part 1: pregnancy, premonitions, and polyhydramnios

I longed for a third baby since my second child, Leo, was born at home in 2017. I tried to shake the desire and I tried to talk myself out of it, but it was always there, refusing to stay suppressed, refusing to disappear.

First births are often traumatic, and mine was no exception. My first child, Rosa, was born in 2014 and came into this world kicking up a fuss after 36 hours of labor, a failed epidural at the 30-hour mark that resulted in a cerebrospinal fluid leak (aka "wet tap"; summary: worst headache ever), an epidural that worked, and two "blood patches" to stop the fluid leak. (That is four epidurals in total, if you're counting.) She was exactly 40 weeks gestation and weighed a healthy 7 lbs 13 oz.

In those days, I was working as a legal aid attorney in D.C. and teaching yoga on the side. I was newly married, living in a rowhouse with my husband, cat, and two roommates, and my bike was my main form of transportation. My last day of work was June 20, and I went into labor on June 21, which also happened to be the summer solstice. (I like to tell my daughter that it was the longest "day" of my life...) I had prepared for her birth by reading Ina May Gaskin's Guide to Childbirth, by taking birthing classes and prenatal yoga sessions focused on natural, unmedicated birth, and by seeking hospital midwifery care at George Washington University Hospital. In therapy afterward, I reflected that part of what traumatized me about her birth was that it was completely out of my control, and all my plans had flown out the window. My therapist noted that it seemed a fitting introduction to parenthood.

Indeed.

Leo's birth was redemptive and idyllic. "Only" 22 hours of labor this time, all at home, and born in a birthing pool in our playroom. I credit the better experience in part to my body knowing how to birth and in part to hypnobirthing, which taught me to drop into deep relaxation between contractions. Essentially, I learned to conserve and restore during the minute or two between contractions rather than spending that time reacting to the discomfort of the prior one and anticipating the next. To stop fighting against what was happening and start flowing with it instead.

Leo came into the world at 38 weeks weighing 8 pounds 4 ounces. He was a peaceful newborn and barely cried. Just after the midwife dried us off and helped us to the couch, my Dad, father-in-law, sister-in-law, and Rosa tiptoed in, eyes shining, bearing flowers and a gallon of milk. Joy filled the house.

I felt so supremely happy in that moment that I can remember thinking, "I want to do this again." I think I must have said it. I remember Theron looking at me like I was crazy, and I realized it must have been a crazy thing to say, given the 22 hours of hard labor I had just endured and promptly forgotten about. And the debilitating pelvic and back pain during the pregnancy. Postnatal hormones really are amazing. I was high on a full dose.

As a natural labor and delivery mama, I also did not want any disruptions to the postnatal bonding experience. No eye gel or pricks, no wiping off blood or vernix. I wanted my babies to move directly from womb to breast, skin to skin, heart to heart. Lights off, disruptions minimal, cord clamping delayed.

I had the good fortune of having babies who latched well immediately after birth, and I was able to exclusively breastfeed them. I learned to trust my instincts as a mother and practiced what felt natural to me, including co-sleeping and nursing on demand. Both kids nursed for years. I loved breastfeeding and co-sleeping.

Fast forward... my summer babies are turning 7 and 4. I knew I was supremely blessed. As I approached the last months of my 30s, I proposed to Theron that we "try" until I turned 40, and if it happened, great. If not, we'd close the door. I set the intention that if a third baby wanted to join us, it would have to be OK going with the flow and enduring a little "benign neglect." It would have to be my best sleeper and also raise itself. When I got pregnant right away, I laughed and thought, "the baby has accepted my conditions!"

I should have learned by now that only fools bargain with babies.

When I first suspected I was pregnant, we were on a road trip in a rented RV in South Carolina, visiting Theron's step-father on his farm. It was still too early to test when we left South Carolina to wind our way back to Michigan, with plans to check out the Blue Ridge Mountains on the way home. I was driving the trailer in bumper to bumper traffic in a construction zone when it began to sway and I lost control. Our car was yanked all over the three-lane highway by the weight of the out-of-control trailer, until it spun us around and flipped on its side, pulling the back tires of the Tahoe I was driving two feet off the ground. 

Miraculously, we didn't hit any other cars, and none of us was injured. I remember thinking, among (many) other things, that if I had died, no-one would have known I was pregnant. I took a pregnancy test two days after the accident, in the wee hours of the morning in a dingy Kentucky motel. Despite the disaster that was the end of our vacation, I was over the moon to see the second line appear in the little white window.

I was already the healthiest I had been in years, having taken to the whole pandemic Peloton craze and having lost 25 pounds in the prior year. I was determined to make this my best pregnancy. 

                                            

When I was seven weeks along, we went on our annual trip to Michigan's Upper Peninsula. I swam in rivers and Lake Superior, jumped off rocks and crawled behind waterfalls. I love early pregnancy, when your baby is your little secret. I felt healthy and happy and fully alive.

In true pandemic fashion, we all tested positive for Covid upon our return from the UP. I have chronic asthma, and I was really worried about the pregnancy. But I was also vaccinated, and my case turned out to be very mild. As a precaution and due to anecdotal blood clotting issues in pregnancies post-Covid, I was told to take baby aspirin daily for the rest of the pregnancy.

As I had done with Leo (due to age), I did NIPT genetic testing during the first trimester. NIPT is a blood test that detects fetal cells in the mother's blood and looks for some of the most "common" genetic disorders, including trisomies 13, 18, and 21. I honestly didn't know much about T13 and T18 or the other disorders the NIPT screened for, other than that most babies died from them at birth or shortly thereafter. (Trisomy 21 is Down Syndrome.) I didn't know what I would do if my baby was affected by a severe and life-limiting genetic disorder. I just knew I wanted to know as early as possible so that I could carefully consider how to proceed.

We got the NIPT results back around the 12th week of pregnancy and they were ALL CLEAR. We told Rosa about the pregnancy first, then Leo, and let the kids do their thing and tell everyone else. 

Sometime in the first trimester, I was laying in bed one night thinking about how we would fit a new baby in our three-bedroom, 1957 house. Neither Rosa nor Leo had a nursery. When Rosa was born in DC, we were packing to move to Chicago, and we had no bedrooms to spare with two roommates in the house. We bought a sidecar sleeper to attach to the bed, but it basically ended up holding my water, snacks, and burp cloths as Rosa slept in bed beside me. When Leo was born, the third bedroom in our Ann Arbor house was a home office/dumping ground for all the things we didn't find a place for after our move from Chicago, so we set up a crib and rocking chair in our bedroom. He slept with me at night and in the crib for naps. When he turned one, the crib and Leo moved into Rosa's room, and they have been sharing a room ever since.

In any case, I now had an office downtown, and we were mainly using the third bedroom for the Peloton. This was my first and last chance to decorate a real nursery for a baby, so I started wondering about themes. The theme would have to be gender-neutral, because Theron and I don't find out the sex of our children before birth. (There are few true surprises in life and we loved the revelation at the moment of birth for our other children.) Both times, we simply made short lists of male and female names. After each birth, we waited until things settled down and we could be alone to decide on the name. Each time, the name became utterly clear to both of us before we even discussed it. We felt as if the children came with their names.

As I lay there thinking about nursery themes, a distinct message came clearly into my mind: "I want my nursery to be decorated like The Little Prince."

I burst out laughing. This baby was supposed to be the easy one, and now it was making demands about decor?! I immediately said to Theron, who was laying next to me and probably scrolling Twitter, "I think the baby just told me it wants its nursery to be decorated like The Little Prince." As he has over the years when I've made comments like this that sound a bit crazy, he just shrugged. We had two copies of Le Petit Prince in the basement, because we had each separately started reading it in French when we were studying the language (Theron in Switzerland in 2000, I in France in 2004). Neither of us had finished the book. I had always loved the iconography of it.

The pregnancy continued. It was my best, most active pregnancy. I didn't have morning sickness. I didn't have fatigue. I slept well and comfortably. I had no pelvic or back pain. I worked with my yoga teacher to use the relaxin in my body to open up tightness in my psoas. I had a blast on my Peloton and joined a Peloton pregnancy group. I felt incredible. 

                                                                     

When I was pregnant with Rosa, I had read that the first thing one must remove from the diet when pregnant is FEAR. I had taken that to heart, eschewing all information about things that could go wrong in pregnancy and delivery. I practiced this during my pregnancy with Leo as well, so it was second nature for me. Yet this time, I felt myself drawn to stories about children with life-limiting genetic disorders--not out of fear that this could happen to me or my baby, but out of curiosity. I remember reading a story about a baby who survived only a few months and wondering how the parents could love a baby they knew was going to die. I remember wondering how situations like this fit into materialistic, humanistic, and spiritual existential paradigms. I felt terrible for the babies and the parents and wondered what makes a life worthwhile, worth spending time and resources on, worth living. As a well-trained lawyer, I would try to think my way through these questions, or at least to come up with a satisfactory mental model with which to analyze them. Then I would stop and move on to other things, because they were sad and I could reach no clear answers, and because these were hypothetical questions that I could choose not to think about. My babies were healthy, after all.

I was planning another home birth with the same midwife who had delivered Leo. I was also "dual-tracking" with the hospital midwives at the University of Michigan, as I had before. Dual-tracking allowed me to be a known quantity at the hospital in case I needed to transfer in an emergency, and to access medical testing and screening as needed.  At this point, Theron and my mom were very experienced birth supporters for me, and I was looking forward to the shortest and easiest labor and delivery yet. 

Fairly early in the pregnancy, I started measuring slightly "ahead." This means that the measurements from my pubic bone to the top of my uterus were just a few centimeters over "normal." Not uncommon for subsequent pregnancies, neither my homebirth nor hospital midwives were concerned. 

Sometimes, at night, I would I would try to visualize my coming labor at home. I had done this in preparation for Leo's birth, and it had worked well. But this time, I couldn't visualize a home birth at all. It was like mentally running into a brick wall. Instead, I would see a flash of hospital hallway in my mind's eye. I had a persistent premonition that the home birth wasn't going to happen, and that I would give birth in the hospital instead. I felt it was an emergency; I felt it was a c-section. Not once, but every time I tried to imagine the birth, and sometimes just out of the blue.

For some reason, the premonition did not alarm me. I was curious about where it was coming from, but there was no discernible reason to suspect this delivery to be so different from the others. I dismissed it--or rather I tried to dismiss it--as subconscious anxiety. I mentioned this premonition to my husband several times, and to my homebirth midwife during one of our appointments. She said she thought it was normal to have some anxiety, and that she wouldn't be concerned unless there were other indications that something was off.

I didn't have anatomy ultrasounds with either Rosa or Leo. I recognize that this is a very unconventional choice, and I won't get into my reasons here. With Viggo, however, my homebirth midwife expressed some concern due to my Covid infection early on, so I reluctantly agreed to the anatomy scan at 22 weeks. The scan was totally normal.

I remember clearly one of my second-trimester appointments with a hospital midwife. Now that homebirth midwives are licensed in Michigan (unlike when Leo was born just a few years prior), there are rules that licensed midwives have to follow. One of those rules is that pregnancy must reach its 36th week for birth to happen at home. She mentioned that she recently had a woman who had planned a home birth come to the hospital because she went into labor at 35 weeks and 5 days. Then she said, "Just in case you give birth in the hospital, we should jot down your preferences." As I answered her questions about my labor and delivery preferences, I felt a dizzying wave of heat run through my body. This is going to happen. I'm going to give birth in the hospital. The impression was fleeting but definitive. I pushed it away and made myself stop thinking about it. This was my third baby, after all. Every indication was that things were going to be fine.

At that same appointment, however, I remember joking with the midwife about whether I could be carrying a hidden twin. I was measuring even further ahead now, and I was getting a bit uncomfortable. My uterus was huge and unusually round. She laughed and said that it would be unprecedented for an anatomy scan to miss a twin. She did a quick bedside ultrasound and all was well. I just had extra amniotic fluid, which normally peaked around this time in pregnancy and was expected to go down as the baby grew.

Theron left his job in October to pursue a huge dream and start his own business. We were down to only my self-employed income and I was also trying to save for a few months of maternity leave. When I turned 40 at the end of October, I was still feeling pretty good.                                                     

The holiday rush of November-December totally overwhelmed me. I felt so deeply that I didn't want to be working anymore; that I just needed to focus on nesting for my own sanity. I was surprised to be feeling this in my 30th week of pregnancy; with Rosa, I had worked until the day before giving birth at 40 weeks, and with Leo I had decided to stop working at 38 weeks only to give birth two days later. But I kept getting calls for new business that I didn't want to turn down, so I planned to work until week 34 or 35. 

Distracted and busy with holiday activities and work, I skipped my December midwife appointments. I felt comfortable with this because I had a growth ultrasound already scheduled for January 5, as a precaution due to the Covid in early pregnancy. (Anecdotal evidence indicated that Covid compromised some placentas, causing intrauterine growth restriction in the final weeks of pregnancy.) The irony, of course, is that my belly had been growing exponentially. People were asking me if I was overdue with triplets and other completely inappropriate things of that nature. I would laugh and say, "No, this baby just has its own private swimming pool." Otherwise, however, I was feeling just fine.

For New Years, we traveled to Marquette with dear friends. I went cross-country skiing! Here I am on December 31, just six days before my admission to the hospital for premature premature rupture of membranes (PPROM), and eight days before Viggo's birth. I had no idea at the time how dangerous it was for me to be so far from home. I had a high-risk pregnancy and didn't even know it.

At the scan on January 5, I was surprised to learn that I had a pretty serious case of a rare condition called polyhydramnios--essentially, too much water. The baby was measuring at about four pounds, which was normal, but the black space around the baby depicting amniotic fluid was much greater than it should be. The ultrasound tech said something about "it looks like its bladder and kidneys are working." I didn't understand why she would say this. She went to speak to the OB before letting me leave, and came back to ask about my gestational diabetes screening. I had skipped that, I said, and did a fasting A1C blood draw instead, which was normal. She said I needed to get a diabetes screening right away.

I left feeling horrified and scared. Had I been suffering from untreated gestational diabetes, threatening the health and wellbeing of my child? Why hadn't I just done the one-hour glucose test in the first place?! I looked up polyhydramnios: the most common cause was undiagnosed gestational diabetes, the second most common was a hidden twin, and other more rare causes were congenital digestive blockages, infection, and rhesus disease (where mother's cells attack baby). The rarest cause was "genetic condition." Sixty percent of cases were idiopathic, or unexplained. I was hoping to be in that sixty percent.

I still remember sitting in my van in my parking spot in Kerrytown, crying on the phone with my homebirth midwife. Something wasn't right. I didn't feel like I could focus on my work day, but I had an extremely full schedule and just needed to finish my last clients before I could focus on the baby coming. She encouraged me to cancel some meetings, to go home and rest. I couldn't swing that, or at least I didn't think I could. I felt like the walls were closing in. 

We decided together to request the three-hour diagnostic gestational diabetes test, because if the one-hour came back positive I would need to do the three-hour to confirm the diagnosis anyway. I scheduled it for the next morning at 7:30am, because I was so anxious to get it done. 

That evening, I had dinner at home and said goodnight to the children, then went back to my office to work until 10 or 11pm. I remember kissing Rosa and telling her that I would be gone before she awoke in the morning, but that I would see her the next afternoon.

I could never have imagined that I wouldn't see her or Leo for over a week. Or that the version of me that would walk through the door, traumatized and swollen and bereft, would be unrecognizable to myself. Or that the relatively simple life we all had known would be over, forever.