An Unnatural State
The Age
Tuesday March 16, 2004
Australian women routinely survive complications in childbirth that killed women 100 years ago. But it cannot be taken for granted, as David Manallack discovered.
When my partner fell pregnant we attended antenatal classes - a reminder that birth is actually organic and unpredictable.
Over 12 weeks they tried to shake our ideas of TV-style births, and the confidence that Australia's minuscule infant and maternal mortality rates can give: breech births, forceps, emergency caesareans, cord strangulation; we heard about them all.
Did we listen? Well ?
One mother-to-be asked if coffee-making facilities were available in the birthing room, in case she fancied a caffeine fix during labour. Let's hear it for the lifestyle junkies: "Here's your skinny latte; try not to bleed on Wallpaper magazine, dear."
We may have laughed at her expense but my partner, Jane, and I were deluded, too. The classes were good, and we tried to listen, but we remained convinced that our baby would seamlessly enter the world.
Labour changed that. It started innocently enough, when water trickled down Jane's leg as we were going to bed. After a sleepless night at the hospital, with nothing happening, the doctors decided to induce the baby.
Jane had always thought she could manage without drugs. When labour began, it seemed achievable. But as discomfort became severe pain and, later, agony, it became an ambitious fantasy. Eventually, Jane asked for pethidine: it did nothing.
They checked the cervix to see if the baby was ready and we were shattered to discover that 12 hours of harrowing labour produced only two centimetres of dilation - the cervix needs to dilate 10 centimetres before delivery is possible.
Jane was in trouble, struggling to cope, and there was a risk of infection, being more than 24 hours since her waters broke. The doctors decided on an emergency caesarean. This wasn't in the script. Until now, we thought caesareans were for other people.
They separated us, to prepare Jane for the operation. I was shown to a small, cold locker room and changed into scrubs.
The operating theatre was harsh, unlike our softly-lit and quiet labour room. Half a dozen people worked steadily among endless cables and tubes, while the anaesthetist monitored Jane. She wanted to go home. Her eyes were narrow and bloodshot. A screen divided her body in two so that we couldn't see the operation and, behind it, a couple of doctors worked intently. It happened fast. Soon they were fumbling about with their hands inside Jane, like trying to handle a greasy bowling ball.
"Ooh, it's a big one," they said, then held Liam, purple and alien-like, out of the womb and aloft for us to see.
He screamed like a donkey, and even Jane managed a smile as Liam was swaddled and handed to us. She looked at her new boy, whispered "Oh, good", and then passed out. Liam and I shared a quiet moment. I held him like he was the most valuable thing on Earth.
A hundred years ago, Jane, or Liam, or both, probably would have died (his head was huge, gorgeously lethal in the wrong time or place). We take for granted the facilities that let them survive his birth. It is part of what defines us as a rich nation.
According to the World Health Organisation (WHO), global inequality is most profoundly measured by women dying from pregnancy. A WHO report reveals that, in the year 2000, a woman living in Afghanistan had a one in six chance of dying from pregnancy over her lifetime. In Australia it was a one in 5800 chance.
It makes me think of the people behind razor wire in the desert. I wonder how it would feel to touch the dry earth, to hear the funny accents of the guards, to know that beyond the perimeter is a land where pregnancy is a lifestyle choice, not just life threatening.
According to the WHO, a major problem is that only half of the deliveries within developing nations take place with a doctor, midwife or other skilled birth attendant present.
We had a team of specialists to get Liam over the line.
Still, the toll on Jane's body was enormous. I held Jane during her first walk after giving birth, from her bed to the toilet four metres away. It took minutes, each step only a few centimetres at a time. Probably the longest, and shortest, walk of her life.
Jane took that walk again, two years later. It was easier this time. We knew Jane needed another caesarean in advance, so we rolled up to the hospital at a civilised hour, mid-afternoon, for our appointed delivery. It was all so predictable and refined.
The "caesar" went swimmingly. During the operation I recognised a classmate from primary school. We had a little chat. When the doctors pulled Henry from the womb it was only 4.30pm, which gave us time for visitors, perhaps even a spot of dinner.
Henry slept a lot, which was sweet and made him the butt of jokes. I compared babies with an Arabic family in the bed facing ours. Their daughter had a delightful shock of jet black hair. Henry's was covered in orange fuzz.
But still Henry would not awaken. Sleeping meant that he wasn't feeding and he took a turn for the worse, becoming inexplicably floppy. Nothing would rouse him. At 1 am, on Henry's third day in the world, a nurse told Jane: "I think you'd better call your husband."
The special care ward of a maternity hospital has a way of putting you in perspective. Everywhere you look, tiny and sick babies are connected to machines and encased in boxes. Parents keep a worried vigil. It was down there that a master pediatrician, renowned for his ability to find a vein on a baby's hand, sought to break Henry's slumber. With one tender move the pediatrician slid a needle into Henry's little mitt, then hooked him to a drip.
The antibiotics wiped out the infection and Henry woke up. While the script had been torn up again, it was reassembled to keep a happy ending. Henry was lucky, more fortunate than the little ones staying in the special care ward. And a world away from the newborn babies and their mothers in Afghanistan.
David Manallack is a Melbourne writer and father of two boys. dmanallack@yahoo.com.au
BIRTHS AND DEATHS
In Victoria in 2001 there were:
• 62,149 births (with birth-weight of 400 grams or more, for 20 weeks or more gestation).
• The stillbirth rate was 7.1 per 1000 births.
• 292 infants died in the first year of life, giving an infant mortality rate of 4.7 deaths per 1000 live births (up from 4.2 in 2000).
• 204 of these infant deaths occurred in the first month of life, and 88 between one month of age and the first birthday.
• There were three maternal deaths: one direct death (due to a complication of the pregnancy) and two indirect deaths (due to a pre-existing condition aggravated by pregnancy), and 61,108 maternities. (In 1953, there were 36 maternal deaths in Victoria.) Source: The Consultative Council on Obstetric and Paediatric Mortality and Morbidity's annual report for the year 2001.
© 2004 The Age