*Eudora Koh is a local mom who just recently brought her rainbow baby into the world. In this post she graciously shares her experience with pregnancy after loss.
When I saw a positive result on a pregnancy test in September 2020, all sorts of emotion filled me: I was happy and excited that we would have another chance at bringing a baby into this world. But at the same time, I felt nervous and worried because we had already experienced the worst outcome of losing our first baby earlier that year in January 2020.
Loss, grief and heartbreak were already part of my reality so who was to say it couldn’t happen again. Those kinds of negative thoughts occasionally crossed my mind throughout my second pregnancy and will likely cross my mind for any subsequent pregnancies in the future, something I’ve accepted. I found myself worried, panicked, and unable to focus leading up to any appointments. At every midwife appointment, ultrasound scan, listen on the doppler, I was a nervous wreck. To help manage my anxiety, I had regular appointments with a psychiatrist and counsellor, both from the Reproductive Mental Health program at BC Women’s. It always made me feel better to talk to someone and share with them my fears of losing another baby and how that impacted my emotions and mental health during this subsequent pregnancy.
It wasn’t until further along that I gave myself permission to be excited at the thought of welcoming our baby into the world. But it’s not as simple as it sounds. I waited until I was around 33 weeks before I really felt like I was able to be more open about my excitement.
Unexpected Complications and a 60-Day Hospital Stay
24 weeks into my first pregnancy on January 31, 2020, we lost Joen, our first born baby who was born still. We were told the devastating news that he no longer had a heartbeat and there was no reason why. Life can be so cruel. Naturally, I was holding my breath as I approached 24 weeks this time around. Knowing our history with stillbirth and loss, my OB booked an ultrasound for me at 24 weeks (January 28, 2021), just to help give me peace of mind that everything was okay with this baby – and thankfully he was, based on the ultrasound. But something else was revealed from the scan: my cervix was dilated 3cm, which presented a risk of pre-term labour and a baby who was born too early - I was only 24 weeks pregnant. In the medical world, they call this an “incompetent cervix”, which I think is such an inappropriate term, but that’s besides the point. The confirmation of my dilated cervix set off alarms for the ultrasound tech who demanded that I not get up because I was to be transported to the hospital right away. James was waiting outside due to COVID-19 protocols, so I was alone in the room. In between heavy sobbing, I called James and told him that I had to be transported to BC Women’s. In those moments, my heart was racing, and I was brought back to my first pregnancy at 24 weeks when I was told Joen no longer had a heartbeat. I was terrified.
Before I even had time to process what was happening, I was carried out of the ultrasound clinic in a stretcher and then transported in an ambulance to BC Women’s, where I was met by my midwife and the OB on call. They explained what it meant to have a dilated cervix this early in the pregnancy and what my options were at that point. The biggest fear for everyone was a very premature and small baby arriving early who would require a lot of life support. It was too soon. The OB said they could try to perform a procedure called a cerclage, which meant stitching my cervix closed, almost like a draw string. If successful, the stitch would be removed at around 36 weeks. However, like any operation there were risks too. The risk being that they could rupture my membranes (break the water essentially) and that would potentially put me into labour sooner than anyone would like. I was so scared and wanted to do any and everything to keep this baby in for as long as possible, so I opted for the operation. I was prepared for the OR – I was given epidural so I was numb from my shoulder down. As my body was poked and probed, all I could think of in my head was “why is this happening” and again was brought back to the horror of losing Joen almost exactly one year ago. There were lots of people in the OR; three OBs, a couple of anaesthesiologists, some nurses and me on an operating table, head tilted down, and legs exposed for the procedure to be performed. My midwife was right next to me, talking to me and calming me down, and I had an airpod in one of my ears that was playing classical and calming music. Unfortunately, James had to anxiously wait outside of the OR for updates on how the procedure was going. In my numbed and drowsy state (as a side effect of the epidural), I told myself I was ready to be stitched up. But to my disappointment, one of the OBs told me that as they were about to perform the cerclage stitch, all three doctors decided that the risk was too high in breaking my waters, something they wanted to steer clear of. Because my cervix was already dilated, the membranes were exposed, making them more vulnerable to rupturing. So all three OBs made a collective decision not to go through with the procedure. Even in my drowsy and drugged up state, I was so upset I wanted to cry. I thought I could get the stitch and not have to worry about a baby arriving too early and needing support from the NICU. But very quickly this became my reality.
After the failed attempt at a cerclage, I would spend the next 60 days at BC Women’s antepartum unit, Evergreen, as an inpatient so my body and my baby could be closely monitored. From January 28 to March 29, I was given strict orders to be on bed rest, which then transitioned to modified bed rest and light activity. For two weeks I was asked to be in Trendelenburg position (where the body is tilted to head is closer to ground than legs) to alleviate any pressure off my pelvis and cervix. Three times a day, a nurse would listen to the baby’s heartbeat, take my blood pressure and take my temperature. Once a day at 10pm, I would be given an anticoagulant, administered by injection, to prevent blood clotting since I was on bed rest and had limited movement. Three times a week I had non-stress tests to make sure the baby’s heartbeat was looking good. Every two weeks I had a detailed ultrasound to monitor the baby’s measurements and growth. I took antibiotics three times a day for a week to help prevent infection of the exposed membranes. I had two steroid shots to help my baby’s lungs develop in case he came early. I was given stool softeners every day to help with bowel movements because I wasn’t getting the chance to move around while I was on bed rest. When I was first admitted to Evergreen, the nurses, doctors and specialists anticipated that I would go into labour within 48 hours to a week, the typical statistics for someone who is dilated. We even saw some NICU doctors who prepared us for what it would look like to have a baby at 24/25 weeks. The statistics and numbers we saw were horrifying and shook us to our core with fear. But against all odds, my condition remained unchanged, and I remained stable for 60 days. At 33 weeks pregnant, my OB decided it was safe for me to be discharged and spend the remainder of my pregnancy at home with limited exercise and activity until I was at least full term, or 37 weeks pregnant.
To say this unexpected complication took a toll on my mental health is an understatement. Right from the start I was already on edge with fear, worry and anxiety and a risk of preterm labour exacerbated those feelings. I wanted so badly for this pregnancy to be boring and uneventful – but there were other plans for us; a plot twist in our story, as one of my friends put it. Every day of the pregnancy counted, and every day mattered, as it allowed our baby to continue growing, developing and getting stronger. After our loss last year, I learned about resilience and strength. Add to that a pregnancy that was at one point deemed “high-risk” and my resilience and strength were tested once again and taken to the next level. I told myself I had no other option but to be strong and trust that me and our baby would be okay. I chose to see the silver lining that our baby was receiving so much additional monitoring he otherwise wouldn’t have received. And for a mother who has suffered a previous loss, this was reassuring and very welcome. With prayer, hope and a village of support from our family and friends, we made it through our two-month hospital stay – one that was made even more challenging due to COVID-19 protocols prohibiting any additional visitors besides James (my one support person) to come into the hospital and see me.
Trusting and Honouring My Body
Over the past couple of months, I’ve had the time to think about my situation and what happened earlier this year. And the way I see it, as unexpected as this complication was in my pregnancy, my body didn’t fail me; on the contrary, it did what it needed to do to stay strong and keep our baby in. Even with a dilated cervix, I remained pregnant beyond the 60-day hospital stay and all the way to 38 weeks and 5 days. Instead of being induced, which was part of the original plan once I was discharged, I decided to trust and honour my body because it got me so far already - I’m so glad I made that decision. One day after the day I was supposed to be medically induced, I went into spontaneous labour (May 8, 2021) and Jonah Levi Lao arrived in my arms, alive, healthy and crying (I don’t know who was crying more, him or I) after four hours of labour. What started off as a high-risk pregnancy ended up being a low-risk one with a birth that was as smooth and straightforward. I am so thankful.
I’ve accepted that my journey to parenting a baby earth side was meant to be eventful with twists, turns and a loss that allowed us to never lose sight of what mattered most in life. Maybe everything I’ve experienced over the past year and a half has given me this perspective. Without Joen, I wouldn’t be the person, or mother I am today, and I have him to thank for that and so much more.
Even though pregnancy loss and grieving are part of my journey to parenthood, hope, positivity, love and joy are also part of that same journey. I believe that joy and sorrow can coexist like they do in my life. I hope my story about pregnancy after loss will give others even just a little more courage and strength to keep on going through whatever struggle they might be facing, pregnancy related or not. The reality is, you can only control so much in life and from my experience, sometimes you just have to surrender, focus on what you can control like how you respond, and hope for the best. Our journey to meet Jonah was not as smooth as I hoped for, but he’s here, safe, healthy and happy and we will forever be grateful for this outcome and end to this chapter in our story.