You’re in a hospital room, 26 weeks pregnant, having a scan. Your blood pressure is a little high, your baby is a little small, but you’ve felt the baby kick this morning and it’s sunny outside. You’re lying on the red-cushioned examination couch, the lighting is down, and in the dim glow you’re staring at that industrial square-tiled ceiling that has infiltrated hospitals and schools everywhere. The gel on your belly is cold, but the doctor’s hand guiding the probe is warm and the air conditioning unit on the wall behind you is blasting frigid air at the medical student sitting by your side, sparing you its icy attentions. At your right, a screen shows the constant monochrome metamorphosis of ultrasound, moving and shifting with the glide of the probe on your skin. A pager goes, and the smartly-dressed midwife sitting in the corner shoots you a smile as she walks out of the room to answer it. Fans on the ultrasound machine are whirring away and the doctor is taking measurements: the distance around your baby’s head, the length of it’s thigh bone. His suit jacket is over the back of his chair, sleeves rolled up, and his voice is gentle as he asks you when you last felt the baby move. It was a couple of hours ago, just after your partner left for work, and you tell him this. You look left at the medical student, who drops his eyes from the screen to dredge up a wan smile, awkward, sad, reflexive like he doesn’t know what expression to make. The probe on your belly is still, and you turn back to look at the doctor as he speaks again. The look in his eyes breaks your heart.
“I am so, so sorry.”
I wrote this reply to a comment below, but it got so long I figured I’d just put it into the post. Bear with me, this is long.
Basically the placenta, which is responsible for the supply of oxygen and nutrients to the baby, had failed to implant into the uterine wall deeply enough. As such, the blood flow to the baby was reduced, and although that was sufficient for the first 20-odd weeks of this lady’s pregnancy the demands of the baby kept growing beyond the capacity of the placenta. Mum’s high blood pressure was as a result of her body trying to improve placental blood flow by forcing more blood through the narrowed placental arteries, but unfortunately that was both insufficient and began to threaten Mum’s health.* It is also the reason her baby was small, as it didn’t have enough to continue to grow.
Sadly, what I didn’t mention above is that when we scanned the baby, the heart muscle was still trembling slightly. There was no question that the baby had died, but had we scanned her at the start of the list rather than at the end, the baby would likely still have been alive. Luckily, this didn’t happen – had the baby still been alive on scanning, it would have shown signs of difficulty and Mum would have had a crash C-section, with all the complications that carries, as well as delivering a foetus so tiny that it would fit in the palm of your hand. The chances of that baby surviving would be minute; the chances of it surviving without severe abnormality would have been nil. Likely, the baby would have been delivered and died within a fortnight, and Mum would be left with a classical C-section scar (which increases the risk of rupture of the uterus and placental problems in her next pregnancy, it’s not a cosmetic thing).
Mum had an induced labour the next day to deliver her baby. I didn’t go. She consented to have the baby and placenta examined to see whether there was some abnormality that would have been responsible for the death, and had a battery of tests herself to exclude a variety of things about which the obstetricians were concerned. Currently, the thinking is of an early presentation of pre-eclampsia, but without protein in the urine this is cast into doubt and there are any number of chromosomal abnormalities of the baby which would achieve the same result.
Problem with being an obstetrician is that you don’t get to see the healthy normal pregnancies. In the scan clinic I was in that morning, this was not the only tragedy. It was bruising, and once the clinic finished I promptly went home, wrote the above, and spent the rest of the day distancing myself from it as much as possible.
*In the event that there is a threat to Mum’s wellbeing in any pregnancy, maternal life takes precedent over that of the baby. Obviously, it’s usually not such a black-and-white clinical picture – there is often suffering or difficulty on behalf of the mum that is managed as best as possible until delivery, which solves the problem – but there are instances where the only recommendation the doctors can make is that the baby is either delivered early (can be very early, more common) or aborted (rare) in order to save the mother’s life.