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Health authorities have launched a major investigation after a pregnant woman bled to death after giving birth to her first baby.
Renee Wendy Bayliss, 33, died within hours of childbirth at Auckland City Hospital last week after medical staff were unable to stem excessive bleeding from the delivery of her daughter. Baby Allix survived, but an urgent inquiry has been launched by Auckland District Health Board to pinpoint the chain of events which led to the death.
Kay Hyman, general manager of National Women's Hospital, said her thoughts were with Renee's husband and family, but it was too soon to say what caused the tragedy.
Sources told the Herald on Sunday that part of the focus of the inquiry would be on whether staff were too slow to diagnose her complications and whether a theatre where Renee was taken was properly prepared for emergency surgery.
Hyman confirmed the "chain of circumstances" leading to Renee's death would be examined but said staff reacted to the bleeding quickly.
She rejected suggestions there was not enough blood for transfusions needed to save her.
"If somebody dies of a postpartum haemorrhage, which is obviously excessive bleeding, people may think it's because blood wasn't available," she said. "For someone who's haemorrhaging, people assume you can just replace the lost blood, but there are many factors."
Hyman said the public regarded childbirth as risk free because of the infrequency of death.
"This is a tragedy. When it does occur it is devastating for the family, obviously, and the staff, too."
Renee's family told the Herald on Sunday, through funeral director Martin Williams, that they were too emotional to speak publicly.
Her police officer husband, Nick Blackley, family and friends farewelled her on Friday when tearful police officers formed a guard of honour as her coffin was carried into All Saints Chapel in Auckland.
Nick Blackley was too upset to speak at the funeral but Wendy Bayliss, Renee's mother, paid tribute to her fun-loving daughter who would have been a dedicated mother to Allix.
Renee had always wanted to be a mum, she said, and her pregnancy had strengthened the bond between.
"I'm just so glad her wish came true and that she got to spend some time with her beautiful daughter."
Service celebrant Julia Cameron said the family wanted to celebrate Renee's short life, but grief and love were mixed with anger, as there were unanswered questions over her death.
"How did this happen in a modern society where women no longer die in childbirth?" Cameron asked.
She was described as "Nick's babe", a cherished soulmate, a beautiful mummy to baby Allix, a loved only daughter, sister, aunt and granddaughter.
"A wonderful, unique young woman, loved by all, may your spirit be set free," was written on the funeral service card.
A number of new or expectant mums with their children were among the mourners, friends from the Parnell Birthing Group where Nick and Renee attended antenatal classes.
Renee had been an inpatient at the hospital since New Year with high blood pressure, a symptom of pre-eclampsia, a common condition during pregnancy.
Hyman declined to confirm if Renee suffered from pre-eclampsia, but said it was a common complication with a small risk of danger.
"Renee had complications with pregnancy - she was with us as an inpatient before delivery."
One source said that the hospital staff should have been prepared for everything given Renee's complications during pregnancy, and questioned whether a caesarian delivery would have saved her.
Hyman declined to comment on whether a caesarian would have prevented the death other than to say: "There are risks with childbirth, which increase with complications, and those risks and benefits need to be weighed up for the course of action taken."
Health and Disability Commissioner Ron Paterson said although rare, maternal deaths were now carefully monitored through the Perinatal and Maternal Mortality Review Committee which was set up in 2005 to review the deaths of newborn babies and mothers.
The committee would review the death of Renee and is understood to be investigating the deaths of 12 women during pregnancy, or soon after child-birth, in 2006.
A report is due soon. However, up to half of those deaths were caused indirectly, such as a pregnant mother being killed in a car accident. But a report from the UN World Health Organization, UN Population Fund, the World Bank and the UN Children's Fund shows that New Zealand had a rate of nine maternal deaths per 100,000 live births in 2005 (a total of five fatalities), more than double the Australian rate of four per 100,000.
PREGNANCY RISKS
* Pre-eclampsia affects 5 per cent of first-time mothers
* Obesity raises the risk level of pre-eclampsia by 2-3 times
* Symptoms include high blood pressure and protein in urine
* Leads to liver problems, renal failure and strokes in extreme cases
* Globally 70,000 women die each year from pre-eclampsia
* 1 in 10 pregnancies produce growth-restricted babies.
The most common of the dangerous pregnancy complications, pre-eclampsia is a disorder that occurs only during pregnancy and the postpartum period, affecting both mother and the unborn baby.
Affecting at least 5 per cent of all pregnancies, it is a rapidly progressive condition characterised by high blood pressure and the presence of protein in the urine.
Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms.
Apart from abortion, caesarian section, or labour induction - and therefore delivery of the placenta - there is no known cure.
Typically, pre-eclampsia occurs after 20 weeks gestation, but also as late as six weeks after birth. Proper prenatal care is essential to diagnose and manage it.
Pre-eclampsia, pregnancy-induced hypertension (PIH) and toxemia are closely related conditions. The former two are a leading global cause of maternal and infant illness and death.
MATERNAL DEATHS
National maternal deaths - the death of a woman while pregnant or within six weeks of birth. However, there is no research into whether the cause of death was directly related to pregnancy or childbirth, or an indirect cause, such as a car accident.
1993: 6
1994: 4
1995: 2
1996: 4
1997: 2
1998: 1
1999: 3
2000: 2
2001: 0
2002: 4
2003: 3
2004: 1
2005: 5
