Mothers who deliver prematurely face serious health risks that are often neglected when we talk about prematurity. Today, in honor of Savita Halappanavar’s death from sepsis that was a direct result of her previable premature delivery, I would like to let the world in on the physical perils faced by mothers who deliver prematurely.
Many of us have infections. We rupture our membranes prematurely, and for 40% of us that means bacteria will race up into the uterus. For others, the infection is more stealth and manages to bypass the defense mechanisms of intact membranes and cervical mucous. Regardless, we must be delivered as the infection can only get worse. These infections cause the uterus to contract poorly, so we may hemorrhage at delivery. As 50% of premature deliveries are c-sections, our abdomens and infected uteri are often cut open to save our lives, the irony that infection and a surgical wound is a terrible combination. We drag ourselves to the NICU, desperately trying to pump milk, or even just touch our babies, despite the agony of an infected wound. Our incisions break open, requiring painful dressing changes twice a day. The infection leaves us weak, our recoveries prolonged. Sepsis, the worst possible infectious outcome, happens 1% of the time. We pass in and out of consciousness, our fevers spike to incredible heights, or even more ominously our temperature drops. Because we are young and healthy we look fairly well until we are so sick that we are literally on death’s door. For some, treatment comes too late, and for others the infection simply defies modern medicine.
Many of us are on prolonged bed rest, risking potentially life threatening blood clots during our pregnancies or immediately after delivery.
Some preemie moms have severe medical conditions, such as high blood pressure, heart disease, diabetes, necessitating a premature delivery as their health has been ravaged by their pregnancy. A few of these conditions seem designed by the Devil himself as they only really come out to “play” during pregnancy. And in yet another cruel twist, every intervention is more risky for a woman whose health has declined enough to need a premature delivery.
There are the preemie moms with severe preeclampsia, a condition where the blood pressure gets perilously out of control, risking stroke, severe brain swelling, and seizures for mom and decreased blood flow for her baby. Some women need a premature delivery to save their babies, but for many it is to save their own lives. I remember looking at a the brain MRI of a young mom with severe preeclampsia who I had delivered very prematurely. The radiologist, after spending a very long time looking at the carnage in her occipital lobes, whispered, “Can she see?”
Then there are the medications that we take. Magnesium sulfate to try to give our babies neuroprotection. Imagine, just for a minute, how it feels to be told you are being given a medication to try to protect your baby’s brain? This medication makes you feel terrible, you may pass in and out of consciousness, and, if not monitored properly, can cause respiratory arrest and death. Then of course there are other medications. Antibiotics, injections to prevent blood clots, injections to help a baby’s lungs mature, and medications to try and stop a uterus hell bent on contracting. It’s a twisted Hallowe’en grab bag of almost poisons.
There is also bleeding. Lots of it. An infected uterus contracts poorly and so many of us hemorrhage uncontrollably during our c-sections or vaginal deliveries. Women with preclampsia, placental abruption (a condition where the placenta peels away from the wall of the uterus), and severe infections can all lose the ability to clot their own blood. Blood transfusions, heroic intervention, and emergent hysterectomies may be needed. Sometimes nothing in a surgeon’s arsenal can stop the bleeding.
There is a reason that high-risk obstetrical units have intensive care units and a reason why they are disproportionately filled with mothers who have literally given everything they have for their baby.
We need to reduce prematurity not just for the babies, we have to save the mothers as well.