Losing a baby at 20-24 weeks of pregnancy
Experiences when extremely premature birth is likely
For about half of the parents we spoke to, the pregnancy ended due to premature labour or the waters round the baby breaking very early. For some, this was a long process with repeated visits or stays in hospital. For others it was a very quick process, and they gave birth within a few hours of their first symptoms.
Most of these women’s pregnancies had progressed well in the early stages, so premature labour came as a shock. Lindsay remembered feeling fine until after her 20 week scan. But others, such as Courtney and Asun, had experienced extreme sickness throughout their pregnancy.
Courtney felt sick throughout her pregnancy and the first day she felt “semi-ok” was when her premature labour started.
Courtney felt sick throughout her pregnancy and the first day she felt “semi-ok” was when her premature labour started.
And, and I used to complain because people used to say "Oh, morning sickness." And I'd be like "There's nothing called morning sickness, it's called 24/7 sickness." [Laugh].
And, and that's just the way it is. And it's horrible. But, but I remember the first day that I felt semi-okay was the day that we lost him. I remember waking up and thinking 'today I feel like I can do stuff'. And then obviously that's what happened.
When mothers started to experience symptoms varied widely. For some, the symptoms came on very suddenly and they gave birth extremely quickly. Kirsty’s pregnancy had progressed well and so it was completely unexpected when after an exercise class she went to the toilet and felt she was about to give birth. Some mothers had just a few hours in hospital before giving birth, often waiting for or receiving treatment to try to delay the birth.
Kirsty was taken to hospital by ambulance when she suddenly started to give birth.
Kirsty was taken to hospital by ambulance when she suddenly started to give birth.
Screamed for Matthew. He came in. And he just took control. Absolute control. I'm generally the one in the relationship that takes that stance. He rang 999. And they were speaking to me, telling me to get into this position and that position, what was going on. And there was no other feeling I had to push, there was no other - that was it. I had that obviously - I now know they were contractions. I was told at the hospital I was having contractions. But that was it. So I had this baby that was half in, half out. The ambulance came. And they didn't know how to put me into the ambulance. And I remember being really awkward. I couldn't sit down. I didn't want to lay down. So I ended up hugging a chair, in the ambulance, on my knees. And I remember them saying to me, "We're going to the delivery ward. We're going to the labour ward." And that really confused me.
I remember feeling really confused, and going "Well, why am I going to deliver the baby?" I just didn't understand at the time. It didn't compute that actually I was having a baby. I think in the back of my mind I thought that they'd be able to put her back in, or. Because she wasn't ready to come out.
We got to the delivery suite. And they had a crash team ready for her. And the room was just full of people. And they were all desperately trying to get her out. They were pushing my stomach. They were telling me to push. And I, and I also remember they kept saying to me, "Bear down. Bear down." I didn't know what that meant. I hadn't been to any antenatal classes yet because we hadn't got that far along.
And it was panic. It was just this mass feeling of panic. And then all of a sudden the doctor came to my bedside, she had a stethoscope. And she put it to the umbilical cord, and she just said "There's no heartbeat." And then that was it, and the room emptied. Everybody left. We were left with a lovely midwife. And I think that's when we let go. I think we knew. We both knew, on the way that this wasn't good. We weren't at that stage yet, where it was all going to be okay.
But I think when somebody turns round and says to you, "there's no heartbeat," that's when - that one minute, everything changes. Everything changes. The room emptied. The midwife left us alone. We had a good cry. But I still had a job to do. I had to get this baby out. Courtney was at work when she realised she might be losing her baby and had a long journey to the hospital.
Courtney was at work when she realised she might be losing her baby and had a long journey to the hospital.
And then rang up my husband, and was just like, "You need to meet me at the local hospital."
Went to the local hospital, and they said that the scan unit had closed, so they couldn't scan me. Which I thought was - At the time, I didn't think anything of it. Now, I think it's disgusting. You know? And they said that I'd have to wait until it opened at seven o'clock in the morning, and they were going to keep me in. And I had no bleeding. And they'd had a look and said "It's incompetent cervix. You just need to be stitched up." So, once we scan you, you can see how far back the hole goes, so how much we need to stitch. And I was like, "Fine."
So, went the whole night, terrified. Absolutely terrified. The next morning came, seven o'clock - because obviously we didn't sleep, at all.
Seven o'clock came. And, I was fully expecting that I'd be taken in to have a scan, to have the scan straight away.
And they were saying that the appointments that had been booked that day take priority.
So I was left there, waiting. And then it came to eleven o'clock, and I was still waiting, to try and see to get someone to have this scan, so I could go into surgery. Because in my head, once I had the surgery, everything would be fine, because it'd just be stitched up. And then you could go on with it. Eleven o'clock came. Still didn't have a scan. Twelve o'clock came, still didn't have a scan. Also, not - I'm not, was angry with them or getting annoyed, because - you know - this is the first time that I'm going through this, I'm totally going by their judgement and everything that they're doing, and understanding that they know best. One o'clock came. And I - It's the first time that I said to my husband to, you know, "Go home. All I'm doing is waiting for a scan. Go home. Get some bits for us, and then come back." Half one, I started bleeding. And they come in, and they tell me - didn't even - it wasn't even bleeding a lot. It was like spotting.
And they come in and they tell me that there's nothing they can do, that I'm going to have to let the baby pass.
Without the scan?
Without the scan. The whole time I was there, I never got a scan. I got, I got a Doppler, which allowed the heartbeat. And, and the heartbeat was really strong. There was nothing wrong with him at all.
Like the whole time, his heart was really strong. He never had any issues with him, it was - it was my cervix that was the issue, we just needed to close it up. Kamie described just having a bit of a stomach ache before her waters broke and she was rushed to hospital to give birth.
Kamie described just having a bit of a stomach ache before her waters broke and she was rushed to hospital to give birth.
For other mothers, there was a long period of days or weeks from the first symptoms and an idea that something was wrong until they finally gave birth. The symptoms mothers experienced included bleeding, loss of fluid around the baby or pains around their abdomen. Some mothers stayed in hospital while others were admitted and discharged, sometimes repeatedly. Some felt their symptoms were not taken seriously. Kamie had already experienced the loss of a baby at 20 weeks. So when she had the same symptoms with her next pregnancy she felt upset that people were “fobbing you off all the time, like I don't ring a midwife for no reason”.
Emily and Mike were in and out of hospital with bleeding for 7 weeks. Although they felt something was wrong, they didn’t feel they were taken seriously.
Emily and Mike were in and out of hospital with bleeding for 7 weeks. Although they felt something was wrong, they didn’t feel they were taken seriously.
Mike: That was very frustrating, was every time, and we went to the hospital a good three or four times, and –
Emily: Three, I was admitted three times.
Mike: And every time we went there, we had to go through the same rigmarole of going to A&E, waiting for two, three hours –
Emily: I'd have to sit in the waiting room.
Mike: Going to get into a bed in A&E, wait around more.
Emily: I'd be hooked up to a drip, wouldn't I.
Mike: Yeah.
Emily: And I often had to stay in overnight, just for sort of observation. But it just felt like nobody really knew what was going on. And, you know, I do understand that until a certain age, or - you know - or stage of your pregnancy, they can't really do very much. But it did feel like we weren't really getting any answers, and we just keep being sort of sent home.
Mike: And you just got the feeling sometimes that people think that maybe you're just being a bit of like a –
Emily: A bit dramatic.
Mike: Yeah. About it. Or, I’m not sure quite what the - hypochondriac, is it?
Emily: Yeah. Yeah.
Mike: Yeah. Just - It was just like you were making a big deal out of something - like 'you're pregnant, people bleed when they're pregnant', but. I, like - trying to - And like I kept trying to tell doctors, like "This isn't just a little bleed, this is a substantial bleed -"
Emily: I'd soak the bed, and things.
Mike: When, when - When we had to call the ambulance out as well, they asked me to - Well, to me, it was one of the worst things, like because we weren't sure if it was just a large clot, if Emily had miscarried. And they said that you have to get that out of the toilet. So that was pretty, pretty upsetting for myself. And then trying to tell that to another random doctor, I know that's how A&E work, so I've nothing against that, but having to explain that to them, that this isn't just like a little bleed, again. There's, there's not something right.
Some parents were told the likely outcome by a doctor in very straightforward terms, that there was no room for hope and that their baby would not survive. But some parents received conflicting opinions which raised “false hope”. Matthew described how “the longer we were there we realised that actually nobody has a clue. Right? I mean, people do have an idea. But nobody really knows, until the baby's born”. Waiting a long time to find out what was wrong was often frustrating and distressing, particularly when communication with staff was poor.
Maxine and Steve felt it was “two weeks of a rollercoaster” especially when they went in to hospital for Maxine to have the birth induced and the doctor wanted another expert opinion.
Maxine and Steve felt it was “two weeks of a rollercoaster” especially when they went in to hospital for Maxine to have the birth induced and the doctor wanted another expert opinion.
Steve: Yeah.
Maxine: The purple room.
Steve: And I think we were still, in our minds –
Maxine: She was still alive.
Steve: Yeah, she was still alive. But we were still in the mind of, like Maxine says, you know - come in to take the tablet or whatever. The consultant sort of was going to say, "Right, you know, this is what we need to do. What you saw last week is right." And everything that.
Maxine: It was almost just - we felt that was the confirmation.
Steve: Yeah. And then suddenly, he came and then told us "Ooh, I don't think I can make the decision. I think we need to -"
Maxine: He wanted a second opinion.
Steve: A second opinion. And it was like, well hold on - we're all - Suddenly, we're on a - It was a rollercoaster. But at the time, the rollercoaster was just going along at a level? And I think we were thinking, right this is where - you know –
Maxine: The Tuesday, it's almost –
Steve: The Tuesday, the tablet's going to start. And we're going to, you know, just carry on. Then suddenly we got this boost again, going up, of 'oh, hold on - I want another consultant to, to analyse what we're looking at'. And you think 'oh, hold on' [laugh].
Maxine: That - it was just –
Steve: The hope came back again.
Maxine: The hope came back again. David Z found the toughest part was being in the hospital waiting for information.
David Z found the toughest part was being in the hospital waiting for information.
David Z found it very tough balancing work, caring for his son and visiting Asun in hospital.
David Z found it very tough balancing work, caring for his son and visiting Asun in hospital.
Parents were sometimes faced with difficult decisions, for example around preventive treatment or induction. Some mothers were offered treatment such as stitching the cervix closed to try to delay birth, if it was clinically appropriate. Unfortunately, this wasn’t successful although the same treatment was successful for some of these mothers in later pregnancies. Making the decision to have a stitch (also known as cerclage) was difficult for some parents. They realised that by pursuing treatment to save their baby, they could be delaying birth for only a few days or weeks. This could mean their baby survived, but would be born very prematurely, and so have a high chance of poor health.
Some parents had to decide whether to have an induction to start labour and end the pregnancy, knowing their baby wouldn’t survive. If a woman’s waters break very early, it may be necessary to induce labour due to the risk of severe infection (maternal sepsis). Other parents contemplated an induction to end their pregnancy as they knew their baby was going to be born early and they didn’t want them to suffer. Parents found it extremely hard choosing to induce the birth when the baby seemed healthy. Mothers described feeling strong movements and kicking or they heard their baby’s strong heartbeat.
Collette found it particularly hard seeing her baby’s heartbeat on a scan before giving birth.
Collette found it particularly hard seeing her baby’s heartbeat on a scan before giving birth.
They couldn't get a machine into my room, and they wanted me to go and have an ultrasound downstairs. And the woman there didn't know my situation. And she didn't know my water had broken, and she started scanning, and she was like "There he is, there's his heartbeat. Oh, little boy." And I remember just - My Mum was holding my hand and I was just crying and crying and crying, and she was like "Would you like a picture?" And I was like, "What?" In fact, I said "Yes, I do actually want a picture." I said, "But my son isn't going to live." You know? But I was just - And I know it happens, she's only a person, and there's so many of us and we're all - you know - I want to be understanding, I want to be sympathetic, and. But it's so hard when it's happening to you. Feels like injustice is so bad, and. Don't know.Lindsay felt it would have been easier to make a decision about inducing the birth if her baby had died.
Lindsay felt it would have been easier to make a decision about inducing the birth if her baby had died.
How long did they leave the decision with you?
[Sniff] Not long at all. Like I said, there wasn't really a decision. They weren't really asking me, "What are you going to do?" They were like "These are your two options, and this is what we're going to do." And they really were just waiting for my consent to put me on the induction drip. So probably half an hour from the consultant coming in, to me being plugged in, and asking the midwife a hundred times to just clarify exactly what she'd said, what they'd said. Yeah. So yeah, it wasn't really a choice. I think as they said it, they walked in with the medication, really. And with hindsight, obviously that was the right thing. Because I did have a family to come home to. But it's grief mixed with shock mixed with maternal hormones, is just a [laugh] - a really weird concoction to go through. So they plugged me in.Matt struggled with weighing up the best for his unborn baby when Lisa’s life was at risk.
Matt struggled with weighing up the best for his unborn baby when Lisa’s life was at risk.
And I think - I don't know, maybe it would be more for me, I don't know. Because I was worried about Lisa as well as the baby. And kind of the risks of infection, and that seemed to be the biggest kind of thing that was , they were worried about. And if you put a stitch in, and keep it all there, who knows what could happen. So I mean you said at that point, it suddenly gets really, really - moral, ethical decisions you're making about should I - yeah, should we continue, should we? And I think for us, we've got a strong Christian faith, and so the idea of kind of terminating a pregnancy - it almost wasn't, it wasn't really an option. But then, then you're also conscious of - you know - what's the right thing for Lisa. And you don't know all the statistics. And at the end of the day, they're just statistics. So anyway, we talked to the consultant, and she was a lot more - She didn't necessarily say anything different to what the other people had said, but just the way she said it, and. She was quite - just quite relaxed about things.
For the mothers we spoke to, going through labour and birth knowing that their baby would not survive was extremely difficult and emotional.
Copyright © 2024 University of Oxford. All rights reserved.