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Thursday, November 4, 2010

Amniotic Fluid Embolism, what are the risks?

It is so sad. The story of a new mother dying right after her child is born is enough to make anyone weep.  When I read these stories I cringe and feel so horrible for these poor families.  Back in April I wrote about the tragic story of Julie Welsh and I strongly suspected then that she had died from an Amniotic Fluid Embolism, but in a news story today, that suspicion was confirmed.   The news article says that this is a rare "allergic reaction" that happens when the baby's amniotic fluid somehow is absorbed in to the mothers blood stream- the statistics show this affects only 18 in a million women.  Yes it's rare, but not rare enough.

The Mail Online writes:

Mother, 28, dies moments after being handed her newborn baby due to rare allergic reaction

Julie Welsh suffered a cardiac arrest when the fluid surrounding her son in the womb seeped into her blood stream and caused an allergic reaction. Her partner Peter Brown (also pictured) was at her side
Julie Welsh suffered a cardiac arrest when the fluid surrounding her son in the womb seeped into her blood stream and caused an allergic reaction. Her partner Peter Brown (also pictured) was at her side
A new mother died just seconds after giving birth after suffering from a condition so rare that hospital doctors had never encountered it before.
Julie Welsh only had enough time to hold and kiss her newborn son before she suddenly fell unconscious.
Her distraught fiance Pete Brown looked on as medics battled for an hour-and-a-half to revive her but was left devastated when their best efforts failed.
Their son Isaac had been born just 20 seconds before his mother suffered a fatal amniotic fluid embolism, an inquest heard.
The condition is so rare most doctors never encounter it in their professional careers.

Miss Welsh fell unconscious shortly after holding her son for what would be the first and last time
Mr Brown wept as he told Derby and South Derbyshire coroner Dr Robert Hunter how 28-year-old Miss Welsh had kissed baby Isaac moments before suffering a cardiac arrest.
Fluid surrounding her son in the womb had entered her blood stream and caused an allergic reaction which affects only 18 in a million women. In up to 80 per cent of cases, the condition is fatal."
HERE to read the entire article
One of the main causes of Amniotic Fluid Embolism is chemical inductions.   While the news story does not state that the mother Julie Welsh had been induced, I hypothesize that she probably was:
"However, by 10.35pm  Miss Welsh had not dilated despite many hours in labour and the decision was made to carry out a Caesarean section as the baby was in distress."
Anyone familiar with Labour & Delivery wards will attest to the fact that the first thing medical staff do when a labour is not progressing is to induce active labour with chemical Pitocin.  
One of the most infuriating aspects of chemical inductions is the fact that full disclosure of all the risks and dangers of this (and many many other) medical interventions used during labour and birth is very VERY rarely given.  Was this poor family told that there was a risk of Amniotic Fluid Embolism?  Were they told about all the other risks- to both mother and baby?!   I honestly believe that most people, if they were fully informed of the dangers, would chose to NOT risk it.
Unfortunately so many women and families refuse to believe that there are risks involved and refuse to educate themselves about the risks vs benefits of medical interventions that are so commonly used.  Our society has become very cavalier about it.  Inductions are now so common place that people don't think twice about asking "So when are they going to induce you?" as if it were a trip to the beauty parlor to have your nails done.

Read.  Research.  Inform yourself and spread the word to others so that they can maybe realize that Inductions are not manicures.  Even the manufacturers of the inductions drugs themselves openly admit that they can have catastrophic consequences:
Pitocin Inj

Monograph - Oxytocin
•Adverse Effects

When oxytocin is administered in excessive dosage, with abortifacients or to sensitive patients, hyperstimulation of the uterus, with strong (hypertonic) and/or prolonged (tetanic) contractions, or a resting uterine tone of 15–20 mm H2O between contractions may occur, possibly resulting in uterine rupture, cervical and vaginal lacerations, postpartum hemorrhage, abruptio placentae, impaired uterine blood flow, amniotic fluid embolism, and fetal trauma including intracranial hemorrhage. Increased uterine motility also may cause adverse fetal effects, including sinus bradycardia, tachycardia, premature ventricular complexes and other arrhythmias, permanent CNS or brain damage, and death secondary to asphyxia. Excessive maternal dosage or administration of the drug to sensitive women also can cause uteroplacental hypoperfusion and variable deceleration of fetal heart rate, fetal hypoxia, perinatal hepatic necrosis, and fetal hypercapnia. Rare incidents of pelvic hematoma have been reported, but these were probably also related to the high incidence of operative vaginal deliveries in primiparas, the fragility of engorged pelvic veins (especially if varicosed), and faulty episiotomy repair.When large amounts of oxytocin are administered, severe decreases in maternal systolic and diastolic blood pressure, increases in heart rate, systemic venous return and cardiac output, and arrhythmia may occur; these effects may be particularly hazardous to patients with valvular heart disease and those receiving spinal and epidural anesthesia.
Postpartum bleeding may be increased by administration of oxytocin; this effect may be related to reports of oxytocin-induced thrombocytopenia, afibrinogenemia, and hypoprothrombinemia. By carefully controlling delivery, the incidence of postpartum bleeding may be minimized.
Nausea, vomiting, maternal sinus bradycardia, and premature ventricular complexes reported in patients receiving oxytocin are probably related to labor and not the drug. The risk of neonatal hyperbilirubinemia appears to be about 1.6 times greater following oxytocin-induced labor than that following spontaneous labor, and neonatal jaundice has occurred. Other adverse neonatal effects from oxytocin-induced labor include retinal hemorrhage and low Apgar scores at 5 minutes.
Severe water intoxication with seizures, coma, and death has been reported following prolonged IV infusion of oxytocin with an excessive volume of fluid. Neonatal seizures also have been reported. Injudicious use of oxytocin has also resulted in maternal deaths secondary to hypertensive episodes and subarachnoid hemorrhage.

HERE to read the entire monograph

Like a broken record I repeat my self:   Take responsibility for your life and health.  DO the research.  ASK the questions. 
Even if the risk is so small, do you really want to take the chance of being the one tiny statistic?  Medical inductions do save lives and can be necessary..... but not in EVERY birth.