Savita Halappanavar- the thread to actually talk about the case(106 Posts)
Away from the madness of the other thread.
Can I just mark my place by repeating from the other thread: if you like me are outside Ireland but desperate to do something, please donate to Choice Ireland - they sent me a lovely note last night thanking me for my donation. It said RIP Savita at the end
I have been thinking about this alot, probably because I had a similar experiance.
I wonder if she was given medication that masked the symptoms of infection? For instance steroids for the lungs can mask symptoms of infection. Although I wouldn't think they'd give these as early as 17 weeks.
So can labour. I wonder if they'd induced a few days before if they would have noticed the signs of infection post birth. As it was the infection was probably getting worse the same time as she was induced.
Symptoms of infection such as raised bp, pain, changes in pulse temperature etc may all of been put down to labour when really it was infection iyswim
Raised temp is always an infection??? THis is something I can't get my head around. The infection was probably there when she arrived, or at least soon after. Surely she would have had a temp - Were they not monitoring it?
The whole case just makes me feel desperately sad, on just about every level.
But surely that doesn't explain away the facts that
a) they knew she was miscarrying anyway so even if the infection was masked it didn't make a difference
b) they withheld treatment because she was pregnant and they either feared/misunderstood the law or their religious beliefs affected their decisions.
Either way, it doesn't make any difference. She wasn't treated properly because she was pregnant. Had she been in a situation where she wasn't pregnant different decisions would have been made.
LeBof well no raised temp isn't always an indication of infection, labour can cause an increase in temp as can chronic pain
Of course it makes a difference, if it is the case then if they'd induced her when she wanted 3 days before, labour wouldn't have masked the symptoms of infection. Even so she should have been given antibiotics as a precaution.
Isn't it a case of antibiotics not really being to avoid ( just slow the onset of septicaemia down) if the foetus is dead or dying already?
Not sure, I've had pprom 3 times and was always told they were giving abs as a precaution even though I showed no signs of infection
Moomin - I can see labour will increase body temp like doing sport can. Surely a fever temp (i.e. 38+) would indicate infection rather than just labour?
(I have no idea - just asking. When I went into preterm labour they frequently checked my temp as a common cause of preterm labours is infection).
So the discussion I nearly got into on the other thread was how you can have a definition of when to intervene given that medics are always dealing in probabilities.
If you can intervene when the mothers life is definitely at risk then that is a carte blanche to never intervene as one can never prove life is endangered until it is too late.
If you say potential risk to the mothers life then that includes all pregnancies.
<hopes this isn't one of the banned topics>
That is the think (or one of the things): temperature is routine monitored in labour, antibiotics are routinely given if rupture of membranes has occurred, conservative or active management of miscarriage is offered as a matter of routine.
This woman was not offered what is considered routine medical care in the rest of the Western world (and a fair bit of the rest of the world too btw).
Maybe it would help the discussion about it to refer to 'actively managed miscarriage' rather than the more emotive 'termination'? The pregnancy was terminating itself already, maybe because of infection that was already there.
Having the fetus in utero will have kept any potential uterine infection going.
On Irish radio today I listened to a woman describe a miscarriage she underwent at 12 weeks' gestation. A heartbeat was found for quite a long time into the miscarriage despite heavy bleeding and the woman became very ill. The consultant came and explained to her that he would have to do a D and C to save her life. She was confused as she was so ill and said 'but what about the heartbeat' and he said I'm sorry, there's just no way to save the baby and this is the only way to save you.
So this happened in Dublin 8 years ago and the woman was quite clear about the fact that he had saved her life.
Clearly pg is inherantly risky.
Defining when mother's life is at risk could mean:
making a short list of conditions which pose strong likelihood of death: pre-eclampsia, ectopic pg are two obvious ones. I think this is how Ireland operates in general i.e. abortions in these cases.
relying on expert obs/gyn assessment of risk of death - with guidelines based on precedent perhaps.
as above, but including other health professionals (I'm thinking of psycologists and suicide risk)
making a long list of conditions that are unlikely to lead to death if untreated but carry a greater risk than an uncomplicated pg: not sure of any (I'm not a medic).
As I said in the other thread, you just draw a line in the sand. Debate will continue around the line but this is inevitable in when you draw lines!
Given that Savita was told that foetal death was inevitable and that the pregnancy could not be saved and that she then requested treatment to bring her ordeal to a swifter end, there was absolutely no reason for the doctors not to comply.
Her condition and her request for induction IMO overrides any other consideration (unless the doctors thought that induction/termination would of itself actually increase the risk to her life or the risk of infection). That, I find difficult to believe unless we have a doctor on the boards here who would tell us that induction/termination would pose a greater risk in these particular circumstances than allowing the miscarriage to continue naturally.
So, we are left with likeliest explanation given the comments about Ireland being a Catholic country and the existence still of a foetal heartbeat, that it was lack of clarity in the law or doctors' fear of the law that lead to Savita's death.
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Moomins, snap! I had a massive infection after a miscarriage and also after birth of ds1. In the second case it was completely undiagnosed; I myself noticed it because I'd had one before, and I had really obvious symptoms - high fever, sweating, and a stinky discharge.
I don't think many registrars know much about it. I bet they did miss it until it was too late to treat it with antibiotics. My membranes were ruptured and I was not given antibiotics on either occasion. I think this highlights the shocking lack of care for pregnant women in all arenas.
Sorry, meant to add that in both cases infection came after the end of the pregnancy/delivery of the placenta. Was the foetus the source of the sepsis? I'm pretty sure with ds1 that he wasn't because he was born alive - think it was a hospital germ introduced with instruments.
I'm so angry at Savita s needless death. It should not have happened.
And as mentioned on the other thread,my mother had a symphsiotomy. I have talked of this before on MN,she did not realise until her doctor told her a couple of years ago. She was given it in 1972.
The more I think about this tragic case, the more I feel that this is not actually about termination and where you stand on the subject, but about bad medical care.
Pregnancy and childbirth ARE inherently dangerous, of course, and nobody who has ever been invovled in the care of a woman who died in that context will ever forget about it or be left unchanged by it. It is a horrible event in any set of circumstances, and people do of course die of septicaemia without pregnancy being a factor.
However, once the membranes have ruptured and the cervix has opened it leaves a rather unique opportunity for bugs to enter a very fertile breeding ground, often with disastrous consequeces, usually for the fetus, but sometimes for the mother.
What stinks about this case is that IMO a)this was never going to be a 'termination; the pregnancy was already ending b)she was not managed in what is accepted normal practice, c)it seems she had actively asked for more intervention and was denied it.
My heart goes out to Savita's husband and family.
<<off to donate to ChoiceIreland>>
Can I just point out that LeBOF is one of my old names, and I'm not on this thread but Le B F G is? People do tend to mix them up, but we are different posters.
Agree with pacificdogwwod about emotive terms, but my understanding of the law is that it's illegal to procure a miscarriage, however it happened spontaneously so would if she was offered medical management would the doctors have been 'procuring' a miscarriage?
My understanding is that, yes, that is their reasoning. Which I don't follow at all - the fetus was dying, sadly, so potentially a life could have been saved by removing it and possibly saving the mother's life.
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