I realise that my view of this is statistically skewed, considering that I know far more women who have lost babies at the end of their pregnancies than at the beginning when it is far more likely for a woman to miscarry. Generally, we are conditioned to expect that with good perinatal care, women and babies will survive just about anything that is thrown at them, provided they can get the right treatment in time. But what is bothering me more and more is that we have not left even the smallest opening in our minds to accept what is the harsh reality for the remaining few mothers and babies: that no matter what they do, or how cautious they might be... loss of life is still part and parcel of childbirth (and parenting) and few of us are prepared to really consider that as part of the journey.
Having just read this article in The Age, I am once again irritated by this "new" style of reporting that seems to be happening ALL THE TIME at the moment. I say it's "new" because I have never noticed it before, but maybe it's always been like this and I've just never noticed. Basically, it goes something like:
"Hey, a really horrible thing happened today. Just thought you should know because something equally bad might happen to you too! ... But I won't give you any of the details about how or why it happened, or how it could have been prevented... I'll just leave you with a whole bunch of ideas to piece together however you see fit. Okay? Cool. Thanks for reading".
Signed, Name of reporter (if you're lucky)
Awesome work!! Thanks so much for the brilliant display of investigative journalism. As a concerned 'consumer' about to give birth in hospital, but also being cared for by an independent midwife, I felt compelled somehow by this lack of sufficient information to find out more.... And presto! In about 30 seconds flat, I can jump online and find out what this 'journalist' has been too uninterested to discover (despite the lives and heartbreak of those involved). So what did I want to know? Well, if we know that this woman died of cardiac arrest - and we also know that she was at home when it happened - then it would also be good to also enquire as to whether the outcome would have been different if the woman had been in hospital... wouldn't it?
Through doing my own search, I was able to discover that cardiac arrest affects around 1 in 30,000 women and, disturbingly, they are usually young and healthy. According to the Society for Obstetric Anesthesia and Perinatology (SOAP) report I found:
"Cardiac arrest in the parturient has numerous causes. The most feared and deadly is amniotic fluid embolism (AFE). AFE can present with cardiac arrest, hypotension, bronchospasm, coagulopathy, fetal distress or cyanosis (2). Even with optimal treatment, AFE is associated with a high rate of morbidity and mortality. It has been reported that only 15% of patients who survive AFE are neurologically intact" – and this review, being conducted for hospital-based anaesthesiologists, presumes the woman is receiving hospital-based care and even goes on to list further potential risk-factors associated with being in the hospital environment!
Obviously, in this case, we don't understand the cause of the womans cardiac arrest (and it may not have been AFE), but I still think it's interesting to understand the rarity and seriousness of potential hazards to birthing mothers and their babies, such as cardiac arrest, or catastrophic uterine rupture (which is the adverse event that's been pinned up on the noticeboard for my own impending VBAC attempt).
Once again, another link has been drawn between home birthing and a tragic event, leaving the reader to deduce that it must be more dangerous to birth at home... when in fact, birthing AT ALL is just downright dangerous to the few mothers and babies who are affected by these kinds of adverse medical events. Just because we live in a society where excellent medical care is available to most people (leaving aside the fact that this is true for some more than others), I have only found out the limitations of what is "known" and is "safe" about giving birth through taking an actively inquisitive approach to both my pregnancies.... and ONLY because I was planning a home birth the first time around did I realise the responsibility I had to take for my OWN level of risk with regard to the entire pregnancy and birth. There was never going to be anyone else who was prepared to look me in the eye and promise me "it won't happen to you". I can't believe there are people out there who actually think that this is what home birth is all about, or what independent midwives out there are practicing. In fact, it was one of my independent midwives who pointed out that risk can be measured as a 1 in 100/1000/10, 000 chance..... but if it happens to you, your own risk is actually 100%. Now there's a statistical interpretation worth considering that many people just don't.
It saddens me that the partner and young children of the poor woman who lost her life - will have their grief overshadowed (and even disrespected) by some "debate" about whether she was "doing the right thing". In fact, it's kind of disgusting, now that I write it down in those terms!
Was she doing the right thing... planning to have a healthy baby and NOT have a cardiac arrest during labour? Isn't that what we're all planning to do when we plan to have our babies? - I know I am. Absolutely, I'm planning not to die and planning to have a healthy baby. But at least I'm not ignorant about the risks. At least I've spoken to my family about the risks and said to them, 'Well, so far, so good... but I've kind of just had to accept that there's about a 1 in 1000 risk of something pretty bad happening to me or to the baby. There's not a lot we can do about it, except be well informed and choose the best care providers we possibly can and hope for the best.
Our attempt, as human beings, to hope for the best - is what takes on the form, shape, colour and life to become our experiences. If, through hoping for the best, we wish to birth at home... we wish for a beautiful, peaceful water birth (or for a completely painless caesarean birth) ... and a wardrobe full of freshly washed baby clothes and a list containing those one or two (or 22!) perfect baby names... These are all ways that we are expressing our desire and attempting to 'actualise' this positive hope we all share. It is not recklessness or stupidity to plan for these things... but maybe it's idealistic to plan for them with the expectation that everything will definitely be okay.
It is so, so sad that for this family everything was not okay, and that there will be people judging them for it who wouldn't have judged them if they'd been in a hospital. I have packed my hospital bag, but am by no means confident that something like this won't happen to me or my baby; but we must carry out our plans knowing there is actually nothing I can do to "be safe" except wish it to be so.
It is the individual's family that lives with the outcomes of events like these, and it's nobody else's job to reconcile themselves to the circumstances surrounding a tragedy. We do not judge (in the same way) those who choose to live rurally or further away from a emergency facilities as being "irresponsible", yet this would sometimes mean the difference between life and death for many people in life-threatening circumstances – and is essentially the same issue that home birth presents: the actual distance between the potential for a medical emergency and the type of care that may be needed.
Anyway, enough from me about that. It's back to the sorting baby clothes and agonising over the baby name list... pacing expectantly and rubbing my belly and imagining that, soon, she will be here and that we can all be a family together. This is what the colour and the shape of my "hope" looks like.
Sure.... some people call it OCD, but I call it hope... and I think all women are equally entitled to it!
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