The most common cause of maternal mortality worldwide is postpartum haemorrhage.
—
When I was a child, we were taken every Christmas to see a pantomime. I found these to be disturbing, hectic events: men in dresses, with balloon breasts, shouting like maniacs, children from the audience taken up on stage to stand there, tongue-tied and blinking, adults dressed as rabbits and hedgehogs hurling boiled sweets into the auditorium, heavy velvet curtains with gold frogging and then—most disquieting of all—a thick, flesh-coloured blind dropping down, emblazoned with the harrowing words FIRE CURTAIN.
I remember seeing a man shut a spangle-leotarded woman inside a box, her feather-adorned head protruding at one end and her tiny slippered feet at the other. He then proceeded to slice the box in half, the serrated teeth of the saw hacking and grinding as they slid further and further through the beautiful, gaudy girl.
What horrified me most, as a child, was that she smiled the whole time, her teeth bared towards us, lips drawn back, even when the man swung open the box to show us the severed vacancy that he—mad man, murderer, psychotic—had created while we just sat in our seats and gawped, inert as argon.
The leotard woman flashes through my mind as I lie there on the operating table, sliced open, ruptured, bleeding, my intestinal tract unravelled, on the wrong side of my skin. Whatever it is the surgeons are doing to me on the other side of the curtain is rough, violent, violating. I am not smiling. I am not wiggling my sequinned toes. I am being shunted up the table, bit by bit, until my head rests on the metal edge. I can feel hands rummaging through my innards, as far up as my ribs. Still the blood comes. I catch my first glimpse of the baby, my son, far away across the room, and his face is uncertain, anxious, his brow furrowed, as if he is not sure he likes what he sees (it is an expression I will catch on his face sometimes, even as a teenager). I say something like, bring him here, and he turns his eyes towards me, as if my voice is the only familiar thing for him in the room.
We have agreed, Will and I, that he will stay with the baby in any eventuality. Don’t let it out of your sight, I have exhorted him, late at night, when I have been worrying about the birth, about hospitals in general. I have read too many novels and watched too many films about babies swapped at birth, babies who weren’t issued with an identity bracelet.
My grandmother used to tell the story of how she was brought a baby to feed in hospital, and she knew it wasn’t hers. Of course it’s yours, the nurse had replied. But my grandmother was no pushover: she rose from her bed and went down the ward, checking each cubicle, until she’d located her baby, my future aunt, who had been given to another woman. Whatever happens, I’d said to Will, over and over again, you stay with the baby at all times.
He is keeping his promise. The problem is that I can’t see them any more. They seem to have been taken elsewhere, behind a screen or into another room. I am given more of whatever is in the drip and my head is hanging off the end of the table. I raise my hand. I’m not sure, now, what for. To call a halt? To say, enough? To say, help me, please?
Either way, what happens next is that the man in beige is suddenly there. He has stepped towards me, away from his wall, and he takes my raised hand. He enfolds it in both of his. I gaze up at him mutely. I had not known, until that moment, what a lonely experience it is to be in danger, in the middle of a room full of people who are frantically working to save your life. I am not prone to loneliness—I have always been someone who leans towards solitude—but my overwhelming sensation had been, until that moment, loneliness, isolation, bafflement. I was slipping away, alone, surrounded by people.
The man is wearing those spectacles that react to light so his eyes are hidden behind brown-tinted lenses. He has thick, wiry hair cut close to his head. More hair sprouts over the top of his surgical scrubs. He moves my hand so that it is curled around his wrist, and he places his other hand on top of it. His touch is infinitely gentle but firm and sure. There is no way he is letting go, he is telling me, entirely without words. He is going to stay right here and I am going to stay right here. I clutch at him with the force of a drowning woman. He nods, once, down at me and a grave, slow smile lifts above the edges of his surgical mask.
I wonder sometimes if I imagined him, if he was the figment of a panicking, threatened mind. He wasn’t, though. He was there, he was real.
Our interaction was entirely wordless. I don’t even know if he spoke English. He stayed with me while they stitched and stapled me together again; he took the weight of my head and shoulders as they lifted me from the operating table onto a gurney. He was there when they pushed me into a ward.
After that I lost sight of him. I was suddenly surrounded by nurses who were swabbing me down, rearranging drip-stands, asking about drugs, painkillers, transfusions. Someone brought in the baby.
Did the man see me reunited with my son? I hope so. When he took my hand he taught me something about the value of touch, the communicative power of the human hand. I didn’t know, as I lay there, that I would think of him many times in the years ahead. When my son lay on a hospital bed, age four, with the raging fever of meningitis, I reached through the bodies of the attending doctors and held his slack, heated hand in both of mine. When my youngest child disappeared beneath the waves of the Mediterranean Sea and I had to leap in, haul her out, turn her upside-down so that the water drained from her lungs. Then all she and I could do was sit on the sand, wrapped in towels, contemplating what had almost happened, her small fingers wrapped in mine. When my middle child had eczema so torturous it made her scream and writhe through the night, I would press my hands over hers to stop the scratching, to ease her back towards sleep.
The people who teach us something retain a particularly vivid place in our memories. I’d been a parent for about ten minutes when I met the man, but he taught me, with a small gesture, one of the most important things about the job: kindness, intuition, touch, and that sometimes you don’t even need words.
* * *
* Save the Children’s annual State of the World’s Mothers Report for 2015.
BABY AND BLOODSTREAM
2005
Credit 3
“It was nothing you did,” the nurse says. “It’s not your fault.”
I am silent. I had not thought it might be. I look again at the image of the baby on the screen. There it is. Sitting up in its dark cave, as if waiting for something, as if on best behaviour.
If I sit straight, it seems to be saying, no one will notice.
I know how it should be, how it should look: this is, after all, my second pregnancy. I know the heartbeat should be there, flashing and flashing like a siren. So when the radiologist says that he’s sorry, the baby is dead, I already know. But I carry on staring at the monitor because there is some frail, furled part of me that is hoping there has been a mistake, that the heartbeat might suddenly appear, that the scanning machine might roll further and there it will be.
I can’t look away from the screen, even when the radiologist starts talking again, even when they say I can get down from the bed and get dressed. I want to burn the image of that tiny, ghost-pale form into my retina. I want to remember it, to honour its existence, however short.
—
We are shown into a room. It is down a corridor and around a corner, away from the antenatal department, away from all the other women waiting for their scans.
This room has curtains. The chairs have cushions. There is a large, leather-covered book on a table and a sign above it says “Book of Remembrance.”
“The bad-news room,” Will mutters, as he stares out of the window, as he examines the charts on the wall. And I nod. I cannot stop crying, which is odd because I usually can, if I need to. I perch on the edge of a chair and tell myself I have to stop, I have to get myself under control, but I can’t. Will hands me a cushion, for some reason, and I take it. I hold it carefully, conscientiously, on my knee. It was nothing you did.
The nurse comes in.
She makes a show of shutting the door very gently, as if the noise might be too much for us.
“It’s what we call a missed miscarriage,” she says, “where the foetus has died but not come away.”
I nod again, several times, because I am still unable to speak. I think about how the phrase missed miscarriage must be hard to say. I wonder if the nurse has had to practise to say it so smoothly. It’s the kind of sound-pattern that would trip up a stammerer: those clusters of double consonants, the repeated i sound. I experience a transient, irrational relief that I never became an antenatal nurse, that I never went down that particular career path. Imagine the horror of stammering as you gave someone this news, of being suddenly unable to get out the words. I almost mention this to the nurse, almost compliment her on how well she pronounced the phrase, how seamlessly she said it. I arrive at the decision, just in time, that this probably isn’t appropriate.
She tells me I have three options. I can have a surgical removal, under general anaesthetic, I can go home and wait to see if things start naturally—
“That,” I say, lifting my head. “I’ll do that.”
—
Around one in five pregnancies ends in miscarriage; up to 75 per cent of these occur in the first trimester.* The risk of pregnancy loss, then, in the first twelve weeks is 15 per cent. One in a hundred women experience recurrent miscarriages; a third of women in the UK attending specialist clinics as a result of miscarriage are clinically depressed.
We all, I think, know these statistics, or at least have a vague sense of them. We know miscarriage is out there, at our backs, pursuing us, like Andrew Marvell’s wingéd chariot.
It’s why you’re not supposed to tell people you’re pregnant until you’ve passed the magic twelve-week point, until you come out of hospital clutching a monochrome sonogram picture. Only then can you inform your friends, your in-laws, your employers; only then can you go out and buy wire-less bras and stretchy tops; only then can you leave your antenatal vitamin bottles lying about the house with impunity; only then will you start getting calls from relatives, suggesting old family names, insisting that the daily drinking of Guinness is crucial for breastfeeding, offering knitted matinee jackets, stiff with age.
I’ve never understood the blanket secrecy you’re supposed to apply to early pregnancy. Certainly, I’ve never felt the need to broadcast the news far and wide, but it seems to me that pregnancy at any stage is significant, life-changing enough to warrant telling those closest to you. Even if something as devastating as pregnancy-loss happens, wouldn’t you want your close friends, your family to know? Who else would you turn to at such a time? How else do you explain the grief, the stunned pain on your face, the tears, the shock?
Because losing a baby, a foetus, an embryo, a child, a life, even at a very early stage, is a shock like no other. Intellectually, you know it’s a possibility: as soon as you get the line on a test stick, you look every day for the tell-tale sign of blood, you tell yourself it might happen, you tell yourself not to build things up, not to expect too much, to be sensible, rational, balanced. But you have never had a talent for those things and, besides, your biology, your body is singing a different song, a distracting, absorbing, joyous tune: your blood capacity rises, pulsing along your veins, your breasts swell, like dough, out of your bras, the muscle and capacity of your heart increases, your appetite hears the call, responds to demand, and you find yourself in the kitchen at midnight, contemplating crackers and fish paste, grapefruit and halloumi.
Your imagination keeps pace with your teeming body: you picture a girl, a boy, perhaps twins, because there are numerous twins in your family, both identical and fraternal—your own father is one. It will be blond, it will be dark, auburn, curly-haired. It will be tall, it will be petite. It will look like its father, you, its brother, a melange of all three. It will love painting, pole-vaulting, trains, cats, puddles, sandboxes, bikes, sticks, the building of towers. You will take it swimming, you will rake leaves and light bonfires, you will push it along the seafront, you will tuck it into the basket its brother used. You tell yourself not to be stupid enough to buy anything, but then you pass, in a shop, a knitted rabbit in soft blue wool, with a yellow ribbon and a startled, quizzical expression. You reverse, you hesitate, you pick it up. Quick, while no one is looking. You picture yourself placing this rabbit inside a hospital crib, for the child to look at. Of course you take it to the till and you hand over the money, hurriedly, furtively. You carry it home, you wrap it in tissue and you hide it at the bottom of a drawer. When you are alone, you take it out and look at it.
You leaf through name books and think: Sylvie, Astrid, Lachlan, Isaac, Rafael? Who will it be? Who will be coming?
When it happens—and it will happen to you, over the years, several times—the impact is like that of a wrecking ball. Each time you lie on the scanning couch, you will stare fixedly at the faces of the radiologists as they examine the image on the screen and you will learn to recognise the expression—a slight falling, a frown, a certain freighted hesitation—and you will know before they say anything that this one hasn’t made it either.
It will be hard, every time, not to listen to the internal accusations of incompetency. Your body has failed at this most natural of functions; you can’t even keep a foetus alive; you are useless; you are deficient as a mother, before you even were a mother.
Don’t listen to those bad fairies, you try to tell yourself. It was nothing you did.
For some reason, your body doesn’t follow the normal procedure (it fails even at this, the malicious whispers say—you can’t even miscarry a miscarriage). Your system doesn’t get the memo that it’s all over. Your hormones hurtle on. So, for you, there is never any blood, never any sign of foetal expiration at all. You find out only at a scan. You will walk around, feeling pregnant, looking pregnant, to all intents and purposes still pregnant, but the baby is dead. Sometimes your physiological inability to process the death of the foetus infuriates you, devastates you; at others it seems only apt, sane. Why give up, your body is saying, why let go, why accept this end?
So, after the terrible moment in the dark of the scanning room, you are always taken somewhere else, where you must wait for someone to come and speak with you about “what happens next.” Sometimes this is a reasonable place, like the bad-news room; at other times, not. Once, you are made to wait back where all the other women are queuing for their scans and they regard you, appalled and petrified, as you sit there with your teeth gritted, your hands clamped over your face. They are too scared to sit next to you, as if what you have is catching, so you are stranded alone on an entire bank of plastic chairs. On another occasion, you are shown into what you immediately realise is a labour suite: the bed is still rumpled, there are flecks of blood on the walls; the air is filled with the screams and exhortations, then the sudden new cries of birth. You sit there, disbelieving, listening to someone in the next-door room approach the climax of labour. You send an unhinged text message to your friend: No heartbeat, you write, and I’m being made to wait in, guess what, a labour suite. She texts back: Leave that room, walk out, I’m coming to get you.
You do walk out. The nurse tries to stop you but you don’t listen. You’ve been through this enough times to be fully aware of “what happens next.” As you take the stairs down, away from the scanning department, you feel the notion, the idea of the child leaving you with each step. You feel its fingers loosening, disentangling themselves from yours. You sense its corporeality disintegrating, becoming mist. Gone is the child with blond or dark or auburn hair; gone is the person they might have been, the children they themselves might have had. Gone is that particular coded mix of your and your husband’s genes. Gone is the little brother or sister you pictured for your son. Gone is the knitted rabbit, wrapped and ready in tissue paper, pushed to the back of a cupboard, because you cannot bring yourself to throw it out or give it away. Gone are your plans for and expectations of the next year of your life. Ins
tead of a baby, there will be no baby.
You must adjust to this new picture. You must give it all up. You must somehow get past the due date: you will dread its coming. On that day you will feel the emptiness of your body, your arms, your house. You must intercept the letters from the maternity unit that keep on coming, despite everything. You must pick them up off the mat, almost persuading yourself that you haven’t seen them, you don’t know what they are. You tear them into flitters and drop them into the bin.
You will watch your body backtrack, go into reverse, unpicking its work: the sickness recedes, your breasts shrink back, your abdomen flattens, your appetite disappears.
You will have the general anaesthetic, on the first occasion, and the foetus is removed from you while you are unconscious. After that, whenever it happens again, you admit yourself to hospital, take the drugs to induce expulsion, refuse painkillers, because somehow you want the pain, the discomfort, the ache, the searing cramps: it seems important to go through this, to experience these endings, these cleavings. Each time, you will insist on having the body of the foetus, on being able to take it home. This always seems to cause consternation, wherever you are, whichever city you are in. One doctor says you can’t have it because he “needs it.”
You stare at him for a moment, wondering, did he really say that or was it my imagination? “I need it,” you say.