For some of us mothers and mothers-to-be, we do everything within our control in preparation for pregnancy and labour, and yet things can turn out absolutely nothing like the way we envisioned. Here is my story on enduring one miscarriage, and two preterm births (where the babies didn’t survive), being diagnosed with a short cervix, fifty over days of bed rest, and finally…the birth of one beautiful, precious baby.
There is hope.
Young and carefree
I was married at a very young age, and spent the first 9 years of my marriage child-free and carefree. I had no desire to have children yet, but found myself falling pregnant mid-2017. I didn’t know what to do. I was eating all sorts of things, exposing myself to second-hand smoke, and only visited a general practitioner. By the time I arranged to visit a gynaecologist at 10 weeks, she couldn’t detect a heartbeat. I went through a Dilation and Curettage (D&C). It wasn’t too bad back then; I just felt like I lost something in my body.
The nightmare begins
I got pregnant again the following year, and did the things every pregnant mother would do- diligently going for the usual check-ups, and even opting for all the extra tests that are normally recommended for older mothers, despite being only 31 years old. I found out I had gestational diabetes, but that was easily managed with diet and lifestyle.
But suddenly, at week 19, I found myself leaking. Rushing over to the gynae’s clinic, I was told something that would have been exciting news under very different circumstances. Oh my gosh, your cervix is dilating and you are already 2cm, your baby is going to come out anytime. The doctor suggested that I terminate the pregnancy, or risk having a bad infection, comforting me by telling me that age was on my side and that I could always try again.
I refused. My maternal instinct kicked in hard and strong. I was almost 5 months in, my baby was already so developed, I felt a connection with my child. How could I just terminate?
I was brought to a hospital, where the doctors there once again strongly advised me not to continue with the pregnancy, as chances of saving the pregnancy were slim. Holding my ground, I proceeded with the emergency procedure to stitch my cervix, and was put on bed rest. Despite my best efforts, my water bag burst at 3 weeks due to a bad infection, and I was moved to a hospital with a state-of-the-art NICU department and a team on hand to resuscitate my baby girl, if the situation warranted it.
We will not resuscitate
I couldn’t make it in time to the operating theatre, and gave birth to a beautiful little baby girl in my hospital room. She came out alive- I didn’t see it, but I just knew. She was only 300g for a 21-weeker. I knew this meant she would not be resuscitated, with the criteria for neonatal resuscitation being a minimum weight of 500g and a minimum gestational age of 24 weeks, as advised by my doctor. I felt blank on the one hand, but my heart also felt this deep sense of loss, pain and devastation.
The nurses asked me if I wanted to hold my newborn, and I said no. I was not mentally prepared. She didn’t make it past a few minutes on this earth. She was wrapped up in the hospital cloth and placed in a yellow radioactive bag. My husband was tasked with the painful ordeal of carrying my child’s dead body to the back of the mortuary at the back of the hospital, and signing a letter of release. And just like that, my daughter’s precious little life, with all the opportunities that lay ahead of her, was gone.
Let me join my child
I was a wreck, and the last thing I wanted was to be alone that night (the rules of the hospital were that no visitors were allowed overnight stays). I wasn’t myself, with suicidal thoughts and hysterical moments. “You leave me here and I’ll jump down from the building,” I threatened, when doctors told me I had to stay on for monitoring. I felt like there was no meaning in life anymore. As I kept looking at the window by the side of the hospital bed, there was a little voice that kept telling me “Go ahead and jump off, join your baby.” Unsure of what to do with a suicidal patient, the hospital staff placed the maternity guard to keep an eye on me, as I signed the indemnity form, and checked myself out.
Dealing with grief
And so, I began my confinement period, but with no newborn to care for. There was no baby to soothe, no nappies to change, no breastfeeding duties. It was just me, with my painful, recovering body and my bitter, anguished thoughts. I ended up being emotionally triggered by anyone who was expecting or who had kids, or by anything that was related to children. Noticing strollers through store windows would lead me to take a sharp U-turn, cars with car seats installed would make my heart wrench, and certain songs would start the tears uncontrollably rolling. I unfollowed everyone with children on social media and retreated into a shell in an attempt to protect myself from further pain.
I ended up taking time off work for the rest of the year. I began to hunt online for someone to reach out too, desperate to find ways to manage the loss and the sadness in me. I found a grief therapist on a forum, took a leap of faith, and scheduled a visit. This leap of faith paid off immensely. My journey of healing began with the professional support I received, as I committed two hours weekly to intense discussions on topics surrounding anger, shame and jealousy, and worked through the issues brought about by the loss I faced, as a hopeful mother to be.
Through follow-up visits with the gynae, I was officially diagnosed with a short cervix, also known as cervical insufficiency. This is a condition when weak cervical tissue causes or contributes to the cervix dilating prematurely during a pregnancy, and is the cause for about 1 percent of expectant mothers who experience preterm labor. For women who are considered at risk and have previous miscarriages, Dr. Janani Sivanathan suggests checking regularly for this condition with a transvaginal ultrasound at 14 to 24 weeks of pregnancy. Progesterone supplement, a cervical cerclage (cervical stitch operation), or a pessary (inserting a device to ‘plug’ the cervix) may be offered as treatment.
History repeats itself
Infection in the wound
We tried once again to get pregnant, and succeeded the following year, immediately having a pessary inserted in. But as fate would have it, an undetected infection caused my water bag to burst, uncannily, at the dreaded 22 weeks mark. I was admitted to the hospital on Christmas Eve, and gave birth just four days later to a baby boy. My son came out alive at 22 weeks, weighing 500g. It was déjà vu all over again. The same questions were asked, if I wanted to hold him, and I gave the same reply, no. My husband carried him for a fleeting moment, and helplessly watched him fade away within two hours.
A more positive mindset
Surprisingly, I was a lot calmer and accepted what happened this time round. I didn’t hate God as I previously did, telling myself that maybe, some things were just not meant to be. This just may not be my time yet. I continued to hope and pray that I would be granted a child one day.
I was, and am grateful for a supportive workplace and wonderful co-workers and management. Everyone was sensitive to my emotional needs, in little and big ways. Being involved in marketing, I was taken off campaigns that were related to children and mothers until I felt ready. I restarted grief therapy again, something that I attributed my relatively calm response to this third miscarriage.
Taking a break
I decided to switch to Aseana O&G Specialist Clinic, a specialist in recurrent miscarriages, where the doctors advised me to rest my body for at least a year and to also check on my auto-immune system. Coincidentally, this occurred right before the pandemic, which gave me the perfect setting to rest and focus on my health. I spent most of the pandemic relaxing, checking in with the gynae, and also had a full clean up of my womb, having found foliage along the uterus lining.
My Rainbow Baby
Breaking the curse
Not giving up, my husband and I got pregnant again the following year in 2021. I had a “McDonald cerclage stitch”, went for bi-weekly check ups, detected and treated a few vaginal infections, and held my breath as the weeks crawled by. I passed the 22 week mark for the first time in years, and nervously went for my check up at 24 weeks. The scan showed that my water bag had begun to slide down, otherwise known as ‘funnelling’. I was told to be admitted for close monitoring and bed rest. I remember my doctor looking at me and saying, “Joanne, I generally do not admit patients for bed rest. However, in your circumstances now, I would recommend it.” This meant possibly up to 13 weeks in hospital on bed rest during the Movement Control Order. I had to do this for my baby.
Unfortunately, my bedrest prescription wasn’t a relaxing, try-your-best-to-stay-in-bed scenario. I had to lie in a semi recumbent to almost flat position and wasn’t allowed to sit upright for 50 days. Even eating was done with my body at a slant, to ensure that I didn’t put any weight on my uterus. Because of the pandemic, I was alone in the room with no visitors, and had to wait for my husband to come every Saturday and give me a shower (yes, I could only shower once a week!). My once-a-week shower had to be a quick 5-minute indulgence, done while sitting in a wheelchair at a slant, once again. The discomfort (to put it mildly) paid off. One month in, and I was ecstatic – I had made it to 28 weeks! The doctor hoped the pregnancy will be able to sustain up to 32 to 34 weeks. The aim was for the removal of the cerclage stitch at 37 weeks.
And as with most labour stories, things didn’t go according to plan or target. One week later, my waters broke. The doctor started antibiotics in order to avoid infection setting in and to prolong the pregnancy further. However, I developed signs of infection, and with an underlying group B streptococcal infection, my doctor said it was time for me to deliver. According to my gynae, the success rate was 85 percent, and the baby had to be in NICU for just a little while. I was given injections at night to injections for the baby’s brain maturity and for the prevention of a haemorrhage.
On 14th August 2021 at 8am, my gynae walked into the place I called home for the past month, and greeted me with a bright, cheery voice, “Joanne, are you ready to do this? Today, on the 14th of August, you will give birth to a beautiful baby girl.” My heart soared.
And I gave birth again, for the fourth time. But this time, my daughter was placed on my chest for a few seconds, before being pushed into the NICU. I saw her alive and well the next day in the incubator, and the relief and joy that washed over me was just…indescribable. I now have a child, alive and kicking. One that I would be able to nurture, support and love with all my heart, as I watch her grow into a beautiful woman.
It was all worth it.
By Joanne Lee Mei San (as told to Elaine Yeoh)
Today, Joanne is a proud mama to sweet 14-month-old Abigail. Looking at her today, no one would guess that Abigail was born premature, at a delicate weight of 1.5kg and at the tender age of 29 weeks gestation.
In conjunction with World Prematurity Day, we hope that Joanne’s story of resilience, loss, grit and love will act as a ray of hope for any mothers out there who are struggling with recurring miscarriages or pregnancy-related challenges. We stand with you, #makchicmumsquad.