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Learning From Liam

I cried when I found out I was pregnant with Liam. To be honest, actually, I sobbed.

I was 41 years old, and I thought I was done with having babies. My husband and I were raising four children, and we were plenty busy juggling their needs with our jobs. Our older two were entering the teenage years -- Michaela was nearly 14, Zack would soon turn 13 -- and we were getting a sense of how overwhelming that could be. Elsa was 7, an independent and interesting but high-maintenance child.

But at least there was a light at the end of the tunnel: Natasha, the baby, was nearly 4. She was well out of diapers and had started preschool, giving me three and a half unheard-of free hours on my days at home. Our life was busy, but it had a manageable feel for the first time in years. I was going to yoga classes, swimming laps twice a week, had taken up sewing, and was doing some volunteer work. My forties, I'd decided, were going to be a new beginning for me, a time when I could finally do some things for myself.

But there it was: the purple line. My period was a little late, and I found an old pregnancy test in the back of my underwear drawer, the one left over from the box of two I'd bought to find out I was pregnant with Natasha. It's expired, I told myself, maybe it's wrong -- but I knew in my heart it wasn't. We'd had one birth-control slipup; I'd been hoping all month that nothing would come of it, but, hey, I'm a doctor. I know that it only takes once.

It was early on a Friday morning, and I needed to go to work. I decided to confirm the test before telling Mark, who was still asleep. Really, I was stalling. I figured he'd be upset also; our house is an old fixer-upper that Mark is steadily renovating, mostly on his own, and he was finally getting time to work on it -- time that would go out the window with a new baby. He, too, was beginning to do things for himself, like taking Tai Chi classes and working out at the gym. Having a baby would throw us back into chaos.

I cried my way to work, bawling on the phone to my best friend. It will be okay, she told me, but I didn't believe her. The sweet lab tech at the health center where I work did a pregnancy test for me; she nodded quietly and pointed at the second blue dot. It was real. My mind was swirling with panic. How would we manage? How would the people at work react to yet another maternity leave? And how would we afford another child?

I wanted to tell Mark in person, but he had left to work the night shift before I got home. I couldn't hold it in. I called him in the ICU at Boston Children's Hospital, where he works, telling him through tears that I was pregnant.

He was quiet. "You don't seem upset," I said. "I can't stop smiling," he said. "Why?" I asked, incredulous. "I'm here, surrounded by so much death and dying," he said, "and my wife, whom I love more than anything in the world, calls and tells me she's pregnant. Why shouldn't I smile?"

In that moment, I fell in love with my husband all over again. He was right, of course. And his response was exactly what I should have known it would be; he's a thoroughly good father and loving husband who has greeted each of my pregnancies with celebration. In that moment, Liam started teaching me.

Remembering Aidan

Being pregnant wasn't just stressful from a daily-life standpoint. At 41, I was well into the "advanced maternal age" category, and there were risks, which the genetic counselor was only too happy to spell out for me: 1 in 60 risk of Down syndrome, 1 in 30 risk of genetic problems overall. And we had an added concern, because we'd already had a child with a genetic problem. Aidan, our third child, was born in 1995 with Miller-Dieker syndrome (MDS), a severe brain malformation. He was very disabled -- his development never got past that of a 1-month-old -- and had terrible seizures, as well as feeding and breathing problems; he died of pneumonia ten days after his first birthday. Although the chances of it happening again were quite small, when I got pregnant afterward with Elsa and then Natasha, we did prenatal testing for MDS. I didn't want to make my children watch another sibling die. Both times, it was excruciating to wait for the results of the testing and try not to bond with the pregnancy, but it had felt like the right thing to do. So now I made an appointment for chorionic villus sampling, kept the pregnancy secret, and settled in to wait.

In that waiting, I found myself remembering Aidan. I always remember him -- I think of him every day -- but this was different, stronger. I remembered the smell of him after a bath. I remembered the weight of him in my arms. I remembered the softness of his hair, the deep chocolate of his eyes, the way his far-too-rare smiles lit his face?and I missed him, more than I'd missed him in years. The timing was eerie; I was due in September, ten years since the October of Aidan's birth, in that fall season when I always feel sad and vulnerable, and suffer most for the loss of my baby. A meant-to-be-ness stirred.

And in that remembering, I found myself less afraid. Yes, I wanted a genetically normal child. But we'd lived through having a terribly disabled child, and we were okay -- we were more than okay. Because of Aidan we were stronger, gentler, more loving people.

I felt certain that the life inside me was strong and healthy. I had no sense of whether it was genetically normal, but for the first time since I started having babies, I didn't care. I watched the little boy in our neighborhood with Down syndrome, who is also named Aidan, at the schoolyard and in church; I was struck, as I've always been, by his joy and by the way he makes everyone around him smile. Lives like these are blessings, not something I needed to fear or protect my children from. It had taken me some time to fully understand this, and I don't know that I would ever have seen it so clearly had I not had to make a decision about prenatal testing again.

I went to Mark and told him I didn't want to do the testing. I wanted an ultrasound later, so we'd be ready for whatever the baby might need, but I didn't need, or want, anything else. Mark was overjoyed. He'd never wanted to do it, it turned out; he'd just agreed to it for me.

Waiting for Liam

Usually when I think about our family it's in terms of shopping lists, schedules, or financial planning. But when we canceled the test and went public, person after person told us how great our family is, how lucky the baby would be. It made me stop and think -- and realize that they were right.

The reactions of people who knew me less well were pretty funny; jaws dropped routinely when I told them it was number six. Several mothers in my practice, whose bound aries were a bit different, suggested quite firmly that I get my tubes tied, which made me laugh.

Being pregnant, overall, wasn't that bad. After so much practice, I'd gotten pretty good at it. I knew what to expect at each stage, which kept me calm; I knew what to eat to stave off nausea and what to wear. Not that it was entirely easy. Being pregnant at 41 is different from being pregnant at 27, when I'd started this pregnancy thing, or even at 37, when I thought I was finishing it. I got tired quickly. The nausea, for some reason, lasted well into the sixth month. The varicose veins that were a medium problem with Natasha got huge. "They look like snakes," Natasha would say, and Elsa would point them out to her friends ("Look at those things on my mom's legs!").

Mark and I went into the ultrasound holding hands, ready to take on whatever we were being given. We'd even managed to agree on a name, Zoe; we figured it would be another girl, given our track record, although in our hearts we were hoping for a boy. It wasn't about replacing Aidan, it was about having a chance back: a chance to have a son and brother who could grow up, something Aidan's disability made impossible.

The ultrasonographer went over the baby from top to bottom -- everything was completely fine. We were almost giddy with relief. She asked if we wanted to know the gender, then showed us the area between the baby's legs: It was clearly and obviously a boy. I was stunned with gratitude. Any doubt about meant-to-be-ness was gone.

Raising five

Liam Michael Brown was born on September 7, 2005, my first birth without an epidural (took me that many pregnancies to get up the nerve!), 8 pounds 8 ounces, vigorous and healthy.

Mark and I found ourselves calling him Aidan for the first couple of weeks, and we weren't the only ones haunted. Elsa kept asking me if Liam was okay. "So I don't have to worry about what happened to Aidan happening to him?" she asked, again and again. "He's really okay?" She'd never said that about Natasha. Zack reprimanded me once for having Liam on his belly (how he'd heard about sleep position and SIDS I have no idea). I explained that I was sitting right next to him and watching him. "Whatever," said Zack. "I lost one brother. I don't want to lose another." We were all a little incredulous. It was as if it were too good to be true.

The gap in ages between our oldest and our youngest is a little weird sometimes, like when I went to the high school open house with Liam strapped in a sling -- or when I figured out that we were going to have a child at our elementary school for 20 consecutive years. But actually, I like it. It gives me perspective. When Michaela exasperates me with fights over curfews and grades, I remember her as a little girl and know that this, too, is a stage. When Liam keeps me up at night, I remember how the baby time of total contact is gone like a blink forever -- and I snuggle in and enjoy it.

My forties are not what I envisioned they'd be. I only do volunteer activities that I can bring Liam to, and I'm back to writing at 5 A.M. or with the laptop on my knees while I breastfeed. As for time for myself, well?it will be months before the shampoo in my swim bag runs out, and the yoga teacher is always surprised to see me.

But it's okay. It's worth it for all that I have learned from this surprise baby boy. He's taught me that as much as we plan, life happens anyway -- and that this, really, is as it should be. He's helped me think of Aidan's life in a different way, too, and brought me that much closer to coming to peace with his death.

Even more, Liam has helped me see all that is good in my life: my amazing husband, my friends and family, my job; he has helped me be grateful for everything I've been given and for everything I've learned. When I look into his sparkling blue eyes, I know that there is nothing better or more important in my life than being a mom. There will be time for myself later, when my children are grown. Right now, I'm busy having a wonderful time.

Claire McCarthy, M.D., a pediatrician, writes our monthly Kids' Health Q+A column.

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