Monday, November 21, 2011

Thoughts on cord compressions

So, I got started thinking about cord accidents more by reading a blog post that put the risk of a stillbirth due to a cord accident at 1 in 7 for those who have had one before.  How did I get there?  By the completely normal action of googling the approximate phrase "stillbirth recurrence cord accident."


I'd somehow gotten it into my head from the various doctors that cord accidents were really more or less fluke incidents and not something to really think about recurrence on.  That said, I had been told that if I am ever pregnant again, I would have additional cord monitoring weekly from around 20 weeks including measurements, doppler, and some monitoring of heart rates over a few-minute period, so I probably should have gotten that it was a risk from that. 

I have found myself second guessing was she really a cord accident.  To review the history, we were told at the time of the demise that it was likely that we would never know a cause of death.  We were able to rule out some causes because of having an ultrasound within a day of the death, but there was nothing that gave a clear cause.  Not only that, but we were told that the longer we were able to make it without delivering them, the less likely it was they would be able to identify the cause.  So, delivering almost six weeks later we were not expecting an answer and so were surprised when the neonatal nurse practitioner who attended the birth told us that it was a cord accident and then brought her over and showed us.  It just looked like if you had taken a garden hose and folded it to completely stop the flow.  It was very close to her body on the part of the cord that they left attached to her (longer than what I saw with either of the two boys and so I'm guessing longer than is typical with a live birth). 

My worry is that I was so desperate to have an answer that I just took this.  No, I have no reason in the world to question this NNP's judgement (she proved herself to be one of the most competent over the next few months), but I still do.  When my OB came to talk to us a few hours later, we discussed what there had been and whether this meant that it was unnecessary to do an autopsy and agreed that we had our answer and nothing would come of it.  So, really, I think I should feel comfortable with it being a cord accident, but the image that is forever burned in my head of that white folded cord doesn't seem to match with some of the images I've seen in medical journals.  I think my real reason for doubt is wanting to know how they know that that was the CAUSE of the death and not just something that happened after she died.

Assuming that Aurelia's death was due to a cord accident, this risk of recurrence is enough to probably make me chose to not risk another pregnancy.  It might be different if we didn't have the boys, but taking on that level of risk just doesn't seem fair to them.

In addition to my reading on cord accidents making me question the certainty that this was the cause of death and making me consider the risk of any further pregnancy, it also has me questioning whether I did enough.  On the night of 11/9, I felt such a weird sensation of Jumanji drums and pulling that I went into the perinatologist a day early on 11/10 instead of my scheduled weekly appointment of 11/11.  This was the only time I had called them alarmed.  Having read that fetuses respond to cord compression with fetal jerking and they are less able to do this in multiples pregnancies, should I somehow have recognized this as more significant?  I don't think there is anything that could have been done other than delivering two 24 and change weekers, but I can't stop myself from thinking about it.

I also want to know when and how do fetuses die.  Apparently they can survive five minute complete compressions with no ill effects, so what is necessary to result in death?  Is it frequent recurrence that doesn't allow the fetus to rebuild up resources in their body?  Is it a longer duration?  What makes them go to the state of dead?

There was also a sentence in one of the medical journals that I read which struck me "the important point here is these infants are normal; they are normal, but they are dead."  Not sure why that seems so powerful to me, but it does.

Last rambling thought relates to further pregnancy.  I really think that if the literature and the anecdotal experience of my doctors support the idea that there's a significant risk of recurrence I just wouldn't do it, but if I did, I feel like I would want to know where the balance point is between identifying a potential issue so you know to watch for it and study it and just giving you something to worry about that you can't do anything about.


  1. I think it's perfectly normal that you're thinking about this and thinking about this and thinking about this some more. How can you not? What happens inside our wombs is a total mystery -- despite the advent of high-tech ultrasound technology, fetal monitoring and testing and all the science in the world. In a way, it is very off-limits to us, and that makes it prime space for questioning. But you should try to give yourself some peace in the knowing that you will never truly know (if that makes sense) and you should absolutely not ever let your mind go down the road of "Was there more I could do?" That is a painfilled and fruitless road that circles back around to where you began, ultimately getting you nowhere.
    You loved Aurelia. You wanted her. You nurtured and fed her and kept her protected as best you could, and through no fault of your own, she did not live to see the outside world.
    Why that happened is a terrible mystery. I'm so sorry, friend, that you have to continue to grapple with it.

  2. I can't say it better than Tankia already has. You did everything you could, you did the the very best you could. You loved her, you wanted her. It was just misfortune, in the deepest sense of the word.

    I will also never really know what caused G's death. Like you, I wanted to know the risk of recurrence because I didn't want to put another child through what I saw G go through.

    I can see why that sentence struck you. It strikes me too. I always think of G as, so near but no nearer. She was anatomically normal, nobody could really explain why she was so ill in comparison to her twin. Why she developed so far but still died. It just leaves me feeling very robbed, on my behalf and on hers.