****TRIGGER WARNING**** Contains graphic descriptions of miscarriage
It’s the end of the school year in Portugal and my only full beach day post conference, seems to have coincided with all of the primary schools in Porto, sending their classes to the beach for the day. As I walked on the wooden board walk, across the dunes, following a gaggle of happy 6 year olds, I was over come with a wave of melancholia, which sometimes hits me, when I think of my last visit to this beautiful country and my heart begins to break all over again. I think of the child that I lost here in Sept 2010 and as I meander at the end of the crocodile line of chattering school children heading to the beach, I wonder what that child would look like if it had survived.
It was the end of summer on my post doc at Leeds Institute of Molecular Medicine and I had just started a 20 week long animal experiment, which involved gavaging 80 Mongolian Gerbils with Helicobacter pylori and feeding them specially prepared diets, to control their iron intake. I had just had my contract extended on the EU framework 6 grant I was on, owing to the fact that I had declared my pregnancy as I had recently had the all clear 12 week scan. EU grants are more like contracts and do not cover employee maternity pay, so my employer Leeds University had to cover the extra costs and extend my contract to cover the generous paid maternity leave period accordingly.
I had got over the first trimester hell of nausea and at 16 weeks gestation, was ready for a break in the sun, to top up my Vitamin D (not always easy to come by in Yorkshire) so booked a trip to the Algarve for myself, husband and 2.5 yo child. We chose a tiny beach isolated resort, off the beaten track, that had a kite surfing school. My husband is a pain to travel with, owing to his hyperactivity and must have a task to keep him occupied while I enjoy the ‘fly and flop’ aspects of a bucket and spade holiday.
We had a lovely 6 days, relaxing for me and my son and the right amount of exertion for my husband. I had a cold all week (as always happens when I relax!) and the last few days had a sore lower back, which I dismissed as a combination of viremia and the hideous mattresses in the villa we rented. We packed on the Thursday night, after a lovely dinner out as we were due to fly on the Friday afternoon, back to Leeds. I still had to clean the flat to ensure we got the hefty cleaning deposit back, but figured I before we left for Faro airport by taxi in the morning.
Just after midnight, I was awoken by contractions. I recognised what they were as I had given birth once before and got in the bath, while my husband started to ring for a doctor. We couldn’t raise a doctor and the nearest hospital was in Faro, 50 kilometres away. We started to ring for taxis…with no success, as I cursed my stupid decision to go to an isolated place carless.
Of course, I knew that a full and progressing labour at 16 .5 weeks gestation, was only going to have one outcome. I got out of the bath and started to clean the villa, as my husband went to seek help at 1am from the bars in the tiny town. My son was sleeping while I finished cleaning and packing and by the time my husband had arrived back at the villa with a family from Lisbon, who could speak English (and had helped call an ambulance) I was sitting outside on a park bench under a street light with my suitcases and sleepy child, who was perplexed as to why mummy was so upset.
The family from Lisbon waited until the ambulance arrived and their two tweenage daughters watched me as I sat doubled over, trying not to cry out in pain and grief (as I didn’t want that to be their first experience of childbirth). The ambulance finally arrived and as the paramedic took my vital signs and my details, I could feel the last contraction push the foetus out into my underwear (thank goodness I was wearing black pants and not a skirt).
I was put in the ambulance and my husband and child (and luggage) of course couldn’t travel with me. I vividly remember the horror and shock on my son’s face as they were closing the doors on a van with flashing lights that was taking his mummy away. I had no idea how my family was going to get to the hospital in Faro, but figured they could raise a taxi at some point.
It was a standard hospital transport ambulance but after taking an ECG, my pre existing arrhythmia had sufficiently freaked out the paramedics and so we stopped en route, to transfer me to a MICA ambulance. Thankfully, the paramedic in this ambulance spoke English and I was lucky to have my EU healthcare card with me, so I didn’t incur any costs for my transport and treatment. The paramedic managed to get my pants off and then cut away my underwear. At that point, I told him the foetus had been delivered. He had a quick look and nodded with pity, to confirm what I already knew.
We arrived at Faro hospital and I was taken to the obs/gyn ward. I was asked to get off the ambulance gurney into a wheel chair at that point. I refused, as I knew that I would feel the dead foetus dangling between my legs. None of the medics spoke much English but after a quick con-flab with the paramedic, they bought instruments to cut away the foetus.
The last I saw of my baby was a small but perfectly formed translucently purple foetus, in a clear plastic container, being carried away. I was then overcome with a strong and visceral urge to call them back, to get them to tell me the sex of the child. This urge was then followed immediately by my pragmatic side stamping hard down on the neck of this desire, as if it had a sex, it had humanity….and perhaps it was best to keep it as a foetus in my mind.
I was then ushered into a side room, containing a bed with stirrups and a ultra sound machine. The obs/gyn doctor was an older man, whose hairstyle was reminiscent of an young Elvis Presley. There was a male and a female nurse as well, and the nurse was Polish and spoke English, unlike the others. I was propped up legs akimbo on the bed….expecting a procedure to remove the placenta, which had not been delivered with the foetus.
What followed can only be described as ‘veterinary’ and owing to the language barrier, I had no idea what was about to occur. The nurses stationed themselves at either side of my bed, near my head as Dr Elvis douched me with about a litre of cold saline. Then he nodded to the nurses whilst simultaneously plunging his arm through my dilated cervix, into my distended womb. The nurses grabbed me and held me down to the bed as I had cried out and jumped in shock at such an unexpected physical violation.
I felt Dr Elvis pull the placenta away from one side then the next then bring it about in his fist. I asked to see it and said ‘Completeo?’ to which the reply was ‘Si, completeo’. I was then hooked up to a synthetic oxytocin drip, to shrink down my uterus, to stop any potential haemorrhaging.
I was wheeled out to lie in a ward corridor, with several other patients at the overcrowded hospital. My husband appeared with my son for a brief visit, as men weren’t allowed onto the women’s ward at 3am. I asked them how they got to the hospital and the kind family from Lisbon had driven them with our luggage. They camped in the waiting room, as I remonstrated with the ward staff, to be discharged early, so we wouldn’t miss our flights home that afternoon.
After 4 hours on syncotocin, the bleeding had slowed enough to be managed with sanitary pads. I had managed to sweet talk the skeptical medics, who wanted to keep me in under observation for the recommended 24 hour period, by promising that I would arrive home to Leeds within the business hours of my hospital antenatal clinic, to be checked by my own medical team. We caught a taxi to the airport and checked in on time for our Ryanair flight. I managed to get a pack of maxi pads in the airport chemist and we boarded the plane…..which then sat on the Tarmac for two hours, for an unfathomable reason. (Perhaps a snap strike by Portuguese baggage handlers?)
By the time we took off, my son was agitated and proceeded to throw up on take off and landing…a habit borne from anxiety he continued with until recently. We landed in Leeds and drove straight to Jimmy’s (my clinic was on the same site as LIMM where I worked). Due to the two hour flight delay, we had missed the antenatal clinic and was ushered up to the birthing suite, which is the only place you can find obs/gyn doctors out of hours.
We sat, surrounded to the sounds of women in labour, giving birth to squalling infants, outraged to be pushed screaming into the world. In true NHS style, we were offered as much tea, sympathy and stale curling ham sandwiches as we could stomach, whilst we waited for a medic to get a window between births to examine me. Within a hour, a young Polish registrar came to ultra sound me, to check that Dr Elvis had removed the placenta properly. He gave me the all clear but told me to see my GP over the weekend if I was worried about infected and necrotic tissue.
On the Saturday, I had a 2cm by 10 cm strip of placenta fall out and I then sought prophylactic antibiotics to ensure any left would not go septic. I consoled myself with the knowledge that I could try to get into see my fabulous female obs/gyn doctor on the Monday, when clinic re-opened. Dutifully, I rang at 9.05am on Monday morning, to request an appointment. To be told rather abruptly by the triage midwife ‘we all have miscarriages, get over it’ and that I was no longer allowed to visit the clinic as I wasn’t pregnant, until I had been re-referred by my GP to see my specialist.
Up until that point I had not shed one tear, as my pragmatic side had been in control since Friday. The dam then broke and the visceral flood of pain and grief washed over me like a tsunami. I was devastated to be treated so cruelly by a member of the ‘caring profession’ who then must have realised her mistake and promised to see if she could get me an emergency appt. When she rang back later that day, I had already been to my GP for the requested referral and I rejected her hastily arranged appt, much to her chagrin.
I had never felt so utterly, utterly alone.
It took until December 2010 before I got a chance to see my specialist. We were ushered into the ‘crying room’ of the hospital, a place designed for people who have lost babies pre term or to still birth. It had pastel plastic coloured couches and limp affirmations along the lines of ‘life goes on’, on the wall. It may have even had carpet (a rarity in a hospital). My specialist was horrified by the cruelty of the triage midwife and apologised on behalf of the hospital for such shocking treatment. We discussed trying again and possible causes of the late miscarriage (which at 16.5 weeks gestation, is normally the fault of the maternal environmental). I agreed and had plenty of theories after I had consumed the (surprisingly small) literature on late (post 12 weeks) miscarriages. I even wrote to Faro hospital (on my own hospital letter head) to request any pathology they had done on the foetus. I received no reply.
The experience of that miscarriage was the final straw for my time in the UK. I wanted to be back in Australia to be near friends and family, to be supported again. So I started to look for jobs back home. I checked the Deakin website, to see if the Geelong based medical school had any positions going, as it was my dream place to work. They had a 3 year fixed term entry level Lectureship going (aka my dream job). I knew my track record was slender and that I probably didn’t have a chance, but decided to toss my hat into the ring, just to get my CV read by the Head of Research, for future reference.
To my surprise, I was offered an interview and then offered the job, which I accepted, to start after working my 3 month notice period. Three days later, I discovered I was pregnant again. I arrived as a solo parent of a 3 year old, to take up the job in mid-May2011, 4 months pregnant. I managed to set up my lab (including an animal experiment) in the first three months, as we waited for my husband’s visa to come through. He arrived in the August and my daughter arrived in early October 2011. I was entitled to 3 weeks paid maternity leave from my employer of choice for women.
This event changed the trajectory of my career and my life. It was the first (of several) object lessons that have taught me that while strategy and career planning is great, it’s actual life events beyond your control that can steer the ship, not you. During a subsequent ‘shit happens’ event, my MS diagnosis, I was given a full viral serology work up. I asked them to include CMV. It turns out, that I had titres for CMV consistent with a long past infection. Which makes me wonder if the head cold I had on that holiday was an infection that could have caused my spontaneous abortion.
Although, at the time, I was convinced it was Listeriosis from all of the Portuguese custard tarts I had consumed that week….although my specialist was more inclined to blame an incompetent cervix, and was tempted to stitch me shut, two days before I flew to start my new job and life in Australia.