- Dr Penny Ward
Dying to meet you
Updated: May 6, 2020
In the UK 1 in 20 women give birth on their due date; 1 in 35 000 women have a cardiac arrest during delivery. On April 28th 2012 my beautiful friend Emma was one of both these statistics.
Emma and Jon couldn’t have been any more excited when she went into labour, narrowly missing out on induction by hours. Carrying twins to term was no mean feat but she made it look easy. Emma made everything look easy in fact, she could almost certainly play the violin whilst making dinner in a contorted yoga pose. You know how you meet some people in life who quite literally take your breath away with all that they do. Emma was also tiny and her bump took on colossal proportions by the end, but other than having low blood pressure everything was exactly as it should be.
Arriving on the labour ward she was keen to try for a natural delivery as she had done with her son 21 months earlier. Both girls head down and as eager to come out as their parents were to meet them. The excitement in the room was palpable as the anaesthetist came to top up her epidural in preparation for their arrival, baby girl number one minutes away from being born at this point.
Before the anaesthetist could leave Emma’s heart rate and blood pressure dropped however were quick to respond to some medication and fluid. Baby B was here, cradled in Jon’s arms for the first time.
Baby girl number 2 however started to show signs of fetal distress so Emma was taken to theatre for a C-section. She felt sick and unwell during the procedure but her observations were stable, baby M was safely delivered. It was at this time the obstetrician noted her uterus looked pale, as if it wasn’t getting sufficient blood, her pulses were weak. Something was wrong, catastrophically so. Her blood pressure started dropping along with her heart-rate, this time aggressive fluid and drug resuscitation were required to stabilise them. As her lungs started to fill with fluid she was producing the tell-tale frothy sputum and a portable echocardiogram performed in theatre confirmed her heart was failing.
On arrival in the intensive care department she had a cardiac arrest.
The team worked tirelessly on her, there were four occasions when she lost cardiac output that night. But she survived. Adrenaline, fluid and the most amazing of medical teams put her on ECMO. If there can possibly be a stage-up from life support this is it, this is quite literally the last resort. She required an intra-aortic balloon pump alongside various infusions to help her heart to pump. And as it began to slowly perfuse her abdominal organs they began to bleed.
She received 33 units of blood that weekend.
Jon, the proud Dad of now 3 children under the age of 2, had the most painful of discussions about heart transplants, brain damage, and withdrawal of care. He was given no-hope, spending his time between his 31 year old wife in intensive care and his baby girls on the neonatal unit. Eventually having to leave Emma and take the girls home.
Fast forward to 2020 and Emma is alive. And she is ok, more than ok. People say scars tell a story and they really do, from the ECMO cannula, central lines, tracheostomy and the lines on her abdomen; they are her wings, she survived and she is stronger than anyone I know. She is a professional musician touring often with her band and with her royalties we shop. We love to shop. Sure she gets tired sometimes but as you’ve probably guessed that doesn’t stop her, it doesn’t even slow her down. She is nothing short of amazing.
Maternal death rates in the UK remain arguably higher than we’d like at 8.2 women dying per 100 000. In the Central African Republic this figure is chilling, 1570 women per 100 000 die during childbirth. Here healthcare services are often inadequate or inaccessible, there is a severe shortage of trained medical staff.
I hear women speak often of their ‘birth-plan’ with a degree of inflexibility, believing it is their right to plan the birth they want and they want to stick to it come what may. I talk to them about the advent of the NHS, more women giving birth in hospitals with trained healthcare professionals and close monitoring, regular appointments with a midwife, advice on nutrition, health, screening of their baby in-utero. I tell them about the certified training of midwives, giving obstetricians the recognition they deserve. If giving birth was easy, without complication, then there would be no need for obstetricians, many of my friends would be out of a job. 1 in 64 women in Sub-Saharan Africa wouldn’t die in child-birth if it was easy. Obstetricians, midwives, health care professionals are not trying to rain on their parade, ruin their birth plan. All they are asking for is an awareness, to be flexible, acknowledge they are not necessarily in charge of how this plays out. Not to hold your birth plan in such high regard that you lose sight of the end game. To deliver your baby safely. For both mum and her newborn to be alive.
Emma survived due to the fact she delivered in hospital, due to the prompt action of the medical team around her. From the obstetricians, midwives, anaesthetists, cardiologists, surgeons, blood porters, ITU team, nurses, physiotherapists, phlebotomists….not just in the hospital where she delivered but further afield. More blood products were required from a hospital 65 miles away as supplies were dwindling due to a national shortage of donors, cardiologists in Cape Town were consulted. This really was a team effort and years later her story continues to be told around the hospital. She defied the odds and all expectations, she is a success story. But more than that she is a survivor.
Not unsurprisingly once home Emma experienced vivid nightmares. She spoke of these candidly, trying to banish the demons that came to her when she slept. These nightmares turned out to be her reality. And Jon’s too. He lived through them when he was awake and Emma lived through them when she was asleep. On ECMO she heard, she saw and she felt. It was these memories which haunted her.
Emma and Jon have raised a staggering amount fund-raising for the maternity and cardiology services. They have managed to buy a static ECHO machine to be permanently stationed in the obstetric unit, making cardiac screening a reality during pregnancy. Words can’t begin to explain what they went through or express their gratitude for all that was done for her. Without the most unbelievable team around her, without blood donation, we all know she wouldn’t be with us today.
Change the plan but never the goal. And give blood. Both save lives: yours, your best friend, your family and those of strangers whose hearts will continue to beat because of you.