Mind over matter?

BMJ 2004; 329 doi: (Published 16 December 2004) Cite this as: BMJ 2004;329:1459
  1. Alastair C McKelvey, specialist registrar, obstetrics and gynaecology (alastairmckelvey{at},
  2. James C Dornan, consultant obstetrician and gynaecologist
  1. Royal Jubilee Maternity Service, Belfast
  2. Royal Jubilee Maternity Service, Belfast

    Lucy and Dan (not their real names) were expecting their first baby in 1992, when Lucy was 26. Hypertension resulting from pregnancy meant that labour had to be induced at 37 weeks' gestation, and a girl of 2.8 kg was born by normal delivery. Twelve months later Lucy had another girl of the same weight by normal delivery. Twenty months later a boy saw first light. He weighed a bit more but still came normally. Nearly three years later Lucy was pregnant again. This time the hypertension returned and, with it, intrauterine growth restriction. At 35 weeks' gestation the Doppler studies weren't reassuring. A boy weighing 2.3 kg was delivered by caesarean section.

    Over the next year Lucy had two first trimester miscarriages. Then at 31 weeks into her seventh pregnancy (already complicated by placenta praevia) her membranes ruptured and premature labour ensued. Her fifth child was delivered by emergency caesarean section—the smallest baby, a girl of 1.9 kg. She did well. Next was Lucy's millennium baby: in June 2000 at 36 weeks a girl was delivered by caesarean section, as blood pressure problems had recurred.

    One year later, with Lucy again pregnant, she and Dan decided that this, the ninth pregnancy, would be the last. In June 2001 she was delivered of a 3.1 kg healthy boy, her seventh child and fourth caesarean. Both uterine tubes were doubly tied and the mid-section excised (by the Pomeroy technique) and sent to pathology for confirmation.

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    So with seven healthy children, from the newborn son to the eldest girl of nine, Dan and Lucy settled to bringing up their large family and making a living.

    But—then came the surprise. Less than two years later, Lucy, now 37, started to feel broody. Specious perhaps, but she wanted another child. The urge was strong; she was thinking of making inquiries about reversing the sterilisation when she realised that her period hadn't arrived. Sure enough, the line showed up in the middle window of the test stick, and a scan showed a viable intrauterine pregnancy. Lucy was delighted. After the baby boy was safely delivered by caesarean section, we took a close look at the remnants of the tubes. They hadn't re-anastomosed, and the proximal and distal severed ends were free on both sides. This time we took out both tubes in their entirety, and the pathologist once again confirmed the clinical appearance.

    Did willpower help the oocyte to jump the gap? Isn't it wonderful how nature can work miracles—and that, when surprises occur, not everyone wants to blame somebody?

    View Abstract