It was in spring, six years ago, that I fell madly and deeply in love with Mongolia. When the landscape was brown, the winds were cold, and the steppes were littered with the bleached bones of livestock that couldn’t survive the winter. I felt the first stirrings of a life I could live here.
In Mongolia, in a small northern city called Darkhan, I began to build a life unlike any I could have imagined in Los Angeles. It came with a long-distance love story, cultural clumsiness, a daunting language gap, and a new, expansive family. This life became transformative with the birth of my daughter, Terra, and becoming a wife to Aagii. Eight months after her birth in December, in August 2013, I learned I was due for another—a son this time. Terra and I were both born in the Year of the Dragon. Our son would be born in the Horse Year, like his father.
I kept the second pregnancy under wraps, particularly from friends and acquaintances overseas. I spared people social media updates about cankles, heartburn, and baby bump photos. In part, it seemed so repetitive. So little time had passed since my first pregnancy, things felt more normal than noteworthy.
The early part of the pregnancy progressed without much fanfare. We knew what to expect and did all the things we were supposed to do, but with less stress and constant concern. I took my vitamins, cut some vices, and went to far fewer doctor’s appointments just to be measured, have my blood pressure checked, and be told that everything was fine.
We used the public health care system—it had helped us deliver one healthy child before at a cost of just a couple hundred dollars. There is very little diagnostic testing done in Mongolia during pregnancy compared to in the United States. There are blood and urine tests along the way, an excessive number of ultrasounds, and a mandatory chest X-ray. The X-ray is taken in a gigantic, Soviet-era, sci-fi chamber of doom. You walk your body, one that feels fragile for all the preciousness of your cargo, into a giant lead box that screams radioactivity. A few loud clangs, some lights, and a technician eventually lets you out again. Aside from the ominous X-ray machine, for the most part, these screenings were fairly passive. My OB-GYN mostly looked for big red flags, not troubling points of light in the distance. We confidently started planning for life as a family of four with two under two.
There were no concerns until January. One night, I was struck with a sharp, relentless lower abdominal pain. It was unbearable, and my first concern was the baby. A late-night call to the doctor who delivered Terra had her at our apartment within ten minutes. An ambulance (a Russian jeep with a first-aid kit inside) arrived soon after, and the driver helped my husband and his cousin carry me down five flights of stairs to crawl into the backseat of our own car.
In the emergency room, the initial diagnosis was appendicitis, and the plan was immediate surgery for removal. After an ultrasound to make sure that the baby wasn’t in any distress, my doctor came into the operating room to oversee the procedure. Once I was opened up, it was determined that the pain was the result of an ovarian cyst and not a ruptured appendix, so I was told the cyst would be removed instead. As the hole in my side was being stitched closed again, a nurse showed me a crimson and black mass the size of a small orange, before it was unceremoniously dropped into the biological waste bin.
My belly kept growing. Into the eighth month, just weeks before the anticipated April eighteenth due date, it was time for another visit to the OB-GYN at the general hospital. My husband and I were instructed to see the ultrasound specialist down the hall from the OB-GYN’s office. We had never seen her before, we’d always had them done at the private clinic on the other side of town, but it seemed important to be done then and there.
The hallway stretched the whole length of the hospital wing, lined with exam rooms for doctors of all kinds. It was packed with people that day, people who didn’t want to step aside to let you pass, lest they lose their place in line to see a specialist. Nervous about the OB-GYN’s insistence on the ultrasound that day, I gripped Aagii’s hand tightly as he cleared a path to the exam room at the opposite end of the hall.
The ultrasound technician was abrupt and curt, in true Mongolian public service fashion, and told us that we were wrong about the baby’s due date. She insisted that the baby was due in May and not April, as it only measured at thirty-one weeks of growth and development. When we repeated the date of my last menstrual cycle, she said we were wrong and told us to go report back to our OB-GYN.
We left the office in shock. There was clearly something wrong, and it wasn’t our due date. There was something wrong with the baby. Foiled by one of Darkhan’s frequent power outages, we went to our regular ultrasound specialist the next day for a second opinion.
Our regular specialist helped us understand what we were faced with. The baby had only two vessels instead of three in his umbilical cord, a condition that often affects fetal growth and development. Our baby was measuring far behind the standard for thirty-seven weeks of development. Although my girth had expanded, he said, I had more amniotic fluid than baby, which was something to be concerned about. He also saw an irregularity in the baby’s left hand, indicating radial dysplasia, more commonly known as club hand. He suggested we see a doctor soon for more information. We made immediate plans to get consultation from doctors at Ulaanbaatar’s First Maternity Hospital, the largest care facility in the country.
Our friend Bilegee came with me and Aagii to Ulaanbaatar to help translate at the hospital. Bilegee was an English teacher in Darkhan who befriended me when I first arrived in 2012. Her English was strong enough to help me navigate my new environment beyond what I could manage on my own with a Mongolian-English dictionary and Aagii’s very limited English. However, she lacked the skills of a truly effective translator, editing at her own discretion. In addition, our friendship was superficial, usually involving reimbursement for services rendered.
We first went to the pediatric ward, since Bilegee said she had a friend there who was a doctor that would help us navigate the system. Half of Mongolia’s entire population lives in Ulaanbaatar, and it’s where most of the state’s essential services are located. The First Maternity Hospital operates far beyond its capacity and is consistently understaffed and overworked. During the height of cold and flu season, the hallways of the hospital are lined with bedding parents have brought from home to share with their children for inpatient care.
After pushing our way through the crowded halls of the pediatric ward, we found ourselves in a section of the hospital for seriously ill children. We were told to wait on a bench in a hallway while Bilegee tried to contact her friend. For a half an hour we sat waiting. In front of us was a parade of children who were living with birth defects, tumors, and crippling disease. Aagii and I sat in silence, holding hands. We’d give each other a squeeze as the children passed by, sometimes joining us to sit on the bench. Every beautifully flawed child that walked past us felt like a preview. It was the first of the most tangibly difficult moments in our pregnancy, and it was ominous.
It was a difficult and long couple of days in UB. We met with a doctor who spoke English and seemed to have a good grasp of what needed to be done to get us answers. The doctor consulted with the hospital’s top ultrasound specialist, and the senior doctors were presented with my case in their staff meeting, to arrive at a course of action. It was confirmed that the baby had club hand in at least one arm and that his growth was significantly delayed. They suggested that we postpone delivery only by one week, to give him extra time to grow safely.
An extensive echocardiogram was conducted, with several pediatric specialists looking on, and we were told that his heart was small, but it was functioning normally. With two weeks still left to go before his new due date of April 23, the doctors said that it would be fine for me to return to Darkhan with a plan to return to UB for a scheduled C-section. The neonatal care, which would likely be required, would be more extensive at the First Maternity Hospital. It would be challenging and expensive to give birth far from home, but we thought first of what our newborn son would need.
The following week we focused on getting the house ready for the baby. I sorted out his clothes, new ones from his grandparents and hand-me-downs from friends, and made space for him in Terra’s room. I started researching noninvasive therapies for treating club hand and tried really, really hard not to get focused on the other complications that were often present for babies with the same diagnosis. We kept a bag of his things packed for the trip to UB and tried to relax and enjoy the downtime we had before life was going to change forever.
The next Monday, we went back to our regular ultrasound specialist to check on the baby and see if there had been any growth since he’d last been looked at. The doctor was concerned. The baby hadn’t grown, and he seemed lethargic. He was a much more mellow baby than Terra was during my pregnancy, and while I knew he was much smaller than she had been in her final weeks in the womb, I chalked up the slowdown in movement to the normal slowdown of when their arrival is coming. In addition to the lack of growth and decreased activity, the doctor said that I had less amniotic fluid than the last time he had seen me. He felt that all of these things were problematic. We contacted all of the doctors we had consulted along the way, in UB and in Darkhan, but no one seemed especially alarmed. We carried on, concerned, but without many options. In the next couple of days, I spent quieter moments by myself thinking about how I would cope with losing the baby at this stage. As soon as those thoughts would come together, I’d scold myself for thinking negatively and force myself to try to remember the sound of his heart beating.
On Thursday we went in for another ultrasound. His heartbeat was gone.
My amniotic fluid was nearly gone, and the baby was dead. The technician asked when I had last felt movement, but I had felt something the night before. I was still feeling movement at that point, but it wasn’t him, and I couldn’t remember the last time I had felt something that couldn’t be confused with mild contractions of my uterus. I don’t remember much about that day, besides crying in the hallway of the hospital and walking from one end of it to the other to talk to the OB-GYN about what we had just learned. I remember Aagii’s tears and then his resolve. He instantly became completely focused on my health, while I was crippled by the news.
After consulting with every doctor we had spoken to during the pregnancy, we were advised to go to the hospital the next day to deliver the baby. I repacked my bags for the hospital, with only a swaddle cloth for the baby. I went to sleep cradling my dead belly, which seemed heavier than ever.
The brief research I had done online suggested that a vaginal birth was the healthiest way for a mother to deliver a stillborn child, but I had had a C-section with Terra, and I was under the impression that I would have to have a second C-section. But we felt helpless and trusted in the doctors to know which course of action was the best to take.
On Friday morning we drove to the hospital. Bilegee joined us to help translate. We met with the head doctor at the maternity hospital, who had quickly consulted with the other doctors. She said that I would be checked in that morning and that on Monday, the doctors would decide whether I should give birth vaginally or have a C-section. That meant I would spend three days in the hospital, isolated from Aagii, Terra, and my family, lying on a bed in an active maternity ward with a dead baby inside of me. I insisted on knowing why that would be necessary. The doctor said that they would use those three days to monitor me and give me antibiotics. I insisted that if nothing was going to be done for three days, I be allowed to spend that time at home with my family. The doctor said that was fine, but that if I had any problems or bleeding, to come to the hospital right away.
I had no problems or bleeding, just the odd contraction now and then, my body trying to move on. I spent the next three days with the people I loved, trying to prepare myself emotionally for what I was about to go through. I also tried to learn what I could about what the experience would be like, or at least what it was like in American hospitals. Good friends rallied for me and offered tremendous amounts of love and support while I was still operating in a fog of despair and disbelief. I spent three days trying to ignore my reflection in the mirror, the continued contractions, and the kind but careless touches of my belly by concerned family members. I still felt “pregnant” while the baby was still inside me, but I understood that I was giving birth to the death of a dream.
On Monday we returned to the hospital. I was prepared to set limits about what would happen and to push for things I wanted to make the experience less awful. Monday ended up being a repeat of Friday. The doctor said that they would give me labor induction medication, but that it would take up to seventy-two hours for delivery. That gave me three more days with my dead son inside of me, which I was unhappy about. I asked again why surgery wasn’t an option, and they insisted that vaginal birth was still the safest route for me. I made it crystal clear that I was unhappy about the length of time they were proposing, and that so few options were being presented, but there was nothing I could do. Over the weekend, Aagii and I had talked about going to UB for the delivery, but I was anxious about the idea of being far from our support network and then having to do the three-hour drive home with our dead son in the back seat of the car. We stuck with delivery in Darkhan, despite our apprehensions.
The first day in the hospital, I was angry and depressed and would cry periodically. I cried when I heard the baby in the next room crying and was reminded that I’d never hear my baby boy cry. When we had found out the baby wasn’t well, I had felt guilty for feeling healthy and normal during the pregnancy. I lay in my hospital bed believing that the suffering I was finally experiencing was my punishment for being oblivious to the suffering of my son. I deserved what was happening for letting my son’s life slip away without a fight, without even knowing he was lost to us.
The night nurse came around at midnight to check on all the patients and distribute medication. She checked my blood pressure and then pulled out an aluminum cone to listen for my baby’s heartbeat. I lifted my nightgown to let her look, thinking surely she must be listening for something else and knew there wasn’t a heartbeat to be listened to. She looked perplexed after her search, and then moved on to check on my roommate. After she was finished with the mother with the living child, she told me to follow her into the room across the hall. She wanted to use the fetal heartbeat monitor. As she was turning it on and waiting for it to boot up, I finally broke down and told her, in my broken Mongolian and tears, that there was no heartbeat for her to listen to. I left the room with heaving sobs and curled up into a ball on my bed.
The next day, I started receiving induction medication. The contractions increased in frequency but not in severity, and dilation proceeded very, very slowly, by fractions of a centimeter. In the afternoon, Aagii brought Terra to the hospital for a visit. I sneaked out of my room to go outside to see them. I was reminded of why I needed to stay strong; I had a living child who needed me. About an hour after their visit, the contractions began in earnest. They grew from tingling discomfort to increasingly unbearable, gut-wrenching pain. I was completely unprepared for what the physical experience of labor would be like. The worst moment came when I felt the churning and locking into place of what felt like solid bone across my lower abdomen. I knew that the baby had been shifted into a horizontal position and that it would take another serious contraction to change that. I decided then and there that I would need pain intervention to survive another contraction of that magnitude.
Bilegee came to the hospital (after hanging up on two of my frantic calls) and spoke with the doctors. She told me that they said I couldn’t have pain medication. She emphasized that all women who give birth experience this pain and that I needed to be patient and calm. She added that she had given birth to two babies, and she knew it was painful, but that I had to suffer through it. I asked her if she’d ever given birth to a dead baby, which quickly ended that conversation. I kept insisting on pain medication, reminding everyone that my dead baby wasn’t going to be put at risk if I were to take it.
Bilegee told me that the doctors had asked that I “stop howling,” at which point my “howling” turned into heaving sobs as I curled up into the smallest ball I possibly could, bleeding into an adult diaper that wouldn’t stay on and pounding my head and fists against the wall. While motherhood is celebrated in Mongolia, it turns out that women are expected to go through labor in silent stoicism. Vocal expressions of their pain are reprimanded. In the older, Soviet-era public hospitals, women in the final stages of labor are strapped into chairs with wrist restraints.
Eventually, the doctors agreed to let me have an epidural with a catheter. The anesthesiologist tried to administer it as I sat backwards on a wooden chair from the nurses’ station. I tried to stay as still as possible while the contractions continued. He jammed needles into my lower back three times, and on the fourth attempt, my right leg violently spasmed and a painful, burning sensation ran from my toes to my hips. He tried again, with the same painful result, this time with the pain spreading farther across my hip to my left leg. At this point, now terrified that I was going to be left with debilitating nerve damage or paralysis, I yelled for the procedure to stop.
Nothing more happened that night. The pain of my contractions continued, but I tolerated it. I vomited a few times and used a bedpan because it was too painful to walk down to the end of the hall to use the single toilet shared by all the patients on the second floor. My dilation was checked and still far from progressing. Bilegee ended up spending the night in the now-vacated bed in my room. No more induction medication was given.
In the morning, the doctors gathered after an exam that showed little progress in dilation. Bilegee roughly translated what they had concluded. They said that if I were a Mongolian woman, they would have made me wait four weeks for my body to expel the baby on its own, but because I was a foreigner, they had been willing to try induction. They said that the induction was unsuccessful, and it was dangerous to try to deliver vaginally because my previous C-section scar might rupture. It was time to consider a second C-section to deliver the baby.
In my exhaustion, pain, and frustration, I found room for anger again. The doctors knew all along that I had had a previous C-section. Why had I been put through the process of “labor” if that process was risky from the beginning? There was no possible way for the baby to be safely delivered vaginally, as he was in a transverse position. I understood that a C-section carried risks as well. But there was no new danger. The baby had been dead for at least a week, and there were problems that could arise during surgery. Bilegee spoke with the doctors about those complications but wasn’t translating anything for me. I caught bits and pieces on my own, mostly about bleeding out. I asked if they had blood for a transfusion if it was needed. Bilegee asked and was told they had “some.”
Again, I was powerless. There were no other options but C-section, so I pushed the conversation forward. Schedule the surgery, and end this.
Aagii spoke with the doctors after the conversation they had with Bilegee. He and cousin Jagaa came to my room. Jagaa and Aagii had tears in their eyes, and the color was gone from Aagii’s face. He had heard the information about the risks and was terrified. Their tears brought out my own. I asked Bilegee to tell me what the doctors had told them. She said, “There are so many risks, I can’t tell you.” Outside, in the parking lot, more family had gathered. They stood beneath my hospital room window with Terra. They prayed for me. Earlier that morning, the family monk had been called to our house for prayers and blessings with my family. They called out their love and concern for me and through their own tears, told me to be brave. I was moved beyond words. The anger left and was replaced by a resolute sadness that I was giving over my life, Terra’s and Aagii’s future, and facing the end of our lives with our son. I had no fight left in me but to stay whole for Terra.
I climbed the stairs to the third floor, where the surgery would take place, tears still flowing. I wasn’t told to stop crying by the doctors anymore, just guided through getting undressed and into a hospital gown. A numbness kept growing inside me, and I composed a mantra to get me through the surgery: Get him out. Stay alive. Make sure Terra has a mom.
The baby was delivered sometime between 11:30 and 12:15, but I had no idea exactly when, since the doctors and nurses hardly spoke through the procedure. Extra cloth had been held up in front of me to keep me from seeing what was happening, and of course, there was the silence of a dead baby leaving the womb instead of the sharp cries of a living one.
As I watched the clock on the monitor beside me, I waited for the tugging I remembered when I was sewn back together after Terra’s birth. Instead there was suctioning and discussion between the surgeons. Bilegee was waiting out in the hallway, and I yelled out for her to come in and tell me what was happening. The doctors said that my uterus had taken a beating and needed to come out, along with my cervix. They said they could sew me up and that I could get the hysterectomy later, or they could do it right then. With no particular desire to have a scalpel anywhere near me again in the future, I stared up at the ceiling—not fully processing what this new development meant—and said, “Fine.”
Early on in the pregnancy, I had told Aagii that this was going to be our last baby. I didn’t feel like being pregnant again, and two kids seemed like plenty for us, even if we were short on having the five we were instructed to have on our wedding day. One of each, a boy and a girl. We felt blessed. Terra was our little dragon (like Mom), and her brother was going to be our little horse (like Dad). It was as perfect a scenario as we could hope for. Even when we found out the baby wouldn’t be perfectly healthy, we worried and were scared of what that would mean for us, but we wanted him here. The news of his health challenges had us even more resolute about not having another, and when he died, the thought of going through an entire pregnancy and losing a child a second time absolutely killed me. Now the choice was being taken away from me. Whether we wanted one or not, we would never have another child together again. I cried for yet another loss as the anesthesiologist prepared a general anesthesia, and I woke up six hours later in my recovery room.
When I came to, I found Aagii sitting on the bed across from mine. I had been dressed while I was out, and my legs were working again. I was given some morphine to ward off the pain, and my head felt fluffy, floaty, and out of focus. I had a catheter in me and a drainage tube coming out of my incision. It felt unreal to be lying there with the baby truly gone. I told Aagii that I still needed to see the baby. Bilegee had taken two cell phone photos of him before they cleaned him up. I could clearly see his arms. The club hand was evident in both of his hands, and his head was badly misshapen, most likely from the pressure of labor in an unforgiving womb, but I could see that he had a full head of black hair like Terra had when she was born. I wanted to know what color his eyes were, but they were closed in the photo. Aagii was worried about me seeing him but understood that it was something I needed to do. He spoke with the doctors, who said they would bring him the next day.
Aagii was able to stay with me in the room for two more days, as I was unable to get up and do things for myself. He was with me when they brought the baby in. The nurses had swaddled him in the blanket we brought. He was only there for a moment. He didn’t look like a sleeping baby, he looked like a dead one, and I didn’t ask them to linger, or try to hold him. It’s not something I regret yet, but I may someday.
Later that day, the hospital conducted an autopsy. In addition to the club hand, the baby had a one-centimeter hole in his heart, and his kidneys were fused together. On top of his small size, he would have faced significant challenges if he had been born alive. Somehow, this news helped. Before we knew what he had been dealing with, I tried to comfort myself with the idea that he had died in a place of safety and security and that he was spared the trauma of birth and his first days spent in a plastic box with tubes inserted in him. It’s still impossible to imagine that he didn’t feel any pain or fear, and that continues to haunt me, but I can’t undo what happened to him. I can’t explain or understand why he, of all the babies brought into the world, was chosen to experience this. While I understand that guilt is a useless emotion and there’s nothing that I did (or didn’t) do to bring his problems on, it’s still the first place my mind goes. As I lay in that room with Aagii, I continually apologized to him for losing our son. He made me stop. He was trying to move beyond our guilt and was looking to the responsibility held by the doctors we consulted with throughout the pregnancy, and the doctors who handled the delivery.
Our son is buried now, and the process of moving forward—slowly, cautiously, and continually looking over our shoulders—has begun. I’ll have more to share about that someday, but this is the story of how our son came into this world and quietly left it. The story of how he is absent from our lives is ongoing. For the sake of his soul, we have to let go, but we’re struggling. We stay focused on our daughter now. We feel incredibly lucky to have her, in light of what we lost and how we lost it.
A few days after our son’s funeral, we heard about another couple who had lost their child at the same hospital. The baby was large, four kilograms, and the mother was having a difficult labor. The doctors—the same ones who attended to me—held off on giving her an emergency C-section, and the baby suffocated and died. The parents were devastated. They had a healthy baby who died because of the ambivalence of the maternity hospital doctors. It was a crushing story to hear. Again, it made us grateful for Terra, but our hearts broke all over again at the news. The anger rose again as well. There’s no conceivable reason why women should continue losing their children this way, or be put through the nightmare of saying good-bye in the way I did.
My story isn’t one about giving birth to a “sleeping” angel who will be present in our lives like a welcome ghost. He’s not ever going to be forgotten, but we want him to be able to move on peacefully. In Mongolian Buddhist tradition, which embraces an afterlife that promises rebirth, I hope that the life my son had was as short as it was to give him a quick and painless passage into a better, healthier, and happier life.