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Conditions that threaten women’s lives in childbirth & pregnancy

Natalie

Age at interview: 32
Age at diagnosis: 30
Brief Outline: This was Natalie's first pregnancy. After a quick labour she delivered her son in hospital. However, after the delivery she started to feel very strange and had started to haemorrhage. She lost 3 ' litres of blood but doctors were soon able to stop the bleeding.
Background: Natalie is a software consultant. She is married with one son. White British.

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This was Natalie’s first pregnancy and everything went well, with no major concerns. On her due date she went into labour at home, her waters breaking at 2am. Her labour progressed rapidly and she went into hospital (a midwife led birthing unit) around 7am. Natalie was keen to have a drug free birth and laboured well without any pain relief. Her son was born just after 10.30 am. He was well and she held him and started to feed him in the delivery suite. However, after delivering the placenta, she started to feel very strange. Natalie described a feeling of falling back and feeling disconnected from the room. Her midwife hit the red button and soon the room was full of lots of people. Her husband stayed by her side for the whole time, stroking her head and reassuring her. She haemorrhaged and lost 3 ½ litres of blood. Doctors performed internal compressions (with only gas and air to help her with the pain) and she had a blood transfusion. She was in and out of consciousness, but it felt as though that part of the experience went on for hours. But her notes show it was only 30 minutes or so. The staff were very efficient and reassuring, trying to keep her calm throughout. Once she was stabilised, the doctors started to leave the room, and she was able to start to come to terms with what had happened.
 
Natalie was transferred up to the delivery suite, but observed closely for a few hours. She was given a private room with two beds and she and her husband were able to get some rest. Their baby was fine, and bonding and breastfeeding were not affected by the haemorrhage. Natalie was discharged home after three days, although felt very weak for the following fortnight. She did not have any special follow up at the hospital, just routine checks at the GP. She did, however, appreciate the doctor who did the internal compressions, and her midwife coming to see her at the end of their shifts to check on her and explain what they had had to do. She has been in to hospital for a de-brief on her notes, but found it quite unsatisfactory, feeling as though the staff were being defensive rather than informative. A friend of hers had also had a haemorrhage in childbirth a few weeks earlier which she felt gave her some idea of what was happening to her. But they have not really talked about their experiences since.
 
Looking back on the experience 16 months on, Natalie describes herself as being philosophical about her birth experience. She has been told that subsequent pregnancies would have to be closely monitored, but not a problem. She is not too concerned about having another pregnancy, feeling that if she and the doctors coped with it once they can cope again.
 
 

Natalie had a haemorrhage shortly after giving birth. Once the emergency had been dealt with the...

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And for me this whole period seemed to go for a really long period of time. It felt like hours, that this was going on and they were, you know, so many people around me trying to do stuff, take blood pressure, put needles in, compress, they were doing compressions on the outside, compressions on the inside and then all of a sudden it kind of stopped and they were like, “Okay she’s stable.” I think that was obviously after the blood. I must have had a couple. I think I had two units of blood and they’d gone in and my blood pressure was back to normal. They’d stemmed the bleeding and it was like, right, the consultant, he was very sweet actually. He took my hand, and he said, “You’re going to be okay. You don’t need to worry. You’re going to be fine.” And I think he did the same to my husband actually. My husband was a bit of a wreck and then one by one, people started to leave the room and then there was just my midwife and I think two other people just kind of observing my stats and making sure I was okay. And what clothes would you like to put your son in? 

 

Natalie was transferred to a single room after her post-partum haemorrhage. She was grateful for...

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I don’t think so really. I really don’t think so. I was very happy with the way I was treated. I think had I been in a general ward in the post natal with six other women in a bay I would probably feel very differently. I think I was very, very fortunate to have had a private room. And I felt for me that was important to allow me the space to recover. So if I did want to have a weep, and I think I’m fairly certain now that I must have wept that first night for half the night. Looking back I’m fairly certainly I did. And I don’t know if I would have felt able to do that in a ward full of other women and I think that was very important for me to grieve the labour that I didn’t have, if that makes sense. Although I had a great labour. It was very quick, it was over and done with. I wouldn’t say the pain was unbearable. You know, all of that, it didn’t go as I imagined. For the end I think you have to grieve. You have to go through that process of getting over that. And I think the private room sort of allowed me to do that in the first 24, 48 hours because I was in there two nights and I managed. I was luckily enough I kicked off, they tried to kick me out the second night and I kicked off because the only reason, one of the reasons I’d made the decision to stay was on the condition I could keep in the room. And then at 8 o’clock that night they tried to move me out. Luckily I kept it. If that had happened if I’d been in a general ward I think I probably would have felt very differently and how the care, how I would have liked the care to have changed was if women are having these experiences that are traumatic then they should be afforded the privacy to recover in peace really. But obviously constraints, medical, you know, funding constraints don’t always make that possible, but it’s nice to put that down as a wish. 

 

When she started to haemorrhage (heavy uncontrolled bleeding) after her son was born, the midwife...

When she started to haemorrhage (heavy uncontrolled bleeding) after her son was born, the midwife...

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During the delivery itself she was absolutely great. I mean she was everything I wanted in my midwife. She understood what I wanted, was very hands off, very relaxed, made suggestions if she felt it would help, but it was entirely up to me. So communication up until that point was great. When it all kicked off I think they were more concerned about making sure I was stable. So initially there was pretty much no communication. It was just like, I think she did say to my husband, “I’ve got to press the red button. It’s going to get very busy in here, very quickly. But keep calm. It’s under control. You’ve got no need to worry.” So she pre-warned him about what was going to happen. So he said that he felt as reassured as you can be when you’re wife’s passed out next to you, about what was going to happen, and I do have some recollection of after the first, when they’d got their monitoring machines up and running, so they could check my stats I do vaguely recall someone sitting next to me holding my hand, and just saying, “It’s all right, you know, it’s going to fine. Just they need to get some blood into you.” And I don’t actually remember all of what she said. It’s more a memory present of there being somebody next to me, kind of trying to reassure me. So there was after that initial flurry of activity, I’m fairly certain that there was someone with me, trying to keep me calm. Which I greatly appreciated. And I think it was actually my midwife. I think at that point, they had kind of let the people from upstairs, the main delivery unit had come down and taken over the case and I think she was, sidelined, but her role was then about caring for my emotional needs, rather than my physical needs and they were there to look after my physical needs. That’s my understanding anyway.
 
And afterwards, rubbish. But then you know, I understand how under staffed the postnatal wards can be and I was fully prepared for that going in [baby noisy]. I had no expectation that I was going to have good post natal care in the midwifery, on the ward, through experience with my friends.
 
And actually I’m being harsh because whilst I was in recovery the doctor that did my internal compressions came to me, and she explained what she’d been doing and she said, “My name is such and such. I, you know, was on the team recovering you…” I said, “Yes, you were doing my internal compressions weren’t you?” She said, “I’m really sorry about that, but I had to do that to stem the bleeding. It was very important.” I mean she was lovely, she was, and I really appreciated her coming to talk to me, because she could have gone off at the end of her shift and not bothered. 
 
 

Shortly after she had delivered her son, Natalie started to feel strange, as she was receding...

Shortly after she had delivered her son, Natalie started to feel strange, as she was receding...

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And then that’s sort of when it all went blank. I said, she got up to go to the cupboard to get all of her equipment and I said, “Oh it feels very strange. I can feel, I felt myself receding into myself and I had like whooshing sound in my ears, and… the next thing I knew I came round. I’d obviously passed out, and it was a bit frantic. I could… there was… she, I don’t know the order of events so this is going to be very out of sequence. But I know the emergency button had been pressed to get a number of people into the room, I suddenly lost a lot, a great deal amount of blood. 
 
So you described kind of being in and out of consciousness?
 
Yes. And what I, there’s kind of a few key things that I remember. The first one was them saying, we need to do we know what blood type she is. We need, we need to get some blood, we need to cross whatever it is. Cross type for matching, or whatever it is they say. And I remember trying to say, because I donate blood and I know what blood group I am and I was saying, “I’m O positive. I’m O positive.” And they couldn’t hear me. And I’m convinced that I said this. And my husband says he doesn’t recall me saying it at all. But I remember thinking oh my God they need to give me a blood transfusion. I’m losing a lot of blood. 
 
And the other thing I remember hearing them say, “Her blood pressure…” They were like, because they were calling out the various statistics and once they finally got the cannulas in and then they were trying to get my blood pressure and one woman was saying, it was either 20, it was like 40 over 20. Or, it was very low, like. And I said to my husband afterwards and he said, “Actually at one point they said its 40 over nothing. We can’t get the bottom whatever it is.” And I’m glad he didn’t, he told me that quite a long time after.
 
 

Natalie was transferred to a single room after her post- partum haemorrhage. She was grateful for...

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Natalie was transferred to a single room after her post- partum haemorrhage. She was grateful for...

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I don’t think so really. I really don’t think so. I was very happy with the way I was treated. I think had I been in a general ward in the post natal with six other women in a bay I would probably feel very differently. I think I was very, very fortunate to have had a private room. And I felt for me that was important to allow me the space to recover. So if I did want to have a weep, and I think I’m fairly certain now that I must have wept that first night for half the night. I, you know, looking back I’m fairly certainly I did. And I don’t know if I would have felt able to do that in a ward full of other women and I think that was very important for me to grieve the labour that I didn’t have, if that makes sense. Although I had a great labour. It was very quick, it was over and done with. I wouldn’t say the pain was unbearable. You know, all of that, it didn’t go as I imagined. For the end I think you have to grieve. You have to go through that process of getting over that. And I think the private room sort of allowed me to do that in the first 24, 48 hours because I was in there two nights and I managed. I was luckily enough I kicked off, they tried to kick me out the second night and I kicked off because the only reason, one of the reasons I’d made the decision to stay was on the condition I could keep in the room. And then at 8 o’clock that night they tried to move me out. Luckily I kept it. If that had happened if I’d been in a general ward I think I probably would have felt very differently and how the care, how I would have liked the care to have changed was if women are having these experiences that are traumatic then they should be afforded the privacy to recover in peace really. But obviously constraints, medical, you know, funding constraints don’t always make that possible, but it’s nice to put that down as a wish. 

 

When she started to haemorrhage (heavy uncontrolled bleeding) after her son was born, the midwife...

When she started to haemorrhage (heavy uncontrolled bleeding) after her son was born, the midwife...

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During, during the delivery itself she was absolutely great. I mean she was everything I wanted in my midwife. She understood what I wanted, was very hands off, very relaxed, made suggestions if she felt it would help, but it was entirely up to me. So communication up until that point was great. When it all kicked off I think they were more concerned about making sure I was stable. So initially there was pretty much no communication. It was just like, I think she did say to my husband, “I’ve got to press the red button. It’s going to get very busy in here, very quickly. But keep calm. It’s under control. You’ve got no need to worry.” So she pre-warned him about what was going to happen. So he said that he felt as reassured as you can be when you’re wife’s passed out next to you, about what was going to happen, and I do have some recollection of after the first, when they’d got their monitoring machines up and running, so they could check my stats I do vaguely recall someone sitting next to me holding my hand, and just saying, “It’s all right, it’s going to fine. Just they need to get some blood into you.” And I don’t actually remember all of what she said. It’s more a memory present of there being somebody next to me, kind of trying to reassure me. So there was after that initial flurry of activity, I’m fairly certain that there was someone with me, trying to keep me calm. Which I greatly appreciated. And I think it was actually my midwife. I think at that point, they had kind of let the people from upstairs, the main delivery unit had come down and taken over the case and I think she was sidelined, but her role was then about caring for my emotional needs, rather than my physical needs and they were there to look after my physical needs. That’s my understanding anyway. 

 

A friend of Natalie’s had had a haemorrhage. When she started to feel very faint she was grateful...

A friend of Natalie’s had had a haemorrhage. When she started to feel very faint she was grateful...

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And at the time I was sort of, I had no idea what was going on, but at the same time I did know what was going on, because one of my friends from my ante natal group had also had a haemorrhage and I’d literally seen her four days before, the first time after she’d had her baby, a week before, and she looked pale as anything when she walked in and we were all sat here, and everyone was going, “What happened, you know, [friend] what went on.” And she said, “I really don’t think I should tell you.” Because I was the last one to have the baby. I was the last one pregnant. Everyone else had had theirs. And she said, “I don’t want to make it bad for [name].” She was really paranoid and scared about labour. So I think she was worried about making me in the same sort of frantic state she had been and I remember taking her to the side in the kitchen and I said to [friend], “I really do want to talk about it, and don’t if you don’t want to, but I’m not going to be freaked out by it and I think it’s helpful to know what to look out for.” 
 
And because she’d explained to me this sensation of, you know, falling away from people and getting very faint and light headed and feeling like she was on gas and air, even though she wasn’t on gas and air. As soon as that started to happen to me, I said to my midwife, “I don’t feel very well. I don’t feel quite right.” And I do remember saying to her, “Oh I feel a bit funny.” And I’d even said my midwife about [friend] to her after the delivery, and I don’t know why I had been talking about my friend who’d had a haemorrhage. But I’m so grateful that she said what she did, because as soon as I stated getting exactly the same symptoms that she’d, she’d described, I was able to kind of try and tell my midwife that and she was perhaps.. And I think that’s why she’d been concerned about the fact that I hadn’t passed any water and that I was still seemingly passing clots and losing blood and she 
 
Later she came to talk to me in the, in the post natal ward and she said that sometimes a full bladder can [pause] stop the, I can’t remember exactly what she said, but it was very important to her that my bladder was emptied because that would give her a clear indication of how much blood I was losing.
 
 

Natalie and her husband were back on the ward, after the emergency of her haemorrhage had passed....

Natalie and her husband were back on the ward, after the emergency of her haemorrhage had passed....

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My husband’s very contained. He’s very, he contains his emotions very, very well and he did that very much when it was happening. So I would never have known. He wasn’t freaking out, he wasn’t panicking, he was being calm, he was keeping me calm. He was very comforting, he was very reassuring. And I think that’s his way of dealing with the situation. I don’t think he allowed himself to think about what was going on at the time. And I think it was only afterwards when we were in the recovery room, that the emotions overcame him, and he just thought, he just thought he was going to lose me, and he was like, what would I have done? And he was terribly upset by what had happened and what he’d seen. And overjoyed at the same time that, you know, his son was here. So I think it was a whole range of experiences, emotions going through him at that time. But he’s since confessed, in that birth thing, birth story, he did say that he had a weird feeling that something was going to happen and that towards the later stage of my pregnancy, he had actually been distancing himself from the pregnancy and me to some degree because he didn’t, he was almost afraid to become attached because he had some weird feelings something was going to happen.

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