Late Termination

1.
I punched the 5 digit number into the phone and waited for someone to answer… “Hi, this is the gyne resident, you paged?”

“Yes.  The induction is here. Can you please come and write orders and get things started?”
I wasn’t aware of any induction, nor was I in the right frame of mind to initiate an induction.  Where I live, “late terminations” by induction of labour can be performed for lethal or life threatening fetal anomalies up to 24 weeks.

I went to the ward where the patient waited for me.  She was likely not expecting the person about to initiate her induction to be just as pregnant as herself.  Her chart was clear – her due date only 2 days before mine.  Her unborn baby the same size as mine… moving and kicking and full of life, just the same as the one inside of me.  The only difference: my baby had a normal heart, and normal kidneys, and a normal bowel.  Hers did not.

I went into the room to find her laying still on the bed.  I hoped my scrubs were loose enough to disguise my swollen belly, even though I knew it wasn’t likely.  I explained to her the procedure – how I was going to giver her some medication that would make her cervix soft, and that I would put a small balloon inside her cervix to help it open up.  Essentially I would be inducing her labour, and then she would give birth to a pre-viable fetus that would not survive.  My baby in.  Her baby out.

I sat on the cold, metal stool between her trembling, spread out legs.  I placed the speculum and opened to find her swollen, closed cervix.  “You might feel some cramping now,” I said as I slid the catheter into the opening.  I began filling the balloon.  She winced.  Bright blood started to trickle from the end of the catheter.  I slid the speculum out and placed the medication in its place.  “We’re done.”
I felt my own baby kick me from the inside.

2.
It was 5pm and my night shift was just getting started with handover.  “The woman in room 6, she’s  an indiction for cardiac anomalies.”  I cringed.  It had been less than a week since the last induction.  I didn’t think I could handle another one so close.  “The patient and her partner are not coping well, just so you know.”
This time the baby was already gone – the family had chosen an intracardiac injection prior to induction.  This time her due date was the same as mine.

I decided not to meet the patient – unless there was a medical issue that needed attending, there was no need for me to go in.  I hoped that it would be a slow process and that I could get through the night without being called to see her or her stillborn baby over the next 14 hours.  It almost came to be.
But 30 minute before the end of my shift the nurse called me: “I’m really sorry, but her foley came out and Dr. X called and wants you to break her water.”  It would have been “inconsiderate” for me to leave that task for the person coming on after me.  So I went.

Again, I was too conscious of my own pregnant belly – of my own live, healthy baby who is perfect and who is still alive.  I pulled the scrub gown I was wearing backwards around and over my swollen-ness.  I introduced myself with trepidatious confidence and then sat at the end of her bed.  I proceeded to do what I do so often for women in labour with babies that they are going to bring home with them.  I felt her cervix and stretched it open.  With elegant ease I slid the hook up against my fingers until it reached the tough, premature membranes.  I felt sick at the thought of my hand being so close to a dead baby, the same size as mine.  I almost said that I wasn’t able to reach, even though I could.

I tore the membranes apart and watched as the clear, straw coloured fluid poured from her body.  Suddenly my fingers felt vast space and openness.  I felt my heart skip a beat as I was unable to tell if her cervix fell from my grip and I was feeling her vagina fill with fluid, or if her cervix was suddenly wide open and at any moment I would catch her baby with my fingers and deliver it right at that moment.  The water seemed to gush forever and my hand was paralyzed in place.  I feared that I would feel the delicate touch of her baby’s hands or feet or head and I wanted that moment to be over.  When I could no longer handle the thought of delivering a stillborn baby the same age as mine, I pulled my hand out and tried hard to stand without fainting.

It was the end of my shift.  I went home to sleep.  I woke up hours later and decided that I was done doing late terminations as long as I am still pregnant.

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