The last few weeks of my pregnancy were blissful.  I was not too fat, not too bloated, not constipated and not cranky.  Teymour and I had finally settled into what felt like a comfortable rhythm.  We had moved into a new apartment and were eager to begin our lives as parents.  Teymour was deep into parenting books; I was happily nesting.  We spent Thanksgiving with friends cooking and going for long walks in the park.  The weekend was one of the happiest of our married life.  We went to the Metropolitan Museum of Art to see the Genghis Kahn exhibit, (Teymour was still searching for suitable names for our child—he teased me with “Hugalu for a boy, Batu for a girl!”), shopped for a Christmas tree, and watched silly movies on TV.  I did not at all feel as if my labor was imminent, even though Teymour was CONVINCED that the baby would arrive that weekend.

     Saturday night we snuggled in bed and chatted about the arrival of our baby.  I went to sleep thinking that we should savor every moment because soon our lives would change forever.

     I was awakened sometime in the early morning with the sensation that I was about to wet my pants.  I got out of bed and went to the bathroom (without ever turning on the light).  When I crawled back into bed, I thought “maybe my water has broken!”  There was no gush of fluid as I had imagined there would be, but it was different somehow than my usual 3am bathroom run.  At first, I thought that I was just getting overly excited and fantasizing that anything was happening. Then, I felt the baby move: an unusual, strong and jerky-sort of frantic- movement.  I remember being alarmed for a split second and hoping that everything was ok.  I laid in bed for a few minutes wondering if I was going into labor or not, and must have drifted off to sleep because I was awakened again with the same sensation.  This time, I felt my underwear, and indeed they were wet.  But, when I looked at my hand, I could see a small streaky clot of blood.  I went to the bathroom, turned on the light and saw blood all over the floor and on the toilet.  Surprisingly, I was giddy with excitement.  I sat down on the toilet again and felt what I thought was my mucous plug pass (in retrospect, it is obvious that this was just a clot).  I called to Teymour to tell him the news.  He jumped out of bed and exclaimed that he KNEW that the baby would come at exactly the right time.  He came into the bathroom and wondered about the blood he saw on the floor-and the bloody handprint on the door (mine).  I reassured him.  We looked it up in one of our MANY pregnancy books and found the section on the “bloody show.”  And, then I made him peer into the toilet bowl to see if he could see my plug.  We decided to call my OB (a high risk OB—even though I wasn’t thought to be) and I sheepishly described what had happened.  It was 4:25am and I was very embarrassed to be calling to get reassurance about what I presumed to be a “bloody show.”  I explained that I thought my water had broken and asked if it was normal for it to be bloody.  He explained that it was probably just my cervix dilating and the breakage of tiny capillaries on my cervix.  He asked if I was having contractions (I was not) and told me to come to the hospital to be induced.  He asked if I would mind being checked in by one of the residents, and I said that would be fine.  (I would have said yes to anything he had asked.  I was trying so hard to be the perfect, non-neurotic patient.  I was a fool.)  Then, I asked him if I had time to shower and dry my hair or, if we needed to rush to the hospital.  He said no, that since it was my first baby it would likely be a long while before I was ready to deliver.  We had plenty of time.  I showered and then blew dry my hair.  I wanted to look my best for the arrival of my baby!  Looking back, I cannot believe how silly this was…but, hindsight is everything. (I also remember thinking to myself in the shower “I hope everything is ok.  I hope that I never regret taking this shower.  But, I dismissed this fleeting thought as an anxious rumination of a soon-to-be first time mom.)  We packed, Teymour took his vitamins and then we were off.  But, not before taking several photos.  We thought we were documenting what would be the happiest day of our lives.  We hailed a cab, took more photos and admonished the taxi driver to take his time.  We were not in a hurry.  I was still not contracting. 

     When we arrived at the hospital, we were met with big smiles from the security guard and directed to labor and delivery.  I felt proud, excited, and important.  When we got to the labor floor, it was determined that I had a “convincing story” and so instead of stopping in triage, I was ushered into a room.  I changed into a hospital gown and climbed onto the bed.  One of the nurses strapped a fetal heart rate monitor on my belly and that is when I knew things had gone TERRIBLY wrong.  I could not hear a heart rate at first.  And, then, when I did it was all wrong.  I was LOW, really low.  I began to get anxious, but in a there-must-be-a mistake-this-cannot-be-happening sort of way.  I started imploring the nurse to get a doctor and soon was surrounded by medical personnel.  I looked over at Teymour, who was seated across the room and whispered to him” this is really bad.”  The ultrasound machine was wheeled in by an intern who confirmed that the fetal heart rate was 77.   She looked for fluid (there was none) and I continued to ask/demand “why is the baby’s heart rate so low?” over and over again, I asked if my OB had been called, and then the attending OB appeared.  I repeated my mantra “the heart rate is really low, why is it so low, I am really worried about the heart rate!!!”  She did an internal exam to assess whether there had been prolapse of the cord (there had not) and a quick ultrasound.  I asked if I was abrupting, and she said that she was not sure.  She said to the intern that it could be a Vasa Previa. 

     Meanwhile, the nurses had started an IV and people were frantically scurrying back and forth.  Someone yelled, “Get the OR ready” and I began to realize that this was my worst nightmare coming true.  My baby’s brain was being deprived of oxygen and was dying inside of me.  I was about to have a crash c-section.  The attending OB instructed me to roll onto my left side, and for a moment, the fetal heart rate popped back up to 135.  The OB said, ok we can wait for your OB.  But, as she was speaking, I could hear the heart tones plummeting.  I looked at the monitor and saw it reading 66.  I started screaming, “Section me NOW!! The baby is dying.  You have to get it out.”  She replied (not so much to me as to everyone else in the room) “get the OR ready, we have a STAT c-section.  Then they started running with me on the gurney.  The OB asked the intern if she had ever scrubbed for a STAT c-section (she replied that she had not).  Now I was TERRIFIED.  I was about to be opened by an inexperienced resident and my baby’s brain was becoming profoundly damaged.  Amidst the chaos, I was also feeling intensely disappointed that I was being denied the whole labor experience which I had been imagining for months.  Everything was happening so quickly, my mind was reeling.

     I was wheeled into the OR and practically leaped up onto the table.  I was instructed to sit up and round my back for a spinal.  I started to yell, “We need to get my baby out, please get my baby out,” “what is the baby’s heart rate, I cannot hear the baby’s heart beat.”  And, “is my baby dead?”  I was begging them to hurry and cut me open.  I was given a spinal and yelped as I felt a lightning bolt run down my right leg.  I was told to lie on the table and was draped and opened.  I began to cry for Teymour but, he was not allowed into the OR.  I screamed for him over and over…and, finally they let him in.  (Later I found out that they pulled Sophia out of me in a mere 40 seconds from the first cut.  She had already been delivered when they allowed him into the room.)

     I do not know when Sophia was born, the room was silent.  No excited cries of “congratulations!” or “It’s a boy!  It’s a girl!”  Just silence.  No baby crying, just deafening silence.  Teymour held my hand and my gaze…and, did not let go.  I felt pulling on my belly and listened as the OB told the resident that at Bellevue she “routinely delivered babies in 30-40 seconds.”  We finally summoned the courage to ask if our baby was breathing—I asked several times.  My desperate query was answered with silence.  Teymour and I just looked into each other’s eyes.  I said to him, “Is the baby dead?”  I knew that she must not be breathing; otherwise the room would not be silent.  I asked if he knew whether we had a boy or a girl.  Teymour thought a boy; I thought I had heard someone refer to the baby as “she”…

     Finally, he was allowed to see her.  I was left to talk to the anesthesiologist who told be that she was intubated.  Teymour came back to the head of the operating table to tell me that we had a beautiful girl.  Perfectly formed.  But, white as a ghost and limp.  Lifeless, almost.

     Over the next 48 hours, we rode a roller coaster of emotions from sheer terror to cautious optimism, to anxiety, despair and yes even relief…and then, after it was over, profound sadness and loss. 

     We christened our baby Sophia Frances Farman-Farmaian on December 2^nd and on December 3,^rd when it became clear that most of her organs were failing, we withdrew support.  After the tubes were removed, I was finally able to hold my baby.  Teymour and I rocked her and held her and told her how much we loved her, and how much we were going to miss her.  She died in my arms.

     We learned in the OR that my placenta was bi-lobed and velamentously inserted.  However, I did not understand the significance of these findings at the time. (And, my doctors did not want to discuss them, preferring to stick to the “it is a tragedy, but there is no way to predict these things” refrain.) It was not until I was at home recovering that I discovered the Vasa Previa website, and the chronology began to make sense.  I had a low-lying placenta.  It was bilobed and velementously inserted.  I had an episode of third trimester bleeding, and my baby was noted to have poor weight gain in the final weeks.  I had more than 30 ultrasounds in a high risk practice (not because I was high risk—but because I wanted “extra special and extra cautious” care) and no one ever bothered to look for a Vasa Previa.  It is devastating to remember all of the missed opportunities for diagnosis.  We had amassed at least 40 ultrasonic photos of her profile (the last of these a mere 36 hours before her birth.  It was done because I felt her movements had decreased.  But, I was told that everything was “perfect.”)  In the time it took to take one of these pictures, her life could have been saved.  But, instead of a two year old, we have only fuzzy ultrasound images and photos of her dying in our arms.

~ Beth Farman-Farmaian