Debrief me 

Like most parents of premature babies, I’ve been desperate for answers to my situation. I couldn’t comprehend how I had gone from heading into hospital for my third reduced movements scan (which I rationalised as my usual tendency to panic about everything) to suddenly being kept in hospital, learning that I couldn’t go home until my baby was born. At 7 months pregnant.

For the 5 days that I remained in hospital before L’s delivery, I constantly received different interpretations of my situation. In a matter of hours, doctors would fluctuate from deciding I would have a c-section within half an hour to discharging me as the baby had stabilised. It was, and remains, a difficult situation to get my head around. From what I could grasp, my baby was too small and was not getting nutrients from my placenta (a condition called absent end diastolic flow). There was nothing that I could have done. Google was my friend, the scant amount of references to absent edf that I could find reassured me that it wasn’t my fault. But my baby had been fine two weeks early at my 28 week scan. Surely I had done something to harm him.

So I sought answers. I have had three debriefs since L’s arrival five months ago, two of which happened while I was still on the postnatal ward. I suffered from extreme anxiety following my c-section (unsurprisingly) and the midwives arranged a debrief for me. Someone who seemed to be a senior midwife arrived in my room. I talked through my worries and mentioned how traumatised I was from the treatment I received the night before L’s delivery. But I wasn’t seeking to complain, I simply wanted answers. The midwife was extremely abrupt with me, spending our session defending the actions of the midwife in question and trivialising my behaviour on that night (where I could not tolerate an IV drip as I had an extreme reaction). She spent around 20 minutes with me and left me a sobbing mess, making me feel even more guilty.

I conveyed my disappointment to the midwives; it was pretty clear to see, as I spent all my time on the ward in tears (when I wasn’t hobbling down to NICU of course). They scheduled a session with someone they called ‘MoM’ which I understand is the manager of midwives. She was absolutely incredible. The MoM spent over 90 minutes with me, reading every single page of my maternity notes and checking if there was anything I wanted to discuss from each appointment or incident. She apologised for the treatment I had received the night in question, which meant a lot. But most importantly, she explained as much as she could about absent edf. She had never encountered it during her time as a community midwife. I was unusual and extremely unlucky. Or lucky, in her view, that I had trusted my instincts and reported to hospital. I felt as though a weight had been lifted, finally.

But as time went on and I witnessed L go through numerous medical procedures, guilt crept back into my conscience. I needed an explanation from the consultant who made the final decision to deliver my baby early. The last time I had seen my consultant, I was hooked up to the CTG monitors after a night of no sleep and starved for a possible c-section. The last thing she told me was that my baby had a 10% chance of dying during the surgery. I was pleasantly surprised by how easy it was to arrange a debrief; I called her secretary and a few weeks later I received an outpatient appointment for Antenatal Clinic. For some reason, I still needed my blood pressure taken on the day (120/74, go me).

The consultant explained my situation with excellent clarity. I had suffered placental insuffiency, which had led to the absent end diastolic flow. As a result, L had become severely growth restricted (IUGR). The results from my placental analysis confirmed that it was infarcted. The placenta hadn’t been able to cope with L growing any further. He probably stopped growing sometime after my 28 week growth scan. I had reported the reduced movements at just the right time to save L’s life.

The consultant couldn’t explain why this had happened to me. I didn’t smoke, I wasn’t too young or old and I wasn’t overweight. My only risk factor was a first time pregnancy. But not all mums end up with their first born in NICU! My risk of subsequent placental insuffiency is increased compared to the general population, but the consultant thought it was unlikely a future baby would be so severely growth restricted. Interestingly, she said my chances would be increased if I had a baby with a different father (which is obviously the case). Apparently the body tolerates subsequent pregnancies with the same biological father in a better way.

I left the debrief with the knowledge that my stress and worry during the pregnancy didn’t cause L’s prematurity. If I fall pregnant again, I’ll be put on a course of aspirin. But I can’t help thinking my second baby will also be a NICU baby too.

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