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.


  1. You can't blame yourself for trusting in your caregivers care. I know it is difficult not too. But the thing is now you know. You know what to do the 2nd time if you should and your post may just help someone else who doesn't know what to do in a similar situation. This is why I really like what our community is doing. We are educating one another while giving support.

  2. Maybe I can help take away some of the blame you put on your midwife.

    Your pregnancy with Caleb and mine with Aidan were similiar in some respects. I too had bleeding, every day, only mine started even earlier at 9 weeks. Looking back, I'm positive my water broke at 13 weeks and 5 days, only I thought it was the 'blood clot bleeding out' as per my Fetal Medicine Specialist (likely one of the best in the country). I went about the next few weeks thinking things would 'be okay'...but still passing blood (and now likely fluid) every day. Finally at 17 weeks I had the high risk pregnancy specialist do another ultrasound. They found a very abnormal placenta and minimal fluid volume. My ferning test was also negative. And there was absolutely nothing they could do. When it became clear that fluid volume was a big issue at 20 weeks, my husband and I even asked if they could do an amnio-infusion to try to replace the lost fluid. The high risk clinic I went to went so far as to ask people who were doing research on amnio infusions if they thought it would help, and they said there was almost no evidence that it could, or would. It might even cause me to go into labour.

    I agree with you that your midwife might have wanted to send you for an ultrasound in the weeks that you were bleeding in your second trimester. Bleeding in the 2nd trimester is considered very abnormal. But based on my own experience with high risk maternal and fetal medicine specialist (best in the country!)...there is shit all anyone (even the best specialists in the world) can do when your water breaks that early. My specialist also wouldn't admit me to the hospital prior to viability. They said I was at a lower risk of infection on bed rest at home and taking prophilatic antibiotics could encourage the over growth of things like yeast.

    So yeah...I don't know if this helps or not...but I just wanted you to know what a fetal medicine specialist might have said to you if you'd presented to them at 18 weeks with a ruptured amniotic sac. Maybe things would have been different if you'd had an ultrasound earlier to look for the source of the bleeding...but maybe not. Neither midwifes nor OBs are gods...sometimes bad things just happen and there is nothing anyone can do about it.

    But oh how I wish things were different, both for you and Caleb and for my Aidan.

  3. Emily, I rationally know that. They did admit me to the hospital for three says on IV antibiotics when my water had confirmed broken, though, and I always wonder if starting that two days earlier would have helped...or if getting a cerclage at 15 weeks or whenever would have prevented that whole thing from happening, period. But we can never know, which is both good and bad. :(

  4. I've tried playing the what-if game, and it's even worse than the blame game. I think the main thing to focus on from the "at the most" perspective is that your son spent every moment of his life loved and you did everything with his best interest in mind. "At the most", he was loved.

    I've gone to extremes of stupidity in the what-ifing... If I'd taken an extra round of stairs, perhaps they'd have been in different positions and the cord accident wouldn't have occurred was the one that drove home to me that I can never win with this game!

  5. Hi,
    i just came across your blog and my story sounds almost identical to yours..short story bleeding at 15 weeks, leaking amniotic fluid at 17 weeks no ultrasound til 18 weeks, lost all fluid at 18 weeks and delivered baby at 19 weeks 5 days. Just wondering how they diagnosed you with an incompetent cervix?, they chalked my loss up to a fluke.I blame myself for not being more insistant on having an ultrasound after the initial bleeding at 15 weeks, but I trusted my midwives. anyway thanks for telling your story

  6. Hi Devin! Do you have an email address? I can email you with some details. But pretty much it was just me...trying to diagnose myself. My doctor called it a fluke as well. I persisted and insisted on several tests (RPL panel, HSG, etc). Those all came back normal. A friend who had *true* incompetent cervix (i.e. they could see her cervix opened) led me to asking about it. If you click on "testing" and "transabdominal cerclage" in the "Topics" section on the right you can read about my all of that journey and deciding to move forward with that diagnosis.

  7. Hi ,
    my email is, thanks so much for your reply.