AIMS Journal 2002, Vol 14, No 3
by Laura Abbott
There are 20,000 ectopic pregnancies a year in the UK alone. This is more than double the cases of cervical cancer. Laura Abbott, an independent midwife, writes of her experience of 'care' during a traumatic ectopic pregnancy.
My partner and I had been trying to conceive for over three years when we discovered I was pregnant with the help of fertility treatment. We were delighted and began to talk of the hopes and dreams that we had been too frightened to share over the years because of the constant disappointment of not getting pregnant.
I was five-and-a-half weeks pregnant when I had some slight spotting. I wasn't worried about this as I had the same experience with my son seven years ago. However, when I began to have one-sided pain a day later, I became slightly concerned as I knew that this could be a sign of an ectopic pregnancy. I hadn't planned on seeing anyone but a midwife during pregnancy, but knew that I needed to rule out the chance of an ectopic. Being a midwife myself, I felt that I might be being oversensitive to early pregnancy symptoms, but thought I should check it out just to be on the safe side. My GP was great: "You know the procedure," he said and off to casualty I went.
I was seen in casualty after the ubiquitous three-hour wait. My pregnancy test was positive and a beta-HCG test was taken. I was then sent home, still in pain and worrying about the next morning, when I was to return for a scan.
Little did I know that the nightmare was just beginning in a hospital I knew and trusted, where I had worked as a nurse and where I had done my midwifery training.
I sat waiting with the other women in a corridor. There I was with my husband, nervous, scared and worried about the scan. I knew something was wrong and the pain hadn't ceased. "You're the midwife, aren't you?" I heard the nurse say to a woman a few feet from me. "No," she said. The nurse insisted, "But it says in your notes Laura Abbott". "That's not me," said the woman, sounding annoyed. I pipe up then, "I think you mean me." "Oh, so you're the midwife." "Yes," I say sheepishly, as now all the other 'scan women' are looking at me. The where-do-you-work conversation ensued and I politely, but bluntly, gave one word answers. At that moment, the last thing on my mind was my midwifery, and now that the whole waiting room knew what my job was, I felt very uncomfortable.
I was called for my scan. "Nothing in your uterus. Take a seat outside." Tears were choking me, but I couldn't let them out as the other women in the waiting area were all looking at 'the midwife' to see any signs of disaster. I knew then that the baby was in my tube and not in my uterus, and that it meant I would have to be admitted.
After another long wait, now in a cubicle, a consultant came to see me. I was a midwife after all and this was the honour that health professionals receive. Prior to this, I had prepped my shocked husband that I would be admitted to hospital and had asked him not to worry - they would probably do a laparoscopy that day because of the dangers of ectopics. We had even sat and written out a list of things I would need for my hospital stay. I was prepared for the worst.
The consultant came in and, once again, the midwifery conversation ensued, "Oh, an independent midwife. Why don't you want to work in the NHS?" Midwifery was far from my mind at that moment. I was frightened, dreadfully disappointed, but had a stoic face on due to not wanting to let the professional side of me down. I told the consultant that I felt this pregnancy was ectopic-given my history of infertility and my symptoms. I assured him that I was sure of my dates, which he disputed. I knew I was six weeks pregnant, and I knew when I ovulated as any woman does when she has been trying for a baby for such a long time. He felt I couldn't be more than four weeks pregnant. His opinion was that I must have ovulated later.
The consultant proceeded to tell me that I would be in much more pain if it was an ectopic and that it was probably a urinary infection. I didn't think it was, but this was the little bit of hope we clung onto. We wanted this baby so badly and for someone to reassure us that it was all okay was good enough for my non-medical husband and for me.
So home we went again for the second time. I remember speaking to Jane, my midwife partner in our independent practice, and telling her that if it's not in my uterus, then where the @*$! is it? Jane told me about a website that was all about ectopic pregnancies. We looked at it and, yes, I had the symptoms, but I had been sent home. A consultant wouldn't do that if there was any risk, surely. The pain continued as before. I went through the night and the next day. The spotting continued and so did the one-sided pain, but it was no worse (nor any better) than before.
That evening, Graham and I were meant to be going out with friends. My son was at his father's. I felt like staying in so I ordered a curry for myself while they sent out. I ate my dinner and then went upstairs to get something. I started to bleed-not heavily, but the colour was like prune juice, just like the Ectopic Pregnancy Trust website had described. I began to feel very dizzy and faint, and fell on the floor, finding it hard to breathe.
I managed to get to the phone and rang Jane, who immediately rang an ambulance for me. I thought I was dying. I was dizzy and felt as though my life was over-no golden light or angels visiting, just pure fear. I couldn't breathe and I was slipping away. The paramedic arrived, gave me oxygen and shipped me to my nearest A&E. My husband had come back and followed behind. I was quickly seen and scanned again-no pregnancy in the uterus, fluid in the pouch of Douglas. They had to take me to the operating theatre. I was anaesthetised with cricoid pressure because I had eaten, and operated on. I was numb and thought I was going to die. I felt nothing, and thinking would have caused me too much pain. How could I think about my precious seven-year-old without a mother?
When I came round, I was in agony with a pain worse than anything I could ever describe. I put my hand down and felt a dressing all the way across my lower abdomen. I knew what that meant. The emotional pain was searing. They had taken my baby-where was it? I want it back. I think I must have got very panicky at that point as they knocked me out again with some drug.
I had had a laparoscopy and they had found that I was bleeding because I had ruptured. They had cut me open and taken out "the ectopic" (my baby) and "the tube" (my fertility).
The registrar came to see me and told me that my tube had ruptured and that I was lucky to be alive. An hour later and I would have been in a much worse state. But I didn't feel very lucky. My life had been saved, but my baby had been sacrificed in the process. The pain was very bad, but it allowed me to cry like a baby for my lost baby-yes, baby-not ectopic, as this is what it was to me. I had loved her for years and yearned for her, as only a woman who yearns for a child can understand.
Then the vomiting started. With a scar and the agony I was in, this was horrendous. I was given antiemetics, but they made little difference due to the anaesthetic on a full stomach of a curry from the previous night. To puke while in so much pain was just awful. I couldn't even sit up. So there I was in pain, vomiting, no baby and no tube, with staples across my tummy. I was in a sorry state, not to mention the trauma of a near-death experience. Days passed, dragging by slowly as pethidine, in its wisdom, makes time tick slower than a car in a traffic jam. After seven days, I was free to go home, still in pain and now furious at the consultant who had misdiagnosed such a life-threatening situation.
The implications of having an ectopic pregnancy have hit me 10-fold. The complaint I have against the hospital consultant for misdiagnosing a condition that kills five women per year is ongoing. I have not received an apology or any assurance that this will not happen to other women. But you can rest assured that I will not leave this unresolved, and I am now involved with the Ectopic Pregnancy Trust to highlight the dangers and education of doctors. This is a good outlet for my anger, which swells on a daily basis through the grief and loss that has cut through me. It is a loss. To my husband and me, this was our baby-not "the ectopic", the "ruptured tube", the "ball of cells" - nor the "it was never meant to be" or the "good clearout" that I have heard from well-meaning people who never meant to hurt me, but still served to negate the grief I felt/feel for our lost child.
An ectopic pregnancy hits in many ways. I had my living baby cut from me. In my head, this was my child, my future as a mother, a sibling for my little boy. The second child for me, the first child for my husband. The start of having a large family. The family an earth mother like me dreams of having sitting around at the end of the day, sharing their news. The second child in my plan of having five children altogether. My homebirth, something I strive to facilitate for other women which I so want to achieve, too.
An ectopic pregnancy is a termination without consent, a life taken that, had it journeyed a few inches longer, would be sitting in me now, wriggling and hiccoughing and growing. Instead, she was cut out of me. I am a woman who would never consider termination for myself, but have had one because that is what it is like to have an ectopic pregnancy cut out of you. It is inevitable, I now. I am not so sentimental that I don't know that this was the only option. I would have died if she had stayed. This is the cruel twist. So again, I am 'lucky'. Another hour and I would have been a goner. Guilt is a big part of this. Guilt for the lost child. Guilt for even being alive. Guilt for feeling so self absorbed in all of this that my life since April has been turned into turmoil.
"Better luck next time" is what I have heard again and again. "It will happen." "Next time..." Next time? There won't be a next time. I can't conceive! I have to explain that over and over again to well-meaning people who believe they are being comforting. I have only one very blocked tube left. I can't conceive naturally. I would have to have IVF, but I don't want that! So instead, I have spent the remaining credit on my credit card for an exotic holiday in the Far East. I will not be railroaded down a path of hormone injections and test tubes. It's not fair; I don't want to have to work so hard to have my babies.
Anyway, I have put on all the weight I lost during my three-year bid to conceive. I have already done all the hard work and don't want to revisit all of it to lose everything again. I am a risk-taker. I believe in experiencing and living, and going after what you want until you achieve it. I am ambitious and the type of person who wants to change the world. But this? Maybe I'm just not ready or maybe I will never be ready. Maybe it is because I still want the baby I will never hold, but will always love and dream about. How can I think about another baby? She cannot ever be replaced in my mind.
See also the article "Ectopic Pregnancy: The Facts" from the same issue of the AIMS Journal.
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