An Intimate History of Premature Birth. Sarah DiGregorio
for size and everything looked fine. At 24 weeks she had fallen into the 13th percentile. It wasn’t good news—falling off her growth curve could presage a problem with the placenta, which was the thing we were dreading—but it wasn’t catastrophic, either. So we waited and tried not to worry.
“I think she’s had a growth spurt,” I said to Amol on our way to our 28-week scan. It was uncharacteristically optimistic of me, and also incorrect. As soon as the wand hit my belly, I could tell by the ultrasound tech’s face that the news was not good. It was November 26 and I was due February 16. The tech disappeared to talk to the doctor.
“She’s not growing,” I said.
“Don’t jump to conclusions,” Amol said. “We don’t know anything yet.” I did, though.
We were ushered into another office, another lacquered desk, another doctor. Mira had indeed stopped growing entirely. She was below the first percentile; she was off the charts. She was approximately the size of a 26-week fetus. She was going to have to come early. How early was not clear. We had to go to the hospital. I had to get a steroid shot. I could not go back to work. (“What do you mean I can’t go back to work?” I heard myself say. “I have to go back to work.”) I could not so much as go for a walk.
We caught a cab to the NYU Langone medical center. On the way I called my cousin, who is a high-risk obstetrician. “How many weeks?” she asked. Twenty-eight and one day. “How many grams are they estimating?” Eight hundred. There was a long pause. “Okay,” she said. “Okay. You need the steroid shot.”
We had to go up to labor and delivery. We stood in silence, waiting for the elevator, until I realized I was no longer supposed to be standing whenever I could help it. I sat on a bench. “Nothing’s going to be normal now,” I said.
“Here we go, chicken,” said a nurse, jabbing an industrial-sized needle into my thigh. That was steroid shot number one. A fetal heart monitor on a thick belt was strapped around my less-than-impressive belly. Mira’s heart rate was decelerating, speeding up again, and then decelerating again, so they admitted me. I signed a consent for an emergency C-section, but it wasn’t clear when it would happen. A nurse came in and said they needed to start a magnesium drip, which would help protect Mira’s brain if she came soon. Amol ran out for a sandwich and the nurse hooked up the bag to my IV. Seeing that my husband was gone, she made some excuse to stay in my room and do paperwork while the magnesium started up. Suddenly I felt like I was burning up from the inside out. I couldn’t catch my breath. “I think I’m allergic to this,” I said to the nurse. She disappeared and came back with a resident, who checked me. I was fine. “It’s just the mag, honey,” said the nurse. “It makes you feel like that.” It was a twelve-hour course; I sweated and tossed through the night.
So there I was, sweaty and confused, when, early the next morning, a neonatology fellow dispatched from the NICU came in to tell us what to expect when you’re expecting a premature baby. At that point no one knew if I would need to deliver in hours, days, or weeks, but there seemed to be no hope of getting to term. Mira was diagnosed with severe intrauterine growth restriction as a result of “unexplained placental insufficiency,” a fancy way of saying that no one knew why the placenta was shutting down. I was not providing her with enough nutrition to grow. Soon I might also deprive her of oxygen. I was a well-fed food editor, and my fetus was starving.
The doctor perched awkwardly by the bed and vomited up a litany of potential complications that arise from being born too soon. Bleeding in the brain, holes in the heart, butterfly-wing lungs that struggled to inflate, intestines that died while the baby still lived, blindness, loss of IQ, attention issues, disabilities of all sorts, infection, cerebral palsy, death. He said we had roughly a 50-50 chance of getting out of this without a disability of some kind. Did we have any questions?
It was the first real information I had about prematurity, and I felt like I was drowning. I remembered that a pregnancy book I was reading had said that a 28-week baby has a 90 percent chance of survival—so I asked: Was that right? The doctor blinked. “Well, no, because she’s so small, more like the size of a 26-weeker, and because she’s been so stressed in utero, her odds of survival will be somewhere between a 26- and 28-weeker.” What did that mean? Eighty-five percent? Eighty-eight? I didn’t know, but I didn’t ask again.
“But,” he went on, brightening, “premature girls tend to do better than boys. And African Americans tend to do better than whites.” Amol and I took this in. (The evidence that black babies tend to fare better than others is actually mixed and not at all conclusive; on the other hand, there is new evidence that black and Latinx babies are more likely to get inferior NICU care.) “What about half-white, half-Indian girls,” I asked. “Does she get a little bump for being biracial?” No one laughed.
It was Thanksgiving Day, and I had gotten two steroid shots and the course of magnesium. Mira’s heart rate had steadied, so after scans upon scans that showed the umbilical vessels were still working to keep Mira in oxygen, the doctors decided they could discharge me home. The goal was to stay pregnant for as long as possible. My obstetrician, Dr. M., whom I loved, said the goal was 32 weeks. But the goal was also to keep Mira alive, and the two aims were not necessarily compatible. At some point—no one knew exactly when—my placenta, which I imagined as a beat-up old car, chugging along, belching smoke, would simply stop working, and she would suffocate and die. The high-wire act was to keep Mira inside until the last possible moment and then get her out. So they sent me home, but I needed to be on bed rest and I had to count kicks. If I couldn’t feel Mira moving, I had to come back to the hospital immediately.
For the two days that we were home, I lay on the couch and Mira moved more than she ever had before. She flipped and flopped. I allowed myself to imagine that everything might be okay. And then on Sunday, November 30, she just stopped. Amol was at Ikea, in a frenzy of baby-room buying and assembling. I ate a cookie and drank a glass of juice, because a sugar rush supposedly wakes a sleeping fetus. I moved around and tried to rouse her. “No kicks,” I texted Amol. “Fuck,” he texted back.
Back we went, through the Brooklyn-Battery Tunnel, up the FDR Drive, to the hospital, a drive that would soon be too familiar. I was weirdly calm, which is not like me. Amol looked nervous, which is not like him. After we parked the car, he was half jogging to get inside the hospital, and I said, “I don’t think it’s an emergency.” He gave me a funny look.
Back up to labor and delivery. A nurse behind a desk. “I’m 28 weeks and I’m not in labor,” I announced. “So, why are you here?” she asked. “Oh, no fetal movement and IUGR,” I said. They put me in a bed behind a curtain. The woman on the other side of the curtain was in made-for-TV labor, panting and moaning.
On ultrasound, Mira’s heart was still beating, but that was the only sign of life. She wasn’t moving; her tiny hands were slack. Her heart rate was completely steady—ominous, because heart rates are supposed to be variable; it’s a sign that the central nervous system is active. It was, I later learned, a category III fetal heart rate tracing, which necessitates delivery. It means death or brain damage is an imminent risk; there is no category IV.
The obstetrics resident asked for a second opinion, and another, older doctor with a formidably serious countenance came in, looked at the heart rate tracing, took control of the gel-slicked wand, and stared at the motionless fetus on the monitor for a moment. There was no choice presented, for which I am grateful, because I could not really grasp what was happening. Being born nearly 12 weeks early is bad, but being stillborn is worse. The doctor turned to me and said, “Things are going to happen very fast now.”
I lay back and covered my eyes with my hands. “Now?” I asked. “Right now?” A nurse was already taking my clothes off, putting a gown on me, finding a vein for an IV.
And just like that, I was swiftly wheeled toward an operating room with what seemed like dozens of doctors and nurses trotting along beside. Dr. M. was on call, and she came quickly down the hallway. “What’s the presentation?” she asked. “Transverse,” someone else said. Amol said later that it was like being in a car crash: the cold clutch of fear, the way time seems to slow in a sickening, unnatural