Tuesday 11th May: Summary of autopsy results

If you are sqeamish or if reading the details of how our baby died would be too upsetting, it might be best to skip this post.

We met with our GP Andrew last Friday to discuss the autopsy results. As predicted, the autopsy didn't yield much new information, and it's like trying to work out what a jigsaw picture is when don't have the box and you have only 300 pieces of a 750 piece puzzle. Here are the jigsaw pieces we have:

• Salome died of meconium aspiration syndrome, as predicted.
• Jillian the Obst said that at the time of delivery the meconium was really stale, and she said may have been up to 10 days old. The meconium in the waters was definitely not something that happened on the day of delivery.
• There was no information arising from the autopsy as to why Salome would have got distressed up to 10 days before delivery (they told us not to expect any information on this from the autopsy).
• In the 10 days before delivery I attended the delivery suite on 2 other occasions, thinking labour had started. Salome was monitored on both occasions, and neither time did she show any distress. So whatever distressed her enough to do all those poos wasn't something that kept her distressed from then onwards.
• Autopsy confirmed Salome's cord was compressed during delivery ("perinatal asphyxia with MOD"). This happened in the last 10 or 15 mins of the 7 hour labour. Salome has been monitored regularly during the labour and had shown no distress until then, apart from a slight drop in the first 20 mins of monitoring.
• There were no weird genetic conditions that left Salome at risk of this.
• There were no other problems with Salome's body. She was perfectly formed, and not overdue. Estimated weight at birth was 3.7 kgs.
• By the time Salome died, she had substantial brain injuries. These were caused by 3 things. Firstly the perinatal asphyxia (cord getting compressed in the 10 mins before she was born, leading to less oxygen), which alone can lead to some brain injury. Secondly, the inside of her lungs got coated with thick gunky meconium, and so she couldn't absorb enough oxygen after she was born. For her whole 2 1/2 days of life, she wasn't absorbing enough oxygen. Thirdly, whenever someone gets a brain injury, standard practice is to reduce their temperature to between 32 and 34 degrees Celsius for 72 hours after injury. Salome was on cold packs from her time of birth until she deteriorated on the Friday night. Then they said to us "We are getting desperate. We can either save the brain or save the baby and we are going with saving the baby. We need to heat her up to normal temperature and we will do this faster than is safe to do so. This is likely to further injure her brain." Autopsy describes a hypoxic / ischaemic brain injury pattern, with injury to the cortex and both hippocampuses (Ammons horn).
• By the time Salome died her kidneys were stuffed, due to lack of oxygen ("medullary haemorrhagic necrosis').
• At death, Salome's lungs weighed twice as much as they should of, due to being filled with meconium and the inflammation caused by the meconium.
• Summary of autopsy results "This child died of gram negative bacterial pnemonia and diffuse alveolar haemorrhage on a background of infant respitory distress syndrome (hyaline membrane disease); meconium aspiration is confirmed. No structural changes of pulmonary hypertention was seen in pulmonary vessels, probably related to the short duration. Hypoxic / ischaemic brain injury is confirmed. Renal medullary infarction in a manifestation of ischaemia / circulatory failure."

I don't know what to say about all this. It is a relief to know there was nothing wrong with Salome that X or K would need to worry about when their time comes to consider children. It's very painful to be told we will definitely never know why this happened to Salome. Matt says there's no evidence to support my beliefs that it was my fault Salome died. I say there's not much evidence to refute my beliefs either.

I took the autopsy report to the cemetery on mothers day and read it to Salome. It almost feels like an insult to Salome that she died of such mundane causes.

Mothers day was wretched actually. I didn't think it would be as hard as it was. I spent 3 hours alone at Salome's grave and that was the best part of the day. It was gorgeous weather, and I took a picnic blanket and some Thai takeaway and a good book. I'm not the only person who goes to that cemetery with a fold-out chair. There's an old bloke who visits someone buried about 4 rows away, and he brings a wheelie bag and a golf umbrella as well. I think it's his wife buried there, and I think she might have been Pacific Islander. There are a few Islander people and Maori buried there (maybe because it's the only cemetery in the region right on the beach?), and those families know how to get comfortable at a cemetery. They bring their life to the graveside, and set up fold up chairs and bring themos of tea and lunch and stay there for ages. Mothers day was a good day to visit. There were lots of people about, and about $1000 worth of chrysanthemums dotted around.

It was hard to leave the cemetery on Sunday. I hope I never have another mothers day as shitty as that. The next one at least won't be my first mother's day since Salome died, and I won't have got the autopsy results 48 hours before. By this time next year I will not be feeling like this.