I cut in. I smiled wryly. I’d had a feeling something wasn’t right; Eilie hadn’t done her usual gymnastics during the non-stress test. So, just like I’d done with Jude, 13 months and almost to the hour before, I allowed myself to be escorted to ultrasound for a biophysical profile of my baby. I was surprisingly calm. I texted my mother who would call my aunt who was watching Lillianne to tell them I’d probably be late and to have my dad pick up Lillianne when it was time for my aunt to leave. I called Sean who was leaving work an hour out of town right to tell him not to panic or to rush but that we were doing a biophysical profile…that I was sure everything was fine (even though I wasn’t completely sure).

My doctor, Dr. T., sat through the biophysical profile with me. Everything was gradually checking off of the list of requisite things for them to observe. Fluid levels and Eilie taking a breath were the two things I was most concerned about; those were two abnormalities in Jude’s biophysical profile. It felt like an eternity, but Eilie finally took a breath. And after roughly 20 minutes, the BBP concluded with Eilie hitting all of her points. During the test, I tried to envision myself going home that night, going to bed, and sleeping. It was so conceptually absurd. I mean, there was just no way I’d sleep.

We walked back to the office, and instead of being checked for dilation (typical at 37-38 weeks) as we were planning, Dr. T took me into her private office. “So, I don’t know how you feel about this, but I’d like to send you to the hospital for a couple of hours to sit on the monitor. It would just make me feel better.”

“Yes, I think that’s a good idea,” I concurred without hesitation.

Soon, I was on the monitor, and Sean was there. “Did you know you’re having contractions?” a nurse who fluttered in asked.

“Really? No, I had no idea,” I said, amused at the phantom contractions. I’d had some great inner thigh cramps because of how low Eilie sat in my uterus throughout the pregnancy, but I certainly hadn’t had any contractions I was aware of (other than Braxton-Hicks). Because Eilie had resumed her usual level of movement, I was at ease.

A few hours after we’d been checked in, there was no indication we were leaving anytime soon. Dr. T came back to the hospital and checked me. I was 2-3 cm dilated…something else I wasn’t aware of. The “wait and see” game was thus extended to morning.

Given that we were one day away from being full term (38 weeks), I rationalized that Dr. T would want to wait until at least Thursday if we were going to deliver early…maybe longer because women dilate all of the time and aren’t necessarily in labor. I mean, I wasn’t in labor; I had labor contractions with Lillianne, and believe me, I know what labor feels like. So, needless to say, it felt like the air had been sucked out of my lungs when Dr. T came into our room, sat down, and candidly said, “I think we’re going to have a baby today.”

For the first time in the past 24 hours, I was so flooded with emotion that I nearly cried. “Are you okay?” she asked.

“Yeah, just a little shocked…and overwhelmed. Why now? Why today?”

“You’re having contractions that are about 7-10 minutes apart, so rather than send you home knowing you’ll be back, I’d rather go ahead and deliver you.”

Having lost Jude, I wasn’t up for taking risks; I trusted Dr. T implicitly, so the next question was, “When?”

Half an hour later, I was in the OR getting the spinal tap while nurses and other medical staff requisitely prepped for a C-section delivery. I laid down; the partition was raised, and Sean came in wearing his yellow “husband scrubs”. Unlike Lillianne’s C-section, I was attentive to every detail of this delivery. I was aware of the cover over me. I was aware of the numbing sensation that was gradually overtaking my lower extremities. I was aware that the procedure was starting. I must’ve been oddly quiet because the anesthesiologist kept asking if I was okay. I was fine. I was occasionally vacillating between wanting to burst in to tears and to laugh out loud…but mostly to cry…but I was fine.

“Oh wow, you can see her face,” someone said. I looked up at Sean who was peering over the partition with a look of absolute wonderment.

“You can see her face,” he confirmed. I wasn’t quite sure what was so impressive about this other than the fact that Eilie had been sitting incredibly low in the birth position for the better part of the last two and a half months, so perhaps they were marveling that the face was the first thing they saw in lieu of a back end or something like that.

As the procedure progressed, I overheard a few whispered words among the medical team on the other side of the partition, “…that was really thin….” Were they talking about my c-section scar? Because Jude and Eilie were so close, I worried constantly that I would experience dehiscence or rupture.

Finally, the unmistakable sputtering wail of a newborn pierced the air. And suddenly, there she was. At 7 lbs, 71/2 oz, Eilie Colette was born…one year, one month, and one day after Jude.

The next day, Dr. T came to check my recovery, and I inquired about the procedure, “I overheard someone say something was thin. Was it the scar?”

“Actually, it was the area below the previous scar; it was like a window.”

Oh. “Do you think that if we’d have proceeded with waiting the outcome might have been different?”

“It’s a possibility.”

“I know you know we want to maybe try to have one more….”

The uterus, she explained, will thicken as it heals. She believed that this thinning most likely occurred because Eilie was sitting so low and because I’d been having contractions for such a long period of time (during a “panic” visit in later November, I was told while hooked up to the monitors at the high risk hospital that I’d had a couple of contractions; I couldn’t feel them either.).

I was unable to ignore the fact that had it not been for Jude, Dr. T most likely never would’ve chosen to deliver when she did. After all, had it not been for Jude, Eilie’s pregnancy wouldn’t have been regarded as high risk. I never would’ve had a non-stress test that day; had it not been for Jude, Dr. T wouldn’t have made the cautious call to get on the hospital’s monitor after a normal BBP. We would’ve never known about the contractions, and well, the outcome may have been very different for Eilie.

When I recounted this story to another mom, she suggested that the outcome could’ve been different for me, too. “You could’ve died,” she said. “He was looking you, so you could be here for your family.” While I agreed, as maternal morbidity is a possibility with uterine rupture, I never felt like my life was in danger (ignorance is bliss?). I have more than once looked at Eilie and seen Jude. Especially when she’s sleeping, she looks like Jude when we buried him, and it’s absolutely jarring.

After all of this transpired, I recalled a much earlier conversation with a friend in that I pointed out that without having lost Jude, I wouldn’t have (then been expecting) Eilie. Had Jude survived or made it to his due date, Sean and I would’ve never conceived another baby in May of the following year. My friend said she felt that her babies were her babies and would be no matter when she had them. While I understand what she means, technically, that’s impossible. The genetic material that created each of my babies was unique and wouldn’t have been in existence at another time of conception; that baby would be and is a different person entirely than Jude or Eilie.

That said, I do believe that both of these babies were meant to be my babies. We chose both of their names –Eilie and Jude- when we were expecting Lillianne. Eilie was an uncommon Irish name. Jude was a name that we really liked. Lillianne ended up being Lillianne, but I already felt that I’d one day have a Jude and an Eilie. These babies were meant to be mine, and I think there’s a reason their tiny lives and beginnings have played out thusly.

While Jude’s purpose is far from through, I believe that part of his reason for being was to save his sister’s life. I support this belief with the unplannable “stranger than fiction” reality that they were due one year and one day apart (2/11/16 and 2/12/15) and were impossibly born one year, one month, and one day apart (12/26/14 & 1/27/16) after I was hospitalized under nearly identical conditions with both pregnancies (a non-stress test, a biophysical profile, hospitalized gestational monitoring, unscheduled Cesarean delivery).

Yes, life…it’s stranger than fiction, but it has purpose. Every drop of it, and it’s by no means random; rather, it’s being orchestrated in such a beautiful and fine way that we can’t always make sense of it; at times it’s like like jazz. Other times, such as in Jude and Eilie’s case, it’s a classical composition in which we can see how the notes connect and interact, and we can make sense of the music.

 

Hey Jude,

 I know that somewhere over my rainbow, there’s an angel looking down on us, and it’s you.

Thank you, my baby. I love you, and I miss you, and I keep you in my heart. Always.

(Left: Jude 12/26/14; Right: Eilie: 1/27/16)

Hey Jude – A Tree of Life

Author’s note: Please keep in mind that the contents of this piece are a reflection of my observation and of events and relationships as I perceive them; others may feel differently; however, these are my perceptions and thus my reality just as another who observed these events may have different perspectives. As Albus Dumbledore once said, “Of course it’s happening inside your head, Harry, but why on earth should that mean it is not real?” Thus, this forum for expression reflects my reality as wells as of how I’ve managed certain important relationships.

I feel that promoting certain food items as “foods that heal” is propagandizing Mother Nature. Of course there are foods that heal; there are foods that inherently battle cancer, high blood pressure, heart disease, and a plethora of other disorders all of the time. Rather than just eating naturally and healthy, I feel the majority of our society has become enslaved to trends. For example, at what point did it become sensible to obsess over kale and its many uses and properties versus just, you know, treating it like any other leafy green? Obviously, kale, spinach, endive, collards, arugula, Brussels sprouts, cabbage, Swiss chard and any other green / green variant can “heal”.

 

Making Memories with Cereal & M&Ms

Of course, in addition to their nutritional value and ability to defend against physical ailments, I’ve found that, more importantly, food can act as a balm on emotional wounds, which is why comfort sweets are most often sought when people go through a breakup (not to be cliché) or when they get home from work and are tired (it’s no secret that Sean has an M&M jar that he beelines for when he gets home each day (though, he does usually have a small bowl of whole-grain cereal with Lillianne when he gets home, too, which is a little tradition that I find to be very charming). That said, while food can soothe emotional wounds, it can also trigger them.

 

Pineapples

Years ago, my dad got into a habit of buying a fresh pineapple for me at the grocery store when they were in season. I love fresh fruit and pineapple has always been a favorite; though, I found the gesture to be incredibly random because at the time, I was in my mid-20s; I was living on my own, and I hadn’t knowingly revealed that I really liked pineapple…dad just started buying them.

The routine of being gifted a pineapple whenever I saw my dad got to the point that I once half-joked to a friend that one day, when my dad wasn’t here, a breakdown in front of the pineapples at the grocery store was imminent. I say half-joked because I really did think that if something were to happen to my dad at that time, pineapples would’ve triggered an emotional crisis

This was at a point in my life where I would sometimes lay in bed and think about that inevitable time when my dad would only be alive in my memory, and I would cry for the 22 years spent living with someone I didn’t know…for the 22 years of time wasted not getting along.

 

Disciplinary Roots

Some have suggested that the reason dad and I didn’t get along is because we’re “so similar” (it’s a common misconception for many who don’t see eye-to-eye); however, that’s not why we didn’t get along. Truth be told, I had a craven desire to be a “daddy’s girl” and to feel approved of and emotionally validated by my dad as a child and young adult, and it took a long time for me to understand why our relationship was so full of static.

Dad was raised by two people who –by today’s standards—would be considered abusive parents. I love my dad’s biological parents, but they were both products of their hard life-circumstances and (I believe) often too self-involved to have better-prioritized their only son’s emotional well-being. Dad labored on the family farm at a very young age…he was capable of driving a tractor at age 5; even though he was an extremely well-behaved child, his parents were fast to blame him for any kind of disruption and even quicker to physically punish him. In addition to this hard-knock approach to child rearing, his parents never supported or nourished his individuality or talents throughout his childhood and young adulthood.

Thus, the product of their “parenting”, my dad, was a Red Foreman-type (That ‘70s Show). He was a hard, manly man who knew how to work hard. Period.

Children in dad’s world were to be seen and not heard. We did as we were told or we were yelled at…or spanked…or both. To this day, the sound of vacuum cleaners agitates me because I only remember being yelled at for the way I vacuumed and the arguments that ensued. We had an industrial-strength Kenmore; it could’ve sucked the wallpaper off of the walls (pity it didn’t). It left visible lines in the carpet; you could clearly see where you’d cleaned. This is the gist of an exchange as I remember it:

Dad: “Vacuum like this.” (Demonstrates uniform lines as one would mow the lawn)

Me: “Why? I can see where I vacuumed.” (Gestures to vacuum lines)

Dad: (annoyed) “Because I said so.”

Me: (genuinely curious) “But why is that better.”

Dad: (irate) “Don’t smart-mouth me. Just do as your told.”

Further “challenges to his authority” as he perceived them would merit a quickly-administered spanking (there weren’t second, third, and fifth chances or mere threats of spankings; if a spanking was promised, it was delivered without hesitation). The thing is, I wasn’t being a smart mouth; I was a really inquisitive kid; I truly wanted to understand why in the name of all things sacred it was vital to only vacuum a certain way. Was it better…did the floor get cleaner? Did it matter that it might have been more expedient if I didn’t necessarily care about being the fastest I could be? Of course, the answer was no. The floor wasn’t any cleaner nor did it matter if it was the fastest way, but it was what he wanted. Questioning that incited a reaction.

Once when I was in elementary school, I made the mistake of asking if our neighbor could stay for dinner in front of her. We’d been advised to not do that. We understood there wasn’t always enough food for a guest and that it was impolite to ask in front of the guest lest the answer need to be no. In my childish exuberance, I brashly asked if our neighbor, K, could stay for dinner in front of her. And dad punished me in front of her. I tried to run, but he grabbed me; I tried to get away, but this made it much worse. I ended up in the air, suspended by my ankle, being spanked and humiliated in front of my friend who consequently remembered the incident (and reminded me of it) at our 8th grade “graduation”.

Despite this southern-fried style discipline, I want to assert that Dad wasn’t cruel or abusive. He never berated or insulted us; he didn’t not love us; he was who he was… a product of his ignorant parents’ emotionless and harsh “parenting” methodology.  Again, while I love both of my grandparents for reasons that are very detached from who they were as parents, I realize that it was their fault that Dad was the way he was during my formative years; it was their selfish preoccupations with their addictions and with their dysfunctional marriage above being loving and supportive parents to the person they were designated to protect.

This actualization alone made it possible for me to forgive my dad for “wanting to break” my inquisitive, left-handed creative, expressionistic spirit for the entirety of my life under his roof. (While I can’t remember the context of the argument, he did once say verbatim that he ‘tried to break me’, I assume like you would a horse; oddly, I’m very proud of this because as a woman, if your own dad can’t break you, it’s a certainty no one else can.)

 

A Relationship Re-Rooted

Dad and I hit a wall in my mid-20s, and between my ability to look past the past and the fact that I was maturing as a human being, we were able to form an actual relationship. Today I see my dad as calmer. I’ve gotten to know him as a wise, reserved, and reflective individual. He’s a really good person who is highly intelligent and who has overcome a lot (more than I realized or have communicated here); I understand him a lot more and find it very easy to love him and to advocate for him. I can also understand why he had a lot of anger and frustration for so many years.

Admittedly, I wish this version of my dad was the version I had known as a child. I didn’t need the McGoo namby-pamby, pleated-khakis, feel-good heartfelt emotional lessons with the sappy music Danny Tanner dad (shudder) ; heck, even though I was a Clarissa in a Babysitter’s Club world, I didn’t even need (or want) an artsy Marshall Darling dad.

What I needed and wanted was a dad who wanted to spend real time with me. Perhaps, if our relationship hadn’t been tainted with perpetual discipline and resentment, I would’ve cultivated some of our similar interests sooner. Perhaps I would have learned how to discern weeds, to plant a garden, and to work in a flowerbed sooner. I love gardening; my dad is an excellent and skilled gardener who always has beautiful lawns and flowerbeds that look professionally landscaped. I could’ve also learned about some of the mistakes he made before I also made them…and maybe I could’ve avoided them all together (maybe not, but there’s no way to know).

 

Surviving the Winter

Alas, none of that happened, and dwelling on it and wishing it did is frivolous. Holding onto it is also silly because it threatens any new growth we’ve cultivated.

A (now former) student who, one year ago this January, lost his 21 year-old daughter to illness made all of this even more poignant; the only time he had with his daughter was roughly the exact amount of time dad and I wasted. I couldn’t help but wonder, What if that had been us? And then I was just thankful that it wasn’t.

My student has a son in his mid-20s who suffers a similar illness to his daughter. Before acknowledging what’s kept us going after losing Jude, I thought, “Why waste your time with school when what’s important is so obvious?” However, I quickly remembered that we keep going because that’s what we do. We keep going because when our only options are to lie down and to die or to keep moving forward, we just keep going…harder and stronger. We don’t let the things that try to break us break us.

That’s what this man (my student) did. That’s what Sean and I did after we lost our beautiful Jude. That’s what dad and I did after we didn’t get the first 25 years right.

 

The Grapefruit Tree

I started reflecting on all of this (foods that heal, grapefruits, pineapples, and my relationship with my dad) on Dec. 26, 2015 when I ate the first grapefruit I’d had that year from my dad’s tree. Often prolific, the tree produced only a handful of the nourishing fruit because it sustained a lot of damage during last year’s hard and harsh freezes. For me, my dad’s grapefruits are not only most delicious, but they also hold powerful emotionally soothing properties for me.

When Jude died, when we were at the hospital, in addition to his tears of grief for his only grandson and emotional support for Sean and me, Dad brought a bag of grapefruit, and I sustained on nothing but the fruit for least a week. Though other food was brought for me to eat while I numbly “recovered” in the hospital, it usually ended up uneaten either because a sympathetic visitor would arrive and it would be cold by the time they were gone; or because I was sleeping when it arrived, and it was unappetizing by the time I woke up.

Instead, the only activity that I could manage in my shattered state that held any peace was the satisfying labor of pulling away the grapefruit’s skin, then peeling away thick layers of pith before pulling the fruit apart and quietly eating the pieces at my leisure. Nothing spoiled. It was never cold or unappetizing; it was, in fact, the only thing that had any flavor to me.

A year later, it was very important for me to have a grapefruit from my dad’s tree. I had a total of six this growing season. As I said, it was a hard year for the grapefruit tree; it had such a brutal winter last year…it was lucky to have survived, but it had a strong foundation and was well established. And, like the people its fruit nourishes in every sense of the word, it kept moving forward when confronted by the option to give up; it, like me and like my dad, refused to be broken when life’s winters were harsh.

Hey Jude — Everybody Hurts

Hi, Sweetie.

It’s really hard to believe that today and for four hours now, it’s been New Year’s Eve. Last year, I was also awake after a relatively sleepless night.

I remember waking up while the morning was still dark and finding your obituary online.

I remember deliberating for roughly an hour before deciding if and how to share it on social media.

I remember reading it and weeping.

I remember how beautiful and perfect you were because I look at your photo every day.

This year, I’m awake because the phantom monster that is prenatal anxiety came back. Your sister has moved her position or is moving differently, whichever; regardless, I haven’t been satisfied with her level of activity to allow myself to rest, so here we are. (Thankfully, we have a doctor’s appointment today.)

 

Everybody Hurts

After your funeral last year, your father and I talked as we both had different experiences during your wake and afterward at home with the family; we had different interactions and conversations. One thing that your daddy’s uncle said that still stands out and has resonated harder and harder lately is that, “There’s more than one way to lose a son.”

Some people might find this comment selfish given the circumstances, but I didn’t (particularly because I know his situation). After all, I find writing these love letters to you to be an inherently selfish and somewhat narcissistic activity…as though I’m the only person who’s suffered a painful loss. I cannot even begin to count the number of people who’ve suffered significant, life-changing losses –many harder to bear than mine—with a quieter dignity; however, we all cope differently (and I like to stay in touch with you).

What this comment and my reflection of it inspired is the realization that everybody hurts. Thus, I’ve started trying to take the journey others have endured.

Last night, I was thinking of my doctor who I know delivered a still baby on Mother’s Day last year. I wondered what it must be like to do that, to bring a non-living baby into the world, then to have to “do your job” at the same time. How taxing that must be on a person’s soul. I have another doctor friend who said that patients and patient families can be…well, not understanding. So, then I imagined the doctor who, while inwardly mourning an innocent loss, is simultaneously on the receiving end of a wounded person’s vitriol? The anger quickly becomes blame, and the doctor, who is certainly more than just someone doing their job, has to take it. Not only do they have to take it, they have to take it home; they internalize it; they analyze every step and moment to determine if and how the circumstances could’ve been different.

My doctor has told me numerous times how often she has revisited your life in her care in the hopes of finding something to answer the question of why or how…and there’s nothing. You –like your sisters—were perfect; you were perfect until you weren’t. None of her colleagues (including my high risk doctor) had answers either, which I hope eased her soul at least where we’re concerned; however, I know she hurt for us.

A week after your funeral last year, the bug guy came around to do his job. I kept the appointment on January 7 because…well, I just did. J arrived on time, and because we were in a fog and had forgotten the appointment, we were still in our pajamas and were rather unmade. J didn’t mind; he came in, and perhaps feeling it necessary to explain our appearances or all of the flowers, we told him about Jude.

J told us about his second baby, a little girl, born with a trifecta of genetic defects that meant she could cry but couldn’t produce sound, that she lacked the proper anatomical cavity for going to the bathroom, and that her heart had issues. For eight months, J and his wife endured…they endured surgeries, their baby’s quiet yet obvious suffering, and endless what-ifs and God-knows what else. At the end of eight long months, it became obvious that there was little more modern medicine could do to sustain their baby’s life, and they had to decide to allow their infant daughter’s suffering to end naturally.

His story filled me with sympathy and gratitude (I was appreciative that we never had to make those kinds of decisions for you, Jude…that you never knew Earthly pain and suffering or even the sensation of cold; I felt very blessed that my baby had only ever known warmth, love, and comfort). What J and his wife endured would have turned me into human road kill; I can’t fathom where my strength would’ve come from to be the people he and his wife had to be those eight months. In telling us this, he wasn’t trying to diminish the significance of our loss; rather, he was a person with pain sharing a story. But they survived; they had two more children after losing their second. J was among the first people who helped me to realize that everybody hurts.

 

Everybody Copes

Last year, just after we lost you I wrote what would be my first letter to you. I wrote about how we decided on your name, how during a tribute concert with friends where “Hey Jude” was played, I felt that was what I wanted your name to be because I wanted you to be able to make me a better person, to have a more open heart, and to be more hopeful. After a long couple of years of home renovations, struggles to advance financial, and marital and familial growing pains, I was rather guarded, which I didn’t like.

You, in your tiny and infinite perfection, have enabled me to let go of all of those burdens. One year later, because of you, the stresses of those damaging growing pains have been lessened. Your father and I are happier and healthier together; your sister is, well, she’s always been a little light, but she talks now. As you can see, I’ve just had the best year as a freelance writer and editor, and this was only year one.

It’s very odd to reflect and to say that so much about this past year has been good when it’s also been so painful, when missing you has been so hard; however, one emotion I couldn’t find relative to losing you was anger. I never got angry. You were and are too beautiful; you’re too perfect. Anger is ugly, negative, and generally ignorant as far as emotions go. You deserve better, and so I’ve only reserved the best for you.

I think this (or something similar) is whatever most who suffer a tragic loss comes around to…a pacifying acceptance that they can cope with and live with and maybe even grow from. Yes, they walk closer to the veil the separates life from death; they stop to look at it as they contemplate its larger significance. Somehow, seeing the veil flutter carelessly in the wind, walking alongside it, and realizing its significance, they find that life is too brief, too fragile, too precious to do anything less than to live (and what’s more, to live a little extra for those just beyond the veil).

I love you, sweet Jude. Thank you for everything this past year; you’ve given me so much…so much more than I could’ve anticipated when you and I started this unanticipated journey last year. Thank you for living through me and for giving me more to live for. You are and will always be my perfect middle child.

PS: I miss you.

Hey Jude — Loved Boys & Everland

Finding Everland

A few days ago, I got into the shower and was inexplicably thinking of the 90s movie Hook starring Robin Williams as an adult Peter Pan who must rediscover his identity as Peter Pan in order to rescue his children and their childhoods, which he’d thus far been missing.

My thoughts then slid to focus on Robin Williams and his untimely death due to suicide. How fitting for Robin to play Peter, a character who was frozen in time in Neverland. At the moment one’s final bell tolls, we all trespass from Earth to Neverland. We never grow older. We never give the world new memories of our former selves. We pause. Thus, we will only ever remember or know Robin Williams to a point.

I then recalled that Sean recently told me that Peter Pan’s origins were darker than Disney’s buttered-up animated film made them seem. Predictable. Thinking about Neverland and Peter Pan’s irreversible fate to never grow older, I determined Peter Pan must be about a child who died.

While the nature of James Barrie’s adult life and proclivities are subject to scrutiny and debate, the character of Peter Pan was indeed inspired by a child’s death. One day when he was 13, the “golden” son of the Barrie family, David, was ice-skating when a fellow skater hit him; he fell, cracked his skull, and died. David was 13. The boys’ mother was consumed by grief. She fixated on the death of her most beloved son to the extent that young James began to adopt his brother’s mannerisms. Perhaps this was done to comfort his mother or himself or to receive affection from her; I don’t know. When he turned 13, James stopped growing. He never grew taller than 5’, and his voice never fully matured. He, like his brother David, froze in time; except, James’ heart kept beating, and he kept aging (though, I doubt he grew much older in other ways given the subsequent chapters of his life).

In the early 1900s, the character of Peter Pan was first introduced in a story titled The Little White Bird. In this story, Peter was a baby who at seven days old flew away when he to live with fairies as all babies are born as birds (per the story); however, he soon forgot how to fly, so he returned home only to peer in through his nursery window and to find that his mother had a new baby and had forgotten him. The public’s curiosity and intrigue in baby Peter prompted the successful writer James Barrie to pen the play (Peter Pan, or the Boy Who Wouldn’t Grow Up) that became the Peter Pan story (Peter Pan and Wendy) we know today.

Nothing about Barrie’s story or the lives touched by his story or the real people who inspired the story is without tragedy or irony. As I reflected on all of this, Jude and his own permanent pause were forefront in my thoughts.

Lost boys…forgotten boys.

Neverland.

My baby isn’t lost nor is he forgotten, I thought. He is a loved boy. He’s in heaven, not a lonely place where he believes he’s unloved and unmissed; he’s in Everland. After all, to believers, heaven is a place of eternal life. That’s where my baby is.

In the past year, I’ve joined a culture of moms who also experienced a third-trimester loss. I’ve also joined a group for people who use the blood thinner Lovenox during pregnancy. These two online social media support groups have been equally heartbreaking and inspiring. All of these parents have one thing in common next to their losses: they all love and miss their babies. They’re all scared and anxious and lost at times, like me. At no point would they not jump out the nursery window to retrieve their baby who flew away if they were to come back.

“You’re missed! I love you! Please don’t leave me again!” I would shout to Jude if I thought he would hear me. I would hug him and hold him and swaddle him with love and bathe him with tears. This past year wouldn’t have happened. It all would have been the nightmare that I kept hoping that it was a year ago.

 

One Year Ago…

One year ago. How has it been a year that it was Christmas and that we were growing ever-closer to February 11, the date that would be Jude’s birthday? I still remember waking up time to time during that first post-op night between the day he died, December 26 and the wee hours of December 27, groggy, bleary-eyed, and disoriented in a twin hospital bed with Sean curled next to me. Please let this be a bad dream. It was a nightmare. It didn’t happen. Oh God, please don’t let this be real.

It did. My flabby, deflating belly was evidence of that. The tender, angry, puffy incision between my hips verified it. Tears welled. I pushed the button in my left hand, dosing myself with Dilaudid before falling back to exhausted sleep only to repeat the cycle every couple of hours.

I understood how Harry Potter felt each time he awoke from a dreamless sleeping drought after yet another loss in his young life. The pain and emptiness starts over every time you come out of that deepest medically-induced sleep. You want to return to it and run from it at the same time.

We left the hospital on December 28, and I was sorry to go. I was leaving the place where Jude had flown out the world’s window far too soon. I was leaving the place where for two uninterrupted days, time stood still, and Sean and I were mostly alone with our grief, holding each other as though our lives depended on it, as though we were lost children. Time and days and hours and nights didn’t exist in that hospital bed and in that room. The world and its oppressive weight of decisions and responsibilities and expectations were concepts, not real things. We were briefly allowed to heal at our own pace.

At first, my physical recovery from the C-section and my emotional recovery were paced at an even keel; I was utterly helpless on both forefronts. Sean led me take my first shower after the surgery, and he gently bathed me because he knew I didn’t have the strength or the ability.

He literally helped me walk again. Together, we shuffled around L&D. I held his arm, and he escorted me to the window and then the vending machines and then around the nurse’s station. Then, while we were still as fragile and as unsteady as my shaky steps, it was time to go; I was physically well enough to go home, but I wasn’t ready…my heart and my emotions were still fragmented. I wasn’t ready for it to be real; I wasn’t ready for the clock to start ticking again.

After that, only excerpts of moments stand out in my memory. Jude’s funeral was on New Years Eve. It was a clear, bright blue, icy cold day; it was so perfect. My best friend heroically flew down from Virginia to hold my hand. The night she arrived, she and I sat on my couch, and I reflected on Jude’s life…on all of the things I’d never see my son do. I would never hear his voice. I would never hear him say, “I love you.” I would never see him fall in love or get married. I would never be able to throw him a birthday party. I would never know what characters and stories he would like. I would never get to see him smile. This –his funeral, would be his only birthday party; a lifetime of memories that would never transpire flashed before my eyes. And then all of the things that nobody knows how to say passed between us as we held each other and cried for my loved boy.

Sean’s brother also dropped everything and came down to support us and to see and to say goodbye to his nephew. So many special and beautiful people came to show us they cared or sent flowers and plants or loving cards. It was the only party we would ever get to have for Jude, his only birthday party, and everyone came.

 

One Year Later…

One year later, nothing and everything have changed. A year ago, I didn’t sleep with a teddy bear named Jude Bear. A year ago, by best friend revealed she and her husband were “trying.” A year ago, I wrote “Research Administration” on the job title line of important forms. One year ago, I had no reason to doubt that I was going to have a little boy to watch grow up. I had a writhing, active baby boy inside of me; he was 33 weeks old on Christmas Day.

This year, I have a writhing, active baby girl inside of me. She will be 33 weeks old on Christmas Eve. This year, my best friend’s first baby will be due just after the New Year. This year, I put “Freelance Writer” or “Exhausted Toddler Mom” or “Trying to Have It All” on the job title line of important forms. This year, I have every reason to doubt that I will have another little girl to watch grow up.

This year, I have anxiety attacks that have grown increasingly frequent and intense as the clock ticks away the moments to December 26, a date on which I’ve mentally superimposed the end of the world. When and if the sun comes up on December 27 and if I still have Jude’s little sister kicking and wiggling and living inside of me, a shred of time that froze last year will have thawed and will tick forward. It won’t undo the pain and aching emptiness I feel at Jude’s absence, but it will signify there is life beyond December 26 and maybe even beyond 33 weeks.

Until then, until three days from now, I’m on edge, shadowboxing with my biggest fear…waiting for it to all go wrong again, constantly looking for “the problem”, buying time with biweekly doctor’s visits to ensure that everything is still “perfect” and to stave off major panic attacks. If I can catch the problem this time, then I can save this baby, and it’ll be like I’m saving Jude. I realize how crazy that sounds, but I have to wonder if that’s not why I panic when the logical side of me knows there’s nothing to worry about.

 

Jude’s Birthday GIft

One year ago, time stopped. Jude took part of me with him when he ascended into Everland as a Loved Boy. He took my fear. He took some of my filter. He took some of my reserve. He took things that kept me from fully living. He took the veneer of strength and dignity and left a raw strip of humanity in his tender little wake.

By doing this, he’s made me stronger and better. I have more faith because of him. I tell people that I care more. I don’t just “like” someone’s pain or pleasure to show love and support. I comment. I text. I call. I confront. I don’t worry about money and things. God will provide; He always has, he always does. Why worry? What will that do? I’ll manage. Even if times are tough, it will be fine. I don’t worry about the mean and ugly things in the world. About hatred. And terrorists. I feel sorry for people consumed by those destroyers of happiness. I’m not afraid to stand up to them if they come for me.

Losing a child was my biggest fear –and it still terrifies me as evidenced by the uncontrollable anxiety attacks this pregnancy has brought, but I don’t live a life of fear (there is a difference between being afraid and living in fear; one means you’re aware; the other means you’re petrified).

One year ago, I unexpectedly and unwillingly faced my biggest fear. I survived. I hope I never have to survive it again, but my son’s perfect life was beautiful and is meaningful. He has made such a difference in my life in the short time he’s been gone from it. This is how I know time hasn’t stopped for me, and in a way, it also hasn’t stopped for him because while he took part of me with him, he left part of himself with me. Through the phenomenon of microchimerism, Jude’s DNA is still living in me. He’s shown me I have nothing to fear and no reason to stop in time despite irony and parallels. He can’t be replicated or replaced nor can what he does in and for my life. Because of this, Jude will never be a forgotten Lost Boy; he will only be a Loved One.

 

Happy first birthday, sweetheart. Thank you for the gifts you give us today and everyday until forever.

Love, Mommy

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I’ll love you forever, I’ll like you for always, as long as I’m living, my baby you’ll be.

Hey Jude – Thanks to You

Hi, Sweetheart.

It will be Thanksgiving in one and a half hours. You’ll be 11 months old. It’s really hard to believe that I should be planning your birthday party right now…perhaps bemoaning (while smiling as I wouldn’t really be bothered) that I’m planning a one-year-old’s birthday party while also doing Christmas. I wonder if you’d be walking by now. I’m sure you would; you were so busy…those little legs never stopped when you lived inside of mommy.

I can just see you now puttering after your sister; you might still use a walker; I’m sure you’d terrorize the cats (it’s okay; after what they did to the furniture, they’d have it coming). I think I would secretly be worried that no one would come to a birthday party the day after Christmas, but I’m sure they would…surely.

I bet your smile would light up a room. I bet you’d have a funny giggle…something weird, perhaps overly effusive…something that would make everyone laugh when you did. I’m sure we’d have nicknamed you 100 times over by now; I bet I’d call you my Joy Boy because you’d fill us with so much joy.

When we’d pray with the family tomorrow, we would say thanks for you along with Lillianne, and there’d be a moment in Daddy Joe’s prayer where perhaps he’d mention you were nearly one and how thankful we were for that. Yes, you’d have been a preemie, so we’d be very thankful for your health.

I wish with all of my heart that I was eagerly counting down one more month before we reached a year on nursing. I wish with all of my heart that I wasn’t here writing this…that I was in bed, perhaps still awake, thinking of things for tomorrow like when I would start braising the cabbage and where my popover pan was.

I miss you.

I miss the weight of where you should be on my hip as I try to do things like be a good mom for Lillianne and cook food and keep the house reasonably clean.

I miss you when I look at your photos and am forcibly reminded that we celebrated your birthday and every birthday that you’ll never have on December 31 last year.

I miss getting to hold you even though the few times I did hold you, you weren’t there.

I miss that you were warm the first time we held you.

I miss that you didn’t look quite like yourself again after that.

I miss you so much, and your daddy does, too.

After we let you go last December, your daddy said he wanted to get you back and to hold you one last time. I think I understand that better now than I did then…at least now, I can think of what it felt like to hold you, and I wish so much that I could cradle you to my chest again…just one more time…and kiss your beautiful, innocent little face and imagine what it’d look like with a smile one it.

I know you’re smiling at us all of the time. You do make me so happy. You make me so much a better person, and I’d be lost without you.

Please know that I’m thankful for you; I’m thankful for everything you do. I wouldn’t be me without you…none of us would. So, thank you my baby. I’m so happy and so blessed that you’re mine.

 

Hey Jude – Flying Again

I am thankful; I’m more thankful than I’ve ever been in my life. You’d think that wouldn’t be the case considering my son, perhaps the only son I’ll ever have, isn’t here; he was only here for a fleeting 33 weeks before he was taken on December 26, 2014. Those weeks he spent kicking…he was so vital, so funny. It still doesn’t seem possible that he’s gone or that he was taken in a way that fragments the foundation of any confidences I ever had in anything.

 

Anxiety without Fear

After all, a seemingly perfectly healthy baby in a pain and issue-free pregnancy simply lost his heartbeat. I do have a theory on how that took place, but that theory does nothing to strengthen by belief in the probability that history won’t repeat itself. If anything it makes it that much worse. I won’t pretend I’m full of bravado, that I haven’t spent countless nights laying awake jostling a sleeping fetus so that she’ll kick me just to prove she’s alive for at least 10 more minutes. I won’t pretend I haven’t talked about it to my doctors like they’re therapists each and every time I visit. I won’t pretend I don’t think about it. I sleep with a teddy bear. I won’t pretend that I would much rather pretend that I’m not obviously pregnant. I won’t pretend that I want to talk about it. I’m sure people who don’t know or who think I should act more grateful think I’m a…well, it rhymes with peach, but I don’t care. Losing Jude wounded me to the core.

 

Flying Again

I have an ultrasound to see Ocean Baby every time I go see my high-risk specialist. I always start the visit very present, but I zone out quickly…I barely pay attention to the growing baby on the screen. Instead, I talk.

A disembodied hand moved a wand around on my jelly-coated abdomen while I stared unseeing at the screen. “It’s like being in a plane crash,” I said during a recent visit. “You’re in a plane that crashes on landing, and then the next time you fly again, everyone tells you just to be cool on the descent because it probably won’t happen again. I realize that statistically that’s unlikely, but that doesn’t make it any less anxious-making.”

My doctor nodded understandingly. We can all understand how terrified we’d be to fly again. Yet, here I am, exactly one year later; the plane is getting ready to make its descent. The gate knows we’re coming; we’re so close to the ground that if something were to go wrong, we should be able to salvage all of the passengers; of course, we should have been able to last time (perhaps); though, it’s hard to say what happened. We didn’t; there were casualties. I wasn’t one of them. I made it out. I was broken, bruised, burned, damaged, and changed forever, but I crawled away from the plane crash with my husband.

We never once considered not flying again. We knew we’d want to, but we were given a boarding pass and were taking our seats before we knew what was happening. This trip wasn’t planned. I’ve had some moments of anxiety including a recent visit to the Women’s & Children’s clinic because I felt a painful pea-sized lump under my arm that I thought might be a clot or something (an incident I shall henceforth remember as “The Preggo and the Pea”) (I should add that the doctors who inspected me did say they felt swelling, so I wasn’t being completely paranoid.).

That said, I’m not afraid of the crash even if I’m anticipating it. I’ve become unafraid of so much in the past year. Jude has given me so much strength and peace and courage…I can’t explain it. I truly don’t want to lose another baby ever, ever again. I pray with all of my heart that it never happens again, but I’m so proud of my baby boy for doing everything I ever could’ve asked him to do; he constantly makes me a better person.

 

A New Foundation of Faith

Ironically, losing Jude has made me realize just how much I have to be thankful for…I have so much love in my life. I have my incredible, beautiful little girl. I have my perfect angel boy. I have a good, faithful, hardworking husband who not only puts up with me but seems to genuinely like me most of the time. I have a safe, warm home. I have jobs that I love.

Most of all, I have faith that when the foundation of everything else was shaken, I was able to look to a higher power and let go. I was able to walk on air because I’d lost everything; there was nothing holding me to the ground any more. Suddenly, I was liberated by the reality that I can’t control anything. I finally understood what was meant by “I can do all things through Christ that strengthens me.”

Losing Jude by all accounts should’ve killed me. I’ve always said there are two things that would destroy me. One is my husband choosing to be unfaithful; the other –more terrifying prospect—is losing one of my children. In being forced to face my worst fear, I showed strength I never knew I possessed; I was surprised by my own faith. I truly had no idea who much of it I had in me; not once did I blame God or ask why (sure, I tried to find answers medically-speaking), but I never got angry…I never asked or wondered why. I just held fast to belief that there’s a reason and that perhaps I’m not meant to know that reason.

 

Jude’s Purpose

I know not everyone believes that events in life are purposeful. I am one of those people who believes there’s purpose. Jude’s already serving a great purpose; he’s helping me become a stronger, braver, and more fearless a person than I ever would or could’ve been without him.

I’ve imagined my life and marriage if we’d never lost Jude. Sean and I were in the midst of very stressful times. We’d recently moved into a house that we’d had fully renovated. Our finances were still tight but we were working on it; still, there was no excess. Our tense squabbles were typical of a working married couple with a young child: no personal time, no time to get things done, and money was tight as we worked to pay off student loans, pay our mortgage and other household expenses, etc. We both felt alienated and overworked and misunderstood for different yet equally valid reasons. Though some times were better than others, we were a structure under immense pressure and were a structure preparing to sustain more pressure. Jude was planned and we were excited about having him, but I think we both wondered just how much more we could take. Of course, we’ll never know.

The night we lost Jude and the nights after, Sean slept next to me in that hospital bed. I physically craved having him close to me; I felt things that I hadn’t felt toward him in a long time, which is sad to say considering how short of a time we’d been married. We lay intertwined, holding each other like human life preservers for two nights. We fell asleep here and there; I held him while he shook with sobs, and later when it was my turn, he cradled me as I broke apart. I never want to be without him, I thought. I never want to be away from the only other person who knows what this feels like. I never wanted to leave that hospital bed, our haven of security and intimacy away from the world alone with the pain of losing our son.

In much the same way having a living, healthy baby forges a bond between a couple, losing a baby does, too. In much the same way that raising a living, healthy baby can drive a wedge between a couple, losing a baby can, too. Of course, the stress of changing and adjusting to becoming a parent doesn’t have to be a wedge; a baby can also be a bookend.

I won’t say our sweet then-18-month-old Lillianne was a wedge because we’ve always both been involved and engaged parents; neither of us are selfish with our time (we were definitely both stressed to the nth degree more often than not, though, and very starved for personal time), but we were still adjusting to parenthood when we lost Jude.

Jude was a bookend; he slammed us back together and while we’ve had our moments this past year, Jude’s presence has been a quiet reminder that we’re in this together. My son’s life had and has purpose, which is why I’m not so afraid to fly or to land that I won’t ever stop boarding airplanes.

Hey Jude — Finding Answers without Solutions: How and Why We Lost You

For most of us becoming a mother forces a change of chemistry; we have a natural urge to protect and to nurture our children. Losing a child –no matter faultless we are—is also transformative and is damaging.

When Jude died, there were no early warning signs. Jude had been active like any health baby in utero should be. I didn’t have gestational diabetes. At our 20-week ultrasound, he measured fantastically. I’d been well on the way to deliver another healthy baby. In the afternoon of December 25, 2014 I noticed Jude wasn’t moving as much. After giving it some time and making every effort in the book to get him to start his usual patter of kicking, we went to the doctor on December 26.

Jude had a good, steady heartbeat; the only reason they checked me in for additional monitoring was because of slight polyhydraminos (25 cm instead of 24; women can have as much as 40-something centimeters of excess amniotic fluid and never know and everything be fine). The fact that our baby hadn’t taken a breath during the half-hour ultrasound that confirmed the poly was (or at least could be) considered not a cause for concern.

At around 6:30 p.m., we were led to the hospital where the baby and I would be monitored overnight, given a steroid shot, and monitored twice a week until we were due. It was all very standard and not a reason to be seriously worried. Within hours, Jude’s heart stopped and he couldn’t be saved.

The doctor on call and our nurses cried; they had no idea what happened. It didn’t make sense, this perfectly healthy woman with a perfectly health pregnancy to have suddenly lost her baby while she was being monitored (no less). Our efforts to save Jude (an emergency C-section) meant staying in the hospital for an additional few days during which time my regular OB came in to see us. She held me and cried with me and expressed her disbelief at our loss.

The months after Jude’s death yielded many sleepless nights of wondering and searching. I laid in bed surfing Safari on my iPhone looking for answers. There were none to be had; each of my suggestions for what might have happened were rejected due to medical evidence that they weren’t viable scenarios.

There was a slight possibility I had a C-Protein deficiency, which could cause blood clots, but even that was proven unlikely when a follow-up blood test (though I was already pregnant again) yielded negative results. Ultimately, I accepted what happened and stopped looking for answers.

 

Finding Answers Part 1: Pieces to the Puzzle

Fast forward to August of 2015. We were getting close to being able to find out the gender of our third baby. I looked at a photo on our refrigerator of Lillianne revealing Jude’s gender at the exact same time one year before and felt very sad. Jude and his sister (yes, our third baby is going to be a girl) are one day apart on their gestational timeline. Jude’s gestational due date was February 12; his C-section was scheduled for February 11, my mom’s birthday. This baby, Ocean Baby, as Lillianne has nicknamed her, is due on February 11; her C-section delivery will be scheduled for February 3. We didn’t intend to have these pregnancies mirror one another or to be so close.

One night as we approached the gender reveal, I decided to Google some right side pain that came and went. It was in the area of my liver, but I didn’t have any signs of liver or gall bladder problems. I searched “causes of polyhydraminos” and high blood pressure was listed as a culprit. I made a note to look more into it the following day and headed to bed.

Halfway down the hall, I remembered that I didn’t have high blood pressure; I have low blood pressure, something I only recently found out because I spent the first couple of weeks of what technically counted as my third pregnancy’s first month in the hospital with pasteurella from a cat bite, and the doctor’s and nurses were concerned. “Is your blood pressure usually really low?” I didn’t have a clue; I called my OB’s office as they’d been the last group of healthcare professionals to monitor my BP and yes –I did have low BP.

I began searching low BP and polyhydraminos and soon found limited yet important research that validated that low blood pressure can be a factor leading to stillbirth.

 

Finding Answers Part II: How Low Blood Pressure Plays a Role in Stillbirth

The more I researched, the more convinced I became that my low BP was a critical factor in Jude’s death. Australian researcher Jane Warland has done some of the more recent studies that shows a relationship between a patient’s low or borderline low diastolic pressure and stillbirth. Warland’s studies remove systolic pressure as an indicator of risk of stillbirth.

Specifically, Warland’s studies show that stillbirth is more likely among women with “borderline” low pressure, which is diastolic pressure between 60 and 70; anything lower is considered hypotensive or extremely hypotensive. Warland also conducts a mean arterial pressure (MAP) calculation in one of her studies that shows that a MAP of 83 or less has a much higher likelihood of an occurrence of stillbirth.

Unlike a typical MAP, Warland’s MAP places double emphasis on the diastolic pressure. Warland’s MAP is calculated as thus: [(2x diastolic) + systolic] / 3. Per an article by Warland, a MAP of less than 83 carries “almost double the risk of stillbirth.”

It took a week and $165 to get my medical records from my entire hospitalization with Jude. I recovered my BPs from my pregnancy with Lillianne as well from the doctor’s office. I contacted Warland. While she didn’t respond to my inquiry regarding my MAPs, all of which were lower than 83 (the highest was 81; the lowest was 64), she did state that the rationale for assuming a borderline woman was at a higher risk is because “I THINK that this is probably related to what happens during sleep. The woman who has borderline BP during the day probably has a significant drop when she sleeps where as if it is already low during the day, it physical can’t actually drop much lower during sleep.”

While I understand this logic, I also tend to think that having a low BP can be problematic given that the issue with having low BP is that there’s not enough pressure to push nutrient-rich oxygenated blood through the placenta and to the baby.

I do concur with Warland in that there are –and must be—a variety of factors present for low BP to be a contributor to stillbirth. Warland strongly believes that back sleeping versus left side sleeping can be detrimental particularly if the woman already has low BP. Importantly, in a follow-up communication, Warland stated, “So, in my research women with borderline BP were at twice the risk. Let’s say the background risk for stillbirth is 1:100; this means that if your BP is borderline, your risk would be 1:50. That still means that 49 of 50 women with borderline BP are going to have a perfectly happy baby. Similarly with sleeping on your back, the risk for stillbirth is approximately doubled. That still means 49 of 50 mums who lie on their back will get away with doing that. This is where the triple risk model comes in as it shows what might happen with a number of converging risk factors and a vulnerable baby.”

What I infer this to mean is that a stillbirth with variables related to low BP is the perfect storm. What I also interpret this to mean is that if you can try to address one or more of those variables, it could make a difference in fetal outcomes.

 

A Medical Theory of What Happened to Jude

Looking at my BPs with Lillianne and those with Jude, Lillianne should have been the baby at a double risk of stillbirth as all of my BPs with her were borderline. While Warland said, “I don’t think we have any evidence that less exercise puts you at risk,” I disagree. If a pregnant woman with high BP is discouraged from exercise because it elevates her pressure, than a woman with low BP should exercise to keep her blood moving. When I was expecting Lillianne, more out of vanity than anything, I ran or walked 5 to 7 days a week. In the third trimester, when running with the extra weight became harder, I started doing leg lifts with ankle weights to strengthen my muscles. I did this before bed every night for the majority of the third trimester.

With Jude, I’d never gotten back into shape; I walked some at the beginning of the pregnancy but after daylights savings time and when it got cold, I more or less stopped. I also started working more often at night, which meant I sat at a desk to work during the day and I sat to work at night. I was more or less sedentary. My BPs were what Warland’s research would classify as “hypotensive” or “extreme hypotensive”.

During my pregnancy with Jude, I wasn’t concerned about fitness. I also probably rolled onto my back during sleep more often than I should have; I’d been lulled into a false sense of security by the fact that many pregnancy advisories are overdramatized. For me, back sleeping during pregnancy is much more comfortable, so it happened sometimes. Whether or not that was a factor, we’ll never know.

My theory, which my high-risk specialist said had merit, is that Jude suffered from placental insufficiency and then failure. Placental insufficiency occurs during the late second and early third trimester. Typically, babies who suffer from placental insufficiency are small. Jude was born at a healthy 4 lb 2 oz; however, they don’t have to be (small).

I speculate that my low BP combined with other factors led to a diminished supply of oxygenated blood being pushed through the placenta over the course of several weeks. On December 25, Jude wasn’t moving as much; the following day, I was diagnosed with acute polyhydraminos and Jude didn’t take a breath on ultrasound.

Without oxygen, the brain cannot grow; with enough oxygen deprivation, the brain dies. If Jude had suffered from placental insufficiency, then this would explain why he still have a steady heartbeat when we went in for monitoring; it would also explain the slight polyhydraminos; he was neurologically no longer capable of breathing in the amniotic fluid critical for his development and survival. This is why, too, then, that within hours of being checked in for monitoring, Jude’s heart stopped.

 

Significance

Of course, this is all theory; even if we were able to prove beyond the shadow of a doubt that this is how Jude died, it would change nothing for my pregnancy with Jude’s little sister or any of his future siblings. Placental insufficiency isn’t visible; it’s only evident when the baby starts to show signs of troubled development.

No doctor is going to put a woman with low BP –even with BP as low as mine (my most recent was 80/50) on medication to raise BP.

Additionally, had I not had a loss, even if I presented this information to my doctors, they probably wouldn’t be very concerned as I don’t have any “trouble” signs of low BP. I don’t faint or get dizzy or have trouble concentrating. I do get headaches easily, and lately, I’ve noticed some tingling in my legs (occasionally) when I sit to work, but there’s no indication that being hypotensive causes me any distress. That’s not to say that it doesn’t; my BPs are definitely lower during pregnancy than normal.

So, all that we are doing is additional monitoring; I’m trying to walk at least 5 days a week, and I’ve started wearing compression socks to bed to keep my blood flow up at night. As I told my doctor, I realize that most of this is psychological; it helps me to feel like I’m in some modicum of control even though I recognize the reality of this predicament.

I allow myself to believe that there is nothing I could have done to help Jude; even if I’d been armed with more knowledge at the time, it’s highly likely we’d have had the same tragic and traumatic outcome. This, at the very least, means that I don’t blame myself or anyone else for what happened. On the other hand, it also means that I have no control over what happens with Ocean Baby, Jude’s sister. It’s a catch-22 of sorts because nothing changes…only the amount of knowledge that one has and that we now have a prospective theory of what happened to Jude.

Today marks 10 months since we lost Jude. He would have been 10 months old today. I don’t dwell on what he would have looked like or anything like that. I do think, sometimes, that he might be walking now and he’d be eating solids and following Lillianne around. I feel his presence all of the time; it’s like he’s just out of reach; he’s a warm shadow who stays close. I know he’s just beyond the veil and I know it will be a long time before I reach him. I know he knows I miss him, and even though I value every second of life here, I also appreciate that every second forward brings us closer.

 

Resource Links:

http://m.aje.oxfordjournals.org/content/153/7/642.full

https://books.google.com/books?id=5uB5DHPHwFwC&pg=PA205&lpg=PA205&dq=jane+warland+low+blood+pressure+stillbirth&source=bl&ots=LRR_f0YZIZ&sig=M4fAoawOtv5k8vONlZ6iLMWG_Q4&hl=en&sa=X&ved=0CCsQ6AEwA2oVChMIn-rP5enfxwIVCRceCh3T7QVk#v=onepage&q=jane%20warland%20low%20blood%20pressure%20stillbirth&f=false

http://www.starlegacyfoundation.org/files/Maternal%20Blood%20Pressure%20in%20Pregnancy%20and%20Stillbirth.PDF

http://starlegacyfoundation.org/wp-content/uploads/2012/09/Does-low-blood-pressure-increase-the-risk-of-stillbirth.pdf

http://www.biomedcentral.com/1471-2393/12/S1/A9

http://www.pubfacts.com/author/Jane+Warland

http://starlegacyfoundation.org/published-research/

http://lib.ajaums.ac.ir/booklist/American%20Journal%20of%20Obstetrics%20&%20Gynecology%20(%20AJOG%20)-Dec05.pdf