Wednesday, February 9, 2011

Blame Game

Last year, on April 5, I was 18 weeks and 3 days pregnant.  Late that night, I felt a sensation like a water balloon popping and a gush of blood. I was sure my water had broken. First thing in the morning, I went to the midwife's office. The baby's heart was beating away, loud and clear.  She gave me a fern test, which tests for amniotic fluid. It came back negative. My big anatomy ultrasound was scheduled for 20 weeks exactly; she decided to move it up a week - three days from then.

Two days later, my water broke for sure. This time it was clear, and I immediately went to the ER.

Five days after that, Caleb was born.

I'd had very minor spotting at the beginning of the pregnancy, but around 15 or 16 weeks it picked up, and there was bleeding to some degree nearly every day.  I learned later that bleeding like that can be a very typical symptom of cervical changes. I also learned later that the fern test isn't accurate when accompanied by blood and the blood can obscure the amniotic fluid, giving a false negative.

I question everything.  I blame myself, but I trusted my caregivers. I thought they would take care of me and my baby.

Why didn't the midwife tell me, after I'd gone in several times for bleeding, that I wasn't a candidate for midwifery care anymore?  Why didn't I get an ultrasound to look for the source of that bleeding? Why didn't she know that the presence of blood could give a false negative on a ferning test? Why didn't she order an ultrasound immediately upon my coming in with the concern that my water had broken?  In retrospect, waiting three days was completely insane. But I trusted her when she said everything was okay.  Why didn't she consult with one of the doctors at that point?  The midwife practice I was seeing was in a hospital, and shared office space, staff, and the L&D area with both the regular OBs and the high-risk doctors. Why didn't I insist on a second opinion??

I'm convinced that my water broke that first time, and that it broke a second time two days later (the bag can reseal, temporarily or permanently, after breaking). 

If I'd gotten an ultrasound at 15 weeks when I started bleeding, would they have discovered that my cervix was shortening?  Would I have gotten a cerclage at that point? Would that have saved Caleb?

If she'd used ultrasound to check on my fluid levels instead of using a ferning test, would she have discovered that my water had broken 48 hours before it broke "for real"? Would I have been admitted to the hospital at that point, given antibiotics earlier, gone on bedrest earlier?  Would the bag of waters resealed and stayed resealed?  Would that have saved Caleb?

We'll never know if different care would have changed the outcome.  Maybe it would have been the same and he would have died no matter what we did.  But maybe he would have had a chance if I'd been more knowledgeable; if she'd have been more aggressive.

I still believe in the standard of care that most midwives provide for low-risk, uncomplicated pregnancies and births.  I do believe that when I started bleeding at 15 weeks, the midwife should have bowed out of my care.  I do believe that when I was sure my water broke at 18 weeks, she should have bowed out of my care.  I don't blame midwives in general.  I'm not even sure I blame her specifically. I should have spoken up. I should have insisted on an ultrasound. I should have asked for a second opinion. I didn't.  At the least, we share blame. At the most, as his mother, the blame falls on me for not protecting him.

The what-ifs in do nothing but frustrate and sadden me, so I try not to think about them too much.

But please. Be an advocate for yourself and your baby. If something doesn't feel right or you don't feel like the care you are receiving is enough, speak up. Your baby's life may depend on it.