April is the cruelest month

It was in spring, four years ago, that I fell madly and deeply in love with Mongolia. When the landscape was brown, the winds were cold and the steppes littered with the bleached bones of livestock. I felt the first stirrings of a life I could live here.

I’ve talked about that journey and I’ve shared the experiences of the past two years living here with my husband, his amazing family, my new friends, new ventures, new experiences and the birth of my daughter Terra. I’ve been less vocal about the events of the last nine months. In August of last year we discovered that we would be expecting again. I kept it under wraps for a while, with the discretion of “babies aren’t that big a deal” and “here we go again”. I spared social media from updates about cankles, heartburn and baby bump photos, in part because it seemed repetitive and so little time had passed since my first pregnancy that things felt more normal than noteworthy.

The pregnancy progressed without much fanfare at home as well. We knew what to expect and did all the things we were supposed to do, but with less stress and immediate concern. I took my vitamins, cut some vices, and went to far fewer doctor’s appointments just to be measured, have my blood pressure checked and be told that everything was fine. We use the public health care system here, and there is very little diagnostic testing during pregnancy compared to the U.S. There are required blood and urine tests along the way, ultrasounds, and even a chest x-ray (which take place in gigantic sci-fi x-ray chambers of doom) but for the most part, these screenings are fairly passive and mostly look for big red flags not troubling points of light in the distance.

There were no concerns until January, when one night I was struck with sharp, searing lower abdominal pain. It was unbearable, and my first concern was the baby. A late-night call to the doctor who delivered Terra had her at our apartment within 10 minutes and she came with us to the emergency room for a diagnosis. The initial diagnosis was appendicitis and the plan was removal. After an ultrasound to make sure the baby wasn’t in any distress, my doctor came into the operating room to oversee the procedure. Once I was opened up, it was determined that the pain was the result of an ovarian cyst and not a ruptured appendix, so the cyst was removed instead.

I recovered from the surgery in the women’s and maternity ward of the hospital so that my doctor could monitor the health of the baby, and everything turned out fine. I healed well and was back home within a week.

Things kept moving along and my belly kept growing. Into the eighth month, with just weeks before the anticipated April 18th due date, it was time for another ultrasound. We were instructed to see the ultrasound specialist down the hall from the OBGYN’s office at the general hospital. We had never seen her before, but it seemed more convenient than going to the private clinic on the other side of town. The specialist was abrupt and curt, in Mongolian public service fashion, and told us that we were wrong about the baby’s due date. She insisted that the baby was due in May and not April, as it only measured at 31 weeks of growth and development. When we repeated the date of my last menstrual cycle, she said we were wrong and told us to go report back to our OBGYN.

We left the office in shock. There was clearly something wrong, and it wasn’t our due date, it was something wrong with the baby. We went to our regular ultrasound specialist the next day, foiled by a power outage the day before, for a second opinion that we trusted.

Our regular specialist clarified what we were faced with. The baby only had two vessels instead of three in his umbilical cord, a condition that often affects fetal growth and development, and our baby was measuring far behind 37 weeks of development and measuring at 31 weeks. Although my girth had expanded, he said that I had more amniotic fluid than baby, which was something to be concerned about. He also saw an irregularity in his left hand, indicating radial dysplasia more commonly known as club hand. He suggested we see a doctor soon for more information. We made immediate plans to get consultation from doctors at Ulaanbaatar’s First Maternity Hospital, the largest care facility in the country.

Our friend Bilegee came with us to UB to help translate at the hospital. We first went to the pediatric ward, since Bilegee said she had a friend who was a doctor there who would help us navigate the system. After pushing our way through the crowded halls of the pediatric ward we found ourselves in a section of the hospital for seriously ill children. She told us to wait on a bench in a hallway while she tried to contact her friend. For a half an hour we sat waiting, and in front of us was a parade of children who were living with birth defects, tumors, and crippling disease. Agii and I held hands and gave each other a squeeze as the children passed by us and sometimes joined us, waiting on the bench. It was the first of the most difficult moments in our pregnancy, and it was ominous.

It was a difficult and long couple of days in UB. We met with a doctor who spoke English and seemed to have a very good grasp on what needed to be done to get us answers. She consulted with the hospital’s top ultrasound specialist and the senior doctors were presented with my case in their staff meeting to arrive at a course of action. It was confirmed that the baby had club hand in at least one arm and growth was significantly delayed. They suggested that we postpone delivery only by one week to give him extra time to grow safely. An extensive echocardiogram was conducted with several pediatric specialists looking on, and we were told that while his heart was small, it was functioning normally. With two weeks still left to go before his new due date of April 23, the doctors said that it would be fine for me to return to Darkhan with a plan to return to UB for a scheduled c-section. The neo-natal care, which would likely be required, would be more extensive at the First Maternity Hospital. It would be challenging and expensive to give birth far from home, but we thought first of what our newborn son would need.

The following week we just focused on getting the house ready for the baby. I sorted out his clothes, new ones from his grandparents and hand-me-downs from friends, and made space for him in Terra’s room. I started researching non-invasive therapies for treating club hand and tried really, really hard not to get focused on the other complications that were often present for babies with the diagnosis. We kept a bag of his things packed for the trip to UB and tried to relax and enjoy the downtime we had before life was going to change forever.

The next Monday we went back to the local ultrasound specialist to check on the baby and see if there had been any growth since he’d last been looked at. The doctor was concerned. He hadn’t grown and he seemed lethargic. He was a much more mellow baby than Terra was during my pregnancy, and while I knew he was much smaller than she had been in her final weeks in the womb, I chalked up the slowed down movement to the normal slow down when arrival is coming. In addition to the lack of growth and decreased activity, the doctor said that I had less amniotic fluid than the last time he had seen me. He felt that all of these things were problematic. We contacted all of the doctors we had consulted along the way, in UB and Darkhan, but no one seemed especially alarmed. We carried on, concerned, but without many options. In the next couple of days, I spent quieter moments by myself thinking about how I would cope with losing the baby at this stage. As soon as those thoughts would come together, I’d scold myself for thinking negatively and think back to the sound of his heart beating.

On Thursday we went in for another ultrasound. His heartbeat was gone.

My amniotic fluid was nearly gone and the baby was dead. They asked when I last felt movement, but I had felt something the night before. I was still feeling movement at that point, but it wasn’t him, and I couldn’t remember the last time I had felt something that I hadn’t been confusing for mild contractions of my uterus. I don’t remember much about that day, besides crying in the hallway of the hospital and walking from one end of the hallway to the other to talk to the OBGYN about what we had just learned. I remember Agii’s tears and then his resolve. He instantly became completely focused on my health while I was crippled by the news.

After consulting with every doctor we had spoken to during the pregnancy, we were advised to go to the hospital the next day to deliver the baby. I repacked my bags for the hospital, with only a swaddle cloth for the baby, and went to sleep holding my belly, which seemed heavier than ever.

The brief research I had done online suggested that a vaginal birth was the healthiest way for a mother to deliver a stillborn child, but I had a c-section with Terra and I was under the impression that I would have to have a second c-section. We trusted in the doctors to know which course was the best to take though. On Friday morning we drove to the hospital. Again, Bilegee joined us to help translate. We met with the head doctor at the maternity hospital, who had quickly consulted with the other doctors. She said that I would be checked in that morning and on Monday, the doctors would decide whether I should give birth vaginally or have a c-section. That meant I would spend three days in the hospital, isolated from Agii, Terra and my family, lying on a bed in an active maternity ward with a dead baby inside of me. I insisted on knowing why that would be necessary. The doctor said that they would use those three days to monitor me and give me antibiotics. That was ludicrous, and I insisted that if nothing was actually going to be done for three days, that I be allowed to spend that time at home with my family. The doctor said that was fine, but that if I had any problems or bleeding, to come to the hospital right away.

I had no problems or bleeding, and I spent the next three days with the people I loved, trying to prepare myself emotionally for what I was about to go through. I also tried to learn what I could about what the experience would be like, or at least what it was like in American hospitals. Good friends rallied for me and offered tremendous amounts of love and support while I was still operating in a fog of despair and disbelief. I spent three days trying to ignore my reflection in the mirror, the continued contractions, and the kind but careless touches of my belly by concerned family members. I still felt “pregnant” while the baby was still inside me, but I understood that I was giving birth to the death of a dream.

On Monday we returned to the hospital. I was prepared to set limits about what would happen and to push for things I wanted to make the experience less awful. Monday ended up being a repeat of Friday. The doctor said that they would give me labor induction medication, but that it would take up to 72 hours for delivery. That gave me three more days with my dead son inside of me, which I was unhappy about. I asked again why surgery wasn’t an option and they insisted that vaginal birth was still the safest route for me. I made it crystal clear that I was unhappy about the length of time they were proposing, and that so few options were being presented, but there was nothing I could do. Over the weekend, Agii and I had talked about going to UB for the delivery, but I was anxious about the idea of being far from our support network and then having to do the three hour drive home with our dead son in the backseat of the car. We stuck with delivery in Darkhan, despite our apprehensions.

The first day in the hospital was uneventful. I was angry, depressed and would cry periodically - when I heard the baby in the next room crying and realize I’d never hear my baby cry. When we found out the baby wasn’t well, I felt guilty for feeling healthy and normal. I lay in my hospital bed believing that the suffering I was experiencing now was my punishment for being oblivious to the suffering of my son. I deserved what was happening for letting my son’s life slip away without a fight, without even knowing he was lost to us.
The night nurse came around at midnight to check on everyone’s vitals and give injections. She checked my blood pressure and then pulled out her aluminum cone to listen for my baby’s heartbeat. I let her look, thinking surely she must be listening for something else and knew there was no heartbeat to be heard. She looked perplexed after her search and then moved on to check on my roommate. After she was finished she told me to follow her into the room across the hall to use the fetal heartbeat monitor. As she was turning it on and waiting for it to boot up, I finally broke down and told her that there was no heartbeat for her to listen to. I left the room in tears and curled up into a ball on my bed.

The next day I started receiving induction medication. The contractions increased in frequency, but not in severity, and dilation proceeded very, very slowly by fractions of a centimeter. In the afternoon, Agii brought Terra to the hospital for a visit. I snuck out to see them and was reminded why I needed to stay strong. About an hour after their visit, the contractions began in earnest. They grew from tingling discomfort to increasingly unbearable gut-wrenching pain. I was completely unprepared for what the physical experience of labor would be like. The worst moment came when I felt the churning and locking into place of what felt like solid bone across my lower abdomen. I knew that the baby had been shifted into a horizontal position and it would take another serious contraction to change that. I decided then and there that I would need pain intervention to survive another contraction of that magnitude.

Bilegee came to the hospital (after hanging up on two of my frantic calls) and spoke with the doctors. She told me that I couldn’t have pain medication, and that all women experienced this pain, and that I needed to be patient and calm. She added that she had given birth to two babies and she knew it was painful, but that I had to suffer through it. I asked her if she’d ever given birth to a dead baby, which quickly ended that train wreck of a conversation. I kept insisting on pain medication, reminding everyone that the baby wasn’t going to be put at risk if I were to take it.

Bilegee told me that the doctors had asked that I “stop howling”, at which point my “howling” turned into heaving sobs as I curled up into the smallest ball I possibly could, bleeding into an adult diaper that wouldn’t stay on and pounding my head and fist against the wall.

Eventually, the doctors agreed to let me have an epidural with a catheter. The anesthesiologist tried to administer it as I sat backwards on a wooden chair from the nurses’ station and tried to stay as still as possible while the contractions continued. He jammed needles into my spine three times, and on the fourth attempt in my lower back, my right leg violently spasmed and a painful burning sensation ran from my toes to my hips. He tried again, with the same painful result, and again, with the pain spreading further across my hip to my left leg. At this point, now terrified that I was going to be left with debilitating nerve damage or paralysis, I yelled for the procedure to stop.

Nothing more happened that night. The pain continued, but I tolerated it. I vomited a few times, and used a bed pan because it was too painful to walk down to the end of the hall to use the single toilet shared by all the patients on the second floor. My dilation was checked, and still far from being sufficient, and Bilegee ended up spending the night in the now vacated bed in my room. No more induction medication was given.

In the morning, the doctors gathered after an exam that showed little progress in dilation. Bilegee translated. They said that if I was a Mongolian woman, they would have made me wait four weeks for my body to expel the baby on its own, but since I was a foreigner, they were willing to try induction. They said that the induction was unsuccessful though and it was dangerous to try to deliver vaginally as my previous c-section scar might rupture. It was time to consider a second c-section to deliver the baby.

In my exhaustion, pain and frustration, I found room for anger again. The doctors had known all along that I had a previous c-section and the danger wasn’t new. Why had I been put through the process of “labor” if that process was risky from the beginning? There was no possible way for the baby to be safely delivered vaginally as he was in a transverse position. I understood that a c-section carried risks as well. The baby had been dead for at least a week and there were problems that could arise during surgery. Bilegee spoke with the doctors about those complications but wasn’t translating anything to me. I caught bits and pieces on my own, mostly about bleeding out. I asked if they had blood for a transfusion if it was needed. Bilegee asked and was told they had “some”.

Again, I was powerless. There were no other options but c-section so I pushed the conversation forward. Schedule the surgery and end this.
Agii spoke with the doctors after we had. He and cousin Jagaa came to my room. Jagaa and Agii had tears in their eyes and the color was gone from Agii’s face. He had heard the information about the risks and was terrified. Their tears brought out my own. I asked Bilegee to tell me what the doctors had told them. She said, “There are so many risks, I can’t tell you.” Outside, in the parking lot, more family had gathered. They stood beneath my window with Terra and they prayed for me. Earlier that morning the family monk had been called over to our house for prayers and blessings. They called out their love and concern for me, and through their own tears, told me to be brave. I was moved beyond words. The anger left and was replaced by a resolute sadness, that I was giving over my life, Terra and Agii’s future, and facing the end of my life with our son. I had no fight left in me but to stay ok for Terra.

I climbed the stairs to the third floor where the surgery would take place, tears still flowing. I wasn’t told to stop crying by the doctors anymore, just guided through getting undressed and into a hospital gown. A numbness kept growing inside me and I composed a mantra to get me through the surgery: Get him out. Stay alive. Make sure Terra has a mom.

The baby was out sometime between 11:30 and 12:15, but I have no idea exactly when since the doctors and nurses kept the procedure as silent as possible. Extra cloth had been held up in front of me to keep me from seeing what has happening, and of course, there was the silence of a dead baby leaving the womb instead of the sharp cries of a living one.

As I watched the clock on the monitor beside me, I waited for the tugging I remembered when I was sewn back together after Terra’s birth. Instead there was suctioning and discussion between the surgeons. Bilegee was waiting out in the hallway and I yelled for her to come in and tell me what was happening. The doctors said that my uterus had taken a beating and needed to come out, along with my cervix. They said they could sew me up and I could get the hysterectomy later, or they could do it right then. With no particular desire to have a scalpel anywhere near me again in the future, I stared up at the ceiling - not fully processing what this new development meant - and said, “Fine.”

Early on in the pregnancy, I had told Agii that this was going to be our last baby. I didn’t feel like being pregnant again, and two kids seemed like plenty for us, even if we were short on having the five we were instructed to on our wedding day. One of each, a boy and a girl. We felt blessed. Terra was our little dragon (like Mom) and her brother was going to be our little horse (like Dad). It was as perfect a scenario as we could hope for. Even when we found out the baby wouldn’t be perfectly healthy, we worried and were scared of what that would mean for us, but we wanted him here. The news of his health challenges had us even more resolute about not having another, and when he died, the thought of going through an entire pregnancy and losing a child a second time absolutely killed me. Now, the choice was being taken away from me. Whether we wanted one or not, we would never have another child together again. I cried for yet another loss as the anesthesiologist prepared a general anesthesia, and woke up six hours later in my recovery room.

Agii was sitting in the bed across from me. I had been dressed while I was out and my legs worked again. I was given some morphine to ward off the pain and my head felt fluffy, floaty and out of focus. I had a catheter in me and a drainage tube coming out of my incision. It felt unreal to be laying there, with the baby truly gone. I told Agii that I still needed to see the baby. Bilegee had taken two photos of him, before they cleaned him up. I could clearly see his arms. The club hand was evident in both and his head was misshapen - most likely from the pressure of labor in an unforgiving womb, but I could see that he had a full head of black hair like Terra. I wanted to know what color his eyes were, but they were closed in the photo. Agii was worried about me seeing him, but understood that it was something I needed. He spoke with the doctors who said they would bring him the next day.

Agii was able to stay with me in the room for two more days while I was unable to get up and do things for myself. He was with me when they brought the baby in. The nurses had swaddled him in the cloth we brought. He was only there for a moment. He didn’t look like a sleeping baby, he looked a dead one, and I didn’t ask them to linger, or try to hold him. It’s not something I regret yet, but I may someday.

Later that day, the hospital conducted an autopsy. In addition to the club hand, the baby had a one centimeter hold in his heart, and his kidneys were fused together. On top of his small size, he would have faced significant challenges if he had been born alive. Somehow, this news helped. Before we knew what he had been dealing with, I tried to comfort myself with the idea that he had died in a place of safety and security, and that he was spared the trauma of birth and his first days spent in a plastic box with tubes inserted in him. It’s still impossible to imagine that he didn’t feel any pain or fear, and that continues to haunt me, but I can’t undo what happened to him. I can’t explain or understand why he, of all the babies brought into the world, was chosen to experience this. While I understand that guilt is a useless emotion, and there’s nothing that I did (or didn’t) do to bring his problems on, it’s still the first place my mind goes. As I lay in that room with Agii, I continually apologized to him for losing our son. He made me stop. He was trying to move beyond our guilt and was looking to the responsibility held by the doctors we consulted with throughout the pregnancy and the doctors who handled the delivery.

Our son is buried now, and the process of moving forward - slowly, cautiously, and continually looking over our shoulders - has begun. I’ll have more to share on that experience, but this is the story of how our son came into this world and left it. The story of how he left our lives is ongoing. For the sake of his soul, we have to let go, but we’re struggling. We stay focused on our daughter now. We feel incredibly lucky to have her, in light of what we lost and how we lost it.

A few days after our son’s funeral we heard about another couple who lost their child in the same hospital. The baby was large, four kilograms, and the mother was having a difficult labor. The doctors - the same ones who attended to me - held off on giving her an emergency c-section and the baby suffocated and died. The parents were devastated. They had a healthy baby who died because of the ambivalence of the maternity hospital doctors. It was a crushing story to hear. Again, it made us grateful for Terra, but our hearts broke all over again at the news. The anger arose again as well. My husband and I are committed (to different degrees) to reporting the doctors and our experience at the hospital to authorities who can hold them accountable. It won’t undo anything that happened to us, but we hope that it will make a difference in the care that’s offered to families in Darkhan. There’s no conceivable reason why women should continue losing their children this way, or be put through the nightmare of saying goodbye in the way that I was.

My story isn’t one about giving birth to a “sleeping” angel who will be present in our lives like a welcome ghost. He’s not ever going to be forgotten, but we want him to be able to move on peacefully, and I wanted to share my story since there were so few stories I was able to find to prepare me. My friends and family have been patient in giving me space and time to get to a point where I could articulate this experience. I thank them, and you for taking the time to read and experience this with me.