"Birth story, limited resources"

Hi, I would like to share my birthing story at Karratha Health Campus (KHC) with the aim of improving services and resources for families in Karratha.

Earlier this year I gave birth to our second baby at KHC.

I went into Labor after a stretch and sweep. Over the subsequent 3 days I went in and out of labor, each time my contractions were 5-10 min apart we went into KHC to get baby checked and each time baby was ok but my contractions stopped. I was seen by different obstetriceans and midwifes. The obstetricians had different opinions and the midwives had different views to the obstetriceans.

Mid afternoon on the third day my waters were broken, and my labor augmented for a short time. By evening my labor had slowed down and we were told that I had only dilated 6cm. The Obstetrician recommended that we go for a C-Section.

Throughout my labor our baby was monitored with an external Fetal monitoring band, their heart beat was stable.

The C-section was a very long procedure. We were told by the Anesthetist that it would be around 10minutes. I could feel the 2 obstetricians were having trouble extracting our baby and were trying different techniques. At around 20-25minutes after incision time our baby was extracted and made 1 small sound followed by silence. The team commenced CPR and after around 10 min the MET team arrived. Our baby was intubated and received a dose of adrenalin. At around 15minutes a heart beat was established and by around 20minutes my baby started to breath spontaneously and was extubated. Their Apgar’s were 0,0,0,2 (4) by 20min.

Reasons we were given as to why the operation took so long were that my previous C-section scar was very thin and tricky, our baby's head was impacted, they had difficulty bringing them up due to the flexed position of their chin and a tight band of uterine muscle around them, the uterine muscle did not respond to GTN, a longitudinal incision was then made however the placenta was at the front so had to be dealt with, the placenta was sticky.

Time of birth of our baby was around 21:00

We were told that our baby qualified for a treatment called cooling due to lack of oxygen causing hypoxic ischemic encephalopathy. The aim being to minimize brain damage.

I was taken to our room while the Nursery was being arranged for my bed to be put next to my baby. My baby's father was there with a piece of paper which said there was a 40% chance of our baby being severely mentally retarded – he was distraught.

The Cooling was commenced using ice packs and muslin wraps that had been chilled in the freezer.

The Pediatrician explained to me that we would be transferred to Perth and that we could be transferred to Port Hedland Health Campus while we waited for the Royal Flying Doctors to Transfer us, however we would only be in Port Hedland for 2 hours before the Royal Flying Doctors arrived. The team decided to keep us in Karratha to minimize transfers. We were told that the Royal Flying Doctors would arrive the next morning. My baby's father booked a Flight to Perth and left Karratha early the next morning. The Royal Flying Doctors were delayed, they arrived in the late afternoon of the next day mid afternoon (we waited 18hours). We arrived at King Edward Memorial Hospital that night. 22 hours after our baby was born, they finally went onto the dedicated cooling equipment.

During the time that our baby was being cooled at KHC it was not possible for the treating medical team to keep their body temperature in the recommended therapeutic range. During the late morning that day, my baby became distraught and it was not possible to comfort them. I was not able to pick my baby up or feed them. At one point when my baby was being cooled the medical team mentioned they were running out of ice packs, so I got out of bed and got an armful of perineal ice packs from the freezer to put around our baby. This is what we kept my baby cool with until the royal flying doctors arrived.

It was hard to see our baby screaming from the discomfort of lots of different cold spots around them.

It was hard to see our babies body temperature readings not in the recommended range as I knew this was not giving them the best chance of recovery -potentially having an effect on the rest of our lives.

When our baby was put on the proper cooling equipment at King Edward Memorial Hospital, they were calm and their body temperature was kept within the recommended therapeutic cooling range.

What we would like to be improved.

-I feel the Karratha Health Campus needs to purchase cooling equipment so the baby’s temperature is kept within the therapeutic cooling range giving them the best chance of recovery, to minimize brain damage and neonatal distress.

-I feel transfer times by the Royal Flying Doctors need to be more timely and communication on arrival time needs to be more accurate so the treating medical team can make informed decisions.

-The communication of the chance of our baby being severely mentally retarded could have been delivered to us together and could have waited to allow time for the previous events of the night to be digested.

-I believe the model that Karratha Health Campus uses for antenatal care needs to be more consistent to provide continuity of care.

The anesthetist, obstetricians, surgical, medical and maternity teams did work well together to bring our baby into this world, and I would like to thank them for that. We were lucky to have a midwife who had prior experience in Pediatrics and a pediatrician present at the birth who commenced the cooling straight away and stayed with my baby until the Roal Flying Doctors Arrived.