There’s no way to prepare for this.
By: Aruna Zehra
Tags: Parenthood, Qtipoc, Micro Preemie, Single Parent, Preterm Birth

Reflections on a year since going into Pre-term labour and getting a cervical cerclage. This was the start of the emotional rollercoaster my journey has been in parenthood.

***Trigger Warning: This post contains mention of child/infant loss, labour, birth, medical systems and interventions, burn out, body hate/blame, surgical procedures, loss, grief, family, ableism. Please just take care of yourself while reading. It may bring up things you don’t even know are there!

***Disclaimer: This is strictly and specifically MY experience of all of these things, and no outcome or baby are the same. I don’t pretend to know any and all experiences of every birthing person, but I wanted to share my experience for those to anticipate what might also be their process. None of what I’m sharing should be used as medical advice, I am not a medical professional.

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A year ago today, my whole life changed. I didn’t know it when I woke up that day, that I was never going to be the same. If you had told me what was going to happen next, what would happen that afternoon, I wouldn’t have believed you. You would think that such a transformative experience would be one akin to the day I gave birth to my daughter, or when I found out I was pregnant, or the day I held her. But somehow, this day still marks the beginning of the most terrifying, traumatic and hardest thing I’ve ever had to do. On November 12, 2019, I was 19 weeks pregnant and unbeknownst to me, going into pre-term labour.

One of the only pictures I took with my belly. This was a week before I was admitted to the hospital.

That day before I found out was going great, I worked from home during the day and was planning on heading to the Holiday Inn at Dufferin and 401 where I was going to spend the next 3 days organizing and facilitating the last conference for the GTA Legal Aid Clinics (#fuckford). I had planned to get my long-awaited 20 week ultrasound that evening. For those that don’t know, this is the mid-way point ultrasound that takes about 1.5–2 hours to go over the entire baby’s body and parts and determines if they are growing on schedule and if there are any issues or things to deal with. I took an Uber from my house to the ultrasound place, and lay there alone until the ultrasound tech came in and started. He started and was quiet, and said over and over how he couldn’t give me any results or information in the most monotone voice because I kept anxiously asking if the baby was okay. He was joking a bit about Surya (my kid) having her back towards us and making his job really hard. Of course I was growing a little rebel. Already making me proud. Time went by and things felt easier. My mom and sister eventually came and were hoping for a chance to see Surya on the big screen. They ended up coming in a bit at the end and saw her weird back shots. After they left, the tech said he had one more thing he needed to check and I could go, I was anxious to get out of there so I could start prepping for the conference. He did an intra-vaginal check with the wand, and his tone changed. He said he needed to talk to my midwife and for me to get dressed and wait outside his examination room. Immediately my heart dropped, I knew something was wrong. I told him I could message my midwife and text her since she’s one of my close friends, he said to call or text her asap. I did and she got back to me about 10 minutes later (it felt like hours). He took the phone, went into the other room and gave it back to me after talking to her. I felt like I was going to throw up, I had no idea what was going on other than tense feelings and this tech now looking at me with terror in his eyes. My friend on the phone told me: “I need you to get to Sunnybrook as soon as possible, like right now. I need you to stay calm, and you will meet the midwife there. Your cervix is opening and is very short, you are going into pre-term labour.” I had a million questions and I had no idea what that even really meant but I tried to hear her words and focus on what I needed to do next. Mind you, there were NO symptoms this was happening. None. No extra fluids, no blood, no pain, NOTHING. I was in pre-term labour and had no idea. I ran to the waiting room sobbing and told my mother and sister that we needed to go to Sunnybrook 5th floor immediately. I could tell they were just as terrified as me. In the car my sister held my hand and I held my belly and I prayed. I prayed to every god, ancestor and sacred being that it not be too late to save this baby. I had spent the entirety of this pregnancy being anxious, so scared that it wouldn’t stick, that I would lose the baby or something bad would happen. I was later diagnosed with peri-natal anxiety. I was convinced that I prophesied or even manifested this to happen. I hadn’t taken pictures, had a baby shower, planned a baby shower, or even told my workplace I was pregnant at this point. I had just booked a pre-natal class to take with my best friend the night before. I felt like I jinxed it, I blamed myself completely. A year later as I’m writing this, I still feel that way sometimes. This was unreal. When I got to Sunnybrook and put into a room, after a few painful attempts at looking at my cervix, it was confirmed that my cervix was less than 1 cm (a “regular” cervix at this point of pregnancy should be between 3.5–5 cm) and that part of it was opening. The cervix should not be opening and at this point, if I went into labour, the fetus would not survive. I was being ransacked by every possible emotion, mostly just disbelief. In all the scenarios of losing this baby that ran through my head, my cervix had nothing to do with it. That’s the thing about this kind of pre-term labour, or any pre-term labour: we don’t talk about it. It makes sense why, it’s devastating, often leads to the worst loss anyone could imagine (losing a child) and we are taught as a society to not grieve in public.

I was officially diagnosed with an “incompetent cervix” also known as an “insufficient”, “deficient” and many other words that misogynist medicine tells us about our bodies. What the midwives called it is “dynamic”. I had a cervix that had shrunk down to pre-term labour status for any possible unknown reason. Because I was 19 weeks and not fully open/dilated, I was eligible for a procedure that could possibly keep the fetus and it’s membranes (the water sac it was living in) inside my uterus for a longer period of time. After confirming a room for me and talking to me about the procedure, I almost immediately said yes. They admitted me and it would be done after I fasted for over 12 hours. I was getting a Cervical Cerclage. There is a whole world of cerclages available for people at different periods of their pregnancy journey. It all depends on the size of your cervix, how far along in your pregnancy you were and various other factors. Due to how short my cervix was and being 19 weeks, the only option I had was getting an emergency Macdonald stitch cerclage to close my cervix up. I spent 4 days in the hospital, praying that this would work. My first night my sister stayed with me and brought a bunch of my things, the next morning, the surgeons came to talk to us and explain what their plan was. They said because my membranes were bulging out of the cervix, there was a very high chance that if we went through with the cerclage, the membranes could break and then that would be the end of it all. Even if we got the stitch, they said the longest they could see it lasting would be about 6 weeks.

The hospital room where I was in during my time at Sunnybrook. This bed was in Trendelenburg most of the time.

I remember this moment vividly and think about it all the time. I was lying in that hospital bed, in Tredelenburg position (which I put myself in against my nurses advice because it was based on what I saw a few nights before on Grey’s). My sisters, my midwife/forever friend and another beautiful friend of mine were all standing or sitting around me as this doctor gave me three options: 1) You go ahead and risk the cerclage and all the possibilities that come with it, 2) You do nothing and most likely go into labour in the next few days, 3) You choose to abort the fetus today. I looked at my sisters, and I said what we were all thinking, we are going to fight for her. As an abolitionist, pro-choice and committed to body autonomy, I believe that everyone deserves to choose what is best for them. This was my choice. I went ahead with the cerclage and a few hours later I was given an epidural while being bear hugged by the surgery nurse because my body wouldn’t stop shaking. While they were doing the procedure, they thankfully saw that my membranes were no longer bulging out and they were able to more safely close the cervix. (Little wins.)

So now I had my cervix sewed up, Surya was still swimming around safely in my uterus but I was not in the clear yet. I spent the next night being monitored and then was released to be on bed rest at home. I spent the next 5 weeks absolutely terrified. Bed rest meant that I had to be consistently lying down, taking all pressure off my cervix as much as possible to keep the stitches in place. My body had betrayed me, all I could think about was how I was already unable to keep my baby safe. As a fat person, as a single parent, overworked organizer, I found every possible reason to blame my lifestyle, my sleep habits, my work habits, my trauma and most of all, my body for what was happening. I hated my body more than ever. I hated it for not being able to keep this baby safe, for taking away the possibility of carrying this baby to term. I was distraught and it hurt me to know that even though I did everything I could, this was still happening.

Every morning was filled with gratitude for making it another day. For babies this small, every second and minute counts. Babies aren’t considered “viable” until they are at a particular weight and gestation. In Canada, the official “viability” age of gestation is 23 weeks. It was explained to me later that if a baby is born before 24 weeks, they do not have a medical obligation to resuscitate it (if it’s not breathing), they would only do so if the parents requested it. That was a decision I had to eventually make. I went home at 19 weeks. I had to somehow keep this baby inside me as long as possible.

Flowers that loved ones sent to be with me while I was on bed rest

I can’t tell you the emotional, psychological and mental toll this process takes on a person. I was afraid to sneeze or cough, to poop, I looked at the toilet paper every time I wiped with a deep fear of what would be on it. I looked up every blog, article, writing, experience on cerclages and pre-term labour, I joined Facebook groups and forums and apps to get all the information I could. I was taking progesterone and waking up constantly checking for amniotic fluid, terrified my waters broke. My sister made me a calendar and as an exercise I would cross off each day to try and get closer to our goal, 28 weeks. 28 Weeks. When friends of mine are pregnant now and pass their 28 week mark, I cry a little in gratitude for their little one and for them. That was our big goal. It was our goal because at 28 weeks, the baby’s insides and outsides are *mostly* developed, and it spends the rest of the time to acquiring the fat that it needs to survive outside their parents body. The lungs are one of the last things to develop, which is why micro-preemies have many issues with their lungs and breathing. I had weekly ultrasounds and check ins at the High Risk Obstetrics to see how my cervix and cerclage was doing. I luckily had an amazing team of people, both bio and chosen family that started a care team for me, to bring me food, clean my apartment, help me shower, spend time with me, take me to appointments and cry with me. These people saved me, they prayed by my bedside while I was in the hospital and made sure I still laughed and had what I needed. Everyone deserves that.

My calendar countdown to 28 weeks, reminders that it was ok to be afraid and keep going from other parents across the continent who sent solidarity.

By week 3 of my bedrest, I was re-admitted to the High Risk Unit. My cervix was opening up again and they wanted to monitor me in the hospital. I was only 23 weeks when I was admitted. Again, all the worst feelings and possibilities came to the forefront. We were in crunch time, I needed to get to 28 weeks, I prayed so hard and did everything I could. Showers only happened on a must do basis, and when I did it had to be quick and supervised in case my waters broke. I lost so much muscle mass in my legs because of the bed rest and could barely walk. When I got to 23 weeks and 6 days, I took two shots of steroids to give Surya the boost for her lungs in case she came out within that week. In the 24th week, things started to leak more and blood appeared, even though the doctors waved it off as nothing, I knew that my body was opening more and getting ready. Nights were the worst because it was when I was mostly by myself, the thought of going into labour alone was absolutely terrifying, especially because I had no idea what was going to happen. The neonatologists from the NICU came to visit me and gave me stats on survival rates (very low for 24 weeks but better than 23!) and told me what possible outcomes could happen if she came this early (CP, developmental and physical delays, autism, etc.) None of it mattered, my family, Surya’s family was ready to support her. As mostly QTBIPOC organizer folks, we know how to make things happen and advocate for ourselves and loved ones. I won’t go much into her birth but the week leading up to it was a blur of visits, bad hospital food, and obsessions with Facebook groups and statistics. I needed to know that she had a chance. That she could be ok.

4 Days before Surya made her entrance to the world, on Winter Solstice, feet first, at 24 weeks and 4 days gestation. I was exhausted, terrified and didn’t want to take any pictures to remember these days but I’m so glad I did document something.

There is nothing that prepares you to be a parent, I knew that going into this journey. Surya is the most intentional choice I’ve ever made in my life and I would go through this over and over for her if I had to. I wrote this because we never talk about this stuff. I know I am one of the lucky ones to be able to hold my kid and grow with her, and I hope that her survival gives hope to those currently dealing with any type of pre-term labour (this is just ONE of many ways someone can go into labour), or parents in the NICU but also allows for her to honour the struggle of survival for these little, resilient babes. I want to hold space and time for those that did not make it, because many of these little ones don’t. Her birthday is coming up and I want to honour her existence with the joy and amazement that she brings to this world and our lives, but today… today is about remembering that I made it to the other side of those 5 weeks. Everyday since November 12, 2019 has been a struggle to come to terms with the PTSD that I now live with in my body and the grief and loss I experienced through this. Writing this out is part of my process, and making it public is important for me to share what has happened. Thanks for reading ❤.