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Why was I not warned about the dangers of my high risk labour?

Originally published in Lay It Out Magazine:

Ten weeks ago I experienced by far the most painful, and scariest, moment of my life. Of course, you expect childbirth to be painful. That was a given. After a draining nine months, I finally went into labour only to be told that what had been a relatively normal, low risk pregnancy could actually be quite dangerous for me and my daughter.

I had been in labour for eight hours when the midwives came to my house to examine me. Before they could, they skimmed through my maternity notes and quickly pointed out that my child had an isolated single umbilical artery (iSUA), which could lead to a length of complications during my labour. Now, I was in pain and anxious. How would my baby cope throughout their birth? I was also hit with a rush of confusion as to why I hadn’t been made aware of these complications at an earlier stage, but mostly I was angry. 

What is an isolated single umbilical artery?

This is a slight malformation of the umbilical cord where there is only one artery instead of two. My partner and I were told about this at our first scan at 12 weeks of gestation, but we were assured that it wouldn’t be an issue.

At the time, I questioned. If it wasn’t an issue, why were we told about it being an abnormality? I basically ran to Google as soon as we left the hospital. There wasn’t a NHS page about iSUA, but there was tons of information associating it with chromosomal anomalies such as Down Syndrome and Edward’s Syndrome.


Suddenly, the panic hit. Only six years ago my mother lost a pregnancy due to Edward’s Syndrome… Could it be genetic? I was overrun with anxiety for a few weeks so decided to book a specialist abnormality scan. Thankfully, we were told there were no other issues.


For my subsequent NHS scans, the iSUA seemed to not be an issue. My baby was healthy and measured at a decent weight. It was only when I was in labour that I was, once again, struck with fear around my child’s health.

The right to choice during pregnancy and labour

My partner and I had longer for a baby and could not wait to meet them. I thought about how and where I’d like to give birth for a long time, but eventually I decided that I wanted to give birth at home - if medically advisable. I remember mentioning this at our eight week booking appointment with the community midwife.


As this was my first child, I was slightly hesitant to how my midwifery team would react to the suggestion of a home birth. To my surprise, all my midwives were unusually supportive, and actually encouraged a home birth. 


Despite their positivity, it was made clear that this all depended on whether my pregnancy and labour was deemed low risk. In the UK, a pregnant person has the right to choice during their pregnancy and labour, which includes choice over place of birth.


Most NHS trusts will automatically assume that a pregnant person wants to give birth in a hospital, but there is always a choice. Even in pregnancies that are deemed of a higher risk, where it is recommended to birth in a hospital, the pregnant individual has the final say. 


Alongside this, health care professionals have a duty of care to ensure pregnant people are given all the relevant information regarding their pregnancy in order for you to make informed decisions about your choices in pregnancy, birth and postnatally. This includes the implications of any medical diagnosis and therefore the risks and benefits to consider when choosing where and how to give birth. 


The UK-based charity Birthrights advocate for greater communication and understanding of these rights to those who are pregnant. Meanwhile, Birthrights will aid pregnant people in acting upon their rights and choices. 


Weighing up potential risks during labour


For me, I was happy to listen to the medical advice given to me throughout my pregnancy and beyond. Just four weeks before my due date, I sat down with my community midwife again to formally discuss my birthing preferences. 


As expected, I was deemed low risk and my midwife saw no issues with me birthing at home. Nonetheless, I was told that another midwife would need to double check this by performing a visit to my home. This was a midwife who had never met myself as my healthcare notes needed to be checked over by ‘fresh eyes’. When this midwife visited my partner and I, she too saw no problem with my pregnancy or labour. 


Despite having all this signed off and ready to go, I still wasn’t sure how my labour would pan out. I think you know that childbirth is potentially unexpected and may not go the way you’ve planned. That being said, I didn’t expect to end up in the hospital so quickly. Midwives were called to my home around 9am. 


In the nicest way possible, they explained to me the risks of birthing anywhere with an iSUA, let alone at home. All of a sudden my child was at risk of losing blood supply which could in turn make their heart rate drop. I was grateful for their information, but stressed out, scared and still contracting. Clearly, it wasn’t a safe situation to carry on at home.


As I made my way into the hospital I felt so emotional. Of course, I was in labour. But, it was more than that. I felt let down. 


Why is there a lack of knowledge about traumatising foetal anomalies?


While there is little to no information surrounding SUA in the UK, there has been research conducted abroad that highlights the risks. In 2019 a Norwegian study found the presence of an isolated SUA accounted for a more than five times increased risk of both intrauterine and prenatal death. Babies born with an isolated SUA were also more likely to be born prematurely or have a low birth rate.


As a result of these adverse risks, the research suggests that all pregnancies with an iSUA should be closely monitored in the third trimester. Likewise, pregnant people should be made aware of the potential complications that could occur during active labour, such as a lack of oxygen and blood flow to the baby and a drop in their heart rate. 


This is exactly what happened during the latter stages of my labour. My daughter’s heart rate started to plummet which meant she, and I, had to be monitored continuously throughout the labour and our stay in hospital. My entire birth plan went out the window as soon as we entered the hospital. I was strapped to the bed for the whole labour. No walking, no upright positions and no birth pool. I was trapped lying on my back on a hospital bed with machines attached to me.


Don’t get me wrong - I was happy to listen to the medical advice given to me. BUT, I had been told about the iSUA at my 12 week ultrasound. I was also told it wouldn’t be any worry and that it wouldn’t impact my child or labour. They were wrong. My child was at risk. My child was distressed during labour. Her heart rate did drop. She did have a low birth weight, especially for a baby who was overdue.

I was let down by health care professionals


Since my daughter’s birth I’ve had so many questions as to why I was led to believe that my pregnancy and labour was low risk when it was not. I knew that I had to raise my concerns with my NHS Trust, but I was unsure of where to begin. After reaching out to Birthrights, I was directed to the Patient Advice and Liaison Service (PALS). PALS helped me submit a formal complaint as well as arrange a one-to-one meeting with a senior member of management from my Trust.

I’m not usually one to complain, but I felt I needed to. In the end, my labour was traumatising - so much so that another child is completely off the table. I feel let down by the health care professionals that cared for me during my pregnancy as my labour could have been extremely dangerous for us both. 

I am so thankful to the midwives who told me of the dangers of birthing with an iSUA, but I wonder what could have happened had I not been told. How bad could my labour have been? Then I wonder, how many other pregnant people had similar experiences to myself. As I await so many answers I am so grateful that my daughter, and myself, are well. But, our health does not disregard the level of carelessness, inattention and irresponsibility I still feel from healthcare professionals. 


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