Conditions that threaten women’s lives in childbirth & pregnancy

Experiences of Intensive Care Unit (ICU) or High Dependency Units (HDU)

Often women who experience severe life-threatening complications in childbirth need to spend some time in intensive care or on a high dependency unit in the hospital after the birth. Here we look at these experiences.
 
Intensive Care
Women are admitted to intensive care units (ICUs) - sometimes called intensive therapy units (ITUs) or critical care units (CCUs) - if their condition is life threatening and they need constant, close monitoring and support from equipment and medication to keep normal body functions going. This is a level of care that most maternity units are not equipped to offer (although a very few hospitals do have maternity critical care units). Women will receive 24 hour, one to one nursing care and monitoring. Situations in which this might be necessary include: if the woman is suffering from septicaemia (blood poisoning), if she has had major life-saving surgery (e.g. an emergency hysterectomy) or if she has had a major haemorrhage (heavy uncontrolled bleeding).
 
Waking up
For women who have gone to hospital to have their baby, it can be a deep shock to find themselves in critical care or high dependency, separated from their baby. Women going into labour had no expectation of needing to go to intensive care before their labour started. There had been a medical emergency during or just after labour, which was unexpected, so when they woke up they had no idea where they were and it was frightening. Hannah was sent up to intensive care after a uterine rupture. “I think there was nowhere else to send me… so that was quite a scary thing. I think that was the scariest thing of all.”
Like others, Rachel and Anna talked about the very vivid dreams and nightmares they had when they were waking up in intensive care. Rebecca said, “It’s a very scary place. Because you’re having so many drugs you start to feel like… I started hallucinating.”
 
Understanding why they are there
For many women, it took a while to understand both where they were, and what had happened. Paula described how she and her partner “just sat and tried to piece things together a bit for a while.” Alison T had amniotic fluid embolism (AFE), a very rare complication of pregnancy in which amniotic fluid, fetal skin or other cells enter the woman’s blood stream and trigger an allergic reaction, and was in intensive care for several days. When she woke up she had no idea where she was. “One of the consultants came in and sat on the end of the bed and said, “I told your husband to pray for a miracle, and I think we’ve had one.” Yes, and just said, “You’ve been very, very poorly. Did I know where I was?” And you know that sort of thing, which I didn’t.’
 
Anna had septicaemia after the birth of her second son. She was admitted to ITU for over a week while doctors tried to treat her infection.
Cara had a haemorrhage and hysterectomy and was in ITU when she woke up. She didn’t really appreciate how ill she had been until her mother brought in a photo of her newborn and stuck it on the end of the bed. “I remember looking at this picture and going, it’s the sort of thing people do to help you pull through. My funny mother. And I sort of went, this isn’t good, is it? I’m genuinely really sick? And that sort of brought it home.”
 
Being in ITU
Many of the women described how important the kindness and support of ITU staff was in making the situation more bearable. Lisa said they were “faultless angels”. Hana was very distressed at not being able to wash herself, “that is when you hit rock bottom. Actually they had to give me a bed bath that day, because I just felt really just not very nice. She was a wonderful nurse that day though, she was really kind”.
 
In spite of the attentive and kind care they received, women often found their time in ITU very distressing. They were disturbed by the physical state they found themselves in, found it difficult to communicate and were afraid to go back to sleep. Women described feeling humbled and humiliated. Karen said, “Because of the haemorrhage I was still seeping a lot of liquids, and they were having to be changed and almost feeling like I was a baby myself having my nappy changed. You know it was very, quite humbling in a way. You felt very out of control, I’ve never felt like that before. That was quite hard”.
 
Rachel described a terrible thirst. Alison and others, were horrified by how swollen their arms and hands were.
Women were also distressed at not being able to communicate properly, because they had breathing tubes in their mouths. Mandy said, “Because of the tubes that went down my throat, I couldn’t speak. So to me I was speaking normally, but to everyone just mumbling. So communication was really tough.”
Being a new mother in ITU
But for many women, the hardest aspect of being in ITU was being a new mother and having to be separated from their newborn baby. While some hospitals were able to make arrangements for the baby to visit their mother, in other situations this was not possible. Doctors and midwives may feel it is inappropriate to bring a newborn into an ITU; the patients are too sick and there might be a risk of infection. Alison found it very hard not to be able to be the mother she had imagined she would be.

You have this idealistic picture in your head, what it’s like when you’ve got a baby, that you’ll spend all the time cuddling them, and I didn’t feel I could do that, because just holding him to start with was just exhausting. So that was a really difficult sort of emotional battle really.” (See also Hana clip above.)
Sometimes it may be possible for the mother to go and visit the baby if her condition is not so critical. This was the case for Farkhanda, who had a major haemorrhage after the birth of her son. He was in neonatal intensive care and she was focused on getting to see him as quickly as she could. The staff were very supportive, giving her morphine so she could travel in a wheelchair to see him. (See Baby in neonatal unit (NICU)).
Being in a High Dependency Unit (HDU)
Some hospitals have High Dependency Units (HDUs), also called step-down units. HDUs are wards for people who need more intensive observation, treatment and nursing than it is possible to provide on general wards or maternity units, but less than is given on an ITU. Some women woke up in these units, others were transferred to them out of ITU.
 
For some women, being transferred to HDU was a relief, a step in the right direction. Simon described how he was able to stay overnight with his wife (Hannah – Interview 01) and baby when they were in the HDU. It was a very important time after the trauma of what had gone before.

For more experiences of being in intensive care see the Healthtalk ‘Intensive Care: Patients' experiences’ and ‘Intensive Care: Experiences of family and friends’ websites. 

Last reviewed April 2016.

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