Last Sunday as we were eating family dinner she suddenly shook herself and said “gosh I’m itchy” My midwife lizard brain was immediately on high alert as this is a cardinal sign of Obstetric Cholestasis, a condition that puts the unborn baby at significant increased risk of stillbirth. It turns out that she was indeed diagnosed with a nasty case of Obstetric Cholestasis and after an anxious few days wait she was induced. Putting it frankly she was induced at 37 weeks in order to prevent stillbirth. While we will never know how close she actually came to losing her baby this has caused me to reflect on the messages we give pregnant women and those we don’t.
Cate’s pregnancy has been an interesting journey for me. It has been interesting to hear when and where she has been told information and the nature of that information. She was told to avoid alcohol altogether and given the usual messages about avoiding soft cheeses. She was immunised against whooping cough and told that it would be wise to ask her family members to get a booster too. She was told to get to know her baby’s individual pattern of movements and immediately report any changes. When she presented with itchiness they followed the SA perinatal practice guidelines to the letter. All of this reflects superb care that I, for one, have been very impressed with.
So what is my point? ...well it’s this. She had outstanding care and she took amazing care of herself yet she still came uncomfortably close to stillbirth. Why didn’t Cate know that itchy hands and feet during pregnancy is not normal and needs to be reported? Because no one told her. Why didn’t they tell her? Well that is an interesting question. “Obstetric Cholestasis is rare”, you might say and I would agree BUT fetal alcohol syndrome , listeriosis and whooping cough in the newborn are vanishingly rare yet she knew about and took steps to avoid each of these. So it is hard to justify why she knew about these more rare risks and took steps to avoid them, yet didn’t know about a more common condition.
I think the reason why she didn’t know about Obstetric Cholestasis came down to her care providers (excellent as they were) not being prepared to have a conversation with her which was about preventing stillbirth. I have no doubt that this was motivated by a desire to avoiding “making her anxious” but if by possibly avoiding a little anxiety you end up with a stillborn baby then that’s a huge risk that should not be taken. Cate was quite happy to avoid alcohol, soft cheese and to be immunised she is a good mother who has the best interests of her baby at heart. Yet for some reason her care providers did not give her all the information that she needed to keep her baby safe. Avoiding alcohol, listeriosis and whooping cough did NOT make her anxious, it empowered her and enabled her to demonstrate she is a good mother. Therefore, withholding information which could well be the difference between life and death for fear of provoking a little anxiety is not only totally unethical but simply WRONG WRONG WRONG.
Thank God, she and her baby are ok, but was lucky, lucky that she happened to mentioned it to me, lucky that I knew it wasn’t normal even if she thought it was. BUT a baby’s life should not come down to luck. Maternity care providers need to give ALL mothers ALL information to keep their baby safe. We need to stop thinking that information causes anxiety… it doesn’t it empowers women… BUT even if it did there is no way a little anxiety is worse than a lifetime of grieving a stillborn baby. Let’s trust and empower pregnant women and give them the information they need. Can we start today please?