by David M. Loucas, MD
For Makita the contractions were becoming harder, and more painful. This 24 year old African American woman was in a patient room on the obstetrical ward of the Baptist Hospital Medical Center in Winston-Salem, North Carolina. She was alone, dejected, depressed and very disappointed in herself. Unwed, pregnant, having an abortion, these were not events that she ever expected to plot on the graph of her life- not her, not the Cum Laude academic over-achiever.
Every contraction of her womb rekindled memories of the tainted love affair with her married supervisor from the investment firm at which she worked. Each painful contraction came as a punitive reminder to her of the adverse outcomes that can result from unconsidered actions and their consequences. Makita's chart noted that she was about 18 weeks pregnant. This was to be a second trimester abortion. The process had begun when her private physician inserted a device in the cervical canal to make it open and expand, and then injected a chemical into her womb that would begin the contractions that ultimately would expel the fetus.
As a first year resident on the Obstetrical service I was making evening rounds to familiarize myself with the patients. When I came to Makita's room I could see that she was not only very saddened but also frightened. Her grip was limp, hands were cool and damp, her pulse in the 90's. I introduced myself, "I am Dr. David Loucas. I am the Resident on call tonight for the obstetrical service, and I am here to make sure that everything goes well for you."
After the intro I asked if I could examine her abdomen, and she said to go ahead. Much to my concern her womb was sized more consistently with a 22 to 24 week pregnancy. In the medical center the rule was that no second trimester pregnancy terminations were to be done after 18 weeks. But as the cliché goes 'the horse was already out of the barn', and this second trimester expulsion of the fetus was inevitable.
Makita told me that she had planned to have the baby and to either love and raise it, or to give it up for adoption. But living in her parent's home was stifling. Her unwed status was the very thing that her middle class parents railed against. It was antithetical to everything that they believed in. She was branded with the stigma, 'Single Pregnant Black Female', and pummeled with the outspoken disapproval of her disappointed parents. After relentless denigration and degradation she broke down and went to see her Obstetrician/Gynecologist, and literally begged her to terminate the pregnancy...
After having delivered a normal, healthy full term baby boy I returned to check up on Makita. Beads of sweat coalesced on her upper lip. The neat, groomed appearance that she had when I had first seen her three hours earlier gave way to a disheveled look, with matted hair, salty streaks from tears along the side of her face and lachrymal moisture pooling over the notch of her nose and mixing with nasal mucus. I pulled out a facial tissue, placed it over her nose and after light compression I asked to blow, which she did. Her last contraction was subsiding and she knew that she would have a few minutes of reprieve before the next punishing one. She propped herself up and regained some composure, "You seem like a very nice doctor. Can I tell you something?"
A long sigh and Makita continued, "I don't want to do this. I know that I started something that I cannot stop. It was done out of frustration and anger. The anger was with myself for being so generically naïve in believing that my consort would leave his wife and three children for me. Dumb, right? I feel like I need to apologize to someone, perhaps to my parents for letting them down, or maybe to Bradley, the sperm donor for believing that he was interested in anything other than the moments of his orgasmic releases with me. But, no, that's not it; I really want and need to apologize to this life that I started for having chosen to snuff it out. I am just so very sorry for what I have done."
I responded, "I hear you Makita. I think that the best thing you can do is to learn from this so that you never have to be in this no win position again. In time you will put all of this behind you and you will be okay. Perhaps you will consider going for counseling as well. I'll be in to see you later, and I will be here all night."
It's 2:30 in the morning and after being gently awakened by the nurse on duty I am being led to Makita's room. There she is panting and crying as she pushes with each painful contraction. The nurse lifts and bends Makita's legs and spreads her thighs. I can see two tiny feet and two legs extruding from her vagina. I slip on an examination glove and gently sweep my finger around the cervix.
Addressing the nurse in soft low tones, "The cervix isn't fully dilated and the fetal head is stuck at the level of the chin. Please get me a set of premi forceps and let's get this fetus expelled."
The nurse said nothing, just nodded.
"What's happening doctor?" Makita inquired.
"You are okay, Makita. I just have to help you expel this fetus. What I am going to do is give you some medication that will help you relax and also will reduce any pain. Then I will gently slip on some tiny forceps and when you push with your contractions I will gently tract on the forceps and that should do it."
The application of the forceps went quite smoothly. Looking at my nurse I whispered, "With the next hard contraction, you push down on the uterus and I will gently pull. Let's get this done already."
Two more hard contractions and the fetus was expelled, a tiny female, hairless and almost translucent, completely intact and still attached to its umbilical cord. It measured about 9.5 inches from head to heel and it weighed less than 500 grams. What happened next was remarkable. I began to push down on the uterus and to pull on the umbilical cord in order to deliver the placenta. It was during this maneuver that this fetus, lying on its back and motionless, suddenly blinked its eyes. WHAT? I froze momentarily and just stared at it. Was it looking at me? Tiny fingers and toes began to move almost imperceptibly at first, and then chest muscles expanded and then contracted as it gasped. I was looking at a tiny, living newborn human being that at the same time was looking at me.
I could hardly speak. Stammering and stuttering I said to the nurse "Oh my goodness, we have a live birth. This is a living baby. Oh my goodness! Please, get me umbilical clamps and some sterile scissors. After I cut the umbilical cord wrap this baby up in some warm blankets and get a get a pediatric neonatologist here right away."
Makita stirred, "What's happening, Dr. Loucas?"
All I could say was, "I believe that the good Lord heard your cries Makita, because contrary to anything that I thought was possible, you have given birth to a baby girl, the most premature baby I have ever seen, or ever thought possible.
"Let me see her."
The neonatologist had just arrived to the room with a portable incubator. I had just enough time to slightly unwrap the infant and let her mother take a look at her.
Tears of pain and sorrow transformed into tears of joy, "Oh my God, she's so small, and yet so very beautiful. Thank you Lord. Thank you Jesus. Thank you Dr. Loucas. For as long as I will live, I will love this child with all my heart. I have never received a true gift from God before."
Following the handoff to the Pediatrician specialist and after 13 weeks in the neonatal intensive care unit, Makita left the medical center with her three and one half pound, otherwise healthy baby girl. Before she left the medical center she came to see me.
"Her name is Davida. Her name will be a living reminder that you saved my baby's life, and you gave me back my life as well. I will never forget your kindness and the miracle that came to me because of you."
I took one last look at Davida, my namesake. She now looked like a newborn baby with fine fuzzy black hair and bright hazel eyes. I knew that she would be loved and well cared for. I gently took her from Makita and held her near to me for a moment. She had that sweet smell of new life, and as I returned her to her mother I could see that Davida was looking at me- then she smiled.