One of the first blog posts I published told the story of our daughter Ariana's very traumatic, asphyxiated birth, six years ago.

Follow-up posts have centered on my anxieties (and neuroses!) around her subsequent and resultant health, particularly with respect to a question mark placed over her sight. Ariana's Pediatric Neurologist explained, at the outset, that most babies born as severely oxygen-deprived as she was acquire Cerebral Palsy and gross mental retardation. The strongest known antidote to such disability is the 72-hour Hypothermia Treatment, which our baby was nothing short of blessed to receive. The equipment for this intervention was expensive and rare, and our hospital was one of only a few in the country equipped with such.

While we were discharged from the hospital singing the praises of her NICU therapy, and given a clean bill of neurological health, we quite quickly became extraordinarily worried that she had "Cortical Visual Impairment". CVI is a relatively common derivative of Birth Asphyxia, wherein the oxygen deprivation at/around birth damages the connection between the eyes and the brain, or the part of the brain responsible for interpreting visual input. The result is anatomically perfect eyes that just cannot see. Think lamp not plugged into electricity socket...

But it would appear, clinically and by our observation, that Ariana does not have CVI. A series of investigations have yielded "normal" results, and the child now so clearly sees, in a way that she really didn't until about a month ago. The term currently being brandished about by her doctors is "Delayed Visual Maturation", and I am so grateful for a much less damning,less significant diagnosis. So thank God for that...

An aspect of our ordeal that I have downplayed quite a lot, however, is the WHY of her birth condition. WHY was our daughter born with Birth Asphyxia? I think that, when something like this happens, you ask the questions, but are much less focussed on etiology than on outcome. You just want your baby to survive, and survive well... Similarly, at the coalface, treating physicians are naturally more mindful of intervening than speculating around cause. My gynaecologists (I essentially had two, as they share a practice and tend to each others' patients, at times) take no responsibility. I've mentioned before that, as they were stitching me up, they chatted to each other about how she was "happy in, and unhappy out". I was swimming in ruptured oceans of trauma and chaos at the time, but nonetheless remember registering how defensive and staged this conversation sounded.

Because Ariana was not "happy in". There's a chapter in this tale that I've yet to tell, but that will certainly fill in gaps for anyone who has followed our ordeal.

I am a first-time mom, and as such, I had very little idea of what was "normal" in pregnancy.  But I am an avid, even obsessive reader, and I Googled my way through, minute-by-minute, hour-by-hour, day-by-day, week-by-week and trimester-by-trimester. I became a literal expert on each phase of gestation, and its related phenomena, and potential complications.

I was never sure that my baby was moving enough. My sister had made a throwaway comment at some point about how her son had been something of a disco-dancer inutero, and this stuck with me. Because my womb just never felt like anybody's nightclub. Sure, there were tangible kicks, and yes, as Dr Google instructed, I could encourage them, with ice water or orange juice, and count them, and probably arrive at the appropriate number. But I was just never reassured by her movement. I must mention that, despite worrying about kick-counts and movement, I did mostly believe that I was simply neurotic, and all was fine. In the story that follows, I always felt that I was overreacting.

One evening, at 34 weeks, I was somewhat bored, and my attention turned to my bump, which I felt hadn't reverberated terribly much that day. We live very close to our hospital, and I was aware that I was "allowed" to present myself at the maternity ward at any time of the day or night that I was concerned, from 20 weeks' gestation. I am a sucker for peace of mind, and so chatted to my husband and decided to pop across for a "CTG". A CTG involves having a monitor placed over the fetus's heart, and another over your uterus, and then sitting for a period of time while the activity of each is tracked and traced. A fetal heartbeat should be range from 120 to 160 beats per minute, and should show a lot of variability between these two points over a 30 or 40-minute period. (The uterine monitoring basically registers contractions, and would, when appropriate, indicate labour, and extent of labour, but this is irrelevant in this context).

Thus I arrived at the ward, was strapped to the machine, and got the answer I knew I'd get: a strong, normal fetal heart beat.  I was about to skip out of the hospital and return home, when the nurse asked to do a blood pressure reading. 158/120. Horror! Gestational hypertension! Potential Pre-Eclampsia! Imminent c-section! Prematurity! I knew all the permutations and extrapolations of this reading. Much fuss was made, my doctor was called, hospital garb was thrown at me, and I was admitted. Shortly post-admission, I was, on my doctor's orders, injected with Surfactant, a chemical known to spontaneously fast-track fetal lung development, and thus prepare the fetus for premature delivery. I was to have that dose, another 12 hours later, and, if my blood pressure remained elevated, an emergency Caesar would be performed.

I lay there quite incredulous. I really hadn't really thought that there was anything wrong... I probably had felt her move sufficiently that day... I was really just bored, and neurotic, and looking for something to do... Truth. So I was quite flummoxed and perplexed that this was happening.

Then, alas! - my next blood pressure reading was normal. And the one after that. And the one after that... The initial elevation was ascribed to measurement error/fluke, and Pre-Eclampsia and emergency c-sections floated off into the horizon. I was examined by my doctor the next day, who ruled these out, but said I needed to remain in hospital for a day or two post Surfactant administration. As is standard Maternity Ward protocol, I was, from time-to-time, hooked up to the CTG machine to monitor what the baby's heart rate was doing.  And this is where the whole game changed...

All would be fine for 5 or 10 minutes... 120bpm... 142bpm...158bpm... 122bpm... All within range, and with good variability. And then, without warning, the number would just PLUMMET, to 60 or 80 beats per minute, dramatically lower than the minimum 'normal' of 120. THIS was now becoming worrying... Possibly even MORE so, for me, than the high blood pressure reading on admission. SOMETHING was horribly wrong! These "decelerations" became the focus of my inpatient stay, and I was hooked up to the CTG machine three times daily.  On most occasions, the pattern would remain as I describe. Normal... normal... normal... then this massive dip into the realm of the distressed fetus. I took pictures of the traces, and insert one below to illustrate the scenario. You'll notice a lot happening between 120 and 160bpm, and then this drastic deceleration to 80. This is one of many graphs that were compiled.

My doctor, at this point, had two hypotheses. I myself was born with a congenital heart defect, and he speculated that my baby may also have a cardiac condition. In the absence of this, he felt that the decelerations would then need to be ascribed to fetal cord compression, where the life force to my baby was being "compressed" inutero, intermittently, and then restoring itself. I was taken off to a Pediatric Cardiologist, who spent about 80 minutes scanning my fetus's heart, through my big, stretched belly.  Despite being extremely thorough, he found nothing to suggest that there was anything at all wrong with Ariana's heart. And so, cord compressions it was!

My doctor and I had a chat, and he expressed his view that this situation did not warrant premature delivery of my baby. He argued that there was sufficient variability within the traces to suggest a healthy child, and further stressed that the decelerations were very short lived; her heartbeat did not remain so low for any period of time. He asserted that the impact of prematurity was greater and more destructive than the impact of a deceleration here and there. And so I trusted him. Because that's what you do when you are in a specialist doctor's care. And I suspect that, at that point in my pregnancy, he was right.

He discharged me from the hospital, told me to return to my life, as usual, and pop in for another CTG in a few days time, and thereafter only if I felt my baby's movements decrease. I returned to his offices for the requested CTG, which I felt was extraordinarily "flat". The "variability" which was heralded as Ariana's redeeming factor was simply not there. I was concerned. I questioned the doctor, who looked somewhat aloof and stated simply that "she is sleeping". I was then 35 weeks pregnant. And I felt, from his attitude, that this was all "much ado about nothing". And so I viewed this chapter as complete... A phase in my pregnancy now resolved. And I continued to plan for my little girl's arrival - nurseries and nappies and baby clothes.

In subsequent visits to these doctors, I was not treated as a high risk pregnancy. In fact, at my last visit, on a MONDAY, the doctor decided that the baby was big enough, and would be imminently ready for delivery, and so scheduled my c-section for the following  Thursday. Please note that this procedure was booked for TEN DAYS from that appointment. No CTG was performed. And I was instructed not to make another in-office consultation, but to simply check in to the hospital in 10 days time, and he would be there to cut me open and pull out my baby. I strongly feel, in retrospect, that it was this one lapse in judgement, this one oversight, on the part of my doctor, that nearly cost me the life of my unborn child. Everyone knows that late-stage pregnancies are assessed on a weekly basis... And how much more so should a pregnancy be where cord compression has been an issue. Logically, such compression might dramatically increase in those last days and weeks, when the baby is growing exponentially and running out of room in any event.

But I was not my own doctor.
And we trust what we are told.

The "kick count" method of self assessment also flies out the window in the 36th and 37th week, as everyone  tells you the baby moves less, as space is now so limited.

And thus, enter 28th March 2013... Bags packed, expectant parents brimming with excitement, family and friends piqued with interest and anticipation... A happy day was expected by all... A bouncing baby girl was on her way!

But, when hooked up for a final routine CTG prior to the procedure, the baby's heartbeat showed marked bradycardia... It now just hung around between 105 and 115 beats per minute, for pretty much the entire time... No longer was it mostly between the expected healthy 120 and 160 bpm, with the occasional dip. Now it was just sluggish. But you know, at this point you're so pumped up with the excitement of the day, that you become somewhat oblivious to what can go wrong... I decided she was sleeping, which is what I'd been told weeks before, when I did actually feel huge trepidation at how flat her graph was. The nurses, funny enough, were more concerned than I was by how flat and slow her pre-caesar heart-rate was. The one, in particular, said something like, "well, let's just wait and see how baby is when she comes out..."  Prophecy of doom, right there... But still, none of them alerted the doctors. None of them sounded the alarms... Why should they..? It wasn't their baby...

And so I was wheeled into theatre.
Epiduraled.
Sliced open.

And so the grey, lifeless, desperately distressed, desperately oxygen-deprived little person was pulled from my body and thrown to the attendant pediatrician. And so little Ariana fought and fought to hold on to her life... And so she was intubated and ventilated and pierced and probed and coerced into being...

And so began her tiny little life. Her welcome to the world.

It didn't have to be that way. I don't think we can call this "malpractice", and I never have. An oversight, perhaps... And I guess we can all drop a ball, at times, in all manner of ways. I just wish there's been a touch more care... A touch more interest. A little more thought around how many days would transpire between an appointment and an operation... Perhaps a request of another CTG.

"Happy in, unhappy out".

Yeah, right...

But as I've said before, I'm just so pleased that 6 years on, our little baby who didn't breathe is a healthy, well little girl who keeps us on our toes. The greater moral is that, to whatever extent is possible, we need to be vitally engaged in our medical processes... We need to read, consult and debate, every step of the way. I myself have found this difficult, in recent years, despite this early lesson - if we're not doctors, we simply cannot necessarily understand in ways we need to. But I can say, with certainty, that there were moments in Ariana's pregnancy when my intuition was SINGING SONGS, and I held back for fear of upsetting people, offending doctors or just looking stupid and neurotic. So perhaps that is the greater lesson...