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

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. 

Global MOMS Act

	Tell Congress: No women should die during childbirth. Urge your Representative to co-sponsor the Global MOMS Act today!

		Hundreds of thousands of women die each year from pregnancy-related complications. The vast majority of these deaths are unnecessary and preventable, caused by a lack of access to timely, quality health care. The Global MOMS Act, supported by Amnesty International USA, will have a lifesaving impact. In some countries, it truly could mean the difference between life and death for a woman. Urge your Member of Congress to co-sponsor the Global MOMS Act. The Global MOMS Act will support activities that help expand access to better quality maternal health services, remove barriers to such services, and ensure that they meet international human rights standards.
		Women dying during pregnancy and childbirth is not just a public health emergency, it is also a human rights crisis. Amnesty International has identified obstacles to lifesaving treatment faced by pregnant women around the world. In Peru, poor, rural and indigenous women face language barriers and too few accessible clinics. In Burkina Faso, women die because they cannot reach a health facility capable of treating them or because they arrive too late. Two years ago, the U.S. House of Representatives passed a resolution affirming "commitment to promoting maternal health and child survival both at home and abroad through greater international investment and participation." It's time to match commitment with action. The lives of millions of  women are at stake. Tell your Representative to co-sponsor the Global MOMS Act today! Thank you for joining our cause. In solidarity, Daphne Jayasinghe Advocacy Director, Women's Human Rights Amnesty International USA

Everything you NEED to know about pitocin!!

Any of my regular readers know that I have  a serious dislike of chemical inductions used to try to kick start a womans labour. The evils of Misoprostle/Cytotec are well known (thought still used extensively), and while there are many studies coming out that are linking medical inductions to serious side effects and consequences (like an exponential increase in the risk of having a caesarean section with all the extra risks that come with THAT), until I read this article, I had no idea of the actual risk associated with the Pitocin drug itself!

Any woman who is being threatened with an induced labour by her care provider- hell, every woman in general!  - should read this article.  Here lies the Pit of despair!!!

Pit of Despair

Pitocin – a very useful drug that improved obstetrics and gave us options to help women in ways we weren’t able to before!
Pitocin – a very seductive drug that changed obstetrics, increasing risks to mothers and babies in ways that are often not even taken into consideration.
Both of these statements are true – how can that be?  I will do my best to explain this complex issue in a simple and straight forward way.  Be warned…much of what you are about to read will probably be new to you because these are the things that aren’t being talked about!
I already did a previous blog post on inducing labor and some of the risks/benefits associated with the decision to induce, so I do not want to rehash that once again.  The decision to induce is one thing (and a decision that is not to be taken lightly), but what about once the decision is made?
I’m going to simply focus on Pitocin.

Pitocin is a drug used to induce or augment labors here in the US.  It is most often given via IV infusion, although immediately postpartum if an IV isn’t already in place it may be given as an intramuscular injection.  It was created for the first time in 1953 and became available just 2 years later.  Mothering magazine writes, “A survey by Robbie Davis-Floyd, a cultural anthropologist at the University of Texas, found that 81 percent of women in US hospitals receive Pitocin either to induce or augment their labors.”  It has been said that only 3% medically require it....

The author goes on to discuss the difference between natural Oxytocin that our bodies produce and the chemically derived pitocin given in hospitals.  This point really hit home to me:

Preparing fetal neurons for delivery. Crossing the placenta, maternal oxytocin reaches the fetal brain and induces a switch in the action of neurotransmitter GABA from excitatory to inhibitory on fetal cortical neurons. This silences the fetal brain for the period of delivery and reduces its vulnerability to hypoxic damage.

 But the real shocker for me was reading the list if side effects associated with Pitocin- not just the risks of artificially inducing a mother before her babe is ready- but the dangers of the drug itself!!!

WHAT ABOUT SIDE EFFECTS OF PITOCIN?

So many people are given Pitocin without ever hearing a single risk or side effect other than, “it can cause too strong of contractions…but if it does that we’ll just turn it down or off.”
Lets see what rxlist.com has to say (you have to go to PAGE 3):
“The following adverse reactions have been reported in the mother:
Anaphylactic reaction
Postpartum hemorrhage
Cardiac arrhythmia
Fatal afibrinogenemia
Hypertensive episodes
Nausea
Vomiting
Premature ventricular contractions
Pelvic hematoma
Subarachnoid hemorrhage
Hypertensive episodes
Rupture of the uterus
Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.
The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.
Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.
The following adverse reactions have been reported in the fetus or neonate:
Due to induced uterine motility:
Bradycardia
Premature ventricular contractions and other arrhythmias
Permanent CNS or brain damage
Fetal death
Neonatal seizures have been reported with the use of Pitocin.
Due to use of oxytocin in the mother:
Low Apgar scores at five minutes
Neonatal jaundice
Neonatal retinal hemorrhage”
Now is when you get angry when you realize that you were given this drug without any discussion whatsoever of these side effects and risks.

....This is such a complex game of Russian roulette that we are playing, and there are a lot more bullets in the gun than we are being told.  There are definitely times when we should thank our lucky stars that Pitocin has been created and it has saved moms and babies from undergoing cesareans or from having other complications such as postpartum hemorrhage which is a common cause of DEATH in lesser developed countries…but it is NOT the same thing as just encouraging your body to do it!  Rather than fixing the problem of stalled labor by acknowledging the relationship between the mind and body and baby and working within it’s natural balance, we resort to trying to put a bandaid on it and don’t even stop to ask what kinds of problems covering the wound might cause.
My solution?  Start by recognizing that our bodies are much more complex than we are acting like they are.  Recognize that labor and birth is a whole body experience, not just a uterine experience.   Treat the cause of the stalled labor, not just the uterus, and give this mom and baby ample time to both start and complete this process.  Making her feel safe, nurtured, secure, able to be vulnerable and relaxed and free….carries a heck of a lot less risks than Pitocin does.

HERE to read the entire article on the Nuturing Hearts Birth Services site