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 units (ICU)
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).
Waking up in ICU
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.”
Rebecca had a planned caesarean, but doctors discovered during surgery that she had placenta…
Hana had emergency surgery to deliver her twins. Waking up in intensive care was very surreal…
Alison had a haemorrhage and hysterectomy. She came round in intensive care but had no idea where…
Lisa was shocked when she woke up. Her partner looked bedraggled and she was surrounded by…
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 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.
When Anna woke up in intensive care, her partner was delighted. She was concerned to know if…
Paula was sent to intensive care after she had amniotic fluid embolism. When she woke up she felt…
Cara had a haemorrhage and hysterectomy and was in ICU 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 cared for in ICU
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.
After her haemorrhage and hysterectomy, Alison woke up in intensive care. She was bloated and…
Karen was shocked by how swollen she was when she was in Intensive care. Nurses had to cut off…
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.’
Karen was frustrated by not being able to talk to her husband.
Rachel woke up after losing her baby and a hysterectomy. She couldn’t speak, felt swollen, and…
Being a new mother in ICU
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.)
Paula asked to see her baby, but was told that it wouldn’t be any time soon, as they needed to…
Kate was in HDU after she suffered from HELLP syndrome. She felt just some useless person lying…
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)’).
Farkhanda was still in intensive care on lots of drips and painkillers, but was determined to see…
Being cared for 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 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.
Simon was able to stay overnight with his wife and baby when they were transferred to the HDU.
For more experiences of being in intensive care see the Healthtalk ‘Intensive care: patients’ experiences’ and ‘Intensive care: experiences of family and friends’ websites.