The Baby Shower
In Ireland, Ashley said, where the tradition started, friends would throw a bridal shower when the family of the bride didn’t approve of the match, to help the girl set up the household. I think it’s the same for a baby shower—friends are supposed to arrange it.
They were sitting on blankets on the long grass in Ashley’s backyard, the lawn shot through with crab grass—Ashley and three women, Emma’s friends, whose names she’d already forgotten. A plump brunette with an infant, a pretty blonde in shorts, and a mousy-looking, thin woman. Sitting under the sprawling mulberry tree. What a menace it would become in a week or so, staining everything left under it with bruises of purple: blankets, the lawn chairs, the table, all pockmarked by the falling fruit. Ashley had no idea what to do about it. A shame to raze a decades-old tree just because of a few stains.
Really? the mouse said and picked up a stray leaf that landed on her sleeve without granting Ashley so much as a glance.
What was her name? A classmate from high-school who resurfaced in Emma’s life out of the blue? Ruth, Ashley remembered. She wondered why Emma had invited her. Was she a teacher? A paralegal?
Our grandmother eloped and her friends threw a shower for her, Ashley said. Her father disapproved of the boy and they ran away to Canada. My grandmother’s friends gave her a set of cast-iron pots; she brought them along when they emigrated. We still have them.
Cool story, the brunette said. She looked like she wanted to clap her hands.
Ruth sipped her champagne.
The occasion was a baby shower for Emma, Ashley’s forty-year-old sister. Nothing was ever easy with Emma, but this pregnancy, suddenly was. A miracle, Ashley thought, a fully blessed miracle, after what Emma and Jack went through last year with their first baby. So far, so good, Ashley thought, inwardly crossing her fingers and spitting over her left shoulder. For years of Emma’s singledom, Ashley had worried about her sister’s fading fertility. But as it happened, two years ago, only a month after a honeymoon in Palau, Emma got pregnant with Madeline and Ashley was on her way to becoming an aunt.
Except it wasn’t meant to be…
Well, at least the drinks are good. Ruth waved her flute, the sparkles in the wine catching the sun. Although it would be classier if it was served in the real champagne glasses. Those open, wide ones¹? She took another long swallow.
I never had a baby shower, she continued. I had so much trouble getting pregnant, I didn’t want to jinx anything. I told everybody to hold off buying gifts and things until after the baby was born. I am so glad that Emma is finally pregnant, Ruth said. I know she’s been quite distraught, trying for so long.
I know, said the blonde while the breast-feeding brunette nodded vigorously.
Ashley opened her mouth to correct Ruth. Getting pregnant wasn’t Emma’s problem; what were these women talking about?
It can be a problem if you wait too long, Ruth said gravely. I thought about waiting but then decided my career should not take precedence.
Ashley bit her lip to stop herself from saying something she’d regret. What a cow.
So how far along is she? the brunette asked. She’s not showing yet.
Thirteen weeks, Ruth said promptly.
She’s eighteen weeks, Ashley said and Ruth looked at her. Are you sure?
I’m her sister, Ashley said. And a doctor.
Do you deliver babies? Ruth asked.
I’m a gynie-oncologist. I treat women with ovarian and uterine cancers.
Well, delivering babies is very different. Ruth said. When I was pregnant, my obstetrician did things I didn’t ask for. It was awful. Not to mention what they do with the placentas after the baby’s born². Ship them off to South America to make youth-enhancing cosmetics.
Wow, Ashley thought while the other women sat up straight, steeling themselves for those pregnancy-related problems, the worst type of problems any woman could face. The breast-feeding brunette said: I know what you mean. I…
Eight months of infertility³, Ruth spoke over her. Puts a spanner in the romantic works, I tell you. When I finally got referred to the fertility clinic—I had to wait until it was more than a year, those are their rules, they don’t care how worried or scared a woman is, they will not see you earlier. That’s what you get with public healthcare. Everything was a battle. At a private clinic, I wouldn’t have had to fight for my turn at the ultrasound and the timing of my bloodwork. I had to line up for ultrasounds before six in the morning. Once, this woman tried to get in front of me and I told her that if she didn’t get lost, I would report her to the coordinator and she said, go ahead, and I did and the coordinator ended apologizing to me profusely. This woman thought she could just show up and things would get done. She cried and the coordinator had to take her to her office to calm her down, but I kept my place in the line.
Maybe she was going through something, like with her husband or her job, the blonde said. You know, something…
Who cares? This was a fertility clinic, not therapy, Ruth snapped. I needed my ultrasound to be timed just right before the sperm injection that morning.
The blonde clucked sympathetically. Of course.
When I finally got pregnant, they tested me for Down’s syndrome⁴ without telling me. They had no right. Sixteen weeks along, finally happy and past all the danger for miscarriage, just after I started telling everybody, I get a phone call from my OB’s nurse saying that some tests⁵ showed my baby has a chance—Ruth mimed air quotes—of Down’s syndrome. She wouldn’t explain over the phone and I needed to wait two days for an appointment. Then they said that I would need an amnio that would tell me for sure if the baby had Down’s syndrome or some other chromosome trisomy. The OB said that my blood showed that I had a risk of a forty-seven-year-old woman for a chromosome syndrome. And I was only twenty-eight! The OB laughed, said it wasn’t like that, that it was statistics and not exact number⁶. If it isn’t an exact number, why would you talk about it? I mean, this is life-changing information and you cannot just give it willy-nilly without a proper scientific basis. I didn’t want a baby with Down’s syndrome but I didn’t want an abortion, either. And, they were saying something about false negatives and false positives. If you are going to have false results, the test isn’t very good, is it? Maybe you should be improving it before you impose it on unsuspecting people?
It was a screening test⁷, Ashley said and Ruth scowled. A screening test only detects the chance of a condition; it does not diagnose it. The doctors weigh the risks of the miscarriage and the risk of the condition and offer the amniocentesis only if the risk of Down syndrome is higher than the risk of miscarriage from the amnio.
Ruth sat lining up the pleats on her calf-length skirt. One by one, perfectly spaced, at right angles to her waistband, she smoothened them with the fingers of her free hand, her lips a bloodless straight line. She wasn’t hearing a thing.
They were totally pushing for amnio, but I would not have it, Ruth said. Doctors just want to do the procedures. Do you know how much an OB gets paid for amniocentesis? Like a thousand dollars a pop⁸!
Ashley raised her hands, but Ruth kept talking. No wonder they keep drumming up the business. Anyway, nobody was poking a needle into my belly and accidentally sticking it into my baby. Don’t shake your head, that is one of the risks of amnio, I researched it. When I told them no amnio, they suggested another blood test, some other alphabet soup⁹. That one came back with another problem! They couldn’t interpret it exactly—again!—but it looked like it was a girl that was missing one of her X chromosomes. That one is called Turner’s¹⁰ and those girls are infertile and have all sorts of health and development problems. Between that and the Down’s, I had no choice but to have the needle in my belly and boy, did it ever hurt. They do it without any freezing or numbing; I felt it go all the way through the muscle of the uterus. Then I had a massive back cramp and I thought I was going to lose the baby right then and there, and I passed out. I had more cramps later that night. I researched it and found out that spasms and cramps mean that a miscarriage is coming, and I didn’t sleep for a week afterward.
Two days later they told me that the baby didn’t have Down’s syndrome and wasn’t missing the X chromosome. I thought that was that, the end, but no, they did one more test I never asked for and two weeks later they told me the baby had a variant on her chromosome eleven. By that time, I was flinching every time my phone rang. And this young chick, a twenty-something geneticist or a genetics counsellor, couldn’t even explain what chromosome eleven did. She called the change a variant and couldn’t tell me what that meant. They had a term for it, what was it?¹¹ Then she said that if they tested Brad and me they might be able to tell us what that variant meant. Except that Brad faints when he needs to give blood so that was very traumatic for me because I had to hold his clammy hand and then drive him home; nobody cared how I was managing through all that. In the end, since neither of us had the variant, they couldn’t tell us at all what it would mean for Zoë. Because we named her when they told us that it was a girl. Zoë, meaning truth in ancient Greek,¹²—Ashley opened her mouth—because we have always been truthful with each other, Brad and I. In the end, Zoë didn’t have Down’s and she didn’t have Turner’s, but they still couldn’t tell me if she would have problems later on. Because of that variant. What was I supposed to do? Abort her? At five and a half months? They said that I could if I wanted to. Can you believe that? They didn’t call it abortion but “stopping the pregnancy”, as if that made any difference.
Ruth tipped her glass and finished her wine, the others making soothing noises.
And after all that, they wouldn’t even refer me to the high-risk pregnancy clinic! They said I was having a healthy pregnancy and there was no risk to the baby or me.¹³ What about all the emotional stress and turmoil, huh? They sent me back to my GP to deliver the baby! In the end, all I could do was hope for the best, that all that trouble will have been worth it and forgotten once I held her. Ruth held her arms by the elbows and rocked them, tilting her head to the side and half-closing her eyes. I really believed that everything will be fine, she whispered.
Wasn’t it? The brunette asked. Her baby, draped over her shoulder, burped loudly. I saw Zoë earlier, she looks great. There she is, on the swing! Such a lovely girl.
No, Ruth said, her voice catching. It wasn’t all right. When she was born, she had a hole in front of her right ear, just there, a little dot. All these doctors at the delivery and none of them saw it! I had to point it out to the pediatrician. Zoë has a preauricular pit¹⁴.
She looked at each of the women in turn, stared at Ashley the longest. That’s where the amniocentesis needle poked her little head.
That’s not true, Ashley blurted out, instinctively.
Of course, they denied it, Ruth snapped. They said it was quite common and unrelated to the amnio, but I know better. It’s a scar. Everybody’s covering up for each other just like you are. She glared at Ashley. Protecting the OB who stuck the needle in my baby’s head even though you don’t even know him! Even the ear-nose-and-throat surgeon I demanded examine Zoë looked me straight in the eye and said it had nothing to do with the amnio. Told me not to worry about it, that it wouldn’t affect her hearing or anything.
If you knew embryology, you’d know, Ashley began.
I’m not stupid. I did my research: WebMD, Wikipedia, tons of photos online of babies and kids and adults with these pits. I even went to the university medical library to look at anatomy atlases. You all take an oath in medical school¹⁵ to protect each other, not a single doctor will break ranks. The books say the same thing because they are written by other doctors. Needle pokes happen during amnio and nobody will admit it. There are photos of needle marks on babies after amniocentesis on Reddit. It’s a conspiracy of silence. Zoë has it. She’s already had two infections there, I’ll have you know. Don’t tell me it’s nothing.
Ruth wiped her nose on her wrist. All you doctors should be ashamed of yourselves.
The mulberry tree soughed above their heads in the summer breeze.
¹ A champagne flute is a tall and slender glass. Its narrow bowl retains the wine’s fizz and aromas for longer and allows the bubbles to rise smoothly to the top. A champagne coupe has a wider and shorter bowl, and loses the fizz more easily but there’s more space for the bubbles to move around and oxygen to interact with the wine. They are used interchangeably; one isn’t considered classier than the other.
² The hospital disposes of human placentas, umbilical cords, and blood lost during delivery as medical waste, most commonly by incineration.
³ Infertility is a condition defined by the inability of a couple to achieve a pregnancy after twelve months or more of regular unprotected sexual intercourse.
⁴ The correct term is Down syndrome, without the possessive apostrophe.
⁵ Enhanced first trimester screening (eFTS) is a standard component of prenatal care. It is offered from nine
weeks of pregnancy onward.
Emma had eFTS when she was pregnant with Madeline, too, and she had a positive result for trisomy 18.
⁶ The risk of Down syndrome increases with mother’s age. A twenty-five-year-old woman has a 1 in 1,300 chance of having a baby with Down syndrome, while a forty-five-year old woman has a 1 in 30 chance. If a twenty-five-year-old blood results shows a screening risk of 1 in 270, it can be compared to the risk of a woman who is thirty-five years old. It does not mean that the woman’s ova are prematurely aged; it is a statistical construct to communicate the increase in the risk.
A similar pattern of increasing incidence with maternal age occurs for trisomy 18.
⁷ A screening test determines the chance of a disease, not its presence or absence. An inherent part of screening test is the false positive rate which means that the screen testing is positive for the condition but the patient doesn’t actually have it. In prenatal screening, a “positive screen” for Down syndrome or trisomy 18 needs to be followed up by a diagnostic test to prove or disprove the result. During an amniocentesis, a sample is taken directly from the fluid around the baby. That fluid contains cells shed from the baby that are then tested for the chromosomal differences.
Emma’s eFTS was reported “screen positive” for trisomy 18. The amniocentesis confirmed it. Madeline was tiny, tiny and had a complex heart defect. Emma and Jack knew that their baby would not survive because the heart defect was inoperable but they continued the pregnancy. Madeline lived for ten hours and died in Emma’s arms, with Jack holding her little hand, and Jack’s parents and Ashley huddled around her in the hospital room.
⁸ The Ontario Health Insurance Plan fee for code Z773, Amniocentesis, diagnostic or genetic, is C$102.00.
⁹ NIPS (non-invasive prenatal screening) is more detailed than the eFTS because it tests the fragments of baby’s DNA that make their way into the mother’s bloodstream across the placenta but it is still a screening test with its associated false positive and false negative rates.
Emma didn’t have NIPT but went directly for amniocentesis because Ashley explained to her the pitfalls of
screening tests.
¹⁰ Turner syndrome.
¹¹ A variant of uncertain significance (VUS) is a difference in a genetic result whose significance is not known. VUSs can occur in as many as forty percent of people tested, depending on the type of test. In the future, a VUS may be reclassified as either a disease-causing or benign variant. In prenatal testing, VUSs are problematic because their effects on development and general health cannot be predicted. Unlike VUSs, the effects of trisomies
are predictable and the natural histories of these conditions are well known.
Madeline’s short life was typical of trisomy 18.
¹² “Zoë” means “life” in both ancient and modern Greek. “Alethea” is an English-language female name derived from the Ancient Greek feminine noun ἀλήθεια, truth. In Greek mythology, truth was personified as the goddess Aletheia, daughter of Zeus. In an Aesop’s fable, “a man was journeying in the wilderness and he found Aletheia standing there all alone. He said to her, ‘Ancient lady, why do you dwell here in the wilderness, leaving the city behind?’ From the great depths of her wisdom, Truth replied, ‘Among the people of old, lies were found among only a few, but now they have spread throughout all of human society.’”
¹³ High-risk pregnancy clinics care for physical complications of pregnancy. These could be maternal such as high blood pressure, diabetes, cardiac disease, blood clots, or cancer; or fetal such as blood type incompatibility, fetal growth failure, too much or too little fluid around the baby, multiple pregnancy, fetal malformations, or genetic disorders. Pregnancy-specific complications include preterm labor, premature rupture of membranes, pregnancy-induced high blood pressure, infection, or detachment of the placenta.
¹⁴ Preauricular pits are small dimples in front of the ear canal that develop during the sixth week of pregnancy when the ear is forming. They look like piercings but they end blindly under the skin. About one percent of all newborns have them. They are not associated with hearing loss or balance problems because they do no connect to the middle or the inner ear.
¹⁵ The Hippocratic Oath, based on an ancient Greek medical text and taken by medical doctors at graduation, is an oath of ethics. In its original form, it requires a new physician to swear by the healing gods Apollo and Asclepius, Hygiea and Panacea, to uphold ethical standards which include respect for one’s teachers, non-maleficence (the obligation of a physician not to harm the patient, commonly expressed as “first, do no harm”), and patient confidentiality.
Photo graciously provided by Freestocks from Unsplash.
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