Women’s experiences of medical emergencies in pregnancy
We spoke to women who had experienced different life-threatening conditions during childbirth. These are sometimes known as 'near misses' and are described in 'What is...
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.
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 very few hospitals do have maternity critical care units.
Patients in ICU 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).
For women who have gone to hospital to have their baby, it can be a deep shock to find themselves in a critical care or high dependency unit, separated from their baby. They would have had no expectation of needing to go to intensive care before their labour started but had an unexpected medical emergency during or just after labour, 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.”
For many women, it took a while to understand 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 ICU for over a week while doctors tried to treat her infection.
Many of the women described how important the kindness and support of ICU 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.”
Despite the attentive and kind care they received, women often found their time in ICU 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.’
But for many women, the hardest aspect of being in ICU 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 ICU; 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’s 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)’).
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 ICU. 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 on 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.
We spoke to women who had experienced different life-threatening conditions during childbirth. These are sometimes known as 'near misses' and are described in 'What is...
Women who experience obstetric emergencies during childbirth often need to stay in intensive care or high dependency care units (ICU and HDUs) for several hours...