[Read] Hot Desk Extract: Violet Kieu - Flutter

As part of The Wheeler Centre’s Hot Desk Fellowship program, Violet Kieu worked on an essay collection on fertility. This creative non-fiction collection explores many facets of reproductive health, asking – what should we do with our individual and collective fertility in this world? As a Fertility Specialist, Violet looks through a bio-psych-social lens at contemplating pregnancy and the different paths and considerations towards forming a family.

This extract is from Flutter, an essay about stillbirth. That hope for fertility can sometimes be met with biological tragedy – but we can still offer presence, empathy and honour to the lived reproductive experiences of others and ourselves. 

 

^{Image by Pixabay}

***

 

I knock on the door, wait for a faint reply, and slowly walk into the birthing suite. The golden morning sun frames the family. Amelia is resting in the maternity bed, her partner Benjamin in the green recliner next to her, and a cot between them. I walk over and see the name placard. Matthew.

‘Welcome to your beautiful baby boy Matthew.’ I say.

We are taught to acknowledge the birth of every child, including those who are stillborn. Start by saying their name. By recognising the reality of their existence and their family’s grief.

‘I’m so sorry for your loss.’

Baby Matthew was born sleeping. I bow my head, giving him respect. Tiny, he lays tucked under a cream blanket with a matching knitted beanie, crocheted and donated by a hospital volunteer. His eyes are closed. The cot is powered to keep him cold.

They are quiet. It has been a night of birth and death, of bleeding and now depletion. In such a raw birthing space, I feel awkward, at a loss for words to say. I have heard, though, that nothing you will say will make it better – but not saying anything can certainly make it worse.

‘I’ve come to check in on you.’ I say. ‘To see how you are going. Are you in pain?’

A small shake of the head.

‘I feel nothing.’ She says.

I nod and sit down slowly on the black stool with silver roller wheels, feeling the weight of the situation, grateful that the seat takes my heaviness.

‘May I examine you?’

‘Yes.’

I check her vitals chart, her belly and look for bleeding. She is physically stable.

‘I’m here to talk to you about what happens next.’ I say. ‘The counsellor will be here shortly, too. One thing to consider is we can help give you a tablet to stop your breast milk from coming.’

A small involuntary sob. Benjamin passes her a water bottle.

‘This is a lot.’ I say. ‘I can come back, after the counsellor. For now, your vital signs are stable, your belly soft and not much bleeding.’

Pause, and I say softly, ‘I do need to ask for your consent if you wish for us to examine Matthew. I’ll leave this paperwork so you can have a look first. It’s to see if you would consider a post-mortem examination. If we can find any factors that may have contributed to the stillbirth. It is your choice. You may have questions, and I will try my best to answer them. If I do not know, I will ask the team and get back to you.’

Amelia says nothing. Benjamin looks at the papers. On her bedside table there is a little A5 sized keepsake booklet that the midwives have stamped with Matthew’s hand and footprints. There is space for photos.

‘The memento book is beautiful.’ I say. ‘I will see you soon.’

 

***

What can you offer in the face of such loss?

You can cook a meal, buy a toy bear, sing a song, name a star, light a candle, but really, what it comes down to is kindness and thought and time, when someone is having one of the worst days of their life. Make sure they have access to supports, books, podcasts – acknowledge that others face this too. Like a brick the grief will always be there to carry, but like Atlas they may get stronger to shoulder the weight. There will be no fanfare, drum roll, fireworks or applause. But in the quiet, a hope, that they know we honour them, their grief, and their baby.

***

I had started my shift after dinner. As the night obstetrics registrar, I was responsible for the medical care of patients on the birthing suite.

Amelia was in Room 8, our special suite with a separate air lock antechamber. The room was used for labouring patients with COVID or other infectious diseases, but it was also our stillbirth room. The extra double doors meant privacy. A sound barrier to block out excited voices, guests, baby cries – the world – and aim for a dignified silence.

The outer doors held a laminated sign. No words, just a printed ClipArt picture of three butterflies: pink, yellow, and purple. Butterflies with their short life spans that fly away and ascend too soon. We ask patients to notice their baby’s kicks, as reduced fetal movements are a sign to seek medical attention. Butterfly kisses, so light you may miss them, may leave tragic stillness when they are gone.

That night Susan the Midwife Unit Manager, MUM, was on duty. At Christmas, she was the one who brought a homemade cheese ball dip (‘It’s really easy to make, cheaper than a cheese board!’) and gave me the recipe unasked. Once when it was a staff member’s birthday, she bought a supermarket chocolate mud cake and stuck a self-lighting clear plastic speculum on top as a candle. And when there was a stillbirth, Susan was the one who took out the arts & craft box to make a scrapbook for the parents.

Stillbirth is defined as death of a baby of more than twenty weeks gestation, or four hundred grams of birth weight. For Amelia, no fetal heartbeat was found at a pregnancy scan. We had started her induction of labour that morning – medicine to start contractions of her womb.

***

The buzzer goes off after midnight.

‘What’s happening?’ I ask as I enter Room 8.

‘She’s started pushing,’ says the bedside midwife. ‘I did a vaginal exam, but she’s not fully dilated.’

This may happen with preterm birth. A small baby slips out of a not fully dilated cervix, and then the cervix clamps down before the placenta comes out.

Amelia delivers her baby in one swift, economical movement. She is bleeding, but no placenta comes out. We wait, as my gloved hand places firm traction on the umbilical cord. Pull too hard and it will snap. Nothing happens. Her birth now requires emergency management.

‘Call theatre.’ I say. ‘We need to perform a manual removal of placenta.’

That is, extra manoeuvres to remove her placenta in the more controlled environment of an operating theatre, to prevent further bleeding.

Susan, our MUM, steps into action: portable phone on speaker, whilst directing other midwives to talk to Benjamin, organise an extra intra-venous line, collect paperwork, call the porters, hold the emergency lift.

***

Birth suite at 3am in the morning can be the loneliest time. Even with people around, it is the decision-making and consequences that echo in your head and fall on your shoulders.

Birth suite has institutional memory. We need this to be a safe space, by so many definitions of the word. Each person has their role. And if we start with calm, it can snowball. The kitchen staff discreetly leave breakfast and tea on the desk outside the butterfly sign for Amelia and Benjamin. The morning medical staff see my exhaustion and offer to help with the paperwork. I hand over care. I appreciate their work ordering morning blood tests, booking in the six-week post birth review. I say thank you to Susan. (‘No worries, hon!’) But I will do baby Matthew’s death certificate. I bear witness.