Tuesday, August 10, 2004

F/u for Maternal Death Post

Already, I have gotten email asking why this mom died... how did that happen... could it happen at home... what meds did she have in labor.

While they pretty much knew why before the autopsy, the diagnosis stated that she did, indeed, die of an amniotic embolism (amniotic fluid embolism... AFE)

Here are a couple of sites to read about the syndrome:

http://www.emedicine.com/med/topic122.htm

Here's one that has case studies where women lived:

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ija/vol5n4/amniotic.xml

AFE happens at home, in birth centers, in hospitals, in ORs during cesareans. It just happens and no one really knows why.

Some women feel, once they know about AFE, that they are safer in hospitals so they can do something if it happens. I have heard of 3 cases of fatal AFE in my life (including the one I witnessed) and they were all in the hospital. Granted, by sheer numbers, the odds are greater, but the hospital did not save the women. The babies did, all live (1 was already born with the AFE occurred), so yes, a cesarean could possibly save the baby if done quickly during the crisis. But, by looking at the stats, even that isn't a guarantee... and, sadly, many of those children are compromised.

The mom whose death I witnessed had no medications at all during her labor. She did have an IV, but only with Lactated Ringers. IVs do not cause AFEs... women have had them without them.

I know all the discussions that revolve around my story. I have heard them since she died in 1987:

What if she had been up walking?
What if she hadn't had a vaginal exam?
What if her waters weren't broken? (they were not artificially broken, she ruptured her membranes spontaneously)

Believe me, if there was something that caused this that someone could pinpoint, we would surely not do it anymore... it is that dramatic.

(I am reminded of Star Trek IV [again! someone just mentioned this the other day] when the doctor is in the hospital and sees a woman going in for Dialysis and he comments how archaic that is! and fixes her immediately. I pray that is what will come to pass each day I work with pregnant and laboring women; that something miraculous will be discovered and women will not have the risk of AFE ever again.)

I often say that midwives are a product of their experiences. (Everyone is, but midwives make judgement calls based on theirs.) This woman dying in my sight kept me from midwifery for another 15 years. I simply was not mature enough emotionally or spiritually to take the lives of two people in my hands.

I am sure that pisses off many UCers reading this... that those lives aren't in my hands. But they ARE when someone hires me to keep them alive should one or the other... or both... need to be re-lifed until help that surpasses my skills arrives to take over.

When I had Tristan, I was so inducted in the Medical Model, I thought his birth was perfect! (I promise to write it out soon... all three of my own birth stories are over-due.) I wrote letters thanking the hospital... thanked the nurses with flowers... the doc with chocolate and a letter of praise.

When I had Meghann, I was angry with The System. My Bradley class taught me all I needed to know to birth alone and, I thought, safely. Dr. White's Emergency Childbirth on the dresser, visualizations of perfection continuing, dozens of books under my belt... and endless discussions with Marilyn Moran (the founding mother of American UC)... all served to help me feel more than ready to have a baby without the hindrance of a midwife or doctor or hospital. I could do it!

And then Meggie nearly died from a shoulder dystocia that no one knew how to resolve. Blessedly, the Universe/God/Nature/her Spirit, twisted her out and she was born needing resuscitation and reviving... a few pumps of her heart with fingers, included. It was terrifying.

I was still in that place of arrogance, however. She had made it. She was so beautiful! I had squatted and had a 10 pound 6 ounce child at home with no midwife, no episiotomy, no tear... delivered my own placenta... nursed perfectly. I was HIGH!

Pregnant with Aimee, I watched this woman die and my pendulum that had swung so widely between Tristan's and Meghann's birth... finally found its center.

I have remained in that center.

Even as I explore a more hands-off birthing style, I am ever grateful and thankful that I have the skills I have... and that I have them available should women want and need them (and their babies, too).

I found humility that day.

I thank the woman for the gift she never consciously knew she gave me... she gave me the maturity to wait many more years... she gave me balance to see that doctors aren't all animals out to eat their prey... that even the most repulsive men and women can work until they fall to their knees to save another human being. I watched men and women, whom I had written off as having no souls, sob into each other's shoulders and their own hands. She gave me a reality... a biting, painful, slapping reality... I had never expected in birth. Hearing about death is one thing, but witnessing it is completely something else.

Witnessing death in birth... another thing altogether.

Thank you, dear woman, who gave her life so I might gain mine. You will never know the gifts I have received.

1 comment:

Silverhawke said...

you constantly amaze me, and cause me to reinvent my own midwife self on a daily basis. I wish I could come apprentice to you.