Getting a Pregnancy Loss Evaluation…one mother’s experience

Dear CLIMB,

I thought I’d let you all know how healing it was for me and for my husband to go through a Pregnancy Loss Evaluation in the Maternal-Fetal Medicine Division of Robert Wood Johnson University Hospital in New Brunswick, New Jersey (http://rwjms.umdnj.edu/obgyn – follow the “Specialties” link, then the “Maternal-Fetal Medicine” link). (Also, the Society for Maternal-Fetal Medicine has a physician locator service– I have not used it, but it might be worth trying: www.smfm.org; telephone: 202- 863-2476.)

Here are the salient facts. We conceived in May 2002 with what turned out to be boy/girl twins. They were/are our 4th and 5th children, and we were all delighted, after some initial trepidation. On January 13, 2003, it was discovered at a prenatal visit that our son’s heart had stopped. Timothy was stillborn that same day at 38-1/2 weeks gestation. His twin sister Gabriella was and is alive and healthy.

Timothy was a beautiful baby, with a cleft chin and a small amount of delicate blond fuzz. He weighed 7 pounds, 4 ounces and was 21-1/2 inches long. The shape of his head fit perfectly the curve of my hand. We knew him and loved him and miss him and love him still.

At the time, it was surmised that Timothy had had a cord accident. We had a Pregnancy Loss Evaluation consult in March 2004. Beginning in December 2003, I gathered my records from all my pregnancies – this took some time as I had delivered my other children in other states and the obstetrician for the twins was, I believe, afraid of litigation. I had bloodwork done (9 vials!) and we paid for a pathologist specializing in perinatal pathology (see www.earlypath.com) to examine the slides of the babies’ placentas. What needs to be done varies from case to case. I know that commonly they also order an ultrasound of the uterus to make sure there is nothing anomalous.

After the group (including the maternal fetal medicine OB/Gyn, the pathologist, and a genetics counselor) evaluated all this data, the physician met with us to convey the group’s conclusions and answer any questions we had about any of our pregnancies. They don’t believe that the cause of death was a cord accident, nor do they seem to think that my OB was not appropriately careful in his monitoring of fetal well-being (we had been haunted by that possibility).

Both twins’ placentas had chronic villitis, which apparently can be caused by all sorts of maternal infections, some of which may not even make the mom noticeably ill. They think that the reason Gabi was born alive and that Timothy was stillborn even though both babies’ placentas were affected was probably just that his placenta was smaller. The Pregnancy Loss Evaluation team don’t think it is likely recurrent in my case, but sometimes this microscopic swelling does recur in subsequent pregnancies. We received recommendations for what they thought an appropriate level of monitoring would be in the future. One of the things that surprised us was that the doctor recommended, if we ever were to have another baby, that we have an amnio to test for lung maturity at 36 weeks and then deliver if lungs were mature. I guess this means that the risk of stillbirth really is pretty significant in all pregnancies.

We were treated with a great amount of respect and care throughout this process. It has given me some peace of mind to feel like I got some answers. I have been able to let go of some of my anger at my obstetrician, and at myself, and maybe even a little at God. It is still awful that Timothy died, and I still believe that we would have had a good outcome if the pregnancy had not been allowed to go on so long, but it was incredibly healing to go through the loss evaluation process and see that this group of doctors took his death seriously and worked to piece together some answers.

I was scared to have this evaluation done, yet am so glad I found the strength to follow through with it. It has felt like one of the ways in which we have been able to honor how important our Timothy was and continues to be.

I hope this can help someone else on their journey as you all have helped me.