Friday, August 19, 2011

Managing the "what if's"

In the packet of handouts and materials for newly grieving parents we were given in the hospital were some pieces on the stages of grief. I'd had psychology classes in high school and college and so wasn't unfamiliar with these stages, but it takes on new meaning when you're in the throes of it yourself.

Reading through these colored papers helped us understand that on the day of our children's births, Paul was exhibiting classic signs of shock: sick to his stomach, a squeezing in his chest and inability to catch his breath, and - most noticeable because it's so opposite of normal for him - an unshakeable feeling of cold. (At one point he had four hospital blankets piled on top of him, some fresh out of the warmer, and he was still freezing. My room was kept cool because my post-birth hormones were baking me from the inside out, true, but the "normal" Paul wouldn't have been that cold no matter the temperature.)

I've picked up the packet several times since we've been home and each time I read through it, new things jump out. Yesterday, for me, the theme was managing the "what ifs".

Almost every day one or both of us makes ourselves crazy in the head with wondering whether anything we could have done differently - anything ANYONE could have done differently - would have kept me pregnant long enough to deliver our babies alive and healthy. Lots of women continue pregnancies with placental abruptions and have a better outcome. Many women with preterm premature rupture of membranes, or pPROM, are aggressively managed, sometimes for 10 weeks or more, enduring strict hospital bedrest after 24 weeks with constant monitoring and go on to deliver their kiddos ok. (Reality check: it's not too uncommon for all those measures to still result in an outcome like ours.)

We understand in our heads that the "what if's" are a very normal part of the grieving process, a feeling that we could/should have been able to control what was really uncontrollable, that perhaps if we can figure out exactly what went wrong then we can go back in time and fix the outcome, sort of like the "Choose Your Own Adventure" stories my brother and I read as kids. Sure, maybe I would have been better off not going to my osteopath appointment and then on to the office for a bit in the hours before my water broke...then again, perhaps my water still would have broken that day, or the next, or the day after that. Paul tries to blame himself or our medical team; I blame myself or the medical team. In our hearts it's really hard not to believe that we, the excited parents of these two tiny beings, could have done something to make it all ok. (The shitty thing is many of the symptoms I experienced - and even talked to the OBs about - are considered "normal" when in our case they were symptoms of impending tragedy.) The fact is, it wasn't in our hands, and there's nothing we can do to change our new reality. We must move down the grief path toward acceptance of what is.

Of course, as I (researcher extraordinaire) continue to search for medical explanations of how exactly this all went to Hell in a hand basket, I'm probably seeking to better control the outcome of future pregnancies. We really must lean into Dr. M., the expert, and express our fears of similar outcomes in our quest to become parents, especially since we plan to start trying again for Baby #3 very soon (within the next two months).

The unfortunate events that happened in this pregnancy - two placental abruptions and the catastrophic rupture of our daughter's amniotic sac - are statistically likely to happen to me again. Then again, we don't know why our daughter's placenta was so fragile...was it location? Was it improperly attached to begin with? Did it contain a freak design flaw? And what about that premature rupture of membranes...was it due to blood from the abruptions acting as sand paper over the membrane, weakening it? Or perhaps blood passing through my cervical canal weakened the mucus plug that was supposed to keep bacteria out of my uterus and introduced infection? (Dr. M. thinks there was infection present, enough of one to impact our babies but not me.) Or, heck, was my body just really not cut out to carry multiples and so this "train wreck" of events throughout my pregnancy happened for that reason?

What we do know and appreciate is we don't have to know the answers, and will probably never know the answers. But we can educate ourselves and work with Dr. M. to make sure all that can be done to prevent a repeat performance will be done. There can be no innocence in our future pregnancies; there's just no way. However, we are looking forward and trying to expect and anticipate a completely different's the only way to survive this. Oh...that, and me doing my best to help other women take their weird symptoms seriously so that maybe I can help control the outcome of their pregnancies. :)

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