I look incredulously at the teenager in front of me, talking so fast I only really catch every other word, the worry evident on her face as she explains, “I was in Miami and I started to bleed, I had a flight to catch and figured 8 hours in the air would make it stop”. Luckily for her this crazy logic seemed to hold true, she had stopped bleeding. On disembarking from her trans-atlantic flight she literally sped to the nearest hospital to get checked. Her mum crying by her side.
“How many weeks pregnant are you now?”, I ask. It is clear she does not have her hand-held maternity records, you know those records which should never ever leave your side.
Her worry lines appear again, this isn’t a good sign. “Well….five months ,maybe”, she murmurs, clutching her mum’s hand tighter. This is her cue to interject. The story unfolds, she has not been to her GP to get booked and get her antenatal care started. She has had no scans, dating or otherwise. She has had no bloods, no screening, no discussion as to how maternity services work in the UK. Thankfully what she did know is that bleeding at 5 months is a cause for worry.
This clearly isn’t the time to give her hassle for her over-sight. She looks well, and the bleeding has stopped which is the main thing. I examine her and her uterus is sitting exactly at her belly-button, 20 weeks pregnant, she is spot on. I get out the Doppler and her baby’s heart-beat is instantly heard at a perfect 145 beats per minute. Her mum starts crying again. I explain an internal examination would usually be performed at this point but without knowing the position of the placenta this wouldn’t be the best plan at this stage. Relief crosses her pretty young face.
She’s thrilled to have heard her baby, whilst most women have heard their baby countless times at this stage, this is her first. And this is all she wanted. She makes it clear antenatal care is not really her thing and had she not bled she would not have seen anyone. She believes in nature looking after her and her baby, medical intervention of any kind has no place here. I look to her mum for help, “God has blessed her with this precious gift” she says by way of explanation.
I throw the bait out there, offering a scan to “see” her baby with the advantage of dating and checking there are no anomalies. She is delighted and accepts. She will come back tomorrow.
The next day one of the sonographers comes to find me, clutching a long strip of scans. My heart stops momentarily, I know what is coming. They are from the beautiful, yet naive, mum-to-be from yesterday. I have to say how in awe I am of the sonographers, the views they get on a fetus 6 inches long are amazing; they see the lips, heart valves, neuroanatomical intricacies in perfect detail. They tell me it takes a trained eye, I beg to differ, my eyes cannot be trained to see what they see.
They take time to point out features on the scan which are worrying. My genetics come back to me, it does not take me long to realise these abnormalities are consistent with Edward’s syndrome, trisomy 18. This little one has survived against the odds to 20 weeks gestation, the chances of survival to term are tiny and in the event these odds are overcome survival beyond the first week of life is unlikely. It really is the most devastating antenatal diagnosis.
I call the consultant.
The warning shots had been given before we get to see the couple. Her husband thankfully had come to the scan with her, and her mum, her unwavering support by her side. I’m impressed at how intuitive our young patient is. She is wise beyond her years, asks amazingly astute questions and seems beyond capable of assessing the information given at such a distressing time. She looks again to her mum for support, her rock. “Your baby is too precious for this life, God will bless you both with another child”, she murmurs into her daughter’s hair. I feel myself wilting inside. She stands to leave, giving the couple time to think. As she leaves, she takes my hand, it is clear I am going with her.
Outside the room she pulls me close, never releasing go of my hand. She explains their faith in nature, how the natural balance is always restored but medical intervention does not always allow this. She does not believe we should interfere with life and things should be allowed to play out on their own. There is only one thing she believes in more than this. And that is her daughter’s well-being. If she will lose this baby regardless of what decision is reached today, then the pain should not be prolonged. With that she lets go of me and walks away.
The evoking smell of white musk lingers on me as I quietly re-enter the room.