In some respects, women who suddenly develop pregnancy problems have an easier time from the world at large. They are victims. They have had an "act of God" befall them. Women who are known to be "defective" from the start – and I include myself here with my essential hypertension – are either told not to make a fuss about their condition, or are subtly discouraged from having children in the first place.
And if despite good medical care something goes wrong – it's a case of "well, what did you expect?"
Women are supposed to be good and cheerful incubators. But what if they really want a baby but have a health issue?
In response to an earlier blog on high-risk pregnancies, Sarah commented that: "if women are told the truth about what can go wrong, I suspect that some women would choose to opt out of biological motherhood."
Sarah reveals she has a history of depression and is trying to conceive. She says she has been 'red flagged' for possible issues throughout and after pregnancy. "I have an excellent relationship with my GP, and at this stage I am happy to take her advice and prepare myself, literally, for the worst, regardless of the fact that I haven't had depression for many years. I told my female work colleague about my 'red flag' and I was told 'stop thinking about yourself and stop being so negative.' "
Sarah felt that somehow she had already failed – and she wasn't even pregnant yet. It reminds me of a woman I met at my son's school social. She heard I was writing a book about high-risk pregnancies and came up to me, slightly tipsy. "Interview me, I'm a real loser, I had three high risk pregnancies."
Well, I did interview her, but told her straight away she was no loser – she had the courage to go back to have two more children after nearly bleeding to death after the first birth. She said something terribly haunting – that it felt like such a peaceful way to die and that it wasn't only because a nurse by chance was in the room that they managed to save her.
No – losers are not heroes like this. So why did this woman feel like a loser? Because she wasn't a physically perfect incubator. She had failed this crucial test of womanhood. She was made to feel a loser not by her husband – who nearly lost her and is immensely proud of being a parent with her – but by other women. The ones I call the "smug healthy".
I want to tell Sarah that she won't have this experience. But she already has – and as she points out, she isn't even pregnant yet.
I wish it was different. My sons are now 11 and 8 years old, and I have been fighting for recognition for high-risk women in pregnancy since I had my own pregnancies. I am sorry to say nothing has changed. The media are still not interested in writing our stories. Instead they write articles in papers and on the web like the one Sarah read – about a mother who killed her infant. She had post natal depression and had mostly kept it to herself despite her history of clinical depression. Initially when she said she wasn't coping, she was told 'welcome to motherhood'.
Yes - the media will write about the death, but not the struggle when it's happening. Not the ongoing battle. As I was told by publishers when pitching Handle With Care, the book I wrote about high-risk pregnancies, "the subject isn't sexy enough".
It's time this changed. High risk pregnancy may have been a neglected area of past discussion on maternity services, but this can no longer be the case. As complicated or high risk pregnancies increase - due to maternal age, lifestyle issues and infertility among other influences - more consideration must be given to women in this category.
Yes, Sarah – it's true. High risk women are more likely to suffer from antenatal and postnatal depression because they feel isolated and suffer from high anxiety about the pregnancy outcome and their own health.
The fact is, mental illness and depression in our community is more common than most of us realise. Because one in five Australians will be affected by mental illness at some stage of their lives, it is an important area to consider when looking at those health issues that can, and do, place pregnant women in the high-risk category. But these challenges are not insurmountable.
What can we do? Rather than leave antenatal education to the hospitals which are focused on normal births, high risk women should be offered a fortnightly group session in their area where they can see other high risk women and hear psychologists talk about what they are going through. This occurs in the excellent range of antenatal high risk clinics in hospitals around Australia, including the Royal Women’s Hospital in Melbourne. But if women are not identified and/or hospitalised, they miss out on the care.
After the birth, the maternal health centres are a lifeline for women but they may only get to these places weeks after their baby is born.
It would be better to have them attend a fortnightly session while pregnant to meet other women. Obviously because of numbers, the most local centre might not be appropriate, but certainly one centre in every metropolitan shire, and in every regional town, could host such an event.
Pregnancy and birth is not only a physical or medical experience, it is very much an emotional journey and for the high risk mother who has the odds stacked against her, the journey and the lack of services available means its often an uphill battle.
The government needs to get serious about high-risk women, instead of simply issuing finger wagging directives against caesarean birth statistics. It needs to recognise the existence and needs of high risk mothers with provision of relevant services.
Australian women and their babies should be able to access high quality safe maternity services, as close to home as possible, in line with their assessed level of risk.
And society needs to extend some compassion and understanding when the red flag is raised for women like Sarah.
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