Paige Eaton wanted to stay open-minded about the birth plan for her first baby, so when she ended up needing an emergency C-section, the Kitchener, Ont., resident felt somewhat prepared.
Still, she never imagined the terrifying rollercoaster to come.
A few days after her son Archie’s birth in June 2023, Eaton developed severe pain, chills, and a fever. She was readmitted to hospital and treated for cellulitis, a serious bacterial skin infection at the site of her C-section wound, which progressed to a pelvic abscess, inflammation in her abdomen and uterus, and eventually life-threatening sepsis.
The first-time mother was stunned, but she could barely process what was happening due to the pain radiating from her infection. Wound cleanings felt torturous, and Eaton recalled screaming when one health-care worker gave her an injection to try numbing the area.
“Anytime they touched it slightly, I was in excruciating pain,” she said.
Eaton spent two weeks in the hospital, breastfeeding her newborn baby around the clock while undergoing a host of treatments and constant IV antibiotics. At one point, she even went into early septic shock, leading to abdominal surgery, a blood transfusion and a months-long recovery.
“It’s really hard to describe the pain of sepsis unless you’ve been through it. Basically all you can say is: it’s just the worst pain you could ever imagine,” she told CBC News. “And the main thing is, you feel like you’re going to die.”
Despite the severity of her infection — and how close she might’ve been to death — Eaton’s experience in the weeks after her son’s birth wouldn’t necessarily be captured in typical data on severe maternal morbidity, a term covering a range of potentially-deadly complications linked to pregnancy and childbirth.
In Canada, it’s thought those serious cases happen at a rate of less than 18 out of every 1,000 deliveries. But that estimate is based specifically on labour and delivery, the relatively short period of time spanning from the onset of regular contractions to the moment the placenta is expelled after childbirth.
New Canadian research suggests close to a third of life-threatening complications also happen to women after that period, during the early weeks following the delivery — a time when mothers typically experience far less medical tracking and support than they did during pregnancy.
4 in 10 cases in Ontario previously missed
From sepsis to severe hemorrhage, nearly 30 per cent of cases of severe maternal morbidity happened within the first six weeks postpartum, according to findings based on a cohort of more than a million births in Ontario between 2012 and 2021.
More than half of those serious cases were during labour and delivery itself, while another 16 per cent occurred earlier during pregnancy.
Overall, expanding the time period showed roughly four in 10 cases of severe pregnancy and childbirth-related complications in Ontario were previously missed, wrote the authors of the paper published on Monday in the Canadian Medical Association Journal (CMAJ).
Senior author Dr. Giulia Muraca told CBC News that maternity care in Canada remains “very strong,” with 97 per cent of pregnancies not affected by these kinds of severe health issues. Still, she stressed that every case counts.
“If we can better surveil when, and in whom, these cases are occurring, we can do a better job of responding to those patterns and reducing the number of people who experience these severe complications,” said Muraca, who is also a perinatal epidemiologist and an associate professor at McMaster University in Hamilton, Ont.
An Ontario mother is fighting for answers more than two decades after a needle was left in her spine during childbirth. Several botched investigations later, Giovanna Ippolito worries no one may ever be held accountable.
The research team said their findings back up global efforts to redefine severe maternal mortality and near-misses to include issues that happen before labour starts, and in the weeks after someone is discharged.
The paper looked only at close calls, not fatal outcomes, but the researchers noted a recent analysis of coroner’s data in Ontario also found the vast majority of maternal deaths happen either during pregnancy — around 47 per cent — or postpartum — close to 46 per cent — while less than eight per cent of deaths occur during labour and delivery itself.
The new CMAJ findings “highlight that focusing only on the intrapartum period will not adequately serve to recognize, prevent, or respond to” severe maternal health issues and deaths, the research team wrote.
As a result, “outpatient surveillance to identify and prevent maternal sepsis is warranted,” including postpartum home monitoring — for metrics such as heart rate and blood pressure — for individuals at increased risk. Expanded midwifery care or postpartum home visits from public health nurses could also fill gaps, the researchers added.
Yet, in contrast, many postpartum patients within the hospital system are typically given a six-week checkup at the most. There’s also limited access to primary and obstetric care in Ontario, the study noted, which leaves “many individuals without adequate care after childbirth.”
A GTA family is calling for accountability and new hospital policies after a mother died earlier this summer, following childbirth. As CBC’s Sarah MacMillan explains, the family says staff at Mississauga’s Credit Valley Hospital didn’t act quickly enough to recognize and treat sepsis.
New insights can help ‘prevent maternal deaths’
Jocelynn Cook, chief scientific officer for the Society of Obstetricians and Gynecologists of Canada, said the new findings help advance maternal health.
“Understanding severe maternal morbidity in this way is critical, as many maternal deaths are preceded by episodes of severe morbidity,” Cook said in a statement to CBC News, adding studies such as this can help improve maternal health and prevent deaths.
Dr. Sarka Lisonkova, an associate professor in the department of obstetrics and gynecology at the University of British Columbia who also researches pregnancy complications, also praised the Ontario team for shining a spotlight on the broader timeframe when major issues can arise and said that “continuity of care” is important.
Patients are ideally evaluated for potential risk factors for complications before being discharged and have follow-up with their family physician or a nurse, she said.
“But sometimes there are groups that slip through this sort of a scenario of good follow-up and monitoring … and sometimes we focus on the baby more than on the mother,” Lisonkova said.
A huge swath of northern Ontario between Timmins and Thunder Bay has almost no one trained in obstetrics, forcing women to relocate for the final weeks of pregnancy. CBC’s Nick Purdon went there to find out what it’s like to navigate the ‘maternity ward desert.’
Certain women at higher risk
A wide range of life-threatening health issues can arise before, during, and after delivery.
The long list includes severe blood loss or a ruptured uterus, acute kidney failure, sepsis, and various heart conditions. Some patients end up having surgical complications, or require mechanical ventilation or admission to an intensive care unit.
Others develop a spectrum of high blood pressure conditions known as preeclampsia, eclampsia, and an emergency situation dubbed HELLP syndrome, which involves the dangerous trifecta of red blood cell breakdown, elevated liver enzymes and low platelet counts.
Certain women may be more at risk of developing these serious health issues.
The latest Ontario findings back up other studies that show links between severe maternal morbidity and patients being Black, having low socioeconomic status, having a higher body mass index, using drugs during pregnancy, or having a pregnancy involving multiple babies.
The CMAJ study also found a strong association between having type I diabetes and severe health issues during all three periods of pregnancy, childbirth and the first six weeks postpartum.
‘I missed so much’
Yet Eaton, the mother who endured sepsis in the weeks after her son’s birth, said that in her case, her sudden medical crisis occurred even though she had follow-up care from a midwife, advocacy from her husband and extended family, and was healthy prior to her shocking diagnosis.
Eaton also recalled her condition deteriorating while her concerns were dismissed over and over, starting with her midwife suggesting her early fever was simply part of routine recovery, to hospital workers later downplaying her fears of worsening symptoms all while sepsis took hold.
In the weeks that followed, the now-36-year-old required home care from a nurse for regular wound checks and dressing changes, and had to carry around a backpack with her IV antibiotic setup and a vacuum pump device that was gently suctioning out any remaining fluid from her infection. The early months of her bumpy recovery left Eaton’s mental health in shambles, and didn’t allow her to properly bond with her newborn son, she recalled.
“I didn’t get to give him his first bath. I missed so much, and it was a blur,” she said.
The ordeal also left her with a jagged scar, both from her C-section and all the trauma that followed it — giving Eaton a constant reminder of her brush with death.
“Every day I have to look at it,” she said.
