A few months ago, I lost something precious, something I had worked 10 months to find and within eight weeks of gaining, it was gone. I didn’t really feel it at first. I was too numb from the entire experience. I was too raw to feel anything and submersed myself in work so as to avoid thinking about it at all. But recently, Angel has come back to haunt me in the exuberant faces and big rounded bellies of other women who are now five months pregnant with other, very precious somethings.

What has also brought this home is the fact that some people have been rather out of the loop. I had an email the other day from a colleague who asked when my baby was due and then at Christmas eve service last night at church, a kindly acquaintance I hadn’t seen for a while asked me the same thing. Put aside the fact that I don’t look five months pregnant (or maybe I do… maybe I’ve eaten way too much fudge this Christmas season), I was kinda dumbstruck and then felt rather mortified for this poor woman who asked an honest question. Her discomfort was obvious and mine too. I just willed the conversation to be over so that I could crawl into a hole somewhere far away. This Christmas, I was supposed to be sitting around on my lard-arse contentedly rubbing my swollen belly, making my mother shift uncomfortably at the dinner table over conversations about homebirth and birthing pools. Instead I just miss my Angel. I miss him/her desparately and wish he/she was here.

I am also reminded that for the better part of the last six years I have spent most of my time pleasing others, doing things to make me feel like I was somehow not such a selfish person. But the truth is, I am selfish and I’m sick of pretending to be otherwise. Recently, I wrote out a mission statement for my life. I really struggled with this because, to be honest, I don’t really know what I want or maybe I’m afraid that what I want isn’t really the right thing to want. I don’t know. All I do know for sure is that I have this vision in my head of spending long days with my children, enjoying their learning, their company and their fun. I have a vision of justice, of doing something bigger than myself, something that leaves a legacy. I also have a vision of truth…. it keeps pulling me back to the nagging thought that I should be doing something other than what I am currently doing.

I am conscious that I have set myself up to be pulled in a million different directions by others. I made a decision earlier in the year to stop putting emotional energy into the personal choices and conflicts of others outside my own family. This choice has confused some but I have to stick to it. My family’s survival, my survival depends on it. I need a full tank to be strong enough to deal with the ebb and flow of my family.

So what do I really want? For those I love to know the hope and love of God and the gift He has given us, a family that knows they are loved no matter what, to be able to make beautiful music and to see my children thrive. Everything else is somehow not so precious to me.

I don’t know if we will try to have a another baby again or not. I’m still raw and hurting from the experience of losing that something precious. But I do know that I will make some different choices in 2009. Some of these choices leave others scratching their heads but they are my choices to make. Somewhere along the line, we all have to decide to stop living life for the will and purpose of others and instead, live a life of purpose that is true to ourselves and honest about what motivates us to do what we do. It is easy to act out of brokenness, from hearts destroyed and confidence lost… it is hard to face the truth that this is what we do and step beyond.

The following article was first published in the Winter, 2008 edition of Kindred Magazine (www.kindredmedia.com.au).

The saying “we are our own worst enemies” has never been truer than when applied to conversations about birth.

There’s a lot of unnecessary guilt and blame surrounding birth. Every time a new piece of research hits the press a war of words ensues between polarised stakeholders—obstetricians, midwives, researchers, paediatricians, mothers, fathers and even people who don’t desire to “breed” at all.

Women who’ve had elective caesareans feel defensive because a compelling body of evidence has revealed that elective caesareans for no medical reason are more harmful to babies and mothers than vaginal birth. In addition, recent evidence showing the compounded risks for the mother and any future babies she might have has rocked the obstetric world.

Women who have had good outcomes from caesareans get hot under the maternity bra straps because negative reports about the operation translate as “you’ve made a bad choice,” instead of “you were given bad advice and/or poor support.” So, women take on more guilt because they feel like they’ve been labelled as bad mothers for agreeing to an operation they thought was best for them and their babies.

On the other end of the spectrum, the diminishing number of women who manage to come out of birth unscathed by medical interventions feel defensive too. Their beef is with those pesky too-posh-to-push Lexus drivers and their private obstetricians who declare that anyone who has a vaginal birth is either lucky, stupid, selfish or downright dangerous.

And it doesn’t end there. Women who give birth in hospital feel criticised by women who choose to birth at home. Women who thank their lucky stars their emergency caesarean saved their baby feel it their duty to give other women some perspective. Forums are filled with women telling those who come out of a caesarean birth feeling mugged, raped and left for dead they should just be thankful for a live baby and get over it.

What is missing here? In my six years as an advocate for informed choice in birth I have seen very little empathy from people in general—whether they be mothers, fathers, doctors or midwives. They all have different and personal perspectives on birth but there seems to be very little understanding of what makes birth good or bad and why it matters at all.

If a woman is brave enough to admit that she feels like a train wreck after a caesarean birth she is told to suck it up and get on with looking after her new baby. She is lectured about how lucky she is to live in a first world country where medical intervention saves lives. Yet, how can a woman get over it, if she is never allowed to process something she obviously feels is significant to her? Why should she bottle up her grief and live with the incredible guilt that comes when you feel bad about a life event that is supposed to bring such joy? –More guilt and a ticket to poor mental health with all its repercussions.

Conversely, why is it that we accuse women of being cowards because they are fearful of childbirth. These women need to be listened to, acknowledged and helped. Recent research has shown that more than 43 percent of women who choose elective caesarean have a clinically significant fear of childbirth. The sad truth is that surgery won’t heal the emotional wounds that underly childbirth fear. It can’t be cut away. It needs to be explored. But how often does this happen when the expert listening is a surgeon and not a counsellor or psychologist let alone one who understands the impact of birth?

Perhaps we need to redirect our angst, not at each other but at a health care system that has put birth into hospitals with sick people and turned it into a disease that needs to be contained with machines that go “ping,” time limits, drugs, and surgery.

As someone who was born by caesarean, I know that birth matters. My mother was deeply affected by her experience and I was never allowed to forget it. I’ve also been the train wreck after a nasty caesarean experience, had a good elective caesarean experience and felt the amazing power of normal natural birth. Subsequently, when discussing birth I often feel like the teenager stuck in the middle of arguing parents. It is true I probably wouldn’t be here if my mother hadn’t had her emergency caesarean but I nearly didn’t make it after my eldest son’s avoidable caesarean-gone-wrong left me traumatised and unable to cope. Should I now feel guilty because I’m not grateful for that?

When I did finally give birth normally with my last child I realised how important birth was to me as a woman and a mother. Whether it was that surge of hormones as I drank in my little one’s eyes or the high from finishing the marathon-like labour I don’t know. But I do know it made me stronger to face the challenges mothering has brought and I refuse to feel guilty for wanting every birthing woman to feel like that.

Only a system-wide rethink about how birth is funded and managed can bring about a change in women’s and practitioners’ thinking about birth. When women (and their babies) are at the centre of care rather than passive recipients, when they are clients rather than patients, our predominant conversations about birth might just change from being about how dangerous birth is to how great it should be. And maybe we’ll stop taking the blame for a system that has set us up to feel like it is all our fault. It is time to remove the guilt from birth.

Reference:

Wiklund, I., G. Edman, et al. (2008). Expectation and experiences of childbirth in primiparae with caesarean section. BJOG. 115: 324-331.

Tuesday, 16 September

I could feel myself slipping away. Dizziness took hold of me as I struggled to walk to the toilet, my husband on one side, a ward nurse I don’t even remember now on the other. I could feel the whiteness of my skin, the shallowness of my breath. It was a futile endeavour. I lay back down on the bed, exhausted, unable to move, in pain.

The nurse came in to take my blood pressure. “That’s quite low!” he said. “I think we’d better get you in for that scan.” I had come in that morning at about 10.30am and had been waiting all day for a scan that would tell me whether or not my baby was stuck in a fallopian tube. Why was it taking so long?

He rushed out to see if he could hurry things along. My husband and my three year old Adam left to pick up our other children and try and find a babysitter. I waited there alone.

At about 5pm, a friendly face came to my side. I recognised her—Rebecca*. We’d done a course together at Community Health. We both had sons with Autism.

Rebecca was about to wheel me into the scan room herself when a wardy finally showed up. With the help of a nurse, Rebecca tried to roll me onto my back. My body seized. I couldn’t breathe and started to panic. She quickly called for help. The nurse gave me some oxygen and put a pillow under my right side so that I wasn’t flat on my back. It was better but I still felt pain with every breath.

It was easy to see that something was wrong straight away. There was no obvious baby blob in the uterus but there was something elsewhere. She then did a scan of my upper right side and found two large gall stones and a lot of excess fluid in my peritoneum. She didn’t say what that was at the time but told me the gall stones were benign. Thank goodness for small mercies, I thought to myself.

The ER doctor was called in and shown the damage. I kept asking, “Are you sure?” Rebecca was certain. The pregnancy was ectopic and my right fallopian tube had ruptured. I was bleeding out and didn’t even know it. That’s why I felt so much pain. That’s why I couldn’t breathe. The fluid was accumulated blood.

The registrar was called in and the nurse phoned my husband to come straight back. I began to cry for the baby I would never meet but didn’t understand that the hurrying around was more about saving my life than getting my baby out of me.

Within a short while, my husband and children had gathered around me. My boys looked perplexed, a bit scared. I reassured them that the doctor was going to make me all better. I found out later how scared my eldest was of losing his mum. I have wept many tears thinking about the unthinkable, what would have happened to them if I had died.

A midwife I knew came in and told my husband, Wayne, she’d take the boys home with her for the night so he could stay and wait for me to come out of surgery. Because I was a consumer representative at the hospital, I knew a lot of staff members in Maternity. They all came to see me at one point or another during my stay in hospital. They all offered support and help. It was humbling and deeply felt.

I had no fear of the anaesthetic. I just wanted it to be over. They rolled me on to the table gently and we waited for what seemed like an eternity for the surgeon to walk through the door. I could hear the anaesthetist say that he didn’t want to put me under until he saw the surgeon. I felt like a beached whale, unable to breathe. The surgeon came in and a mask went onto my face. I heard conversation and felt a funny sensation. The talking didn’t stop and I thought, ‘Why is it taking so long? It’s not working” but quickly realised that I had simply slipped into a dreamless sleep and had just been awoken in recovery. It was over, for now.

The registrar came to my bedside in recovery and said, “You are a very lucky young woman. The surgery took a long time, about 1.5 hours. We tried to do the keyhole surgery but there was too much blood so we had to do a cut through your caesarean scar to remove the tube and the products. The foetus was quite well developed and had a placenta….” I felt a pang of deep pain in my heart.

He went on to tell me that I had lost a lot of blood and that he was shocked at how stable I had been during the surgery. I had been given two units of blood and would probably need more…. All I could think about was my baby and I wondered what they had done with him/her. I wished I’d asked for the “products” to be kept for me but I hadn’t thought about it at the time. And now I had yet another scar on my belly.

The next morning, the registrar came in to see me, check my wounds and go over the surgery with me once more. He said that given the amount of blood I’d lost, he suspected that I’d sprung a slow leak up to a week prior to the surgery… My mind raced back to the week before.

Rewind to the Week Before…

Driving to school one morning I had felt a sudden sharp pain in my right side but it went away, so I didn’t bother to get it checked out. I flew to Melbourne on the Friday, feeling a bit unwell and bloated. The Sunday night I left Melbourne is when things started to go really wrong. I thought I had a gastro bug. My husband had been unwell the week before and I thought that I’d caught his bug. An hour before I had to catch my plane home, I rushed to the toilet and stayed there for half an hour with cramps and diarrhoea. Something was seriously wrong with me. Somehow I made it onto the flight and somehow made it home. When I got home I vomited everywhere and collapsed in bed.

The Monday evening I phoned the midwife we had planned to hire on and I talked over my symptoms with her. She thought I had gastro and said to get plenty of rest. I had pretty much done the bare minimum that day. That night I woke up with massive cramps in my abdomen and couldn’t stop vomiting. I begged Wayne to take me to hospital. I kept saying, “This is not normal, something’s wrong.”

Wayne thought I was just sick and talked me out of going to the hospital. The next morning he arranged for the boys to go to after school care and left me in bed, with Adam in front of the TV, while he went into work for a few hours.

I phoned my friend Deb (who’s also a midwife) and she listened while I recounted the events of the last two nights. Then she asked me if I thought it could be an ectopic pregnancy. I said I thought it was gastro or maybe kidney stones at worst. In hindsight I didn’t want to entertain the notion that I would lose my baby. Nevertheless, she said I should check in with my midwife and get her opinion. I did that and my midwife said that I should get things checked out. By the time I phoned Deb back, I was in agony again and told her I was calling an ambulance. She dropped everything and raced over to my house to collect Adam and got there just as the ambos were getting me into the van. Another friend, Kathy (who runs our local BaBs group), who had phoned me just after I’d phoned the ambulance, also raced over as she lived five minutes away. Adam retreated to his bedroom when the Ambulance officers took me outside so I was grateful that he had some support arrive at that moment.

After the Ambos took me away, Deb went to check on Adam and asked, “What’s wrong Adam?” “I’ve lost mummy,” he said. “Well, let’s go and find her then,” said Deb. She packed up his things with Kathy’s help and then drove to the hospital to look for me.

Deb arrived just as an A&E doctor came in to assess me. I told the Doctor I was eight weeks pregnant. She asked me if I had confirmed that with a blood test. I felt exasperated. No, I had taken a home pregnancy test. She drew my blood to “make sure I was really pregnant.” Deb asked about the scan but the Dr insisted she needed the blood HCG levels first. A&E was busy and the blood test took a long time to come back. They had given me some morphine and nausea medication for the pain and nausea but the pain never subsided. My mouth was dry and I asked for some water. I hadn’t really had any all morning. They refused, saying that my chart said Nil By Mouth. I asked for some ice chips instead and Deb went looking for some, giving me little bits at a time.

The Dr then came in and said she wanted to do a speculum exam to check for bleeding in my vagina. There was none and I wondered why they weren’t just doing a scan. It seemed like a massive waste of time. At about 2pm, Deb had to go but Wayne showed up just as she left. Throughout, Adam just sat there eating and playing. He was fantastic! I told him the Dr House would make me all better. It was after that, that things really started to go downhill.

The Aftermath…

Nights were the worst. The Nursing Unit Manager for birth suites had arranged for me to have a private room in the Maternity Ward, where all the gynaecological patients also go but there was a lot of noise which made sleep difficult. That first night, listening to babies crying, and some mothers crying was awful. Every night, I pretended that they weren’t actually babies but wild animals in the jungle. Mentally, it was the only way I could cope. I felt like that guy in I Am Legend, surrounded by a mutant mass of humanity gone wild.

I was in hospital for a week and it was the longest week of my life. I needed two more blood transfusions because I was still losing a lot of excess blood. That delayed my recovery somewhat. Then a cough developed into spiking fevers on the Friday night and I was sent off for an Xray the next day which showed my lungs had partially collapsed, probably from the surgery I was told.

On the Sunday I was referred to a medical registrar who ordered a preventative heparin injection and sent me off for a CT scan to assess whether or not I had a blood clot in my lungs (pulmonary embolism). This involved injecting a dye into my veins as I went through the large cylindrical CT machine. In the few days I had been in hospital I had been stabbed and jabbed no less than 27 times with about five recannulations. My veins weren’t coping too well with the massive amounts of antibiotics being pumped into them and the blood drawn each day to assess my haemoglobin levels. I was black and blue and looked like a junkie with needle holes all over my arms and hands. The worst was when they took blood out of my radial artery to check my blood gasses. The pain was excruciating. By the end of that Sunday, I just wanted to go home but they said I needed to stay another day for intravenous antibiotics because I had pneumonia…. Well at least it wasn’t a pulmonary embolism.

That last night on the ward I felt defeated. I thought they’d never let me out. I thought about my children who I had barely seen that past week. I missed them terribly. At that moment, one of the midwives I knew through our BaBs group walked in the door to see if I was okay. That happened a lot during my whole experience. At each moment where I felt alone or scared, someone familiar—a friend, my partner, a midwife I knew—walked through the door. I had a room full of flowers to remind me that people were thinking about me and not a day went by without several text messages and phone calls, sometimes more than I had the energy to handle.

I went home on the Tuesday, exactly one week after I had gone into A&E. Going home was definitely the best medicine. I couldn’t wait to hold and kiss my beautiful boys.

How this Has Changed Me…

As I sit here now pondering the events of the past few weeks, I feel a renewed sense of what is important and what I can just let slide. In many ways my near-death experience has overshadowed the loss of our baby (who we have named Angel Riley). I feel very blessed to be alive and make a point of taking quiet time in my day to appreciate just breathing. When my children need me I no longer tell them, “in a minute,” and when they come to me for a hug, a kiss or a cuddle I savour it all. Every day I have with them is so much more precious to me now.

Coming to terms with the fact that a pregnancy made me so sick was humbling and enlightening. In the back of my mind I knew that my previous caesareans put me at greater risk of an ectopic pregnancy but I never dreamed that one of my greatest fears would play out in the way it did. Now I not only carry an increased risk of another ectopic pregnancy but also have decreased fertility. I have accepted that I’ll need to get a scan when I get pregnant again to rule out another ectopic pregnancy. For me it is a cross I will reluctantly have to bear, but somehow it doesn’t seem so important to me now. What is important to me is avoiding another life-threatening disaster and losing my only fallopian tube. What is important is having a viable pregnancy next time around, hopefully with a happy outcome. What is important is to live every day like there is no tomorrow, to love my kids and my partner and be there for my loved ones and friends like they have been there for me these past few weeks. What is important is to be grateful for every day I have on this earth.

*not her real name.