My Story: Sleep well, our Apollo and Artemis
By Kimberly Low
It’s been 12 days since I lost my son and daughter to prematurity. They were born at 24 weeks 5 days gestation – 4 weeks away from having a shot at staying alive and 15 weeks away from being actual full-term babies. How do I even begin to describe the saddest day of my life?
The pregnancy
My pregnancy was uneventful apart from the excitement (and horror) of finding out that I was carrying twins. The babies were growing well, I felt happy and relaxed, I did not bleed like when I was carrying Liam.
At every check-up and ultrasound, I was given the all-clear. Other than some concern with my low red blood cells and placenta being a little close to my cervical opening, I was a healthy pregnant woman. My heart skipped with joy everytime I saw my babies on the screen; seeing the outlines of their faces, their hearts beating strong, their arms waving and legs kicking.
Sometimes I couldn’t believe how lucky I was, happily married to a wonderful man who loves me and about to have 3 kids with only two pregnancies. To become a mum of three; 2 sons and a daughter … my fantasy coming true.
I woke up that day a little tired but nothing alarming. That’s what carrying a heavy belly does to you afterall. I made lunch for Liam and myself, folded the laundry, ate tea jelly with red dates that I made the day before and watched The Good Wife. I touched my growing belly ever so often with quiet happiness. I was contented.
And then I chatted with husband on Whatsapp about dinner and with phone still in my hand, I went to relieve my bladder. It was around 6pm.
Finished, wiped and had a quick look at the tissue. When I saw what’s on it, my heart sank to my belly. I quickly tried to recall what stage of pregnancy I was in. Far too soon. My chest ached at the fact.
I messaged Gareth and said “Spotting” instead, eventhough I knew exactly what it was. I couldn’t bring myself to say it. It wasn’t any ordinary spotting, it was my mucus plug coming out. I sent a photo of the discharge to my husband and immediately he knew what it was too.
I still had a little hope, because in my previous experience, Liam was born 20 days after the mucus plug came off. The babies might just make it? I started calling both hospitals (I was visiting two different obygyns in a public hospital and a private hospital). My private doctor was on holiday and my public doctor was at home. I decided to wait till the day after to go to the hospital.
Gareth came home with some dinner and we ate while discussing our options. We tried to stay positive and offered each other scenarios of good outcomes.
Contractions
By 9pm, my contractions started kicking in. I kept telling myself they’re Braxton Hicks, but I knew they weren’t as they hurt like period cramps. I started timing them and they’re 4 minutes apart.
I started getting really upset. I messaged a friend who knew my public doctor for his personal contact and she gave it to me along with the advice of going straight to the hospital. Decided she was right as perhaps they have injections to help me stop the contractions? So we started packing for the hospital. The reality of what’s going to happen started to dawn on me. In the middle of packing for the hospital, I couldn’t help but cried.
I don’t know how but I had the foresight of removing my jewellery and bringing my own maternity sanitary pads and clean undies. I think the pragmatic side of me knew I was going to give birth but the emotional side of me was still in denial.
We reached the public hospital, headed straight for the labour hall. They wheeled me in, plonked me on the examination bed. I kept telling the nurses and doctor to help my babies, to help me stop the pain, stop me from giving birth. I begged them to stop the contractions. A nurse said in Malay, “Sorry, but you’re definitely giving birth cause you’re in such pain”.
A young doctor on duty gave me a vaginal examination with a speculum and as soon as she inserted it, my water broke. At that moment, I wish I could just die and not feel anything. I knew for sure that my babies were not going to make it. She then proceeded to say that she could feel either fingers or ear.
The labour
Not long after, another doctor came. He introduced himself and mentioned that he’s a specialist and he would take care of me. I have heard of this doctor before and was slightly relieved that he would be taking over. He told me that I had to deliver the babies now and they will try their best. At that point I was in so much pain I just wanted everything to be done and over with.
They wheeled me to the labour room and immediately I started pushing. After a few pushes, I felt the burning sensation of baby crowning and I saw my boy came out. He looked purple. They immediately took him away. When Liam came out he was pink and covered in vernix.
Then, doctor said the girl was breech and he kept massaging my stomach to try to turn her. They also wheeled in an ultrasound machine to scan my belly to check her position. I kept pushing as hard as I could eventhough my contractions had kind of died down. Eventually she too came out, also purple. It’s not even 12am yet.
After my placentas were expelled, they cleaned me up and I waited for Gareth to come in. The doctor told me kindly that they’re doing everything they can with the babies but to be prepared for bad news. I nodded. After all that pain, I was feeling numb.
Gareth finally came in with Liam. We talked about what happened and told ourselves that we would be fine if the twins died as it’s better than for them to be alive with severe disabilities.
The paediatrician came in to tell us that neither twin made it. They lived for about 45 minutes. He explained that they couldn’t really breathe on their own and that they were severely bruised due to the trauma from the birth as their skin was not strong enough. My girl was bruised on her back as she was breech while boy was bruised all over his face as he was born head first.
We didn’t cry. He asked if we would like to see them, and we said no. We told them to just deal with their bodies. A nurse in the room kept telling us to see them but we kept saying no.
After that, they said the “Forensics” were on the way and told Gareth to wait for them. We waited for a while more but Liam was getting really cranky so I told Gareth to just take Liam home. The forensics people never arrived. Now we understand that by “Forensics” that they had meant people from the mortuary.
Post-labour
After Gareth and Liam left, I was wheeled to my ward. I was on pitocin drips to get my womb contracting back to its original size – it was painful. Bad cramp after bad cramp for hours. In between cramps, I cried as the reality of the situation started sinking in.
My babies, my children are gone forever. I delivered 3 babies but I only have one with me. Why? Why did my son and daughter have to die? Why couldn’t I keep them in? They were healthy, thriving babies. No troubles for 6 whole months to suddenly delivering them in just 5 hours. It’s all so fucked up the more I thought about it.
As a fully paying patient, I got my own air-conditioned room with en-suite in the public hospital. In hindsight, I am so glad I got the privacy as I got to cry, groan and wail in my own room without disturbing anyone. I couldn’t imagine myself holding it together while being in a ward filled with women and their newborns (in public hospital the mothers are expected to take care of their babies right after birth).
I did not sleep at all. I couldn’t. I had a lot of time to myself to think. After the shock had passed, I longed to see my babies. I messaged Gareth that we had to see them and he agreed as well. As for what to do with their bodies, we decided to still let the hospital handled them. No ceremony.
The day after I did not sleep a wink. In the morning, my doctor (Dr. Sundar) came to check on me and as soon as I saw his face, I cried again. He told me that what I experienced sounded just like cervical incompetence and that for my next pregnancy, I should put in an elective transvaginal cerclage – basically stitching up the cervix to support the weight of the baby. Dr. Sundar, his colleague and a trainee doctor wheeled me to the police kiosk in the hospital to make a police report, basically to formally give permission to the hospital to handle the bodies. I am very thankful for their kindness.
Later on, the doctor who delivered my babies, Dr. Chopra also came to check on me. He basically came to tell me that he knew we didn’t want to see the babies but he just wanted to convinced us to do it. He said it would help with closure. I told him we had already decided to see them and he seemed relieved.
Gareth appeared around 2.30pm with Liam’s paediatrician (who works at the same hospital). According to Gareth, he was trying to enter my ward with Liam but was not allowed as he’s too young to be allowed in due to the hospital being an infectious disease centre. While talking to the guards, Dr. See serendipitously appeared. He got one of his staff to watch over Liam in a counselling room at NICU and came to visit me with Gareth. Thank you Dr. See!
He looked genuinely concerned, offered his condolences and told me my situation sounded just like cervical incompetence. So now, there are 3 doctors that have told me I have cervical incompetence.
Finally, we got everything sorted out and we had a very late lunch at Texas Chicken. I felt alright. Yes, I was in pain due to the womb contractions but emotionally I felt okay? I was tearful but I thought I felt fine considering the enormity of what just happened. I even messaged my best friend sent her a wefie of myself and Liam to demonstrate my point.
After lunch, we got home. My dad and his partner arrived. I told them what happened and asked dad if he could watch Liam so Gareth and me could go back to the hospital to sort out our babies.
Seeing our children
It’s almost 9pm by the time we left home. We deliberately left at that time to avoid traffic. Gareth was inconsolable while driving to the hospital. I had never seen him cry like that. After we reached the hospital, we walked together to the mortuary. The guy over the counter immediately knew whose bodies we were there for as soon as I mentioned “kembar” (twins in Malay). Filled out some paperwork and waited on a nearby bench while they prepared the bodies. Then the guy brought them out, in a hospital baby cot.
They were wrapped in sheets. Gareth uncovered the sheets and as soon as I saw them, I lost it. My perfect daughter, with her long limbs, fingers and toes, head full of hair and amazing eyebrows. Her high nose and that peaceful look on her face. But she’s dead. My son, big headed just like his brother Liam, not much hair just like Liam and handsome just like Liam too. He’s not breathing either. I couldn’t process it. They were kicking happily in my stomach just a day ago.
We touched them and told them we loved them. We took some pictures. I am so glad now that Gareth took their hospital bands. We spent some time with them.
It was really hard at that time, but now 12 days later I am really glad I had seen them properly and acknowledged them as my children.
The days after
The earlier days were of course the hardest. I was crying a lot. Something as simple as listening to Liam’s laughter could fill me with intense sadness as the thought of him not being able to laugh with his siblings hit me like a tonne of bricks.
I felt desperate, desperately wanted to turn back time. I want to go back to a time when I wasn’t even trying to conceive. I wish I would just be content with having Liam. If only I had done just that, I wouldn’t be saddled by this constant pain in my chest.
I felt like a part of me has died along with them. I felt like I could never feel happiness again. Everything that was good in my life had been tainted and everything that will make me happy will be tainted too. If I wasn’t feeling sad, I felt numb.
When my breast milk kicked in on the 4th day after labour, it was a whole new world of emotional pain. The thought of having no babies to feed my milk to, the sorrow was inexplicable. I tried to coax Liam into nursing again, but he would have none of it.
I have been gently expressing the milk once or twice a day, just enough to relieve the fullness and so far thankfully I am not suffering from engorgement or plugged ducts.
Whatever milk I had expressed, I have sent to a local jeweller to be turned into two bracelet charms. I’ve also sent Liam’s old frozen breastmilk to be turned into another charm.
The thought of being able to wear the charms soothed me. It would be like, my children will be with me all the time.
It has gotten easier. Today, I am no longer crying constantly. I’m making stupid jokes again, back to teasing the husband again. I’m starting to feel more normal. A good day consists of a couple of short sobbing sessions (for instance, when I saw baby girls clothes I could have bought or other fraternal twins having dinner with their parents). The bad days are getting rare.
I’ve also been focusing my energy into researching about my condition.
What is wrong with me?
My doctors have given me a diagnosis of Cervical Incompetence or Cervical Insufficiency (henceforth will be referred as IC aka ‘incompetent cervix’ on this blog post). Basically it’s a condition where my cervix couldn’t bear the weight of the baby, it gets prematurely shorter leading to premature labour.
According to studies, it’s something that affects 1 – 2% of pregnancies but I believe that it affect more women than we know because of how hard it is to diagnose. The illness can only be “sort of confirmed” from a history of miscarriages or 2nd trimester/early 3rd trimester losses.
For women with IC, the losses get progressively earlier with subsequent pregnancies and the labour quicker.
The fact is, Liam’s premature birth was actually a warning sign for IC. Before this happened, I thought Liam’s premature birth was bad luck but now I know it was actually very good luck, because I gave birth late enough for him to survive. My cervix could have given way a lot earlier but all the factors of being a first and single pregnancy (stronger cervical muscle tone and lighter weight) helped.
While my doctor has recommended Transvaginal Cerclage (TVC) for my next pregnancy, I have decided to get a Transabdominal Cerclage (TAC) instead after reading up about my condition. Basically TVC and TAC are stitches you put in the cervix to keep them closed. You can learn more about cerclages here.
TVC can only be done while you’re pregnant and requires complete bedrest post-surgery, while TAC requires abdominal surgery (whether open surgery or laparascopy), does not require bedrest and can be done before a pregnancy happens.
Both are stitches for the cervix to support the weight of the pregnancy, however as TAC is a much higher stitch on the cervix and is not exposed, the success rate of carrying baby to full term is much higher (>90%). TVC on the other hand has only success rate of 70% to 80% with the tediousness of complete bedrest for months and as the stitch is put in via the vagina while you’re pregnant, there are risks to the baby, increased risks of preterm labour and risks of infections due to the exposed stitching.
The downside of TAC is that you must give birth via a c-section while TVC can be taken out later on so you can birth naturally. If you asked me, C-section is a walk in the park compared to dead children, so yeah.
I am just unable to concede with 80% success rate when there’s another option with >90% success rate out there. Unfortunately, there’s no doctor in Malaysia doing TAC as far as my research has told me, so I have made contact with a hospital in India, helmed by a TAC expert. If all is well, I should be heading to India in early 2017 for the surgery.
If you know of anything about the TAC scene in Malaysia, please do let me know. Thank you!
My concern now is just to find an obygyn that wouldn’t freak out at me having TAC to deliver my future babies. They shouldn’t freak out anyway as it would be a routine c-section but you never know? So, fingers crossed.
Anyway, if there’s any mummy who has experienced early pregnancy losses or has been diagnosed with IC, do check out this forum called Abbyloopers. This forum is very helpful and informative when it comes to TAC and IC.
Thank you
Thank you everyone for the kind wishes and gifts that you have sent us. The flowers, nourishing tonics, offers to bring food, to keep me company and many more were much appreciated.
Thank you for your kindness, thoughtfulness and consideration.
Naming our babies
We are required to register their births and deaths so we needed names. It’s supposed to be easy as when I was still pregnant, we had already named them.
However, we’ve decided to keep those names for their future siblings and it’s been a little stressful to think of other names for them. We need to like the names, they need to be dignified so definitely can’t be their nicknames (we called them nunu2 and nunu3 omg) and they can’t be the discarded names we had discussed before.
Finally, after much thought, we have decided on calling them Apollo and Artemis – the twins in Greek mythology. Artemis is also goddess of childbirth, so perhaps she’ll watch over mummy in the future.
Apollo 670gm. Born 1 September 2016, 11.47pm. Died 2 September 2016.
Artemis 630gm. Born 1 September 2016, 11.58pm. Died 2 September 2016.
I love you so much, my dear children. Sleep well, my darlings. Mummy is sorry for everything.
Update – October 2017
It’s been a little over a year since I lost both my son and daughter to extreme prematurity. When it first happened, I couldn’t imagine how I could ever move on from my grief but today I can confidently say that I have moved on from the pain and heartache. Not in a let’s-sweep-it-under-the-carpet kind of way, but in a dignified and positive trajectory that I am sure my husband and all of my children will be proud of.
Usually when people leave us, you have memories of them to hang on to, to remember them by. However, I didn’t get a chance to create meaningful memories with Apollo & Artemis and that was probably the part that was hardest for me to reconcile with. I remember asking myself during my darkest moments whether they even existed. If they didn’t exist, then I shouldn’t be feeling such torment, I reasoned with myself to no avail.
The fact is, they did exist. They swam in my womb for more than 6 months; I felt every kick, every hiccup. I had hopes for them. I gave birth to them, even when they only lived for less than two hours. Those are our memories and nobody could ever diminish or take them away from me. At some point between their passing and now, I realised that their demise is a very important lesson for me as a mother, a wife, a woman, and a person. My twins had rewarded me with the gift of clarity. They had made me a better human being in every way.
I was asked if I had anything to say to any mums out there who may be experiencing a loss and sorrow like mine.
I celebrate their existence by living as meaningful a life as I can every single day. Though it may seem difficult at times, I breathe, cry, ride it out, and then try again. For me, the best way to get through this impossibly painful time is to honour our children by making our lives worthwhile. My children’s deaths were not in vain and neither is yours.
Kimberly Low is a doting mum to her eldest son, 3-year-old Liam. She enjoys sewing, painting and reading in her free time. She blogs at www.kimberlylow.com
