Australia is one of the safest countries in the world in which to give birth, so why are women more anxious than ever about their pregnancies?
FOR most women, the memory of their baby's birth remains a vivid mental replay that awakens sensations at times as sharp and clear as the moment itself.
For Fiona Thomas, such memories are hazy, trammelled by darker ones that involved her fight for survival. All she remembers is the baby, her third, being lifted from deep within her; and then feeling faint and unwell.
As the baby lay in her arms, she was elated to discover she had a daughter (she already had two boys.) But there was tension in the room and the obstetrician seemed preoccupied. As the feeling of faintness dragged her deeper into a place she did not want to go, she signalled to the nurse to take the baby.
She remembers the anaesthetist telling her there were ''some complications'' with bleeding and the obstetrician saying tersely, ''get her husband back here now'' (he had gone with the baby to the nursery).
And then she was lying unconscious, monitored by the rhythmic beep of machines on a 24-hour guard. Meanwhile, the baby slept in the nursery, her life stretched out vast as an open sky.
Unbeknown to her, Fiona was suffering from placenta accreta, a potentially fatal condition in which the baby's food supply, the placenta, attaches itself to the walls of the uterus so deeply that there's a risk of haemorrhage if it is removed. It occurs in one in 2500 pregnancies but is difficult to detect beforehand.
In the delivery suite, the obstetrician worked rapidly to stitch up the ends of the blood vessels but the placenta was an open network, pumping blood at a rate of knots. ''My husband had a fright when he came back into the room and saw the obstetrician covered in blood,'' Fiona recalls. ''I actually think it was harder for him than for me.''
... Fiona underwent an emergency hysterectomy and woke up in intensive care attached to drips and tubes that leeched donors' blood back into her depleted body. Pinned to the foot of her bed was a photo of her daughter ...
AUSTRALIA is the fourth-safest country in the world in terms of maternal mortality ...
The chance of dying in Australia as a result of childbirth is remote - about one in 10,000 ...
But globally, women die of pregnancy-related causes at a rate of one a minute, with 99 per cent of deaths happening in developing countries. Clearly, giving birth is a risky business. Good hygiene and better standards of living and prenatal care have gone a long way towards making it safer in this country, but that doesn't mean it won't go wrong.
Ironically, despite Australia's great record, experts say many women are feeling more, rather than less, anxious about the birth process. Some blame this on our risk-averse society, saying the screens and tests and the increasing level of intervention in birth and pregnancy is geared towards making women fearful. As one expert puts it, antenatal care has become ''antenatal scare''.
Louise Kornman, associate professor of obstetrics at the Royal Women's Hospital, says: ''Birth rarely leads to death, but it can lead to damage. The majority of pregnancies work out fine, but the reality is it doesn't always go that way. There is a belief that technology can save you if things go wrong, and in doing so you can lose sight of the fact there are inherent risks.''
... ''Of course, women might feel that sometimes the medical profession intervenes too much in what is a natural process, but the reality is that if left to mother nature then the outcome is not very good, often, and there needs to be a sensible balance struck between not interfering in a natural process but judiciously intervening when things start to go wrong - or preferably before things start to go wrong, given that prevention is better than cure. It can be a difficult compromise to reach.''
It is worth remembering that obstetricians are at the coalface of difficult deliveries. Does this make their view distorted? Unlike midwives, who oversee successful, normal births every day, doctors bear witness to the worst-case scenarios. Inevitably this difference in experience manifests itself in an ongoing debate on how best to manage childbirth. Midwifery groups push for normal deliveries and natural births while obstetricians err on the side of caution ... Caught in the middle are the mothers.
Rather than becoming too complacent, Melissa Maimann, a private midwife and childbirth educator in Sydney, is seeing more anxiety among her patients, created, she believes, by our risk-averse culture.
Have women been made to feel over-anxious? ''Possibly,'' admits Bernadette White, clinical director of obstetrics at the Mercy Hospital For Women. ''It is easy to focus on the things that go wrong, and for some people that's a source of stress.
''Obviously, a logical approach is to look and say, 'Yes, that could happen, but how likely is it?' But people don't always have an entirely rational view when looking at things that might go wrong in their labour.
''And when you are assessing a risk, there's a very broad spectrum of interpretation. That's why some people will look at one set of figures and want a home birth, and someone else will look at the same figures and want an elective caesar.'' Associate professor Jenny Gamble, deputy head of nursing and midwifery at Griffith University, Queensland, has researched birth and post-traumatic stress.
Her findings show that while birth is a relatively safe physical event in Australia, it remains a hazardous psychological journey.
''If we stick with the premise that a high level of intervention has unintended negative consequences, then yes it does. We have consistently found that 30 per cent of women report that their birth was traumatic; that they feared for their life, or their baby's life. This is a very high figure. We also know that about 6 per cent go on to develop post-traumatic stress disorder.
''Women don't feel safe. Birth is being geared towards making them feel fearful; strangers are telling them this and that, there is screening and testing at every step and they develop a sense that at any moment they might lose the baby or something catastrophic is going to happen. It's called 'antenatal scare' in the trade.''
Gamble is concerned about the ripple effects of such trauma. Affected women may find it harder to bond with their baby, and their relationships may fall apart. They may develop a fear of hospitals and doctors and even birth itself.
''Most of our gains in maternal morbidity have been based around realistic, basic things, like feeding the mother, sending out health messages such as not smoking in pregnancy and basic care in the community. I am not suggesting that we do nothing, but the pendulum has gone too far the other way.''
ERIN Horsley had her first baby in Britain. Despite her plans for a natural birth with no intervention, she ended up having her baby induced and then delivered by forceps when labour progressed slowly.
Attached to a drip and no longer able to move around, Horsley couldn't speak through the pain. ''If you can't tell me what's the matter then I can't help you,'' said the midwife, brusquely.
Horsley emerged from the experience feeling emotionally battered. ''I felt let down,'' she said. ''Not listened to. It caused marital problems. When I had my second baby here in Melbourne I tried to talk the hospital staff about my experiences; they said I was being oversensitive and that birth trauma doesn't exist.''
Shae Reynolds, 31, was also hoping for a natural delivery but a late scan showed the lake of amniotic fluid surrounding the baby was ''potentially low''. (This turned out not to be the case when the waters finally broke.) In the cascade of intervention that followed, Shae found her legs in stirrups opposite an open doorway with several strangers milling around the room, including someone emptying the bins.
A vacuum extractor was attached to her baby's head and one her most horrific memories is watching the doctor put a foot on the bed and pulling, saying, ''We have to get this baby out''. She says part of her daughter's scalp was damaged as a result, and she suffered a big tear.
''I struggled terribly the first six months,'' she recalls. ''I couldn't have sex for over a year. I felt like I'd failed, like I hadn't protected her.''
Reynolds's daughter is now five and she has had two more children, both born without complications and naturally, at home.
But every birthday awakens memories of the trauma. ''It's hard not to feel torn, because one of the happiest days of my life was also one of the most traumatic. Those precious first moments that we had as a family were destroyed. We were cheated of so much more than just the birth. We still are.''
Medics and midwives are united in the belief that it helps if a woman can feel in control, or at least informed about what is happening. Says Maimann: ''We have an excellent public health system. The government's job is to offer a basic and safe level of care, which it does very well. It doesn't suit the emotional or mental needs of women having babies, but I don't think it should.''
She argues that families should be prepared by investing in independent childbirth education, or working with a private midwife who will provide continuity of care at a cost of between $3000 and $6000. Surely this will be out of reach to many? ''We can afford holidays,'' ... ''It's about valuing what you get.''
Melissa Bruijn and midwife Debby Gould run birthtalk.org, a national birth trauma support group ... ''People assume that if birth is going to be safe, there has to be lots of intervention, but reducing the amount of birth trauma is not about reducing what can go wrong, because that's not controllable.
''It's really about meeting the emotional needs of women. Even if they find themselves undergoing emergency caesareans, they can still feel empowered and part of the process if they are looked after properly. It's a myth to say that the most important thing is a healthy baby. Traumatic birth gets carried with you - you don't leave it at the hospital - and it can have profound consequences for both the mother and baby.''
It is almost seven years since Fiona Thomas, 45, an occupational therapist, went into hospital to give birth and ended up in intensive care. She was fortunate to have given birth in a hospital with a good supply of blood; fortunate that there was a team on hand that worked with rhythmic precision to save her. ''You don't expect that,'' she says. ''I went in thinking I was going to have a routine caesarean, just like I'd had before. All our friends were expecting a phone call 10 minutes later with good news, but there was nothing.
''They realised something must have gone wrong and phoned the hospital. I think everyone was shocked by it. It has changed the way I view life. Sometimes I would think, 'What happened if I had died? If those 30 seconds I got to hold her had been her only contact with me?' But then you have to flip it around and see it the other way. ''It makes you realise that life spins on a dime.''