health

The heartbreaking consequences of doctors not listening to pregnant women.

Content note: This post contains stories of stillbirth and may be triggering for some readers.

Cassie Thistleton had been having an uneventful pregnancy.

It was October 2012 and this was the Queenslander’s second child, so she knew what to expect. Her first two trimesters had been great, as far as pregnancies go.

Then heading into her 37th week, she felt contractions she knew weren’t Braxton Hicks.

“I had experienced some contracting for like a whole day. I didn’t rush into hospital about it. I knew I had an obstetrician’s appointment a few days later, I thought I’d talk to them then if it didn’t progress,” she told Mamamia.

“Then a few days after that… I’d been at the shopping centre and I started having these excruciating pains radiating down my leg while I was walking around and I thought ‘this isn’t good’.

“When I was in the car it happened about four times and then it kind of stopped… I started experiencing these extremely high volume kicks, it was rough, it was hurting, it was completely abnormal for his behaviour.

“And then it sort of subsided and he went back to his normal movements.”

Concerned, but not alarmed, Cassie wanted to discuss what had happened with her obstetrician during her appointment the next day and make sure her son Dex was healthy.

There, her baby’s heartbeat was checked and she was told not to worry. Cassie said at the time she was considered to be a high-risk pregnancy as it was thought Dex had a single artery umbilical cord – so she expected a level of care that she didn’t think was met.

“I was completely disregarded. There was no explanation as to what was going on. There was no check of the cervix to see if I was dilated.

“My eldest daughter was born at 37 weeks after I went into labour naturally. There was evidence there that maybe I didn’t naturally carry to full term.”

Cassie said she left feeling like her concerns had not been heard, but also that maybe she had overreacted.

“It was really concerning. I walked out of the office I was like ‘I just don’t feel like she did enough’. I feel like I was disregarded.

“I felt stupid, to be honest. I felt like I was  just being an overreactive mother who was just whinging about nothing.”

The next day she woke and knew she was in the early stages of labour. At 9am she dropped her eldest daughter at school and was on her way home when, suddenly, everything stopped.

“I felt him kick and then very shortly after that everything stopped. The labour stopped. I wasn’t having any more pains and he just stopped moving.

“Again I tried not to panic… I did all those things to try and get him to move and he just wouldn’t move. I think I knew instinctively then that something drastically had gone wrong.”

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Trying not to think the worst, Cassie carried on with her day. That evening at an antenatal class at the hospital, she and her then partner Ryan went in for a check-up.

It was there Cassie and Ryan learned the utterly heartbreaking news: their son Dex had died. Harder still was that when Cassie delivered her stillborn son, they could see he was a healthy-sized baby.

Cassie, her daughter, Dex and his dad Ryan. (Image supplied.)

"He was the healthiest little baby you've ever seen and chunky and had rolls on him. He was well-nourished and he was healthy... and they couldn't find anything that was wrong."

Cassie says she still doesn't know what exactly killed her son, but wishes she had received more tests when she went to the obstetrician at 37-weeks, believing maybe that could have saved him.

"If she had have done her job properly and gone further and done some more checks, maybe she could have picked up what was going on," the Stillbirth Foundation ambassador said.

"Something could have been done, she could have picked something up. Maybe she couldn't have, but she didn't even try - that's the problem.

"Maybe he could never have been saved, but she didn't even try and that's frustrating."

Tragically, Cassie and Ryan are not alone in experiencing the particularly cruel grief that comes with losing an unborn child and knowing there may have been a way to prevent it.

In Australia, six babies are stillborn every day. Of these, it's not known how many of them could have been saved, but according to to the Stillbirth Foundation, research indicates that could be up to 30 percent.

Listen: When Monique lost her baby to miscarriage she knew it was important to take time to grieve. (Post continues after audio...)

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Stillbirth Foundation general manager Victoria Bowring told Mamamia that while there are no statistics or research on how many women's earlier concerns were dismissed before a stillbirth specifically, in her organisation's experience it was "common".

"It's certainly not rare and I think it has, in the last couple of decades, become increasingly common," Bowring said.

Bowring said this increase may be because women are feeling more comfortable speaking up about concerns and that their "mother's instincts" are being valued, acknowledging a lot of hospitals were understaffed and staff members are often stretched.

"I think in general though, it's about research that's been done over the last couple of decades that shows things like reduced movements or changed in movement patterns are indicative of things being not right or something changing for the baby."

Bowring said it's hoped as awareness of such warning signs of complications grows among the public and professionals, the rate of stillbirth will drop in Australia.

"It's about getting the education around that out to not only to pregnant women, but to healthcare professionals, so they know to take that seriously when a mum presents with that kind of problem."

"It would go a long way to reducing stillbirths."

Bowring advised women to trust their instincts and keep raising their concerns until they're confident they've been heard.

"As women, we know our bodies best and that instinct about what's going on in our body during pregnancy is enormously valuable," she said.

"More and more research is showing that instances where there has been an adverse outcome of pregnancy, more often or not, mum has had that instinct along the way that somethings not quite right.

"My advice to pregnant with concerns would be to continue to bring it up with their doctors until something's done."

Melbourne-based obstetrician gynaecologist Dr Charlotte Elder agrees.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Victorian regional committee chair said if a pregnant woman experiences a change in her baby's movements, abnormal or strong pain, bleeding or abnormal discharge, new nausea or vomiting, an itch on the palm of hands or soles of feet or a new severe headache, she should contact her doctor right away.

"When a woman comes in and raises a concern with me, the first thing is to figure out what that concern is, the next thing to work out is why she's concerned about it... and the next thing I try to figure out is what's going on, so the reason for the symptoms," she told Mamamia.

"I'll then explain that to her so she knows what's going on."

Cassie, Ryan and their son Dex. (Image supplied.)
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Dr Elder said women can expect their obstetrician to check their baby's heartbeat and they may perform an ultrasound to check the fluid around the baby, it's size and flow in the baby's umbilical cord.

"It depends on the exact situation of what happening and the stage of pregnancy as to whether those tests are undertaken, but they're the tests that a woman can have discussed with her."

Dr Elder said obstetricians are always trying to deliver healthy babies, and work hard to ensure things aren't missed and women are heard.

"I think the core of it is that obstetricians are human and humans aren't perfect. And so sometimes things do get missed, brushed over or perhaps not given the importance that they should."

"Another thing - that's also a human thing - is that it's not nice to see someone in distress and so obstetricians work really hard to reassure women.

"And sometimes perhaps it's possible to reassure someone when actually the reassurance wasn't the right thing to do."

It's perhaps that need to constantly reassure that lost Anna* and Tom* their daughter.

Bella* was the Melbourne couple's first child, and as a result of their inexperience, there was a lot they were unsure of.

But in June this year, two days prior to her due date, Anna thought she was experiencing all the symptoms of labour, noting that she'd lost her mucus plug.

"We'd read all the baby books, we'd been to all the prenatal classes, we were looking up all the signs and thought that was it," she told Mamamia. 

But when she called the hospital where she was due to give birth, the midwife on the other line told her she was experiencing "false contractions" and advised her to stay at home.

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Listen: The Olympic swimmer shares what aspects of her miscarriage she's grateful for. (Post continues...)

"The midwife said she could tell by my voice, over the phone. She said that if I was really in labour then I wouldn't be able to talk... It was very distressing."

When Anna went in for her 40-week appointment, her baby's heartbeat was checked and she was told she was fine, that she was in "early labour" and she'd have her baby by the weekend.

The weekend came and contractions continued, but when she called the hospital she was only told to take Panadeine tablet and rest. When the midwife asked if her water had broken, Anna told her she wasn't sure, which she took to mean that it hadn't, telling Anna "you'll know when it does".

"I was in so much pain and just to be told there was nothing they could do and 'Oh you're just so overly anxious.. you just need to relax' was really frustrating."

On Tuesday, when her pain had continued, she went in to visit her GP. Once again she was told she was "anxious" and she needed to "calm down".

"I wasn't in there for an hour and they were telling me to go home," she said.

"She told my husband if I was anxious the baby wouldn't come out. Which is just ridiculous.

"It just didn't understand and they couldn't say why the baby wasn't coming."

After an inducement was rescheduled on the Thursday, Anna and her husband went in for an appointment the next Saturday - 12 days after Anna had first felt contractions.

There a midwife checked for her baby's heartbeat and was unable to find it. Bella had died. The next day, she was delivered stillborn via a c-section.

"That day our world stopped. It became a very dark and empty cold place."

An autopsy would show that Bella had died from severe acute amnionitis - an infection of the placenta, which then travelled into Bella. Anna's water had broken - something the hospital would have noticed if they had done a check during any of the times she came in. Anna learned she'd been leaking amniotic fluid for more than a week throughout her prolonged labour.

Anna and Tom say if their concerns were heard, their daughter would still be alive.

"Our daughter lost her life because our concerns were dismissed."

If there's anything to be learned from Anna and Cassie's stories is that pregnant women speaking up about their concerns is important, but so is a commitment from medical professionals to listen when they do.

*Names have been changed.

If you need support for miscarriage, stillbirth or newborn loss, Sands Australia have a 24-hour helpline you can call 1300 072 637.

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