Sarah DiGregorio - An Intimate History of Premature Birth

Of course, I went back to my office and looked it up. Like the extremely responsible Googler that I am, I skipped the many results for pregnancy message-board threads with subject lines like “Low PAPP-A, how worried should I be?????” and went straight for the scientific literature, all of which went something like this: “… associated with stillbirth, infant death, intrauterine growth restriction, preterm birth, and preeclampsia.” It was all associations, not causations: nothing certain, but nothing good.

I went outside to escape my cubicle. I stood in the middle of the sidewalk, buffeted by bodies. In midtown Manhattan, there’s nowhere good to cry, so I balanced on a fire hydrant and sobbed. Two months earlier I had had a miscarriage at ten weeks and a painful dilation-and-extraction procedure to remove the dead fetus from my uterus, which seemed inclined to not give up. I sat up from the stirrups, noticed that my socks were splattered with a horror movie’s worth of blood, and started to understand in a bone-deep way that having a child was not going to be easy. I couldn’t imagine losing another one. But then, no one can.

At my next obstetrician appointment, my preferred OB, Dr. M., was away. The doctor covering for her wanted to talk about our risk for Down syndrome. It was odd, because although that blood serum test, the one that indicated low PAPP-A, can be used to assess a risk of a chromosomal abnormalities, I had also had a fetal DNA test, which identifies conditions like Down syndrome with better accuracy. The DNA had come back normal—“Normal female,” to be exact. (I was surprised how blissed out I was at the news that the baby was a girl.) Nevertheless, the doctor went over the fact that low PAPP-A is associated with chromosomal problems, even though, as far as I could tell, we knew that outcome wasn’t at all likely. I opted not to have an amniocentesis, which would have definitively ruled out a chromosomal syndrome, but which also carries a small risk of miscarriage. As for the other worries—the intrauterine growth restriction (IUGR), the preterm birth, stillbirth—I wasn’t able to extract any meaningful information. “I’ve had lots of patients with low PAPP-A who went on to have healthy, full-term babies,” the doctor said. “We’re going to monitor growth after twenty-four weeks. Try not to worry.”

SHE MEANT IT. It was only one ominous test result, and there was no other indication that anything was amiss. But what I didn’t know then was that when doctors kept saying, “Don’t worry,” they really meant two things: One, there probably really was nothing to worry about. Two, there was no point in worrying, because there was no treatment, no preventative, for what might happen. For what was about to happen. Not worrying was the best we could do. But I couldn’t manage it.

The weeks ticked by slowly: 14, 15, 16, 17, 18. Those stupid apps: Your baby is the size of a nectarine, an avocado, a pear, a sweet potato, a mango. At least, you hope she is. I tried not to worry. From about week 10 on, I had migraines that lasted days—or, rather, it seemed to be one long migraine that occasionally let up for a couple of hours. I wore sunglasses at work to look at my computer and strapped ice packs around my forehead. I dreamed of the day that I’d be able to take fistfuls of Advil again. But I also loved being pregnant. I loved the slippery flutters when I began to feel Mira move. I loved thinking about having a girl, the idea that I’d get to have another mother-daughter relationship, since my own mother died when I was in college. I thought about the books we’d read together. And I loved eating for two.

At the time, I was a food editor at Food & Wine magazine. My favorite selfish pleasure took on a comfortably virtuous cast. It was all for the baby! I drank blueberry-kale smoothies for breakfast and snacked on fat salted cashews. At work I tasted everything the test kitchen churned out: lamb tagine and coconut cake, bitter escarole salad and spiced black-eyed peas. Buttery rolls, homemade croissants. Fried oysters, roasted broccoli, and seafood gumbo. I thought of everything I ate as an experience she and I were having together. I imagined my fetus fat and happy, smacking her tiny lips, perfectly nourished, and destined to be an adventurous eater.

My husband, Amol, and I met in college. We are both only children who were raised in small-town Massachusetts. On our first date we talked for hours about the Red Sox and our early childhood memories of the 1986 World Series heartbreaker. We laughed a lot. It seemed like we were best friends the moment we met. He sustained me through my mother’s illness and early death and my father’s protracted struggle with both mental and physical illnesses.

We had been undecided on having a baby until we weren’t. We always had so much fun together, and suddenly it seemed so obvious that we should say yes . And when I was pregnant the first time, before the miscarriage, we were both giddy, and surprised to be giddy. I knew quite well that more love inevitably meant more vulnerability and sadness, too. But I wanted to be brave enough for all of it—brave enough to be someone’s mother.

At 20 weeks Mira was in the 23rd percentile for size and everything looked fine. At 24 weeks she had fallen into the 13th percentile. It wasn’t good news—falling off her growth curve could presage a problem with the placenta, which was the thing we were dreading—but it wasn’t catastrophic, either. So we waited and tried not to worry.

“I think she’s had a growth spurt,” I said to Amol on our way to our 28-week scan. It was uncharacteristically optimistic of me, and also incorrect. As soon as the wand hit my belly, I could tell by the ultrasound tech’s face that the news was not good. It was November 26 and I was due February 16. The tech disappeared to talk to the doctor.

“She’s not growing,” I said.

“Don’t jump to conclusions,” Amol said. “We don’t know anything yet.” I did, though.

We were ushered into another office, another lacquered desk, another doctor. Mira had indeed stopped growing entirely. She was below the first percentile; she was off the charts. She was approximately the size of a 26-week fetus. She was going to have to come early. How early was not clear. We had to go to the hospital. I had to get a steroid shot. I could not go back to work. (“What do you mean I can’t go back to work?” I heard myself say. “I have to go back to work.”) I could not so much as go for a walk.

We caught a cab to the NYU Langone medical center. On the way I called my cousin, who is a high-risk obstetrician. “How many weeks?” she asked. Twenty-eight and one day. “How many grams are they estimating?” Eight hundred. There was a long pause. “Okay,” she said. “Okay. You need the steroid shot.”

We had to go up to labor and delivery. We stood in silence, waiting for the elevator, until I realized I was no longer supposed to be standing whenever I could help it. I sat on a bench. “Nothing’s going to be normal now,” I said.

“Here we go, chicken,” said a nurse, jabbing an industrial-sized needle into my thigh. That was steroid shot number one. A fetal heart monitor on a thick belt was strapped around my less-than-impressive belly. Mira’s heart rate was decelerating, speeding up again, and then decelerating again, so they admitted me. I signed a consent for an emergency C-section, but it wasn’t clear when it would happen. A nurse came in and said they needed to start a magnesium drip, which would help protect Mira’s brain if she came soon. Amol ran out for a sandwich and the nurse hooked up the bag to my IV. Seeing that my husband was gone, she made some excuse to stay in my room and do paperwork while the magnesium started up. Suddenly I felt like I was burning up from the inside out. I couldn’t catch my breath. “I think I’m allergic to this,” I said to the nurse. She disappeared and came back with a resident, who checked me. I was fine. “It’s just the mag, honey,” said the nurse. “It makes you feel like that.” It was a twelve-hour course; I sweated and tossed through the night.