Miscarriage and pregnancy loss:
Christie Lockhart’s story
Throughout Christie Lockhart’s east Toronto house, there are subtle reminders of Calli. A framed picture of her name written in beach sand sits on the mantle. Upstairs, a cream-coloured keepsake box contains Calli’s first outfit, a girlie infant ensemble. (It was a gamble of a present, gifted to Christie and her then-husband before they actually found out they were having a girl.) There is a framed pink paper bearing the inked marks of Calli’s tiny hands and feet – smaller than a doll’s – taken by a doctor at Mount Sinai hospital after she was surgically removed from Christie’s womb at just after 20 weeks.
Also in the box is a handwritten card from Christie’s best friend, embossed with a butterfly. It’s not something Christie – a practising midwife who knows, all too well, that butterfly imagery is tinged with sadness in the maternity world – ever expected to receive herself.
“At the hospital, when there’s a stillbirth happening, we tape a butterfly to the door so that staff entering the room will know,” she explains. “It’s always a hard day when you go in and see a butterfly on the door.”
Because of her profession, Christie is well steeped in the statistical reality of pregnancy-related risks. “The biggest question I’m asked as a midwife in the beginning of a woman’s pregnancy is, ‘When is it safe to tell people?’ I always answer that pregnancy in itself is a risk – it’s a leap of faith, and there isn’t really a line you can draw in the sand where now you’ve passed the point where nothing will happen. One of the biggest myths and fallacies around pregnancy is that you get to the three-month mark and you’re good. But the first lesson in being pregnant is accepting that you can’t always control everything. We can’t always keep our children perfectly safe. We do what we can to eat the right things, limit our alcohol and cigarettes, but that’s not going to guarantee you a healthy baby.”
Nor will a degree in midwifery.
Christie was about seven weeks pregnant with her second baby when her three-year-old son, Nicolas, came down with a flu-like virus he picked up at daycare. With her immune system compromised due to the pregnancy (and her lack of immunity to this particular virus), Christie picked it up, too. She suffered for a few days with achy joints, fever and the nausea she was already battling, before recovering and carrying on.
“I had a normal genetic screen, a normal first-trimester ultrasound,” she remembers. But at the 18-week ultrasound, a longer appointment that includes an anatomy scan to monitor baby’s growth and development, the scan picked up what is called an echogenic bowel.
“In most cases it’s normal, but it can be a sign of other things – cystic fibrosis, Down syndrome, infectious diseases,” Christie explains. (In 90 percent of cases, an echogenic bowel is not necessarily significant and does not indicate a problem. But the other 10 percent of the time, it can be significant.) The next step was to undergo genetic testing and an amniocentesis to discern whether something was really wrong. Although Christie knew the odds were good that the baby would be fine, she was consumed with worry.
“I knew too much – that was the problem,” she says. “Even though they were saying most of the cases like this turn out to be healthy, I had a feeling something wasn’t normal.”
The evening after her amniocentesis, the hospital’s head of genetics called Christie at home with the news she had been dreading. The simple flu she had come down with early in the pregnancy had actually been cytomegalovirus, or CMV, a common virus kids and adults often contract. “If you’re not pregnant, it’s nothing,” Christie said. But if you are, there is a risk the virus will cross the placenta and transmit to the baby. The possible effects range widely. In some cases there is no impact on the baby; in other cases babies become quadriplegic, blind, deaf or suffer shrunken or enlarged organs. Christie was told the viral load in her amniotic fluid was “off the charts.”
“They told me that it was very unlikely this baby would survive, and if it does, it will have multiple anomalies, and long-term issues. But it might not survive through pregnancy.”
At this point, Christie was 20 weeks and three days into the pregnancy. She was given the choice to terminate or continue with the pregnancy and let nature take its course. After consulting with her own midwife (a friend and colleague), she decided to terminate the pregnancy. But her decision, as it turned out, was moot; when she went back to the hospital three days later to have the procedure, the baby had no heartbeat.
Just past the 20-week mark in her pregnancy, Christie was given two termination options: have labour induced and deliver the baby vaginally, or have the baby surgically removed via a dilation and evacuation, or a D&E, a second-trimester procedure that is only offered in advanced hospital centres. Because of the baby’s size at this point (Christie was 21 weeks by then), the tissue and body parts are dismembered during the termination. Explaining these difficult details, Christie grimaces and says she worries about how others might perceive this kind of procedure. But at the time, it seemed like the right choice for her family.
“The reason I chose the surgery as opposed to the delivery was that it meant less time away from my son. I knew it would be a day surgery. And I just thought, ‘I can’t go through labour. I can’t give birth to a dead baby. But I can go in and be put to sleep to get it out.’ Maybe it was the midwife in me, but I felt like I wanted to reserve birth for a healthy moment.”
To this day, she still struggles with whether she made the right decision. “I was scared to go through labour to deliver that baby. But then I had regrets. I didn’t ever get to see the baby, and when you go through labour, you do get to see him or her. At the time I thought I didn’t want to…but then later on, I wondered what she looked like.”
At home, Christie had three weeks of holidays scheduled to start her recovery. But the shroud of grief would last much longer. Her need to talk and cry in order to cope clashed with her husband’s need to withdraw and a fissure began to crack open in their marriage. Back at work, she battled constant thoughts of how pregnant she should have been.
“It felt like everybody around me was just having babies. I was a full-time midwife with a full caseload of healthy women. I was coming back to work and they were complaining about heartburn and their backs. Of course I was compassionate, but it was a time when I really felt I was the only one that this had ever happened to.”
Christie found solace online, where she devoured “hundreds and hundreds” of stories of loss. She found herself particularly drawn to tales of “rainbow babies,” healthy, full-term children born after women suffered a miscarriage or stillbirth. Three months after her D&E, Christie was pregnant with what was to be her own rainbow baby, but at about six weeks – during a home birth she was attending – she miscarried. “I just started bleeding and had a natural miscarriage.” She says the loss wasn’t nearly as heartbreaking as losing Calli, although it was emotionally tough. “At that point I did start to wonder if I’d have another baby. Something like only one in 1,000 women will get CMV. But once you are that one in 1,000, you think, ‘I could be that one in 1,000 again.’”
Luckily, she wasn’t. On her next cycle, Christie once again became pregnant with what she calls “my most straightforward pregnancy.” It was also her most anxious and fear-riddled. A year, to the day, of Christie’s fateful amniocentesis with Calli, baby Ellie arrived safe and sound. Until she had the baby, though, Christie was in disbelief. “I wasn’t convinced I was having a baby that was going to live until she was born – until she came out and cried.”
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