Anhydramnios: Birth, Death, and Drawing Breath
by Tamarin Norwood
Water is almost eight hundred times more dense than air, and contains a fraction of the oxygen. As they move through water fish open their mouths and close their throats, forcing water through the gill slits either side of their jaw where capillaries thread a flow of blood against the flow of water. These streams of fluid run parallel for some time as they travel the expansive surface area of the gills: extraordinarily compact systems of convoluted paper-thin folds, wrinkled with long finger-like protrusions that extend the surface further still. Should a fish be drawn up into the light and laid on the bank, the tissue of its gills would no longer be supported and the folds would collapse together, reducing the surface area so greatly that respiration stops.
I wrote these words almost exactly a year before an ultrasound scan presented us with a brand new word: anhydramnios.The amniotic fluid was all gone. What there was had been used up, and no more was coming. With no fluid, our baby would develop no strength in its lungs and would only survive his birth by minutes or hours.
We looked up the new word. Babies are sometimes said to breathe amniotic fluid in the womb, but real breathing only begins at birth. The events of labour, the new oxygen-rich air, the cutting of the umbilical cord: these changes reorganize the new-born respiratory system in irreparable ways. Where oxygen once flowed through the placenta and umbilical cord directly into its bloodstream, now an inaugural breath draws a first blush of air into the baby’s chest and all the way to the alveoli, the soft porous buds at the branching edges of the lungs, and breathing begins for real. In the womb, the filling of the lungs with fluid is not breathing, but it is learning to breathe. Amniotic. Somewhere I read that it does not derive from amnesia as I had imagined, but from lamb, little lamb.
This was the ocean of our summer months. It was a lonely ocean, but not unfamiliar to the physicians assigned to our care, who met with us one by one like vessels attending a stricken ship. The purpose of these meetings was to reach a mutually informed agreement for the care of Gabriel until his death. We were grateful for the tenderness with which these conversations rocked and waned to balance the needs of the moment, as analysis gave way to sorrow, to question, to speculation, to sorrow again. We learned that a great deal would remain unknown, how it feels to be born being almost as mysterious to medicine as how it feels to die.
We learned that in the womb a baby is sleepy and often asleep, sedated by the low oxygen in its bloodstream and by hormones that induce sleep and inhibit neural activity. Birth releases the new-born into wakefulness and fullness of feeling at the very moment it is hit by the light and cold and undamped clatter of the world outside. The effort of the first cry is to end this affront and, if met by the embrace of the mother against her skin, miracles of synchrony regulate the temperature, the blood pressure, the breathing of the new-born, calm its crying and encourage first alertness. To begin with, what comfort the baby can find is drawn from poor simulacra of the uterine environment. It is no longer as warm as it was in the womb, but it is warm enough; the mother’s voice sounds less familiar than when it was heard from within, but familiar enough; likewise her heartbeat, her smell, her rhythms. It is not as dark as it was, but perhaps the light in the room is low, and perhaps eyes can be closed.
If Gabriel’s birth was to be a kind of waking up to the day of life, affronted, and then longing for and gradually forgetting the lovely dream of sleep, then would his death be a falling into the sleep of night? Perhaps. Among the consultants we spoke to, the cautious consensus was that his birth would be a greater event for him than his death which, it was cautiously hoped, would be peaceful. I formed the impression that he might experience the ending of his life as the completion of his recovery from birth, his first breaths softening into his last, and everything would just become less and less difficult for him, less cold, less bright, less noisy, then nothing at all.
So they assembled his little raft of measures. He would not be taken from my arms, the poor simulacrum of my womb. Should he show pain or the smallest sign of discomfort there would be a suck of sucrose, oxygen by nasal prong, morphine injected subcutaneously. A specialist would attend in case of need, and a hospice would receive us in the event, against all odds, that he should survive a day or more. Part by part, everything was settled and put to rest, ready for the end of time.
But for now he was alive, and at night when I couldn’t sleep and he would paddle me from within, nothing was settled at all. Surely, my mind rehearsed again and again, as long as he was alive, there were ways we could draw him into the world without ever needing his lungs to breathe. I promised, half dreaming in the dark, that I would learn to hold my breath underwater, to dive so far down I would evolve my own gills just like his, just like his too papery and thin to ever come up for breath again, and when he was born I would be just the mother he needed, just the mother he could live with, in our own underwater world. I stayed inside our dream as long as I could, half awake and half asleep, but in the light of day my promises would dissolve into the air. He had grown no gills, nor was he even underwater now, all our fluid being gone. There would be no diving into a world that would be ours, only a passing farewell at the water’s edge.
Winter arrived, and with it the final weeks of pregnancy. By now there were so many of us: our family, the midwives, the consultants and geneticists of three hospitals, the hospice nurse, many others we never met. In the end, the part of the physicians was to retreat. We agreed that Gabriel would go unmonitored during birth in case his readings should trip hospital protocol and send us to theatre for interventions certain to fail. There would be no limit to the care they would provide us, but they would only monitor me, not him.
So they rowed back their boats, oars very quiet in the water, not wanting to disturb the calm. There was the clear impression that they were retreating from something precariously balanced; that this needed to be a perfect performance, our one chance, and they knew better than to intervene. We would all trust our two bodies to do their best, perhaps because it would give him the better chance of being born alive; perhaps because there was nothing to be done anyway. It would be a couple of days, no more.
I opened my eyes. The gloved hands of the midwife had hold of a new bright red thing which, in a single arching swoop, she was delivering to my arms. What must have been barely a second spans minutes in my memory. I took him in, this dazzling slippery star, somehow in flight. I took in the single moment of his life not spent pressed against the fluid warmth of his mother—and now, how silently, he was collapsed upon me, exhausted, resting, like a vital organ removed from me and laid on my chest for comfort, and here: he was back in his lake of me.
Before long I was sleepy. I had fused into a kind of dream with our baby, if a dream can be made of body as much as mind. His little breaths rose and fell on the waves of my lungs as though we were sealed together, as though you could press a sonographer’s wand against the surface of our dream and find a single shared interior, our organs mixed, outlines transparent, a miracle of synchrony. Here was life. Nothing the matter. We were settling in, and now there would be nothing else. I would wait with him until our lovely complicated self depletes and simplifies into those who are breathing and those who aren’t.
An hour or so passed, and when the midwife pressed her stethoscope to Gabriel’s heart and heard no sound, she met my eyes without a word and I remember I nodded. In that moment I felt the news of his death to be very small indeed, and that if I could hold it close enough and keep it warm in my arms, it would be a secret safe with me. We had laid him against my skin so my body could regulate his, and so surely, for a little while at least, one heart between two would be enough. There was still air in my lungs, still sleep in my head, and surely my breath alone, sad and strong, was enough to keep us both inside our dream.
During this secret time I watched Gabriel for any sign of what was becoming of the world he had made for himself. His eyes were so closed, little lamb. The thoughts I had imagined him creating would be wetted and stuck down by now, flat and airless like the gills of a fish out of water. The parts of his body that had been making those thoughts were now as heavy as the parts that were lung, were bowel, were heart. I wondered how quiet was his chest when the midwife heard no heartbeat. How long before a body so small falls silent. Surely not so soon. Perhaps she heard something like the sounds of the womb but their opposite: a soft watery jostle of cells relaxing, blood slowing down, organs becoming unfamiliar to themselves, and perhaps, most distant of all, my heartbeat, big and slow like a whale in the sea beneath him.