Sarah DiGregorio - An Intimate History of Premature Birth

So there I was, sweaty and confused, when, early the next morning, a neonatology fellow dispatched from the NICU came in to tell us what to expect when you’re expecting a premature baby. At that point no one knew if I would need to deliver in hours, days, or weeks, but there seemed to be no hope of getting to term. Mira was diagnosed with severe intrauterine growth restriction as a result of “unexplained placental insufficiency,” a fancy way of saying that no one knew why the placenta was shutting down. I was not providing her with enough nutrition to grow. Soon I might also deprive her of oxygen. I was a well-fed food editor, and my fetus was starving.

The doctor perched awkwardly by the bed and vomited up a litany of potential complications that arise from being born too soon. Bleeding in the brain, holes in the heart, butterfly-wing lungs that struggled to inflate, intestines that died while the baby still lived, blindness, loss of IQ, attention issues, disabilities of all sorts, infection, cerebral palsy, death. He said we had roughly a 50-50 chance of getting out of this without a disability of some kind. Did we have any questions?

It was the first real information I had about prematurity, and I felt like I was drowning. I remembered that a pregnancy book I was reading had said that a 28-week baby has a 90 percent chance of survival—so I asked: Was that right? The doctor blinked. “Well, no, because she’s so small, more like the size of a 26-weeker, and because she’s been so stressed in utero, her odds of survival will be somewhere between a 26- and 28-weeker.” What did that mean? Eighty-five percent? Eighty-eight? I didn’t know, but I didn’t ask again.

“But,” he went on, brightening, “premature girls tend to do better than boys. And African Americans tend to do better than whites.” Amol and I took this in. (The evidence that black babies tend to fare better than others is actually mixed and not at all conclusive; on the other hand, there is new evidence that black and Latinx babies are more likely to get inferior NICU care.) “What about half-white, half-Indian girls,” I asked. “Does she get a little bump for being biracial?” No one laughed.

It was Thanksgiving Day, and I had gotten two steroid shots and the course of magnesium. Mira’s heart rate had steadied, so after scans upon scans that showed the umbilical vessels were still working to keep Mira in oxygen, the doctors decided they could discharge me home. The goal was to stay pregnant for as long as possible. My obstetrician, Dr. M., whom I loved, said the goal was 32 weeks. But the goal was also to keep Mira alive, and the two aims were not necessarily compatible. At some point—no one knew exactly when—my placenta, which I imagined as a beat-up old car, chugging along, belching smoke, would simply stop working, and she would suffocate and die. The high-wire act was to keep Mira inside until the last possible moment and then get her out. So they sent me home, but I needed to be on bed rest and I had to count kicks. If I couldn’t feel Mira moving, I had to come back to the hospital immediately.

For the two days that we were home, I lay on the couch and Mira moved more than she ever had before. She flipped and flopped. I allowed myself to imagine that everything might be okay. And then on Sunday, November 30, she just stopped. Amol was at Ikea, in a frenzy of baby-room buying and assembling. I ate a cookie and drank a glass of juice, because a sugar rush supposedly wakes a sleeping fetus. I moved around and tried to rouse her. “No kicks,” I texted Amol. “Fuck,” he texted back.

Back we went, through the Brooklyn-Battery Tunnel, up the FDR Drive, to the hospital, a drive that would soon be too familiar. I was weirdly calm, which is not like me. Amol looked nervous, which is not like him. After we parked the car, he was half jogging to get inside the hospital, and I said, “I don’t think it’s an emergency .” He gave me a funny look.

Back up to labor and delivery. A nurse behind a desk. “I’m 28 weeks and I’m not in labor,” I announced. “So, why are you here?” she asked. “Oh, no fetal movement and IUGR,” I said. They put me in a bed behind a curtain. The woman on the other side of the curtain was in made-for-TV labor, panting and moaning.

On ultrasound, Mira’s heart was still beating, but that was the only sign of life. She wasn’t moving; her tiny hands were slack. Her heart rate was completely steady—ominous, because heart rates are supposed to be variable; it’s a sign that the central nervous system is active. It was, I later learned, a category III fetal heart rate tracing, which necessitates delivery. It means death or brain damage is an imminent risk; there is no category IV.

The obstetrics resident asked for a second opinion, and another, older doctor with a formidably serious countenance came in, looked at the heart rate tracing, took control of the gel-slicked wand, and stared at the motionless fetus on the monitor for a moment. There was no choice presented, for which I am grateful, because I could not really grasp what was happening. Being born nearly 12 weeks early is bad, but being stillborn is worse. The doctor turned to me and said, “Things are going to happen very fast now.”

I lay back and covered my eyes with my hands. “Now?” I asked. “Right now?” A nurse was already taking my clothes off, putting a gown on me, finding a vein for an IV.

And just like that, I was swiftly wheeled toward an operating room with what seemed like dozens of doctors and nurses trotting along beside. Dr. M. was on call, and she came quickly down the hallway. “What’s the presentation?” she asked. “Transverse,” someone else said. Amol said later that it was like being in a car crash: the cold clutch of fear, the way time seems to slow in a sickening, unnatural way. A nurse pulled him aside; he’d have to wait outside the operating room while they set up; he needed to put on scrubs.

Someone warned me that they might not have time for an epidural—they were still looking for an anesthesiologist—in which case they’d just put me under. But as we got to the operating room, an anesthesiologist appeared out of nowhere and said he could do it. A nurse let me put my arms around her as he threaded the needle into my spinal column.

I was half crying into an oxygen mask that had been hastily strapped over my face. The oxygen was for Mira’s benefit; she was perfectly still deep inside me. I lay back and my bottom half went heavy. Amol was still outside. “If something happens to me, can you tell my husband I love him?” I asked a nurse. “Oh, honey, we’re worried about your baby, not you,” she replied. I had a twist of shame. I knew that. But it was hard for me to tell the difference between us, to locate the threat of death, our bodies still knotted together.

“Incision!” said Dr. M. A few minutes of tugging later she called out, “It’s a girl!”—which felt like a gift, a moment to pretend. The neonatal team snatched her up. Silence.

I found out later that there had been nineteen clinicians there in the operating room, and for a while all I could hear was a low murmur of voices, a shuffling of feet. There was Dr. M., beyond the blue curtain, rummaging around in my empty uterus. There was the blinding flare of the lights above. There was Amol, wide-eyed and mute in his blue scrubs and hair net, sitting next to me. There was the neonatal team, huddled around a warmer. “Is she alive?” I asked the silence. “Yeah, they’re working on her,” said a nurse. It wasn’t quite an answer. Someone pulled the oxygen mask off my face.

Mira’s medical record tells me that the cord was wrapped around her torso and neck and the amniotic fluid was stained with meconium. The cord was cut and she was immediately handed to the NICU team and brought to a warmer. “Limp, no spontaneous breaths,” reports the record. She was blue. “Stim [stimulated] and dried but no improvement,” it goes on. “PPV [positive pressure ventilation] started. Intubated in delivery room.”