Fetomaternal Hemorrhage Can Go to Hell Part 2: Innocence Lost

Many loss mamas talk about losing their pregnancy innocence after experiencing miscarriage, stillbirth, or infant death. Suddenly they become acutely aware that two pink lines on a home pregnancy test does not guarantee the safe arrival of a healthy baby nine months later. While pregnant with Leah, my anxiety prevented me from enjoying this optimistic outlook (which the jaded among us might call naivete, given that 1 in 4 women will experience pregnancy or infant loss in their lifetime). I always consoled myself that, once Leah arrived safe and healthy in my arms, I would be able to enjoy subsequent pregnancies because I would have a solid life precedent to confirm that my body is capable of carrying a healthy, full term baby.

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Image credit: Charles M. Schulz

But Fetomaternal Hemorrhage changed all that. Not only did FMH (also called Fetal-Maternal Haemorrhage and Fetomaternal Transfusion) snatch my baby girl’s life away, but it also stole my ability to ever feel “safe” in subsequent pregnancies.

FMH has all the trappings of an anxious-control-freak-expectant-mother’s worst nightmare. Here’s why:

  1. A massive FMH is incredibly rare. Like, 1 in 5000 pregnancies rare. Many doctors have never heard of it. The specialist who oversaw Leah’s palliative care had only ever seen one other case of it in his 30 year medical career. Which means that…
  2. …there is very little research on potential risk factors, how to detect it, and what can be done to prevent it.
  3. In most cases, it has no known cause. Trauma to the abdomen can be a factor, as can placental abruption and particular blood clotting diseases. But for the most part, it happens in perfectly healthy and complication-free pregnancies.
  4. The blood loss can be chronic, as was the case for Leah. Since her massive FMH had likely been happening over the course of several days, by the time her movements decreased, the damage had already been done. However
  5. …it can also be acute, meaning that a large volume of blood is lost quickly and suddenly. Once again, by the time the baby’s movements decrease, the damage is often already done.
  6. For the most part, the baby’s decreased movements are the only sign that anything is wrong. FMH cannot be detected through ultrasounds or routine pregnancy health tests.
  7. FMH most frequently happens to full-term babies. This means that it is more likely to strike pregnant women who are well into the theoretical “safe zone.” Yet
  8.  …it can also happen in the second trimester, meaning it is the equivalent of a biological terrorist that can strike without warning at any time, but most likely when it is least expected.
  9. And perhaps worst of all, not all cases of FMH are fatal. If the stars align and the baby happens to be delivered and treated in the nick of time, the lucky ones may grow and thrive with minor health complications or cognitive delays. Since the majority of cases have a more tragic ending, women who lose their babies or see their children survive with major complications are condemned to a life of self-blame and guilt for not being able to save them.

Many loss mamas feel rightfully relieved in subsequent pregnancies when they surpass particular milestones. Women who experience early miscarriages may feel safe when they reach the second trimester. Women who received heartbreaking news at their second trimester anatomy scans may feel at ease when their next baby gets a clean bill of health.

But where does that leave women whose first pregnancies result in a full term loss, whether it be to FMH or other random and unpreventable complications?

I have been told that my chance of experiencing another FMH in subsequent pregnancies is slightly higher now that I have experienced it once, but overall it is very unlikely to occur again. It would be the equivalent of being in a freak highway accident two times over, or winning the world’s worst lottery twice. Unfortunately now that I have been “the statistic” once, I doubt my anxiety will ever let me believe that I can escape a similar tragedy in the future.

In short, Fetomaternal Hemorrhage can go to hell.

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