incisive observations
Friday, March 02, 2007
Saw the obstetrician this morning and it turns out I am too posh to push. (Who knew that I would one day transcend my West Auckland upbringing in such a fashion?) She had been over my surgical notes from the UK, and it appears that my insides are rather more pre-knackered than I'd realised. Here's why, as it was explained to me:
During a Caesarean section, the surgical incision is made low down in the uterus, fairly close to the cervix. As it happens, this incision site is also close to the uterine artery, which supplies the uterus with blood. During the late stages of labour, as the cervix becomes fully dilated, the wall of the uterus, where the incision is made, is stretched thin and thus weakened, especially if you've been in labour for a long time. When the surgeons cut into my uterus, a tear developed on one side of the incision and extended into the neighbouring uterine artery. This resulted in a haemorrhage: the artery was repaired (at some speed, I imagine) and I had to have blood transfusion before leaving the hospital.
Unfortunately, tears and repairs of this nature leave the artery permanently weakened, increasing the risk of rupture if subjected to the stress of a vaginal birth: arteries being fairly high-pressure systems, they are are not the sort of structures you want to go pop. So there's no question of being allowed to attempt the vaginal birth I'd been hoping for: I've been booked in for a c-section on 22 May, and should I happen to go into labour before then, I should apparently get my pregnant arse to the hospital with all possible speed.
Clearly I must go with the safest option and, disappointed as I am, I accept this. But two questions trouble me. First: could this have been prevented? My labour was induced, and by the time the c-section was performed, I'd been at it for a long time: it took a good 36 hours to get me into established labour, which went on for a further 12 hours before the surgery was deemed necessary. By this time, I was exhausted and running a temperature, and Rebecca was in distress. According to my current midwife, I'd never have been allowed to go on for that long over here, and she thinks that this was a factor in the haemorrhage. The obstetrician seemed to agree; she also pointed out that given the position of the baby's head, the chances of her emerging naturally were fairly slim. Given this, why wasn't the surgery performed earlier, when my cervix was less dilated, and the risk of tearing reduced?
But what bothers me more is this: why was I not told at the time what had happened on the operating table? I first learned that I'd had a haemorrhage when I overheard one of the midwives use the term 'PPH' while discussing my case with a colleague, at the foot of my bed. When I asked her what this meant she said 'post-partum haemorrhage' and left it at that: no further details were offered, and it didn't occur to me to ask for any. I was somewhat knocked back by the whole process, and probably assumed that this sort of thing was fairly common. But given that the nature of the haemorrhage and the resulting damage to the artery have rendered any future vaginal births out of the question, why wasn't this explained to me at the time, and by one of the surgical team? Surely if something goes wrong during an operation, a patient has the right to know, especially if it carries such serious consequences. Did they forget to tell me? Did they not think I'd need to know? Did they just assume I'd find out if and when I came to have another baby? I am baffled, and angry.
0 Comments: