Conditions that threaten women’s lives in childbirth & pregnancy

Joanna

Female
Age at interview: 32
Age at diagnosis: 31

Brief outline: Joanna's first daughter was delivered by caesarean and she was told she could try a vaginal birth after caesarean (VBAC). She went into labour at home, 9 days overdue. She had a uterine rupture which was undiscovered. Her baby died in utero and was delivered during surgery to stop the haemorrhage.

Background: Joanna is a medical sales representative, married with one daughter. This was her second pregnancy. White British.

Audio & video

Joanna had an emergency caesarean section when her first daughter was born. She had found the experience of her first caesarean so bad that she was keen to avoid having a second so was enthusiastic about a vaginal birth after caesarean (VBAC). During her second pregnancy, she was under consultant and midwife led care and it was quite late in the pregnancy that they were told that she could try for a natural birth. In October 2009 she was about 9 days overdue when her contractions started naturally at home. There was a point when in addition to the contraction pain, she experienced a searing pain, as if she “had been stabbed” and she asked her husband to get her to the hospital as quickly as possible. She now interprets this pain as the rupture which later caused her haemorrhage, but she will never know. 
 
Once she arrived at hospital (late Sunday night) and was examined, the midwives told her that she had not even started dilating. They monitored her for a while, then stopped. In extreme pain, not knowing what to expect from a natural birth, and tired, she was given paracetamol and Temazapan to help her rest. No one took or looked at her notes. She dozed through the night. She woke in the early morning covered in sweat feeling simultaneously hot and cold and asked her husband to get the midwives immediately. In the next two hours midwives and consultants (obstetrics, anaethesia and radiography) established that the baby had died and she was haemorrhaging massively inside (there were no external signs of the bleeding). She was told that she would have to deliver the baby, but was too weak to even contemplate it. The baby was almost 10lbs, almost 3lbs larger than her first baby. This was not picked up on, but could have contributed to her tear. She says now had she known how big the baby was she would have pushed for a caesarean section. There were disagreements with the consultant about her due dates and therefore how overdue she was.
 
When they realised she was bleeding internally they took her into theatre. Her husband refused to leave her and stayed with her, and the baby, throughout the operation. The operation lasted about half an hour and then she was transferred to recovery and then a high dependency unit. They were allowed to keep their baby daughter with them for a couple of days before she had to go to the morgue. She was discharged on the Thursday. She had a six-week check with the consultant who she found unsympathetic and they have had to chase the internal investigation several times. They had a meeting with the head of midwifery and others to go through the report that they had written (which identified several mistakes at various stages) but there has been no contact since, at the time of the interview . 
 

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