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.

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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 – 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