Thursday, October 14, 2010

When Hello Becomes Goodbye....

**Warning...this post is about pregnancy loss. I know this is an extremely sensitive topic, and I wanted you to be aware. But even the midwife has a story she needs to tell. Much love, Jennifer**

LM was a "hand me down" client, as I teasingly call them. Her midwife was leaving town for several months, and I was handed a stack of charts, with instructions on when visits were due, directions to different homes, and a wave goodbye. I gleefully made my rounds each week, checking growing bellies, charting vital signs and heart tones, and listening to the complaints, concerns, or questions - as the case may be - of each mama that I saw. LM was one of my favorites, if there really can be such a thing. She wasn't an incredibly expressive lady, but her glad smile every time I came always let me know that I was very welcome. We spent many a visit at her kitchen table, me asking questions and hearing all the latest family and gardening news, while trying not to spill on her chart any of the fresh blackberry pie I was eating. We made plans for her upcoming birth, making sure that all was in order.

One day, a Thursday, I made my usual rounds, and was told that her husband (HM) was going out of town on church business. LM wasn't worried at all, as she had been overdue with each of her previous nine children, and was only about 38 weeks at this point. I did my usual baby check, letting her listen to the heartbeat, watching her smile at the sound. I'm so glad I did. Before leaving, I made sure she had my number on hand so she could call if she needed anything while HM was gone. With a smile and a "See you next week on the usual day!" I was off.

Sunday evening in the middle of a church celebration, my phone rang, and I quickly answered as I do every time I see that particular "Amish-land" area code. I could barely hear her quiet voice over the hubbub in my background. "Hi, this is LM, and I think I'm in labor. I've been having contractions for a little while. No, I haven't been able to contact HM yet. I can't get his driver on the phone." I assured her I would be there soon, and that we would get to her intended place of birth, that being the out-of-town midwife's birthing room. In due time, we got settled in, the ticking clock the only noise in the empty house. I started the usual tasks of charting, checking vitals and heart tones, and the other little things we do to get mom comfortable and ready for birth.

She got up on the bed so I could examine her progress, and found her to be a little dilated, with the curious finding of the baby being a lot higher than it had been just three days before. The next moments are the ones that changed me forever. I got out my doppler and gel and began the routine check for heart tones. Nothing. I smiled, "The baby is hiding from me...I can't find the heartbeat yet!" I moved the probe here and there, struggling to breathe as my heart leaped in my throat, the most awful silence meeting our ears. I tried not to let the worry I was feeling be too apparent in my eyes. "Let me get more gel. I might not have enough on the probe." Still, nothing. Dreadful silence. Unnatural silence. Empty space not responding to the plea of my mind and heart at the moment - "Please baby, be ok. Please just be hiding. Please let my doppler be broken. God....?"

I questioned her about fetal movements. "Well, I think I felt it yesterday, but I know I haven't felt any movements today."

I looked in her eyes, seeing the mirror of my own fear and inner struggle, while our faces remained upbeat and stoic. "Let's go in to the hospital and see if they can find them. I'm a bit worried about your elevated blood pressure, too. We'll let them help us." She acquiesced, and we loaded up to go to the hospital. My mom, my faithful prayer warrior, was quickly updated as to what was going on. I made a phone call to my collaborating physician, and before long we had arrived, and were whisked straight to Labor and Delivery. More machines, more doppler gel, more professionals listening for that elusive sound. More silence. I watched, eyes wide with unshed tears, knowing that for now, it was about her, and she needed me to be strong. An ultrasound tech was called in, and I moved to the end of the bed where I could see the monitor. The wand slid smoothly all over LM's belly, the image of the baby showing up in the unusual form that ultrasounds present. Then the wand stopped, and I could see the immobile object at which it was aimed, and my mourning officially began with each slow type of her fingers - H E A R T.

Her husband still unreachable, we were given a room in which to labor, while the caring, loving nurses tried to make her comfortable, while doing all the usual procedures that hospital birthing requires. One thing about birth in the hospital is that it's noisy - the "whomp whomp whomp" of the fetal heart monitor is never ending, along with the odd assortment of pings and beeps from various machines. Not this time. Again, that silence.

I stood by her bed for the next long hours. I can't even remember just how many times the second hand went around the clock face. I felt helpless, missing the verbal tools I normally had in great supply. It was cruel to say, "You're doing'll see your baby soon!", or many of the other comforting things we murmer during labor. Every contraction brought a strong squeeze of my hand, and I didn't waver when her eyes sought mine in concentration. I'm here with you...I love you...I care...we're going to make it together. I don't know if those words came out of my mouth, or went straight from my heart to hers. I hardly know what I said. I do know what was not said. Through all of this, LM had remained calm, a few whispered phrases to me occasionally showing me the hurt that was welling up inside, but her outward demeanor was one of acceptance and duty - she knew she still had a job ahead of her, and that is what she focused on. She didn't cry, didn't panic, just...labored.

Soon, she was complete and was given the okay to push whenever she felt like it. The doctor gloved up and stood quietly by, just observing. No bright lights, no grand displays, just a word of reassurance every now and then. Soon, the top of the head was seen, then the head was born, and yet the doctor still didn't move. "You're doing just fine...a few more pushes and we'll be there." I watched as the baby oh, so slowly, was born, the doctor holding a basin for it to be born into, as the stillborn are extremely fragile and must be handled as little as possible. A perfectly beautiful baby girl with a cupid's-bow mouth came into view. Every part of me screamed silently against the proceedings. "No, it's not supposed to be this way! Hold her! Why is she so quiet? Birth isn't supposed to be about death..." Still that silence reigned. It's a silence that doesn't make sense.

Then a sound caught my ear and the silence was broken as her mama's face crumpled with grief. We reached for each other, and I held her as she mourned, sobbing for her baby, crying the hurt out. I could say nothing but, "I'm sorry...I love you...she's beautiful...I'm so sorry..." We stayed like that for a full 10 minutes, midwife and mama, holding each other, tears flowing, sharing grief too deep to name.

They took the baby - soon named Mary - away to be bathed and dressed. I found out later that they took pictures, too, just in case these Amish parents might decide they wanted one. She was brought back to LM for her to see and admire. Little Mary was born with Down's Syndrome compounded by numerous internal anomalies, and had apparently been sick for awhile, but there was no way to know that without the routine ultrasounds that are generally declined by the Plain communities. With great faith and resignation, LM looked at me and said with tears in her eyes, "I guess this was just God's will." It was almost posed as a question, one which I could only nod to, affirming her belief in the Father and his unsearchable ways.

The next hours are a blur from shock and sleep deprivation. At some point in the morning her husband arrived, distressed to have not been there. His face, when being shown his lifeless daughter for the first time, is one that lives on in my memory. Some things never leave you. Soon, more family arrived, hushed tones respecting the palpable sorrow. The hospital staff prepared the baby to be taken away by the funeral home. Did I really see that tiny form being wheeled away on a gurney, maroon cloth covering all, or is that a figment of my imagination, blurred by time and the inevitable forgetfulness that comes with stressful situations? No, I think it was real.

Oh, that silence, still ringing in my ears...

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

In another birthing room nearly 2 years later, LM lay quietly laboring. We passed smiles between us, our deep bond and friendship needing few words to communicate. I was proud to be her midwife again, this time being of her choosing. Our prenatal visits went much like before, with every milestone we passed being a blessed relief. She had felt much better this pregnancy. Although joyful to attend her again, every time I applied the doppler probe to her belly, a quick shot of fear would go through my heart, until the faithful "Ca-lunk ca-lunk ca-lunk" would echo through the room. Such wonderful sound. After a long, slow, tedious labor, she was finally able to push. Soon, the top of the head was seen, then the face, then the head was fully born. Midwife hands settled gently on the baby, helping guide its entrance into the world. Another shot of fear. A quick smile and a cheerful word to LM. "You're almost're doing great!" One more valiant push and a gorgeous baby boy with a head full of bright blond hair was born - lustily shouting his arrival. My tears of joy at the noise joined his protestations. This is what it's supposed to be. Noisy. Lungs filling up. Little hands reaching automatically. Mama hands meeting them in welcome.

A look of peace and joy passed between LM and me, knowing that all was well. Later, as I held him, adoring his tiny features, tears and laughter mingling together in a strange mix, I said to LM, "I think he looks like a Levi." She just smiled, admiring him with me, pleased and thankful.

I busied myself with the necessary paperwork, cleanup, footprinting, weighing, and assessing that comes with the postpartum period. I turned to see LM with a smile on her face, and getting a nod from her husband, said, "His name is Levi." I exclaimed with delight, feeling as happy as if they had named a child after ME! It was an honor for them to take my suggestion and make it a reality.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Sometimes hello becomes goodbye....then with a joyful noise becomes "hello" again. To all those who have loved, yet lost, your arms empty, your heart permanently missing a piece, I lovingly dedicate these words. May blessed time dull the ache, while you never let us forget the baby that remained unseen and unknown by an outside world. We care...we hear...we love you.


  1. very tragic. Can't imagine why they used a gurney to take away a newborn. I always hand carried to the morgue.

  2. This is such a beautiful tribute to a tiny little life. I lost my little baby at 9wks - I can't imagine how much worse the pain must be to bond with the little one, to feel her movements day after day, and then have to say good-bye.

  3. What a sad reality. Those whose lives are touched by loss can be a blessing and comfort to others who suffer it, though. If I were in LM's shoes, I would want you by my side as well. <3

  4. Thank you for sharing this..this was so moving. It is a glimpse of the heartbreak that a midwife can feel as well, and the support and love you gave to this Mother was so beautiful. And thank you so much for your caring words for those who have loved and yet lost.

  5. What a beautiful account of a sad but moving tribute. I haven't experienced the loss of a child but can only imagine how comforting it would have been to have someone as caring as you there beside them.

  6. Oh my... Only God knows why death is interwoven with life. Your story is very moving and I don't have words, only thoughts and feelings to dwell on...

  7. This was beautiful, Jennifer. I cried through well I remember that time & how extra special L is. Your words painted the agony of the soul so thoroughly. She might appreciate having your sensitive narrative one day. It's such a thoughtful tribute that captures what previously had no words. To me you embody the essence of all a midwife should be. I'm proud of you.