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Am I anti-hospital?

I think sometimes it's assumed I am, and to be fair, sometimes I might come across that way. But I'm truly not anti-hospital. I believe hospitals play a VERY important role in society generally, and also in maternity care.


What I AM anti is:

fear-based decision making

forcing women to birth in hospital when they don't want to but have no other option if they want clinical support to birth

misinformation

cultural norms being perpetuated as the best or safest when evidence says otherwise

other people projecting their fears onto women who are making decisions different to what they would


medicare funding models that don't well support a woman's ability to change care providers or care models at any time in pregnancy

presenting clinical recommendations as introductions to follow rather than as something someone can choose to do

treating guidelines as laws rather than a frame of reference to assist with making clinical recommendations (almost like... a guide...)

among plenty of other things!


Look, I have given birth to both of my babies in hospital. It wasn't my first choice the second time around, but that doesn't mean I didn't go there when I felt there was a need to.


One of the struggles I have with hospitals is knowing whether I'll be heard or not, because when I am going to a hospital, it's because I've determined I actually need the skills, expertise and STUFF they have that I don't. If I'm in a hospital, I need the people who work there to listen to my concerns and respond appropriately and in a timely manner. And this matters to me so much more than ever after this year, when I find myself needing to put my faith in a system I'm not sure I have good faith in.


Earlier this year, I fell very ill very suddenly - over the course of about six hours I went from healthy and completely fine to feeling like something was really not right and that I needed to get to hospital.


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I was so deeply unwell that I had trouble explaining exactly what was going on and what I was feeling when I was being triaged. After about 90mins in the waiting room feeling progressively worse, I was brought in to speak with a doctor who told me they had the impression I likely had a kidney stone and that she'd get me set up for some morphine and a CT scan to confirm.

She put a cannula in, got me up on a bed, and checked my blood pressure. 90/52 with o2 sats at 94%. I watched her manner change as her face turned stony, and she quickly tried a different cuff to make sure the numbers were correct. They were lower again, and suddenly I was being laid all the way down, nurses and support staff bustled in and barely eight hours after my first symptom of illness (a sudden high temp) I was pushed down the corridor into a resus bay. Things happened faster from here - more cannulas were in, drugs were running through them, my blood pressure was still dropping - down to 60/30 at its worst - yet I was oddly feeling more at ease seeing a response that seemed more in accordance with how badly I was feeling.


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I was in and out of consciousness and at one point when I'd come to, I overheard a doctor above me say "septic shock". It made no sense to me. I knew what sepsis, and septic shock, was, but I also 'knew' that it was something old people got when they were already sick AND it was something that had a high mortality rate. So it made no sense that I could be in septic shock when that very morning I'd woken up well. And I had kids at home - dying was simply not an option for me.


I needed to be transferred via ambulance to be admitted to an ICU, as the hospital I'd presented to didn't have one. But they had to stabilise me enough for the trip, and that took some time. I experienced agonising pain where the cannula in my left arm was and caused the doctors no end of frustration when they checked and doubled checked it, telling me it was perfectly placed and nothing was wrong, that the medication running through it wouldn't be causing pain - if anything the medication in my right arm would more likely be hurting.


Sure, on physical exam, everything looks perfect, but what is your patient telling you? The worst part of this entire experience for me is still the two hours I spent crying, yelling and begging them to help me fix the pain in my arm. I honestly would've accepted an offer of amputation, at my most desperate.

After a couple of hours, having simply had enough of listening to me, I'm sure, one of the doctors sighed and said to me "the only thing I can offer is to put in a central line instead. It has to go in through your groin, it isn't quick, and it can hurt a lot. But if you want, I'll do it".


I begged him to do it. I was almost crying with relief that there was a light at the end of the tunnel.

The doctor shook his head slightly, sighed again and said "Alright, then." The pain in my arm was so great that I hardly registered the burn of the local anaesthetic needle he used to prep me and within a few minutes, it was done.

He made a big deal of showing me with an ultrasound how the needle of my cannula was in the right place, before he finally removed it, as though that somehow proved that I was wrong about my pain. He checked my arm after removing it and said there was no bruising or anything. I could see that myself. But the pain was also gone.

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Truly, it was the worst part of the whole experience, and it was mostly due to the fact that there was something wrong with me and it was causing me significant distress, and I was being told I was wrong. I understood them and believed them when they told me it was in right and nothing was wrong with it, it's not that I thought they were lying to me, but it didn't change the fact that I was still in excruciating pain. And that I couldn't do anything about that, but I needed them to. They couldn't treat my pain with anything much more than paracetamol because my blood pressure was so low, and again, I totally understood that. They needed an extra cannula in that arm because they were running so many different drugs at that time to keep me alive - I understood that too. What I couldn't and still don't understand is why the offer to put in a central line was only given after hours of suffering. I realise a central line is riskier than a cannula in my elbow crook, and the process of putting it in can be tricky and painful, but that should have been given to me as an alternative from the start when I was complaining of such extreme pain rather than just repeatedly reassuring me that the cannula shouldn't be causing pain.


(For those interested, on reflection, I think the pain was actually due to blood pooling because my blood pressure was so low and I wasn't moving my arms at all - once I could move that arm around with the cannula out, the pain subsided. The other arm was at a different angle, which is why that one wasn't hurting. I mean it when I say that I believe them that there was nothing wrong with the cannula - but that didn't mean my pain wasn't also real and extreme)


At about 6am, an ambulance arrived to take me to ICU, escorted by one of the emergency room nurses. I feel I was lucky to be transported to a hospital that had recently had significant renovations, including a brand new ICU which was light, airy and fairly quiet. I had a lovely nurse looking after me who was quick to organise everything I needed, from calling my husband and mum to let them know where I was after I said I wasn't sure that either had been kept up to date, to getting their maternity ward to loan me a breast pump. She encouraged me to get someone to bring the baby to visit so that she could feed, as well. She, and all of the nurses I had in ICU, were just brilliant. They looked after me so well.


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A few hours after I'd arrived there, an infectious disease specialist came in and gave me the lowdown. My blood cultures showed I'd been infected with a pneumococcus bacteria, one that generally only caused mild symptoms and sometimes ear infections in kids. But, my bloods along with my CT (which they did manage to get done at some point over the night, still certain I had something happening with my kidneys) also told them another key piece of information: I didn't have a spleen.


So what, right? You can live without the spleen, I know this because Baby Sitter's Lister Sister book series protagonist, Karen, once fell out of her treehouse and ruptured her spleen. She went to hospital where they removed it and assured her of the very fact that she could safely live without it. I recall it still today, at least 20 years after reading it, because it was of the most exciting stories of the series!


As it turns out, yes indeed, you can live without your spleen, no worries there, but you become highly vulnerable to serious and sudden, life threatening infection. One of the spleen's most important roles is sifting rubbish from the blood - including, most importantly, bacteria. Without it, it's concerningly easy to end up with a blood infection, also known as sepsis.


The recommendation from the doctors (which was simply based on guidelines) was to take prophylactic antibiotics for three years while undergoing a new schedule of vaccinations which would given me greater protection from some of the more problematic bacteria, like the pneumococcus. When I asked about alternatives and other options, they looked at me blankly and just repeated "this is what we recommend". Thankfully, a follow up phone call with the infection disease specialist who I first saw in ICU was a lot more helpful and she definitely understood my concerns. She reminded me (which I appreciated so much, because it's something that I say all the time!) that the guidelines are always going to be risk-averse and therefore not always appropriate for everyone depending on how they feel about their individual risk. She was quite happy for me to do what I had proposed, which was undergo the vaccination schedule, leave the prophylactic antibiotics, but keep an emergency packet with me and if I ever develop a fever, I take four tablets and head straight to hospital (or a GP if time permits).


So that's my life now. Just last week I found myself in hospital for a 24 hour stay after developing a fever. I had IV antibiotics overnight while they screened my blood and swabs and eventually determined that I might have a UTI if I had other symptoms of it (which I didn't) but it was marked as high likelihood for contamination, but I definitely had adenovirus. Adenovirus made much more sense, as I had other cold virus symptoms. Once they were able to identify that I was sick with a virus and that my infection makers were not jumping, I was free to go home and rest.


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I'm fortunate that I'm not a person who gets a lot of fevers, thankfully, despite the fact that I get sick all the time thanks to having two little kids in daycare. So in over six months since I had sepsis, last week was the first time I needed to attend hospital. It means I'm still going to end up having a lot of antibiotics unnecessarily, but given that the mortality rate of sepsis is about 1 in 3, and septic shock is basically 1 in 2, that is the risk I have accepted to avoid becoming septic again. However, I still feel that not taking daily antibiotics is a win and the risk of not doing so is one that I have determined to be acceptable for me.


So, no... I'm not anti-hospital. Like many, I can't afford to be anti-hospital even if I wanted to be. But I do want hospitals to be available when I need them, and for that, we need public hospitals to function. If all women had the choice to birth at home through a publicly-funded model, it could save money that could better be spent on providing adequate ratios for nurses, for example, among plenty of other things. Just a thought.


 

My name is Katelyn Commerford and I am a doula and next birth after caesarean guide who has completed comprehensive doula education. If you want to know more about what I do and how I can help you, please visit my website where you can get your free cheat sheet of my favourite VBAC resources, or find me on instagram @thenbacguide where I answer commonly asked questions about planning the next birth after caesarean and share loads pregnancy, birth, postpartum and parenting content.

Katelyn Commerford - Doula and NBAC Guide

Phone: 0431 369 352

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