As a midwife, I spend half my time working with gynecological patients- doing pap smears, checking for STDs and infections and prescribing birth control. The other half of my job I am working with pregnant women during their prenatal appointments and catching their babies. I’d say 95% of my job is happy. I help people- curing their infections, attending births. But there is a darker side. People think of midwives catching babies all the time, being an integral part of a memorable and joyful time in a family’s life. We also help them through hard times.
Stillbirth. The word I fear most in obstetrics. Miscarriage is heartbreaking. I’ve cried with patients when they miscarry in the first trimester. Stillbirth has no words.
For some clarity, pregnancy loss is classified depending on gestational age. Miscarriage is used during the first and second trimester. Sometimes second trimester loss is referred to as late miscarriage or mid-trimester loss. Once the fetus is viable, or can theoretically survive outside the womb, traditionally 24 week (though arguably as early as 20 weeks these days), loss is called stillbirth.
Stillbirth is uncommon. Happens in less than 1% of pregnancies. But the effect is so huge, that those of us in the field can’t help but worry about it for our patients. There are several factor that can increase the risk- age of 40, morbid obesity, history of stillbirth, uncontrolled diabetes, clotting disorders and chromosomal abnormalities, to name a few.
So here I am, with a prenatal diagnosis of Down Syndrome and a risk for loss. It was the reason I opted for testing- wanting to know my risk (more concerned about trisomy 18, where the risk is 50%). It was the first question I asked the genetic counselor after the diagnosis- what is the risk of loss? The numbers I have are 20% in the second trimester and 12% in the third. These are general numbers- they aren’t broken down by week or by other conditions babies with Down Syndrome face, like growth restriction and major birth defects.
I feel like everyday I am facing my worst fear.
In the beginning, my sadness was palpable. I would cry frequently. I worried about telling people I was pregnant. I borrowed a doptone from a friend to check for a heartbeat. I didn’t want any baby stuff like ultrasound pictures or early baby gifts around, in case I lost the baby and then would be reminded.
I know I have no control over the risk, but a part of me thinks if I can just let the universe know I am so happy to pregnant and I will love this child, maybe I’ll get to meet him or her. If I’m good to the universe, it’ll be good to me. I’m hesitant to complain about the pregnancy because I’m afraid somehow karma will come and take it all away.
There is no easy way to handle this fear. Stay optimistic. Just don’t think about it. Meditate. Distract. There’s nothing that takes the fear away completely. It’s a little easier now that I’ve had ultrasounds with good news, now that I look a little pregnant and now that I feel movement. It makes it more real. I can’t pretend I’m not pregnant- I have to accept it and pretend everything will be fine! If I act that way, sometimes I begin to think that way. And it’s a lot more enjoyable being pregnant, surrounded by pregnant women, to think everything will be fine.