Sent home after induced labour

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I often see induction of labour discussed in the media. As a contribution to this debate and to discussions about patient safety, I would like to share the consequences this treatment had for me and my family.

On the night of 20 May 2009 I gave birth to a baby girl who suffered hypoxic-ischaemic brain injury inflicted at the Women’s Clinic of St. Olav’s Hospital. I had a normal pregnancy up until nine days after my due date, when labour was induced using misoprostol (Cytotec). I learned later that this medication had caused overstimulation of the uterus, which harmed my baby irrevocably. A day of rejoicing became a day of sorrow. I now know that inappropriate treatment had been given. My daughter’s brain injury could easily have been avoided.

As a pregnant woman under the care of the Norwegian health service, I expected to receive the best available treatment. I also expected to be told what was going to happen with my body. I was particularly vulnerable, not only because I was pregnant, but also because I had already had a dramatic experience of giving birth. On both occasions I was given Cytotec to induce labour: 16 days after my due date the first time, and this time nine days after. My first daughter is healthy because we were lucky that time. But her little sister was not so lucky.

Since I was never told how dangerous Cytotec could be for me and my baby, I thought it was safe to go home. When I asked, this was what the doctor said. I was also told that the hospital had no bed for me. But I was not told that this medication is contraindicated in pregnancy or that other labour wards in Norway monitor women in hospital when labour is induced with Cytotec. I wonder whether it was inconvenient for the hospital to tell me this, because I would never have consented to this treatment.

Little Tale’s first encounter with our world was 72-hour whole-body cooling and a ventilator instead of her mother’s breast. What did my Tale do to deserve this? Could not this hospital afford to monitor women whose labours are induced? Why did I have to receive this low-cost treatment when we are told that we live in one of the wealthiest countries in the world? By which legislation and which evidence could St. Olav’s Hospital declare that this treatment was in our best interest? Can you look me in the eye and tell me this? What does St. Olav’s consider to be proper and safe follow-up of pregnant women after labour has been induced? Why has no other hospital in Norway risked sending women home after they have been given Cytotec?

A report on induction of labour published by the Norwegian Knowledge Centre for the Health Services in 2009, and written with «expert help» from St. Olav’s Hospital, states that a retained placenta and postpartum haemorrhage can be a severe complication of Cytotec. This had previously happened to me. Why could not the experts have applied their knowledge, so that I could have been taken better care of, and Tale would have been healthy today? Was the report just an academic exercise? How is it possible that the experts did not take into account the horrifying results of this treatment, as described, for example, by Marsden Wagner in 2004? How could they let me and my unborn child leave the hospital?

Based on these questions I made a complaint about several aspects of the treatment. Two years later the Norwegian Board of Health Supervision concluded that «ambulant follow-up after induction with Cytotec and other prostaglandins is unjustifiable». They told St Olav’s Hospital to cease the practice of sending home women whose labours had been induced. The police dropped the case, since the head of the Norwegian Board of Health Supervision did not think it was sufficiently serious.

I am furious that the hospital has not acknowledged it was at fault for what happened. I am furious because I can no longer work as before, while the persons responsible – irresponsible! – have been rewarded with new positions and greater responsibility within the health services. In the Norwegian Broadcasting Corporation (NRK) programme Puls, on 30 March 2009, doctors from St. Olav’s Hospital in Trondheim said that women get to choose themselves whether they should have labour induced or not. But they kept quiet about the fact that the women would be sent home.

As a result of this disastrous treatment, Tale is almost blind, is fed through a tube inserted through her skin, and will probably never manage to drive an electric wheelchair. She screams with spasms from cerebral palsy. My daughter. Who should have been eating by herself, gleefully smearing food on her face. Who could have squealed with joy at her first ride on a tricycle. Who could have come running to me when I picked her up from kindergarten.

Who could have been talking to me, now.

If only she had been born at a different hospital.

Mother

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