Early in the morning one autumn morning in 2018 — probably sometime between 2 and 3 a.m. — I woke up to scratch myself. I was, by this point, 34 weeks and six days pregnant with my second child. The itching had started a few days prior: Late one night earlier that week, I had gotten up to pee, and I noticed that my legs were tingling. The next night, I was clawing myself so hard in my sleep that my husband had to rouse me; in the morning, I had a crosshatch of blood on my distended stomach. He found me that night in the bathroom, rubbing the palms of my hands with my bristled hairbrush, and led me sadly back to bed, like I was a somnambulist who’d been caught perched on a windowsill.
My second pregnancy was proving to be a marked contrast from my carefree first. With my older child, I marched through the entire pregnancy with completely undeserved confidence and few discomforts, save some nasty heartburn in my third trimester. Fast forward nearly two years: I’d been basically unable to eat for weeks, as the result of severe heartburn. I was told not to eat or drink at the same time and not to lie down until 20 minutes after eating and to chew gum — the end result of which was just me gnawing on Trident constantly and never eating or sleeping or drinking anything at all because even water hurt. I stopped gaining weight. I had the curious sensation that my stomach was softening, shrinking even, and a more frightening sense that the baby was kicking less frequently and less forcefully.
“I am just a little worried that the baby isn’t moving as much,” I told my obstetrician during one appointment.
“Well, you’re much more active than you were in your first pregnancy!”
“I don’t feel the baby kick as much,” I said to my husband, about 10 times a day.
“I’m sure it’s because you’re just out moving all the time. I don’t want to use the H-word but you’re being a little...” He trailed off before he could say hysterical.
I already knew I had cholestasis, a pregnancy-related liver condition, which causes incessant itching that worsens at night and is correlated with late-term stillbirth. Doctors aren’t sure exactly what causes cholestasis — it’s thought genetics and environment play a role — and it’s very rare, affecting one or two pregnancies in 1,000, but I had a friend who’d had it and another friend who was a midwife who specialized in it. Still, I listened to my husband try to convince me otherwise for two days. By Day 3, even he had to concede that something seemed amiss. That day, I woke up in the black early morning and nestled back into my predawn spot in the crook of the couch, hairbrush in one hand and fork in the other. At some point I started to wonder how long it had been since I’d felt the baby move. My midwife friend had taught me that when I was worried about movements, I should drink some juice, lie on my left side, and wait. The thought of drinking anything with my heartburn made me want to vomit, but I took the heftiest gulp of juice I could muster and laid down. A few minutes later, I felt the tiniest flutter, like someone tinkling three keys pianissimo. Then nothing. I raced upstairs, roused my husband with my screams, and we bolted to the hospital.
A few minutes later, I felt the tiniest flutter, like someone tinkling three keys pianissimo. Then nothing.
I had stopped crying by the time my obstetrician intercepted me at the check-in desk and led me to a small bed in triage. He and an ultrasound technician zipped the flimsy cloth curtain closed to afford us some privacy, but I could still hear a woman in the very early, placid stages of labor across the room. The technician squeezed the familiar chilly gel onto my stomach and placed the transducer probe on top. A faint but distinct whooshing sound pulsed through the cordoned area: the heartbeat.
My doctor smiled brightly. “Mishegoss!” he announced with glee, gathering up his papers.
Half an hour later, the attending doctor who had taken over entered our little bunker. The new doctor informed us that some abnormalities had been detected: The baby’s heartbeat was slow, and when it declined, it wasn’t bouncing back as quickly it ought to. A maternal-fetal medicine specialist was quickly summoned. The doctors had formed a plan. They presented it to me tentatively, as if they were underlings offering up a presentation for their boss, fearful she might reject it: I would stay in the hospital, on a fetal cardiac monitor, for seven days, until I hit 36 weeks pregnant. They would give me steroid shots to fast-track the baby’s lung development, Pepcid to subdue the acid burning in my throat, ursodiol to bring the bile acids in my blood down (a blood test quickly confirmed my suspected cholestasis diagnosis), and prenatal vitamins, as if a last-minute dose of iron would quell whatever horrors were happening in my body. If things went south, they could potentially induce labor earlier, even as early as that very day. The idea of going through labor that day terrified me, but I figured it would be worth it if I could at least avoid a C-section, about which I’d heard recovery horror stories.
There was only one private room on the floor, so the team moved me to a bed in the recovery area. Behind the other four or five curtains in the room, women who had just had C-sections were recuperating immediately following surgery; oftentimes they had their mewling babies with them. Two wide, sky-blue elastic bands, which were supposed to rest on my stomach, fed into the fetal cardiac monitor standing like a sentinel next to my bed. It seemed a pretty crude instrument to be doing such delicate work: Sometimes a slight readjustment of my legs would cause the monitor to begin picking up my heartbeat instead of the baby’s, subtly but unmistakably a louder and more forceful drumbeat. For the first few hours, I intently watched the numbers on the monitor, trying to decipher some code hidden within, until eventually I told myself that for the sake of my sanity, I had to do literally anything else.
After two days in the recovery room, a kind nurse lobbied to get me into the private room. That evening was New York’s only major winter storm that season, and outside my giant windows I could see the flurries swirl in the night sky. The lights in the surrounding buildings turned off when the office workers went home, and for a moment, the whole setup seemed almost peaceful. After a day or two, when I became more confident we’d make it to 36 weeks, I wondered if I could start to appreciate this time as a period of relaxation — a highly sterilized babymoon of sorts — before the hairy early newborn days.
At 4:30 that morning, a physician’s assistant I didn’t recognize woke me.
“Everything is fine,” she whispered, “but I have to tell you that the baby’s heart just experienced another one of those big drops. I don’t want you to panic, but I do think the powers-that-be should have a discussion this morning about what to do. I don’t think you’re going to make it another five days.”
I started to cry. “What now?”
“Just try to go back to sleep. Your doctor is on today, so I’ll have him come see you when he arrives.”
Of course, I was already awake when the doctor walked in and began shedding his civilian clothes.
“I think you need to have a C-section. If I put this baby through labor, he’s going to end up in an emergency situation.”
This was not good news: The last bit of hope I had for the situation was to avoid a C-section. I had always heard that the recoveries were worse than vaginal births — how would I handle a newborn and an active toddler post-surgery?
My husband’s lawyerly urge to get all the facts kicked in. “Do we know if there is some holistic cause here? For example, is the cholestasis affecting the heartbeat... ?”
“It wouldn’t normally. Fetal heartrate is not a great indicator of outcomes. The truth is that if you put a cardiac monitor on a person with no heart problems and you watched it all day, you’d probably see some wacky stuff. And even the correlation between cholestasis and stillbirth has been questioned in recent years. I had a patient recently who had cholestasis, and I suggested she be induced and she refused and ended up fine.”
I envisioned this woman: a brave birth warrior woman, no doubt, whose reward for leading with principle was a magical, empowering water birth in a bathtub surrounded by luxury candles.
My doctor turned to address me directly. “You can refuse,” he said.
I shook my head no.
“I have to give you the option. But if you do, I won’t be able to treat you anymore because in my opinion it would be malpractice.”
My husband’s quest for a definitive source of the trouble — I’d long since given up on this — hadn’t been sated. “But what could cause the reduction in movement?”
My doctor shrugged. “I am not sure. When you guys came in, I thought it was very likely the baby had died. But sometimes the cord wraps around the neck or the leg or clamped down in the armpit, and the flow of oxygen is restricted and the heartrate drops. Or sometimes babies experience neurological issues, like a seizure in the womb” — the idea was so horrible, I immediately obliterated it, like an open palm slamming an insect — “so that’s why I’m hoping when we get in there, I’m going to see something with the cord.”
My husband nodded, encouraged.
“I've got to tell you, obstetrics is not a great branch of medicine. We often have to make a guess. This might be a really conservative move. In five months, you might be really angry with me for putting you through this. But you know what? I don’t care. All I care about is that you have your healthy baby in your arms.”
Nobody said anything for a minute.
“I don’t know why this happened,” the doctor said. “I don’t know how the cholestasis and the cardiac abnormalities relate to one another or to the movement or even if they relate.”
He raised his palms upward toward the ceiling, in a gesture half-reverent, half-impotent. “All I can think is that the movements stopping was a sign from above, for you to get help.”
“You can refuse [a C-section],” the doctor said. "But if you do, I won’t be able to treat you anymore because in my opinion it would be malpractice.”
My son was born on a chilly November morning. He weighed 4 pounds and 11 ounces. In my drugged haze, I thought I heard my doctor mentioning something about the cord being under the baby’s arm, but this was never confirmed. My baby’s fragility frightened me, but he was, for all intents and purposes, healthy. He didn’t have to go to the NICU automatically, but a few days after birth, he spent 18 hours there due to low body temperature. He was discharged from the hospital the same day I was. No root cause for his issues in utero were ever found.
For more than a year, I vacillated between wildly divergent narratives. I wondered if the system around me — the doctors, nurses, even my husband — were more inclined to take women’s health complaints seriously, and to believe them when they claim expertise on their own bodies, perhaps the problems could have been pinpointed and treated more expeditiously. Sometimes the blame rested squarely on my shoulders: Maybe when I thought I had been broadcasting distress to everyone around me, I was actually speaking so quietly, so deferentially, that they couldn’t be blamed for not realizing the seriousness of the situation. Or, somewhat conspiratorially, I have even wondered if what had felt so serious at the time wasn’t actually serious at all, and that I was a victim of what natural birth advocates believe is the over-medicalization of a natural bodily function, convinced of a manufactured crisis designed to get me to submit to a litany of costly, unnecessary medical interventions. Maybe if I had done nothing, in other words, my son would have been fine, and I would have felt as empowered as my water birthing foil undoubtedly did. Or, maybe not. Maybe the unthinkable would have happened instead.
While I do still occasionally search for the root cause of his problems in utero, and I still wonder if things could have been different if I had held out a bit longer, the trauma of all the unanswered questions is usually drowned out by the (mostly) joyful chaos of life with two toddlers.
And yet sometimes, when I am motionless, I feel a little twitch in my stomach, some kind of phantom quickening. A slight panic detonates within, until I remember there is no baby inside me who needs saving. But even now, in those moments, I feel compelled to say something, to commemorate the time when the fear was real and the child was in peril, even if we still don’t know how. At once helplessly and courageously, I call out to that still, small voice: I am here. I am listening.
This essay is adapted from the essay “The Still, Small Voice” from the anthology What We Didn’t Expect: Personal Essays About Premature Birth, available for purchase now.