SHARE Atlanta

See story below...

Marcia's Note: Sakina came through our SHARE Atlanta group after her baby Jade died in July, 1999. She made many good friends, dealt with her grief, and she and Clarence had Jasmine in late 2000.

She became very active by promoting SHARE Atlanta's programs and did several pr and/or parent workshops. She did several public interviews (one for 11Alive and one for a radio special).

Then, sadly for us, in the summer of 2003, the family moved to Alabama. As she shares here, shortly after arriving in Alabama, she became pregnant. So, she didn't have an opportunity to interview doctors prior to be becoming pregnant (which is the ideal situation and the one we encourage at our groups).

We have talked on the phone a lot and much of what we discussed is here from her. This has been a very hard journey of finding the right doctor. Her doctor with Jasmine was wonderfully supportive, and that is what she wishes for this pregnancy.

Patients working with their doctors is what we encourage. Being educated and aware is important. The March of Dimes materials (online and written) and many of the sites listed on our website, aid in educating and providing information for a parent to take to the ob. While we don't endorse any one line of thinking, we feel that a parent needs to be aware and a very active member in the care of their unborn baby. Marcia

Note as of 1/6/04 by Marcia:

For those who are following this...Sakina does find a doctor (on December 30) who is very supportive of her and Clarence and Jasmine!

So, her entries point out the need to stay on task, know that we can find supportive doctors and that we need to continue advocacy so more doctors will understand the need to listen, provide emotional support, and understand that subsequent pregnancies are most often very difficult for parents.

This diary is very honest. We have tried to keep our prespective angled from several directions. I believe that doctors are human and can't do all things. We need to find the right doctor - medically and emotionally - for us. Each person requires similar things, but seeking the doctor who supports what we need emotionally and medically is very important. I also believe that different personalities - both patient and doctor - influence our choice in who will be our ob.

Of course, in a small town, searching for a doctor can be limited so we might have to modify what we ultimately want. But, we can continually educate ourselves and, if necessary go to a nearby city for a second opinion.

Sakina's email

Entry #1: 9/12/03

I have good news and bad news. The good news is that today I found out that I am pregnant! The bad news is that I don’t have a doctor. We just moved to Alabama and I haven’t found a doctor that I like or trust. I would have preferred to have had a doctor lined up before I got pregnant, but it just didn’t work out that way. A word to the wise, always check the expiration date on your birth control, it is written there for a reason!

Anyway, I went to a regular doctor’s appointment for a checkup and they informed me that I was pregnant. Isn’t it amazing how God will hand you such a wonderful blessing just when you feel the least ready to receive it?

I have just started going back to school. We just moved to a new state. Currently, we are living in an apartment. I just don’t have all of my ducks in a row the way I would like. With all of that being said, I am excited.

Clarence and I were on the fence about having another child, so I guess the choice has been made for us. Right now my main concern is finding a good doctor. The ob/gyn who informed me that I was pregnant told me that I would be considered high risk. She said that they would be happy to have me, but I might prefer going to the high risk specialist.

I don’t really understand what that means. When a doctor refers you to another doctor I suppose that you should go and check that doctor out. Well, let the hunt for a doctor begin! How hard can it be to find a listening, trusting, compassionate doctor?

Entry #2: 10/3/03

Well, today I had my appointment with the specialist. I was real excited because I felt prepared. I had all of my records from Atlanta with me and since he was a specialist I felt like I would probably be in very good hands. If you remember, I have official been pregnant 3 times (this would make my 4th). My first pregnancy ended in a stillbirth at 37 weeks. My second was a miscarriage/blighted ovum. My 3rd resulted in my living child. So, here we go again. I was with the same doctor for my previous pregnancies, so I have a huge file of records.

Anyway, the doctor reviewed my records. He asked me why my doctor diagnosed me with an incompetent cervix with my first pregnancy. I explained that she noticed that my cervical length was shortening. She had me come back twice a month and the cervical length continued to shorten. So in her opinion, she felt that it would be wise to put a cerclage in.

His response was that he has just come back from a doctor’s conference, and they are not sure if shortening cervical length is an indication of an incompetent cervix. So they are now doing new studies to see if that is true.

They have now decided to stop measuring cervical length and they will not perform cerclage surgery unless the patient has lost a baby due to preterm labor. So he told me that he would not take the route of performing surgery, but he would take a “wait and see” stance with me. If I started to have a problem then he would go ahead and perform the surgery.

My response to him was that I did not ask to participate in their study. I know that I need this procedure in order to successful pregnancy.

OK, here is my question. Why would you want to take a “wait and see” attitude with a woman that has already lost a child? My doctor in Atlanta, (the doctor who I have known for five years, the doctor who I trust, the doctor who has performed all of my surgeries, the doctor who has given me countless number of internal exams, the doctor who has told me “Sakina, I have felt your tissues and they are entirely too soft. Whenever you are pregnant insist on a cerclage because I do not believe that you can carry a baby full term.”), has said that a cerclage is necessary. Why would I trust a doctor who has never even performed an internal exam vs. a doctor who has?

Also, I didn’t ask for a second opinion. In my opinion, we should follow the same formula that we used to get Jasmine here. I do believe that I have an incompetent cervix, I also believe that you need to watch my placenta. My daughter Jade did die due to a placenta abruption, but I am grateful that I didn’t lose her sooner because my doctor caught the incompetent cervix.

I believe that my daughter Jade gave her life so that she would be the roadmap to show my future children how to get here. For the doctors to not take seriously the problem that were discovered through my pregnancy with Jade is a dishonor to her memory.

So when the doctor told me that he wanted to take a “wait and see” attitude with me I started shaking. I was experiencing polar emotions. A part of me wanted to burst into tears, the other part of me wanted to strangle him.

You can not “wait and see” with an incompetent cervix. There are a great deal of women who have no complications, and just go into pre-term labor.

So I asked this doctor, “What would you say to me if at the 5th month mark I am in the hospital fighting for this child’s life because I went into labor? What would you say to me if I lost the baby because my cervix opened up and I didn’t have the stitch?”

His response was that if I wanted the stitch, he would put it in. He would allow me to make that call. Who wants a doctor that you have to fight with to get a procedure done? Who wants a doctor that wants to take your care in a direction that you don’t agree with? This doctor wanting to take a “wait and see” attitude with me pushes my buttons.

To him, this baby is a fetus. To me it a baby. It is a member of family. It is a part of my life. If I lost this child, this doctor’s life would not change. My life, on the other hand, would be changed forever. I would be devastated. I am not being melodramatic. I have already buried a child. I have absolutely no desire to do it again.

Listen up doctors, I have something to say. The day and time where patients just listen to what you say and don’t ask any questions are over. We do not take your word as the gospel. We have this wonderful invention called the Internet. With just a click of a mouse there is wealth of information at our fingertips. We do respect the fact that you have a medical degree, but you must respect the fact that we know our bodies. Don’t disregard our concerns. Don’t make us wait 2 hours to see you and just give us 5 minutes of your time. Don’t have this arrogant attitude that you know everything and we know nothing. Listen to us. Hear us. Medical care should be a joint collaboration between the doctor and the patient.

OK Marcia, I will bring this long drawn out saga about my 30 minute conversation with the doctor to an end. At the end of the meeting, he gave me a recommendation to another doctor who now works for another practice. I will make an appointment with her, and hopefully we will connect better. Therefore, the search for a doctor continues. But like my friend Caroline says, “Keep searching until you find the doctor you trust. It is just a $10 copay.” Talk to you soon, Sakina

Entry #3: 10/31/03

Hi Marcia,

I am writing you a quick note just to let you know how I am doing. The last few days I have been having some cramping with spotting. At first I ignored it, but after the 3rd day I felt that I should probably get it checked out. I am concerned that I might be having a miscarriage. Anyway, I called my doctors office and left a message.

The nurse returned my call and I explained to her the symptoms that I was having. She asked me if I had taking Tylenol for the pain. I felt like this was a strange question because the pain itself was not the issue. My fear was that I might be losing the baby.

Now, I know that there is nothing the doctors can do if you are miscarrying, however I want to know if that was what was going on. Anyway, I told the nurse that I rarely take medication, however I really do not take medication when I am pregnant. She responded that her advice would be for me to take Tylenol throughout the weekend and if I still had pain to call back on Monday.

This advice takes my mind to a whole new category. Not only would I spend the weekend concerned that I was losing the baby, but I would also fear that I am harming my child by taking this medication! Once I told her that I was not comfortable with that, she told me that she could allow me to come in and see another doctor and they could check me out. I told her that I would be more comfortable having a doctor check me out.

Once again, I still have a uneasy feeling with this doctors office. Where is the compassion? A quick heartbeat check could set me mind to ease and we will all be happy.

Well, I went in a saw the other doctor, and she was very caring. I only saw her for a few minutes, but she was able to set me mind at ease. She has actually been the first doctor that I felt I have felt comfortable with.

The baby is fine and has a strong heartbeat. Well, my cerclage surgery is still scheduled for November 11. Please keep me in your prayers that everything goes well. Sakina

Marcia's thoughts: Sakina and I talked about this on the phone. As I suggested to Christie in her trial (read her diary), I think that Sakina absolutely needed to go and visit the doctor. To take a wait and see attitude is not the proper approach when you think something is wrong. You must be the protector of this baby like no other person would be. It is better to make sure everything is fine, then to regret that you have lost your child because you assumed that it was fine. I encourage parents to remember that their doctor is a busy person and that nurses are too, they don't keep up with your chart at all times and you are charting constantly. This is what we ask (and pay) these doctors to do...take care of us and our unborn child. No question or concern should be treated as silly or unnecessary.

The MODs has a great list of things to watch for if you are unsure of what you are experiencing. Check their site, read the information and don't be afraid to approach your doctor, if you are, you might not have the right doctor. I am not suggesting a high level of paranoia, I am stating that if you need emotional or physical support - seek it.

Entry #4: 11/15/03

Dear Marcia,

As you know, Tuesday I had my cerclage surgery. I had already told you that this doctor, whom I will refer to as Dr. K, told me that she felt that mentally I needed the surgery. This made me a little uncomfortable because you really want a doctor who believes in what she is doing before they do anything to your body. Anyway, I was able to push away that uneasy feeling and just go forward with the surgery. Well, about five minutes before they are about to prep me, Dr. K comes into my room. She brings the ultrasound machine to check the baby. As she is monitoring me, our conversation went something like this:

Dr. K: ” You know, there is still some controversy about your first cerclage surgery. We are still not sure if your doctor should have given you the cerclage.”

Sakina: “I know. You are giving me this cerclage because you think that I am crazy, not because you think that I need it.”

Dr. K: “I never said that I thought that you were crazy. I don’t think that you are crazy. If I didn’t think that you needed the surgery I just wouldn’t perform it. I wasn’t there. I don’t know what your doctor saw. I do know that you normally would have to lose a baby before you would get an incompetent cervix diagnosis. Were you kidding when you said that? You sounded mad.

Sakina: “I’m fine.”

Dr. K: “I do want to remind you that there are risks to this surgery. I could rupture your membranes and then you would lose the pregnancy.”

Sakina: “How often has that happened to you?”

Dr. K: “Excuse me?”

Sakina: “How often have you performed this surgery and ruptured a patient’s membranes?”

Dr. K: “Actually, only once. That patient was in a different situation then you. She was already 5 centimeters dilated and she was 5 months pregnant. Actually, this is a good time to do this surgery since your cervix is still long.”

Sakina: “OK”

Then my husband starts to ask questions.

Clarence: “What should she do about work? She works part time for Home Depot. Our last doctor didn’t want her lifting anything. She did not want her to put pressure on the stitches.”

Dr. K: “She is just a cashier. She is fine to go to work. But, you can not have sex for the rest of the pregnancy. Did your last doctor tell you that?”

Clarence: “She is not a cashier. Her job requires lifting.”

Dr. K: “Well, I don’t think that any pregnant woman should be doing a lot of lifting. So I guess I could give you a note.”

Clarence: “Is there anything else she should be aware of?”

Dr. K: “No, you should be fine.”

Marcia, it really wasn’t what she said, but it was the tone that she used that bothered me. I still have this uneasy feeling with her. I can’t describe the feeling, but I don’t feel peace with her. Here are my thoughts on the conversation.

1. We had already discussed in her office how both of us felt about this surgery. I already have an uneasy feeling about her, and I am looking for ways to increase my trust level. I felt that it was extremely unprofessional for her to remind me (5 minutes before the surgery) that she doesn’t necessarily agree with it. I didn’t feel like she would do anything that would cause her to lose her license, but I felt like she didn’t care. I felt like if something went wrong she would just have the attitude that I got what I asked for.

2. I know that doctors are obligated to tell you the risk, but explain the risk accurately. If I have a 5% chance of something going wrong, state that. Don’t minimize nor exaggerate the risk. I took the way she stated the risk as a scare tactic. Her tone was not reassuring and she did not give me any hard facts. It wasn’t until I questioned her further that she had to admit that the risk of something going wrong was slight. Thank God that I had already done my research, and thank God that I questioned her further, or my stress level would have been extremely high as she performed the surgery.

3. Never assume anything about your patient’s occupation. Actually, never assume anything about your patients. I don’t understand what “just a cashier” means. I shouldn’t have to tell her that I have a BA in International Business and Spanish. I shouldn’t have to tell her that I use to work for a fortune 500 company and I chose to give that up to be a mother to Jasmine. I shouldn’t have to tell her that working for Home Depot is a way for me to bring in extra money to build up my daughter’s college fund. It shouldn’t matter. Even if I was a cotton picker, I deserve her respect.

Her job is to help me bring this child to this world alive and healthy. I do find it interesting that she was more concerned about me having sex with my husband, than about me standing on my feet for long periods of time and lifting merchandise that would put stress and pressure on my cervix. My husband and I have been married ten years. We are not newlyweds. Our only concern is for me to get this baby to this earth alive. We are parents trying our best to bring a new addition to our family. That is our only focus. I really feel like she said the no sex comment not because she had my best interest at heart, but just to bother me.

4. Why should I have to twist your arm to get a note for work? I work part time. If I don’t work, I don’t get paid and it is truly not a big deal. I just have an obligation to the company to let them know what my limitations are. Also, Clarence and I are coming from the viewpoint that we do not want to do anything that would cause pressure on the cervix and give us complications.

Anyway, these were my thoughts as I went into surgery. It was truly not the best frame of mind to be in, and it did not increase my trust level with this doctor. If I had my way, I would have preferred someone else to perform the surgery. I just felt like I was between a rock and a hard place. The best time to do this surgery is between 12-16 weeks. I was 13 weeks and I didn’t feel like I had enough time to find another doctor.

After surgery, I went into the recovery room. My nurse asked me if my doctor had said anything to me about bed rest. I told her no. Then she asked me if my doctor gave me instructions on what to take for pain. Again, I told her no. She then told me that my doctor did not write up any orders for me. She said that most cerclage patients have orders for how long that they need to be on bed rest and they have a prescription for pain, but my doctor did do that. She then told me that she would consult with the doctor on call and see what she is suppose to do. Later, she told me that the on call doctor advise me to be on bed rest until I see my doctor again, and to take Motrin for pain.

I don’t even need to tell you how I’m feeling right now. All I will say is that the hunt for a doctor still continues.

Marcia's thoughts: I have encouraged Sakina to return to the doctor that checked her during her emergency. This doctor was kind and supportive and medically aware. The only problem is the doctor is in the same office as the one that did the surgery. But, I feel Sakina has the right to ask if she could be a patient of hers and ask, since this is a high risk situation, that doctor deliver Sakina's baby. In my opinion, the doctor who did the surgery was very unprofessional in last minute surgery dialogue especially since this topic had been covered during the office visit. Sakina is also considering another doctor....

Another e-mail to Sakina by Marcia - focused on the comments and attitude of this doctor:

Sakina, I have been thinking about your comments. I do want to mention something about the 'no sex' comment made by the doctor. I know this bothered you because you and I think alike...we know that we love our husbands and they us, no matter what. Husband/wife loving and sex go together, but when there is a bigger issue, like our baby's welfare, we can continue our loving relationship without sex (if necessary) in order to care for our unborn baby's home and safety. You and I know and appreciate that fact.

I have been amazed, though, at how many parents do not get this. I had a nurse (who is a SHARE Atlanta mom) tell me just a few meetings ago, that she has had women come back soon after a cerclage or a near miscarriage - bleeding and then loose their baby - and they tell her that they had gone home and had sex! She said that she would never have guessed from the woman's demeanor that such a thing would happen. She said that more doctors needed to discuss this.

I have had a few discussions with woman through the years and they have said that they were having sex when all symptoms pointed to a near miscarriage and I was shocked. I, mean, it is none of my business, but, in my book, when you are scared to rattle that cradle we carry our babies in before birth, what would motivate a mom and dad to have sex. I know that my husband and I made decisions to protect that home in any way we could to get a child here. It isn't what we want, it is what (sometimes) is necessary.

So, I wonder if this doctor's tone/attitude and manner of delivery are really the huge issues. Plus, she did some really poor choices of timing (another discussion right before surgery) and, unfortunately, I think that she is biased - in whatever ways people can be. I am sorry for that. I know that people like this are out there and biased - about disabilities, race, religion, politics, you name it. We both know the type. I pray that they will change, but they are there. Then, the left over stitches haven't helped her case, at all, in my book. I wonder about her in the total sum of things.

It is a sad fact of life. I hate it for you, but there has to be other doctors. This one is not right for you. I have burned through a lot of doctors in my life to find the one who most closely matches my philosophy and medical need. I am smiling...and I am not. It isn't funny. BUT, it is one more element in this world. God gives us the strength to carry on. We have to face our hurdles and move on to those people we can embrace. Different doctors work for different people and needs. There are choices...we have to make them.

You and Clarence can do this. You both are dear, gifted parents who have each other and those who care and we know God is your guide. I'm not lecturing...just trying to let you know that I am sorry, but there has to be a doctor that will support you in a more caring manner than this one. You and that wee one are going to find him/her.

I just had to write you and let you know that I care. Let you know that we are supporting you... Take care

Entry #4 and 1/2

Thank-you so much. You are absolutely right. This doctor does have an obligation to tell Clarence and I to not have sex. It was just the tone that she used that irritated me. I couldn't understand why she was more concern about us not having sex than about me lifting boxes and standing on my feet. I think that both situations could be problematic.

Anyway, now that I have calmed down, I'm sure that she meant well. I have just never been in a situation that I felt that I always needed to defend myself. This can be exhausting. I don't want to have a doctor that I doubt. I want to be able to trust her because I feel that in essence I am putting my life and my unborn child's life in her hands. Thank God that I have a strong faith or I would have lost it a long time ago.

I do keep questioning myself wondering if I am asking for too much. I wonder if I am overreacting and if I am expecting too much from these doctors. They seem capable. Their practice seems to flourish. I have just learned to live my life according to where the peace of God is,and so far, I haven't found peace.

I was talking to Valerie (ed. a SHARE Atlanta mom) one evening and she said something that really hit home. She told me that most doctors have no idea about the mental aspect that the mothers go through after losing a child. She went on to say that she felt that it was the mothers' fault because we have not done a good job explaining it to them and making the doctors listen to us. Most of the time we just leave the practice and find another doctor. I do believe that she has a point.

How will these doctors ever know if we don't tell them? How will they ever understand if we don't force them to listen? I have to hold on to the belief that doctors became doctors because they want to help people. If I let this premise become my foundation than I do feel that they would be open for hear us so that they can become more efficient in helping us.

It is just very hard to educate when your hormones are raging and you are trying to fight the internal fear battle. Right now, I just want it to be easy. I just want a doctor that understands me and is on board with helping me get this baby here.

I absolutely hate it that my journal entries have been full of complaints. That is really not the type of person I am. I would love to be uplifting and give people something to hold on. I am just not quite sure how to get to that place yet. I do believe that I will find a great doctor soon. In the meantime, I want to just hold on to the joy of having another child.

Thank you so much for listening and thank you for being honest with me.

Marcia's Comments: Sakina, What a great letter! You are NOT complaining in your letters so far - you are doing exactly what you say here...you are telling it like it is. Valerie is exactly right - our inservices have tried to reflect exactly what Valerie is saying, too.

It is weird, but I have just been thinking this very thing with March of Dimess. They are doing great things for us. They are out there with a great campaign for stopping birth problems, they are sending wonderful information out that talks of babies that die and how with their efforts babies are living. In these notes, on their site and in their materials they have a wonderful understanding of bereavement after a loss BUT they just TOUCH on the emotional aspects of the loss - they are NOT making it their major conponent.

Now, to a point this is correct. They MUST focus on the prevention and intervention to stop/lessen our losses and birth problems. But, to skimp the part of the hell that parents move through after a loss is to miss a huge gift they could provide for future bereaved parents. We all know that their will always be bereaved parents with all the pain that goes with a dead baby.

So, your point is well taken and I agree with you - always have. The continued issue of emotional support and understanding by the doctors is still there. They want us to forget and move on. When parents do this - after having a subsequent child, they leave the next parent to suffer the same pain from their doctor. It is hard enough to get through subsequent pregnancies - no mind trying to deal with doctors who don't get the fear and pain we are feeling during this time. While pregnant we have to deal with our unborn child and our health.

The emotional part is why I have continued to stick with SHARE Atlanta. Others will not support these issues. Many of people stop dealing with all of these issues as soon as they get through the trauma of it all and have the subsequent family. Can you blame them? I don't. It is one of the worse times in someone's life, and no one really wants to continue with the memories.

So, Sakina, what you have already given is huge. Your inservices, workshops and PR and even now with the new depth of understanding and the notes online - all lead to carrying on what we know is true. Not one thing that you have written about in your letters is new. (unfortunately) It is there in many circumstances. You writings are done very well. You point out: denial on the behalf of the doctor and the doctor's staff is huge. Leon said something the other day: what is the difference between some doctors and god? God doesn't think he is a doctor - ever.

So many doctors want to be like a god. They want you to sit and take it sitting down. What ever they say is truth. Well, we both know that isn't necessarily true. Because they are human, there is room for questions and a deeper understanding between patient and doctor. We also know that we HAVE to take care of ourselves. A doctor has a lot on his/her plate, too, so we have to be a watchdog, too. Many doctors that we go to are wonderful - we are so very grateful for them. They let us be part of the process of having our child. They listen to us and do all they can medically and honestly to support us. That is what we ask of them.

I have told you that finding a doctor is not easy. I certainly haven't found it to be - with just about any kind of doctor. There are many to choose from which is a blessing. I wish that you didn't have to do this while pregnant - emotional and afraid. You are working hard to protect your child. In our group, as you know, we encourage parents to do what you are doing before pregnancy. But, as in your situation, that is not always possible.

Change is obvious to me: you would not even be able to THINK the thoughts you are having if you didn't have the input from those who have experienced similar losses - and we have come together in support groups now for about 25 years. MODs is one vehicle that is just now really coming into full force in order for us to have more help.

The roads had to be laid. Didn't the Romans do that for Jesus? I wish that we could have what our minds want much quicker. But, the good news is: we are working on it. YOU, ME, Valerie, other groups, etc. and MODs, NIH, many wonderful doctors and medical personnel, etc.

I love to brainstorm - you're so good at it too! Sakina, it is in the struggle that wisedom is born. I am convinced of that. I don't like struggle. I have cried buckets of tears, written volumes, and talked - brainstormed many hours - with people who I feel are trying hard to work through the grit of life, too.

Mankind is built by survivors. Just because someone has letters by his/her name doesn't make them smart about all things. Doesn't make them survivors...getting the job done and working hard to get it done - those are the survivors and many don't have any extra letters by their name.

These are just my thoughts...

Entry # 5 - 11/18/03

In my last journal entry I told you about my ordeal with the cerclage. Well, when I got home, I had a horrible night. I was experiencing a great deal of pain, and had some burning when I would go to the rest room. I was really concerned that I might have a urinary tract infection. Which, as you know, is not good in pregnancy because it can cause pre term labor.

Here was my dilemma; I was so uncomfortable with Dr. K that I just didn’t want to call her. Therefore, that left me with two options, deal with the pain or go to the emergency room. I chose to deal with the pain and see if it would subside in the morning, if not, then I would have to go back to Dr. K.

In the meantime, I will still search for another doctor. I did like Dr. K’s co-worker, so I was debating about making an appointment with her. Well, my follow up appointment was in one week.

During that time, I cancelled my appointment with Dr. K and I made an appointment with another doctor’s office. Even though I liked Dr. K’s colleague, I think that it would be a good idea to make a clean break. To be honest with you, I really don’t think that Dr. K will even notice.

Well, I went and saw the new doctor. I wanted her to give me a good checkup because I still feel the stitches. Every time I move, I feel the stitches. This is not my first cerclage and I have never felt the stitches before. Granted, I was sore for a few days, but this is different. Something is not right.

So anyway, the process went fine. The nurses were great. I was just praying that this would be the doctor that I have been searching for: caring, compassionate, understanding, and a good listener. I was praying that she would understand my concerns, and be on board with the cerclage and watching my placenta.

So the doctor examined me, and she informed me that I was feeling the stitches because Dr. K left the strings too long and they are poking me. However, she did not want to trim the stitches because she wasn’t sure why Dr. K left them so long and she didn’t want to do anything that would hurt me in the long run.

OK, so I will just live with the strings poking me. As long as the strings help keep the baby inside, no big deal. However, there is a part of me that feels like Dr. K left the stitches long on purpose. I feel like she was saying: You want this cerclage now you have it. Every move you make you will know that the stitches are there. Anyway, I can’t be concerned about that right now.

After the examination, I went into this new doctor’s office so that we could talk. She first addressed the issue with the cerclage. She felt that since I have a cerclage in place, she would like to put me on bed rest for the duration of the pregnancy.

When I asked her why did she feel that complete bedrest was necessary, she told me that this is what she prescribes for all of her patients that have a cerclage in place. I felt that this was a little bit to the extreme simply because I have had cerclages before and the stitch did exactly what it was suppose to do.

I didn’t go around lifting heavy things or doing strenuous activities and the stitch held up well. Now, once the stitch was removed, I was 5 centimeters dilated but the stitch did hold my cervix closed. Anyway, I decided that I would comply. All I want is an alive child. If that means I have to do bed rest, then so be it.

So my next question was how often did she want to see me in her office. She replied that she only needed to see me once every four weeks. This again, didn’t really make sense to me, because if you felt that my condition warranted strict bed rest, why wouldn’t you want to check on me more than once a month?

The once a month formula normally applies to the patients that have no type of complications. If you feel that my condition is already out of the norm (hence the strict bed rest) why not evaluate me more than once a month? I pushed the unsettling feeling down, and just decided to comply. I could always call if I have any problems, so I decided to not push the issue.

Then I asked her how she would handle the rest of the pregnancy. She already knew about the placenta abruption at 37 weeks. I told her that with Jasmine (my living child) my doctors watched me closely and at 36 weeks they tapped the lungs and then induced labor.

When I went into labor with Jasmine, I was in a very controlled environment. I was on a heart monitor the entire time to make sure that the baby was not in distress. I told her that I was very comfortable with that form of action because we got Jasmine here safe and sound.

Her response was that she didn’t feel that an induction was necessary. She didn’t feel that constant monitoring was necessary. She plans on removing the stitch at 38 weeks and just let me go into labor on my own. She told me that my chances for having a repeat abruption were like searching for a needle in a haystack. She didn’t feel that it would happen again. Therefore, no extra monitoring would be necessary.

This is when my heart sunked and tears welled up in my eyes. I just looked at Clarence and said, "She doesn’t feel that monitoring is necessary?" She replied "I think that your chances for having another abruption is so minimal that we don’t need to induce and you don’t need to be constantly watched."

Well Marcia, I had heard enough. I just thank her for her time, walk out of her office, walked into the lobby, sat on the floor of the lobby and just cried. Number one, her facts are incorrect. The medical journal states that once a patient has had an abruption, they have a 15% increased chance of it happing again. This is what THEIR medical document state. However, even if that weren’t true, why would you tell a person who has already experienced an abruption that her having another abruption is like searching for a needle in a haystack? Guess what, I found that needle once. Who is to say that I wouldn’t find it again?!?

1% chance, 10% chance 15% chance might seem like a small number to most people, but it is a huge number when you are a part of that percentage who loses a child. You do not care that 99 women out of a 100 were able to bring their babies’ home. You only care that you were the one out of the 100 that didn’t. That 1% is a huge number when you are apart of that 1%.

I am not in the business of carrying a child full term, going into labor and then going to a funeral home because the child has died. It is just too hard. It is not an experience that I care to repeat. I can not have a doctor that is just so relaxed about my care.

So there I am sitting on the lobby floor sobbing. I feel like I have entered the twilight zone. My husband is standing there and he is saying, "I don’t know what to do. Do I just pack you up and send you to Atlanta so that you can go back to Dr. Ortenzi? Tell me what to do Sakina. Tell me what to do."

Marcia, all I could do was cry. I can not be with a doctor that does not respect my history. Even the cerclage doctor felt that we needed to be aggressive at the end of the pregnancy. I guess I go back to her until I can find another doctor. So I guess that the search for a doctor continues. Thanks for listening, Sakina

Marcia's comments: Sakina and I talked on the phone. Going back to Jasmine's doctor was touched on - if just to get another reference or supportive idea. Going back to the one doctor (from the emergency room) was another thought. None seemed too stellar at this point. There has to be someone who can help Sakina.

Entry # 6 - 12/23/03

A few things have happened since the last time I talked to you. The first thing is that I went back to Dr. K’s office and saw her colleague. I really didn’t think that I had much of a choice. I still need medical care regardless if I like the doctors or not.

I feel so weird going to this doctor’s office. My whole personality just shuts down. I barely talk. I don’t smile. My appointments last no more than 10 minutes because I really don’t have anything to say. I know that they think that I am the weirdest woman in the world. I just can’t help it. I seem to clam up.

Anyway, I still feel the stitches. I was very curious to hear what the colleague would say so I asked her to check them. She informed me that I was probably feeling the knots. She told me that Dr. K put in two stitches and the knots were probably what I feeling. She didn’t think that the strings were too long, nor did she feel that the strings were causing me the problem.

She checked the baby’s heartbeat and told me that everything seemed good, and she would see me in 3 weeks. She also told me to stop by the lab so that they could draw a vial of blood for the AFP test. When I went to the lab, I asked the nurse if she could check my iron. I just feel so tired. I didn’t want to mention it to the doctor because I don’t want to seem like I was complaining.

The nurse checked my blood and did tell me that my iron count was low, but not abnormally low. She suggested that I just keep taking my prenatal vitamins. I thanked her and I prepared to leave.

At this appointment, I am by myself because Jasmine also had a doctor’s appointment and Clarence took her to it. As I left the office and turned the corner to get on the elevator there is Dr. K and my doctor standing in front of the elevator leaving for the evening. They both turned to me, give me a weak smile, said hi, and then continue on with their conversation. Remember that this is the first time that I have seen Dr. K since she has put in the cerclage. She didn’t ask how I was doing or anything. Which is fine. I didn’t expect compassion or caring from her.

But I did see first hand that she and my doctor are really good friends. So if I go in with a complaint about Dr. K (i.e. I think that she left the strings too long), my doctor would probably not admit any wrong doing on Dr. K’s part. Also, I just have this feeling that they feel that I am high maintenance. And since I have no personality while I am there, I am doing nothing to change their mind.

The bottom line is that this doctor’s office is not the right place for me. I know that they are willing to tap the lungs and induce at 36 weeks, but I do not want cerclage doctor to put a needle in my stomach. I just don’t like her nor trust her. And my doctor informed me that Dr. K does all of those types of procedures. The choice is clear, I must continue to look for someone else.

The second thing that happened is that I called my doctor’s office in Atlanta. The center is a unique place because it is made up of women, and they have a combination of mid wives and doctors. To me, there truly is a difference in the way a midwife and a doctor takes care of their patients. At the center, I have had them both, and I like both of them for different reasons. The doctors seemed to be more clinical and the midwives seem to be more holistic. However, both of them were caring, compassionate and great listeners.

Anyway, I called my midwife, and I just poured my heart out to her. She was the first person I met when I was pregnant with Jade. She followed my care until I was passed off to the doctor because of the cerclage, and she was there through the ups and downs while I was trying to get pregnant again. She also delivered Jasmine.

Anyway, my point is that she knows me and she has been very honest with me through out the years. So I told her about my experiences and I asked her to give me her opinion. I asked her if I was asking for too much. I asked her if I seemed high maintenance. I asked her I was going crazy. I shared my concerns with her, and wanted her professional opinion.

The first thing she told me was that I was not asking for too much. She informed me that (ed. some) doctors (ed. like everyone else) have egos, and my biggest mistake (ed. most likely) was that I walked into the office and I told them what my doctors in Atlanta did and asked them to do the same thing. She said that I received resistance, because there are doctors that feel like "Hey, I know how to take care of patients. I have a flourishing practice. I don’t need you to tell me what some other doctor did, I am going to tell you how I do things here."

Personally, I feel that a doctor’s ego has no place in my pregnancy, however if I had known this I would have probably approach things differently. The second thing that she told me is that doctors tend to pay more attention to statistics then patient’s history. They seem to forget that every person is an individual.

She told me that I am bringing my past with me to the table, however this does not make me crazy or high maintenance. I have more at stake if I lost this baby this time around. When I lost Jade, I didn’t have Jasmine. I did not truly understand what I had lost. Now that I have Jasmine, and have been a mother to a living child for 3 years, I have first hand knowledge of what losing this child would mean. She told me that I needed to keep searching for a doctor until I find one that understands this.

She told me that I need a doctor that will respect my history and to try everything in their power to not have it repeat itself. I also need a doctor that can understand that I probably will have more anxiety than a mother who has never lost a child, but they need to be prepared to help me through that. "Sakina," she said, "you have to keep looking. You have not found the right doctor yet."

I asked her if she thought that I should just make the 2-½ hour drive and just come back to them. She told me that with the cerclage in place and me having pre term labor with my previous pregnancies, she just didn’t think that it would be a good idea. She just thinks that I needed to continue to look for a doctor here in Alabama.

So this leads me to the next thing that has happened which is I made an appointment with another doctor. This doctor’s office is right up the street. I pass it everyday. I talked to his nurse, and she informed me that he was in solo practice. I asked her to give me some information about his character, and she told me that he is a caring man. She said that he delivered all three of her babies and she has been working for him for the last eleven years. This made me hopeful. This is what I am looking to hear from a doctor:

I want a doctor that I know my baby matters to him/her.

I had my first appointment with him yesterday. I scheduled a consultation because I would like to see where he stands on certain issues before I take my clothes off and let him examine me. So Clarence, Jasmine and I went to this appointment. Jasmine and Clarence ended up leaving in the middle of the appointment because Jasmine was bored and didn’t want to cooperate. Anyway, I told him about my history and asked how he would care for a patient with a history such as mine.

He told me that he would put the cerclage in. He told me that because I have had it in before, he felt that we should do it again.

He said that he wasn’t sure if he would tap the lungs at 36 weeks. He felt that a placenta abruption is like being struck by lightening, and it shouldn’t hit the same person twice.

He did say that he would probably induce but not at 36 weeks. He also said that if I had another abruption that there would be very little that they could do to save the baby. I asked him if he would be adverse to me having constant monitoring and he said no. He said that he would like to see me once a month. There were a few things that concerned me.

He is in practice by himself. He is only one person. He can not be in more than one place at one time. When I asked him about this, he told me that he has it all under control.

He has no equipment in his office. All ultrasounds and non- stress test are contracted out. They didn’t even have a thermometer. I asked if they could take my temperature because I had a fever and no one could find a thermometer.

When I asked them about them about not having any equipment they said that the doctor would prefer have ultrasounds and NST performed at the hospital because if there was something wrong, it could be taking care of there. I’m sure that this makes perfect sense to the average person, but let’s not forget that I lost my child in a hospital. So I do not believe that just because you are in a hospital that your child can be saved. I prefer to stay away from hospitals if I can help it.

I want a doctor that wants to see me more than once a month.

Marcia, at least I can talk to him and the nurses seem nice. At the moment, he is the best that I have seen so far. I’m coming to the realization that I am probably not going to find what I am looking for. I really feel like nobody cares about this baby except Clarence and I.

If I can except the fact that Clarence and I are in this by ourselves, and make peace with that, I think that I will be a lot happier. Right now I just feel so lonely. I feel like I am on a battlefield all by myself. I know that I have to keep searching for a doctor, but I am just so tired. I am tired of explaining my story and not getting the support that I need. I am tired of running into doctors who want to be so nonchalant with my care. I’m just tired.

Anyway, thank you for listening, and I will talk to you again soon.

Marcia's comments: I talked with (on the phone - several times!) Sakina and encouraged her not to give up that a doctor had to be there for her. I felt that she was not asking too much from a doctor-to-be.

Entry # 7 - 12/30/2003

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Marcia - I actually heard this on the phone before she sent this email!!! We are so very happy!

The search is over. I found him! I found the doctor that I have been looking for. His name is Dr. H. He is a part specialists practice, and he is a male version of my doctor in Atlanta. I went in for a consultation today.

As Clarence and I were traveling to the appointment, I told him that I really wasn’t expecting anything special. This would be the 7th doctor that I have seen. I can’t believe that I have had the strength to go through them all. Anyway, once we got to the office, the nurse had me fill out all of the paperwork. I stressed to her that I was just here for a consultation not an examination. She assured me that Dr. H would be more than happy to speak with me.

As we waited, I started talking to this other couple. They are expecting their first child and are so excited. Marcia, they were so cute. It was refreshing to see a young couple so excited and happy without any fear attached. It reminded me of Clarence and I when we were pregnant with Jade.

So I asked the mother who her doctor was and she told me that it was Dr. H. Then I asked her if she liked him and she told me that she loved him. She told me that he was the nicest doctor that she has ever seen. Her husband said that he hates doctors but he likes this one. So I became cautiously optimistic. The nurse led Clarence, Jasmine and I into Dr. Hs’ office. A short time later, a man with a kind and gentle face walked in. He introduced himself as Dr. H and began making small talk. He first addressed Jasmine so that she was comfortable with him and then he and I begin to speak.

I told him about my pregnancy with Jade. I told him how my doctors were noticing cervical shortening and decided to put in a cerclage. I told him about how I went into labor at 37 weeks and how Jade died in labor. Then I told him about my pregnancy with Jasmine and how my doctors watched me closely and induced at 36 weeks. After I completed my saga, his first response was "You must have been so nervous carrying Jasmine. To lose a child is heartbreaking."

Then he went on to say "How wonderful that your doctor caught the incompetent cervix in the first pregnancy. We also measure cervical length to see if there is a problem, however most of the time doctors miss the signs. This is hard to accept when there is a simple procedure that can help keep the baby in. The risk to the mother is minimal if we perform at the right time."

I begin to relax a little. So far, I like what I am hearing. So I ask him "How would you treat a patient with my history?" He responded by saying, "First of all, we would put a cerclage in. The cerclage got you to 37 weeks with your first pregnancy and it helped you get Jasmine here. Your daughter is living proof that the cerclage works for you.

Second of all, we would do continuous monitoring. We need to keep an eye on your placenta. Now we don’t know if you would have another abruption, however once you have been struck by lightening you tend to not want to stand under the same tree again. Because we know that you have had an abruption once, I consider you high risk and we need to watch your placenta to make sure that it is firmly attached.

We could both tap the lungs and induce labor at 36 weeks, or if you are a little nervous about the amnio, we can wait to 37 weeks and just induce. Statistic shows Black children’s lungs developed quicker and Black girls’ lungs develop the quickest. Since you have a 50% chance of having a Black girl, I would feel comfortable to induce at 37 weeks without an amnio." " That sounds good to me." I replied.

"How often would you want to see me?" Listen to this Marcia, this was his response. "I would like to see you every two weeks until the end of the pregnancy and then I would like to see you twice a week. I am getting you in the middle of the pregnancy and I need for you to get to know me, me to get to know you, and for us to get to know this baby. I need for you to trust me, and the only way that is going to happen is for us to see a lot of each other. We need to keep and eye on your cervix and your placenta. Also, if any problems arise, I want you to feel comfortable to pick up the phone and call me. I imagine that it has to be difficult to move to a new state and find a doctor while you are pregnant. We want you to feel comfortable."

Marcia, did I actually hear him right? I wanted to fall out of my seat. If I weren’t so in love with Clarence, I would marry him. For the first time, I didn’t feel as if I was speaking a foreign language. I found a doctor that understands me.

Can you believe that he actually said I want to get to know you and your baby? I mean, he actually cares about my baby! Wow, what a concept! For the first time since this journey began, I began to relax. I feel that I have a doctor in my corner, so I can now get on with the business of enjoying my pregnancy. I am now able to unclench my fist, relax my body, and just breathe.

I’m having a baby, and I am so excited. Six, that was the number of doctors that I had to go through until I finally found this one. Dr. H is my 7th doctor.

First it was the doctor that confirmed my pregnancy but then referred me to the high risk specialist, second was the high risk specialist who referred me to the cerclage doctor, third was the cerclage doctor, fourth was her colleague, fifth was the "having another placenta abruption is like finding a needle in a haystack, therefore you don‘t need any additional monitoring" doctor, and six was the no equipment doctor. I have made my way through just about every doctor in Alabama, but it was worth it because I have now found him. Some people are called by God to become doctors; Dr. H is one of them.

Dr. H asked if I wouldn’t mind getting an ultrasound so that we could check the baby and measure the cervix. I agreed. The ultrasound technician was wonderful.

Marcia, the baby is doing great. The four chambers of the heart have formed perfectly and are beating perfectly. The brain is developing perfectly. The spine looks good and the organs look good. The baby waved and kicked, so I was able to count the fingers and toes. Everything is just perfect.

I was talking to my friend Stacy(another SHARE Atlanta mom) yesterday and told her that I wasn’t sure how I would be able to love another baby as much as I love Jasmine. She told me that once the new baby is born, it is like you grow another heart. She told me that I would have incredible love for the new child.

Well, my second heart grew once I saw this ultrasound. I am so in love with this baby. My heart is bursting with joy. I am grateful to God for this gift. I know that it is an awesome responsibility to care for a child and I am so grateful that God trusts me enough to do it.

You should have seen me Marcia; I was such the proud mother. I went to work and showed everybody who would pay attention the ultrasound pictures. Most people didn’t even know that I was pregnant, but I announced it in a big way today. The people who did know confided that today I seemed different. Today, I actually seemed happy about the baby.

The truth of the matter is that I don’t feel as if I am on the battlefield alone anymore. I feel that I have a competent doctor in my corner. I feel as if I can release control, hand over the reigns to him and just relax. I didn’t realize how stressed I was until I felt the stress leave me.

Thank-you Marcia, for encouraging me to continue to find the right doctor. Thank-you for being a listening ear and allowing me to express my frustration. Thank-you for constantly telling me that I was not crazy and I was not asking for too much from these doctors. Thank-you for caring about me and this baby.

I feel like we are going to be fine now. I feel like I have done my job as a mother by finding the best care possible. I can’t guarantee that I everything will work out and I will bring a baby home, but I do know that I did my best on finding the right doctor. Now, I just sit back and pray.

Marcia's Comments: WOW!! YES!! Thank, God... Yes, there are no guarantees, but we can do the best we can do and find the support that lets us know that we are doing all we can to protect our family. I wish that each one of us had a Dr. H. to care for us. The doctors who give this kind of support are to be blessed and they are there. We await the next entry on Sakina's wee baby.

Entry # 8 - January 20, 2004

Dear Marcia,

I just wanted to give you an update on my pregnancy. Everything is going well. Dr. H is still fabulous. Last week, I started to have mild contractions. It wasn’t serious enough for me to go to the ER, but I did mention it to Dr. K when I saw him today. He was a little concerned and told me that he would like for me to start taking progesterone. He told me that studies have shown that women who have had preterm labor before seem to carry the baby longer on progesterone. It is amazing when you find a doctor that you trust. If any of my other doctors had suggested that to me, I would have been suspicious. However, with Dr. H, I really believe that he has my best interest at heart. I feel comfortable with him. He chastised me for not calling him when I was experiencing the contractions. He reiterated that he is there for me and would like for me to let him know what is going on be it big or small. I am just so glad that he is my doctor.

Right now, I am just focusing on staying healthy. Pregnancy just brings up so many emotions. Now that I am showing, people seem to be really curious about my life. I am getting the normal questions: Is this your first? Do you know if it is a boy or girl? How are you feeling? The questions are fine, but I still struggle with answering the “How many children do you have?” question. I always tell them that I have one child just because it is easier. I don’t want to have to go into the long story about Jade. I don’t want to let strangers into that private pain.

What is interesting is that when I first lost Jade I wanted everyone to know about her. Also, when I was carrying Jasmine, I would tell some people that she was not my first child. But this time around, I just seem to be in a different place. I haven’t forgotten Jade, and I am not ashamed of her. I think that I am more protective of her and her memory. The average person does not understand the type of pain a parent experience when their child dies. I just don’t feel like educating them, nor do I feel like hearing the stupid responses.

Jasmine has taking to this new baby thing with a vengeance. It is almost a little scary because if this pregnancy doesn’t work out, she is going to be disappointed. She loves looking at my tummy. She is constantly informing me that there is a baby in my stomach.

I watch her with such amazement. Do you think that our children know how much power they have over our heart? Do you think that they understand that their happiness, and their well being, is something that their parents are constantly concerned about daily? I look at Jasmine and wonder if she knows that I love her beyond words. I wonder if she knows that if something was to happen to her it would be nearly impossible for me to pick up the pieces and just go on with life. I guess that is the way life is; children do not seem to understand this type of emotion until they become parents themselves. Clarence and I look at Jasmine and we literally feel God’s love. What an awesome amount of faith that He must have had in us to trust us with this child.

Anyway, Marcia, I can go on and on. The main thing is that everything is well with this new baby. I am happy and excited to have this child in my life and I am truly enjoying the pregnancy.

Thanks for the listening ear. Sakina

Marcia's comments: I hear you about children. You are very right. They can never know how much we love them and how much we pray for them. And, it is like MY mother keeps saying - it doesn't stop. You want the best for them, you hurt when they hurt and, yet, you know that they ARE going to hurt to be in the real world. You also rejoice at their happiness. Life is God's plan and it works well, I am sure.

I am thrilled that all is going well. I'm glad that Dr. K told you to call NO MATTER WHAT. LISTEN TO HIM. That is why you "hired him on." He IS the doctor.

I haven't heard this thing about progesterone. But, it probably soothes the body, too. It would be just more of what your body is already making.

We were just, once again, talking in the group about the "how many children do you have" question. As I know we have discussed in the group, I am convinced, our answer does depend "where we are in life;" who we are talking to; and our energy level. I don't think our answer is ever based on how much we love our baby that died, I think it has more to do with the circumstances at the time of the question. WE will always hold our precious children in our hearts and NEVER deny them and that is what is important.

Our living children do get absorbed in our new baby. That is so wonderful. Like you, I never wanted to think about what I would do without them or if something happened to the baby I was carrying. Hopefully, you will not have to go through that. But, those who do, live through it and with support we each can deal with it. That is why we have a section on the site about "Sibling Grief."

Keep us posted...

Entry # 9 - March 9, 2004

Dear Marcia,

I just wanted to catch you up on my pregnancy. Everything is going well. My check ups hav-e being going great. My cervix has not shortened and the stitch has stayed in place.

My doctor and I were concerned about the amount of contractions that I have been having (approx. 3 every hour), but he prescribed something to help relax my uterus, and it seems to be working. Also, I have cut back on my activities.

As you know, I was working part time at Home Depot. It has been a wonderful experience. This city girl has learned to cut carpet, lay tile, cut blinds, give advice on window treatments, mix paint, and ride a lawnmower. Everyone who knows me is probably laughing right now, because this is so out of character for me. However it has been such a blast learning these new things. Nevertheless, I had to resign.

The contractions were increasing and I knew that I was just doing too much. In addition to working part time, I was also taking two classes-Organic Chemistry, and Microbiology. I do not know what I was thinking when I signed up for those classes. It takes me 45 minutes to drive to my Organic Chemistry class. Back in October, when I registered for the class, I felt that I would have the energy to do it; however, I realize that I am just exhausted. After I drove to class, I just wanted to take a nap! Therefore, I dropped the Chemistry class. I will pick the class up again in the future.

I have learned that I am not superwoman, nor do I want to be. I just want to take care of my family and this baby. The further along I get in this pregnancy, the less energy I have. I promise you that if I could sleep 18 hours a day, I would.

Yesterday, Clarence, Jasmine, and I went to the hospital for a tour of their Labor and Delivery department. It was a class geared towards siblings. Jasmine enjoyed herself and she is so excited about the baby.

I, on the other hand, had a strange reaction. I have not really thought about the delivery. At this moment, Clarence and I haven’t even pick out names for this baby. I am not sure if you would call it denial, or if we just haven’t gotten our butts in gear to pick something out.

However, when the nurse was telling the class about the hospital’s procedures I had this overwhelming desire to ask her what the hospital’s procedures were if you had a stillbirth. I wanted to know if they encourage the mother to keep the baby in the room for as long as she can. I wanted to know if they would take pictures. I wanted to know how they handled those types of situations. I wanted to know more about how they handled things if they went wrong then if they went right. Please don’t misunderstand me, I fully expect to bring this baby home. I fully expect everything to go right. However, I expected everything to go right with Jade, and it did not.

With me being at a new hospital, I just want to know how they did things. Of course, I didn’t ask. Those aren’t questions that you ask in mixed company. I am not trying to scare those pregnant mothers. I would have asked the nurse if I had an opportunity to talk with her alone, but that opportunity never arose. I guess I will discuss it with my doctor. He should probably know how the hospital handles the death of a baby.

Anyway, I am almost 30 weeks. As the end is getting near, I do find myself thinking about Jade more and more. Honestly, I am experiencing a little anxiety. Sometimes, it is so hard to fight those thoughts in your head. It is almost as if you are having this warring battle going on inside of you. Part of you wants to be blissfully happy and enjoy the pregnancy; the other part of you wants to remain distance so that if anything happens you will not be too disappointed.

Each day, I handle the polar emotions differently. There are days when I am overly ecstatic about this baby, and then there are other days when I am a little reserved. In my heart of heart, I do believe that I will bring this baby home, and most of the time I can allow myself to feel that joy.

However, there are some days that I have to fight through the fear that something can go wrong. It helps now that I believe that I have a doctor who cares. I am in that place where I feel that I have done everything humanly possible to ensure a good outcome for this child.

I do know that sometimes bad things happen that are out of your control. Pregnancy is really a leap of faith. There are so many aspects that the mother has no control over. We can’t control when we will get pregnant (There are many people in this world trying to get pregnant and it just hasn’t happened). We can’t control if our child’s brain or organs are going to develop normally. We can’t control if the umbilical cord or if the placenta will function properly. We can’t even control if we are going to have a boy or a girl. The bottom line is, we can’t make a heart beat. Believe me, if that was possible, Jade would be alive today. So many aspects to having a baby are out of our hands.

Learning to relinquish control has been my greatest challenge. I want so badly for this pregnancy to work out, however, I can only do so much. I can go to the doctor. I can eat right. I can take my vitamins. I can get plenty of rest. However, even doing these things does not guarantee an alive, healthy child. All I can do now is pray.

Anyway, these are my thought. Isn’t it amazing that you never seem to stop worrying about if your children are going to be OK? It seems like we do this from conception until death.

Talk to you soon, Sakina

Marcia's comments: One of your very first statement is very, very crucial for every pregnant parent: My doctor and I were concerned.... As usual, you have written and touched on so many "truths" for the expectant mother and father. It does boil down to being able to do as much as we can humanly do so we can feel as though we have as many bases covered as we can. Then, no manner what the outcome, we know in our hearts that we have done all we could do. That means having a doctor who will listen to you and care about you and your unborn child. As you have done, you have to search for that doctor so you know at every turn he is there with you. Christie (Christie's Diary) found this to be true and important as so many of our mothers and fathers have.

If prayer works for you, it does for me, that is the other added ingredient. You have to have some level of outside support. Having others who understand your fears, concerns, joys, etc. is very important, too, as you walk the path of the subsequent pregnancy. Yes, you can survive without all of that support, but you will (most likely) have a more difficult walk.

Your reaction at the hospital during the orientation is normal. I have heard it over and over again. Yes, we believe down deep in our hearts that we will walk out with our baby, but until that truely happens, there is this need to know that we will be taken care of if our baby should die. We know it can happen.

You have done so much to protect your baby and your growing family. Having a family is work...it will be. Yes, we worry and protect always. My mom worries about me. It is a human reaction to loving and caring for those we love. Tragedies bring us to a deeper understanding of what life is about. They can open or close doors for us...it is our choice. I have always worked for them to open doors. We never have to like them, but making them eventually work to the deeper part of us, is important to me. You certainly have worked hard on this one.

It is hard for me to believe all you have accomplished. We do learn a lot about ourselves when push come to shove...as they say. Your focus has to be on Jasmine and your new little one. 30 weeks and counting...we are right there with you, Sakina. Take care...

Entry # 10 - May 1, 2004

Hi Marcia,

I am getting close to the end of my pregnancy, and it is amazing the range of emotions that I have been feeling. The doctor is going to induce me on Tuesday May 4, 2004. I am so excited. I can’t wait to meet this baby face to face.

I feel pure joy of having the privilege of carrying this child. It truly has been an honor. I am also feeling fear. I am not afraid of having to adjust to a new baby. I’m not really even afraid of going through labor. However I am afraid that something can go wrong.

My doctor tells me that I am out of the woods. That everything is fine. And I do believe him….to a certain extent. I just know first hand that it is not over until the baby is in your arms. I know that 37/38 weeks of pregnancy does not guarantee you a child. I know that all hell can break lose at the end. It has happened to me before.

What is keeping me sane is the fact that I am older, wiser, more educated about pregnancy, and more outspoken. Therefore, if I even think that something is not right, I will scream to the top of my lungs for the doctor to cut this baby out of my body! I am ready for this pregnancy to be over. I am so tired of fighting this fear demon. It seems like some days he wins (meaning that I give into the fear), and some days I win (meaning I conquer the fear). Either way, the fight is exhausting.

The mental battle that I go through is much more than what the average person bargains for. These are the subtle ways that losing a child changes you. It is like you are never 100% normal again. Do you know that I have not bought one article of clothing for this child? Do you know that at this moment I don’t even have a name? These are things that the average person thinks about and takes care of. For me, it is really insignificant.

I know that Clarence and I will give this child a name (we first need to find out if it is a boy or a girl). Also, I agree with my friend Valerie that you don’t need anything for the child before it gets here anyway. Besides, Target and Wal-Mart are open 24 hours. My point is, the average person does not go to the hospital without one article of clothing for their child, but I will. I know that this is not 100% normal.

Here’s the deal with the fear. Right now, I am in a very good place. It took a long time to get here. When Jade died, I felt so low. I felt like I had to look up to see hell. Putting the pieces of my life back together was not easy. I have now arrived at a point where I am planning for the future. Clarence and I have 5 and 10-year goals. This is significant; because when Jade died it took all the strength that I had to get through the days, hours, even moments. I no longer cared about the future. Right now, I feel like the stakes are high.

I know the joy a child brings into your life. Jasmine is in my life and everyday with her is pure joy. I also know the pain that losing a child brings to your life. Jade is gone and that pain never heals completely. I don’t want to go back to that dark place again. I don’t have the strength to survive it. I have dealt with more than my fair share of tragedies and I honestly feel like I should be tragedy free for the rest of my life. I just want everything to go well. Please God, let me bring this baby home: happy, healthy and alive.

So these are my feelings. I know that I am going to have to get my emotions under control. I cannot and I will not go into labor being afraid. Fear is not of God. And fear has no place in my pregnancy or my labor. So I am acknowledging my feelings, working through them and getting past them so I can have a clear mind going into labor. For me, believing in God and reading His Word settles me. It gives me the presence of mind to know that no matter what God is with me. That fact is something that I can hold onto.

Marcia, please keep me in your prayers. Thank you so much for you love and support throughout this pregnancy. Clarence will call you Tuesday morning with the news of our new arrival. Until then, Sakina

Marcia's thoughts: Sakina and I talked on the phone on Sunday after this email. We talked of how fortunate that God helped direct them to the doctor they have and we talked about prayer. We discussed the procedure and the wonderful care that her doctor and his nurses provide...one nurse stays with her the entire time. She felt blessed and ready as she could be...knowing that nothing is done without risks. You have to do all you can to protect what you can...and she felt, as I do, that she has done all she could do for this baby and their family.

Entry #11: Baby Jayla Amaya arrives!!! She weighs 6 pounds and 11 ounces - 19 inches long -and is healthy....

Sakina delivered Jayla Amaya after being carefully watched and thankfully by the same nurse and doctor. They got to 9 centimeters but due to Jayla's lowering heartrate during difficult contractions and Sakina's raising - to high - blood pressure and past history - after a valiant try to deliver vaginally - a C-section was ordered and a blessing.

I talked to Sakina and they are very blessed to have their living child with them. They know that and are thankful to wonderful and active, knowledgable medical care by her doctor and his nurses.

Jayla came home on Saturday after being delivered on the Tuesday to a big sister, Jasmine, who was waiting.

I will post what Sakina writes for us. Given her thoughts just before her delivery, we see once again how important having a doctor who we trust is for us. It is a must. Sakina told me that when her doctor told her what he thought they had to do, she was totally ready to follow his lead and grateful that she trusted him so much and that they had gotten to know each other as well as they had. We both were glad that she had sort the medical support she had...both during the pregnancy and at the end. As she said, it is not over until you take that baby home....

Entry #11 - June 3, 2004

Sakina and I had shared all of this information over the phone...it was incredible for her to sit and write it all out. I am glad she did, though so hard to believe, we must be ongoing about taking care of ourselves and thankful for our awareness, caregivers that care, and life itself...

Dear Marcia,

Jayla Amaya Hanson was born May 4, 2004 at 11:23 a.m. She weighed 6lbs and 11 oz. She is beautiful and is doing wonderful. Labor was an interesting experience. It has taken me this time to really be able to sit down and put my thoughts into words. Here’s what happened.

On Tuesday morning, May 4, Clarence and I arrived at the hospital at 7:00 a.m. We were actually calm about the whole event. This was our third baby so we really felt like we knew what to expect. After we filled out all of the paperwork, they led us to a room and tried start an IV. I should have realized then that each delivery (like every pregnancy) is different.

First of all, it took an hour for the nurse to start an IV. My wonderful veins wouldn’t cooperate. After 4 tries, they finally got it in. Dr. H came to see me. He explained that he was going to remove the cerclage and induce labor. He was so wonderful. He told me that today was my day. He didn’t have anybody else on the schedule and he is so excited to see this baby.

So once the IV was put in, they moved me to another room so that Dr. H could have better lighting to remove the cerclage. Normally, the whole procedure takes about 5 minutes. However, this time, it took about 1 hour and 30 minutes. The problem was the cerclage was embedded in my cervix. It appeared that I had tissue that started to grow around it. Dr. H quickly realized that the only way to get the cerclage out was to give me an epidural because he was going to have to literally dig inside me to get it out. He was able to remove one of the stitches, however, he was just able to cut the other stitch. His theory was that as I started to dilate, the stitch would move out of the way.

After the stitch was removed, they moved me back to my room. The greatest thing about this hospital is that they have a 1 to 1 nurse ratio. So my nurse (Lynne) was with me the entire time. She was veteran nurse, and she was worth her weight in gold.

When I was hooked back up to the fetal monitor they noticed that I was contracting on my own. My contractions were about 4 minutes apart, so they did not need to start pictocin. Dr. H told me that he was going to make his rounds and that he would check on me in a little while.

Once he left, my nurse and I just started talking and getting to know each other. She is watching the monitor as I am just preparing myself for the actual delivery. Because I had the epidural, I am not feeling much of anything. They next thing I know, my nurse tells me that she is going to call Dr. H and have him look at the monitor. So little alarm bells go off and I ask her what is going on. She informs me that every time I have a contraction the baby’s heart rate goes down and she wants Dr. H to check it out.

Dr. H walks into my room and he looks at the monitor and then checks me to see how far I have dilated. He told me that I started off at 4.5 centimeters and now I am 5 centimeters. However the baby’s heartbeat should not be dropping the way that it is and if it keeps dropping we are going to do a C-section. Marcia, I heard what he said, but it really didn’t register. For some reason, I never thought that I would have a C-section. I would joke from time to time that if I ever felt like my placenta was seperating that I would want them to cut me open and take the baby out. But I never really believe that that would happen. I guess I always felt that if I could deliver a dead baby vaginally, then I could deliver any other child vaginally.

Anyway, Lynne (my nurse) is still watching the monitor and Dr. H had left for a little bit. The next thing I know is that Lynne says, “OK, I am calling it. You are getting a C-section.” So I ask her “Are you saying that I need a C-section because of what has happen in my past or is this something that you would recommend for any of your patients?” Lynne replied ”I am calling it this early because of what happened in your past. However if you were any other patient, I would only give you 20 more minutes. Here’s the deal. I want your child to be the smartest kid in the 1st grade. The dip in the heart rate is indicating a lack of oxygen. So we need to get this baby out.”

Marcia, that was all I needed to hear. Sign me up for the C-section. The bottom line is that I only had one goal. The goal was to bring this baby to this world happy, healthy and alive. And if they need to cut my body open to do it, so be it. Dr. H comes back in, looks at the monitor, and agrees with Lynne.

The next thing I know is that they are prepping me for surgery. The move me into the operating room and the anesthesiologist come in to give me some more medicine. Dr. H, on the other hand has both of his hands inside me and is stretching me to try and get me to 10 centimeters so I would not have the operation. He is able to stretch me to 9 and then he asked me to push to see if they would get me to 10. Unfortunately, because they turned my epidural up, I can’t feel anything. So pushing was out the question. I swear, that if he could have actually grabbed Jayla and pulled her out of my body, he would have. I have to give him so much credit for trying.

The next thing I know, I start feeling incredibly weak and sleepy. I asked my nurse if I was suppose to feel this way. I asked her if the medicine was supposed to make you feel incredibly sleepy. She looked concerned and started checking my vitals. Come to find out, my blood pressure was 210/98. She informed Dr. H and he told the anesthesiologist to try and bring the blood pressure down quickly as he goes and gets the baby out.

Marcia, the only thing I can tell you is that I felt like I was dying. I felt as if I closed my eyes, I would not wake up. I remember talking with God saying “Please Lord don’t take me. Please don’t take me. My family needs me here.” I can honestly tell you that I was scared.

They pulled Jayla out of me and I heard her cry. I was so thankful, because I knew that she was OK, however I was still concerned about the way that I was feeling. I started to pass out and Lynne was trying to keep my attention to keep me awake. I heard her yelling at me “Stay with us Sakina. Stay with us.” Finally, I felt a little better. I finally got something in my system to help bring the pressure down. Dr. H and his teammate are sewing me up, and it seems like both mother and baby survived.

A couple of days later, Dr. H is visiting me in my room and I ask him to bring me some literature on birth control so that when I come in for my 6 weeks check up I would have already made a decision. He starts going over different options with me. Since I am breastfeeding, he is really only comfortable with a few different options: over the counter contraception, the shot, or an IUD. He did tell me that an IUD was the best option since it last for 5 years.

So then I asked him what was his opinion about women having babies over 35 because in 5 years I would be 36. He then said something that I thought was surprising. He told me that women are in such good shape that having a baby over 35 is not that big of a deal, however if I chose to have another baby he would consider me high risk. This was surprising to hear because in a previous conversation he had told me that I was doing so well and it seems like my body has finally got the hang of being pregnant. So for him to tell me that he would consider me high risk was not something that I was expecting to hear.

Dr. H went on to explain that during the surgery, after they delivered Jayla, my placenta shot out of my body. He really had never seen anything like that happen before. It normally takes manipulation to remove the placenta, however mine had already separated from the uterus. He went on to say that he was glad that we did the C-section because he doesn’t think that she would have survived if we had delivered vaginally. He told me that bottom line was that we were lucky. We were very, very lucky, and he is not so sure if we would be so lucky if I tried to have another baby. He went on to say that if I was to get pregnant again, he would help me through it, but in his professional opinion, he would not recommend that I try it again.

Marcia, if there is one thing that I would like for anyone who is reading this to take from my journal is that I cannot stress enough how important it is for her to find a doctor that she trust. Just think if I had stuck with one of the other doctors, I really do not believe that Jayla would have made it. Those doctors kept telling me that a placenta abruption is a fluke thing that doesn’t happen twice. But it did to me. At least this time I had a doctor monitoring me so closely that we were able to save the baby.

I believe that when I woman gets pregnant; God gives her everything that she needs to take care of that baby. We have that small, still voice speaking to us. We have that intuition that guides us to let us know if something is right or if something is wrong. I have learned to listen to that voice. I have learned to trust myself. Or better still, I have learned to trust the God in me to lead me the right way.

Getting Jayla to this world was not easy. I had to fight with stupid, insensitive doctors. I had to tell my story over and over again. And I had to watch the doctors not respect my history. I have cried countless tears and have been incredibly frustrated every step of the way. However, I didn’t stop until I found the doctor that would listen to me and would use my past as a blueprint as to what can happen in my future. It is so important to have a doctor that you trust. It is equally important to have a voice and to speak up.

Each of my children has taught me different things, but all of my girls have made me who I am. I am honored to be their mother and I am so grateful that they have become a part of my life.

Marcia, thank you so much for the opportunity to share my story. Writing this journal has been so therapeutic for me. Thank you so much for your listening ear and for your shoulder to cry on. You really helped make a difficult situation bearable. Now we can rejoice in the birth of Jayla Amaya Hanson. Sakina

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