When, at 38 years old, I heard four heartbeats at our first ultrasound, I imagined not the patter of little feet across a crowded house, but my own death: the chaos of the delivery room, blood hemorrhaging from me as doctors raced to save one, two, three, maybe even four babies, each weighing no more than a cantaloupe, each no bigger than a guinea pig. My heart raced, my breath seized. It was the first time I’d had a clear threat to my life. “I don’t want to die,” I cried into my husband’s arms. “You’re not going to die,” he reassured me. Chances were good that I or my babies would not make it out of that pregnancy alive.
Besides the risks associated with my advanced age, those of carrying multiple babies were numerous and high: Miscarriage in quadruplet pregnancies is about 25 percent, neonatal mortality can be as high as 30 percent, and, according to the British organization Human Fertilisation and Embryology Authority, maternal death occurs twice more frequently in quadruplet pregnancies than in singleton ones. It’s fortunate that I didn’t know at the time that my chances of death were probably higher, given that the U.S. has the highest risk of maternal death of all developed countries in the world. I cried when I heard these statistics on NPR’s Morning Edition, which detailed a young mother’s sudden death. I was driving to work, having slept very little the night before, when memories of my high-risk pregnancy flooded back – of having lost the fourth baby in the twelfth week, of having almost lost the other three to Twin-to-twin Transfusion Syndrome in the seventeenth week, of experiencing the worst pain in my life after a caesarian, and finally of the weeks and months after when I could hardly make it through the days.
All of it could have gone so wrong. “We don’t pay enough attention,” the NPR article states. Indeed, we don’t. When my babies were several months old, a woman from my Facebook triplet mothers support group posted late at night asking about strange symptoms she’d been having. Very few of us saw the post. Even fewer answered her.
We were busy feeding three crying babies, or enjoying rare sleep, or worrying about emerging cold symptoms in our premature infants whom doctors had labeled “immune-compromised.” We overlooked her concerns because we were absorbed in our own. She died the next day from delivery complications. Our group felt so guilty. We had dismissed her, we thought. We hadn’t shouted from across the country, “Go in right now! Go demand care!” I could have easily been her. I could have been just as overlooked. In the weeks that followed delivery, doctors rarely asked how I was feeling, except to note whether I had started making enough milk to feed three babies.
The survival emphasis was on those monitored around the clock, fed by tubes, watched over by nurses, measured and prodded and weighed. The mother of newborn triplets, I had no idea what to expect from my own body, which felt sent through the thrashers. I bled heavily and cramped consistently, though I thought nothing of it. In the hospital, the nurses had told me that my overly-stretched uterus would need to shrink – and it would be painful. I felt like sludge, unable to focus, often losing my balance. But I was pumping around the clock and recovering from major abdominal surgery. I had no objective measure by which to judge what kind of tired was appropriate. Still, I had an instinct that something was wrong. I made an appointment with my OBGYN, insisting that my healing wasn’t normal, that my cramps felt off. I was right. I had developed a rare delayed post-op uterine infection, which (if I had let go and allowed my doctor to rely on standard protocols) could have killed me. Luckily, I was not overlooked.
Luckily, I live in a thriving metropolis with access to excellent doctors, like my obstetrician, who had also spotted signs of pre-eclampsia late in my pregnancy and admitted me for an early delivery. Luckily, my husband works for a large corporation and we have comprehensive insurance, which paid for bi-weekly visits to maternal fetal medicine. Luckily, I listened to my body and advocated for my care. Not all women are so lucky. I shudder to think what kind of care we would have received had we lived in a rural area, if we’d had lesser insurance, if we’d been labeled as having too many pre-existing conditions. I shudder to think what would have happened to me and my babies if we’d been poor. Would any of us have made it? Would this Mother’s Day have happened? The statistics say no. Our system’s neglect of mothers suggests no.