Should pregnant women be worried about having a c-section after the death of QLD woman, Amanda Sheppard?

The tragic death of a young mother during the birth of her first child on Monday has prompted experts to remind pregnant women that there are risks associated with any major operation, even though the fatality rate in Australia from caesarean section is extremely low.

Amanda Sheppard from Gracemere in Central Queensland was undergoing an elective caesarean at Rockhampton Base Hospital on Monday when the previously healthy young woman died from complications in the routine procedure.

Her baby daughter, named Willa survived and the now nearly three-day-old is being cared for by hospital staff and her father, Glynn.

There are pros and cons of a c-section. Image via IStock

The Australian College of Midwives told Mamamia that pregnant women should not be scared by the tragic news of Amanda Sheppard’s death but should be informed of such occurrences.

Sarah Stewart, the Midwifery Advisor to the College told Mamamia that while they were greatly saddened by the death of Ms Sheppard and that while c-sections undoubtedly saved lives there was no way she could reassure all women they would always be safe.

She said that women needed to be informed as when it came to elective caesareans there are pros and cons.

“Her death is a timely reminder that a caesarean section doesn’t come without risks” she said.

Ms Stewart said that women need to speak to their doctors and midwives and make sure they are fully informed.

“Major operations are not to be taken lightly, it doesn’t do any harm to know the pros and cons.”

When asked if we could assure Australian women that they would be safe during a c-section the college said that while the risk of maternal mortality during a c-section was low there is “no way we can guarantee anything.”

 1 to 2% of women giving birth by c-section die from or after c-section. Image via IStock.

The Courier Mail reports that the death of Ms Sheppard  was believed to have been caused by a suspected embolism.

Dr Ric Porter, a highly regarded obstetrician with more than 30 years experience and resident medical expert on the Nine Network's Today show told Mamamia that if indeed it was an embolism we can feel "encouraged" by the rarity of this complication.

"The aim of good medicine is to minimise risk as much as possible" he said. "And to inform mothers who are thinking of an elective C-section or who need an emergency one in labour. Remember being pregnant carries a very small risk of maternal death, so does a vaginal birth and so does a caesarean section. All three should not be taken lightly."

For many women, pregnant, or planning on having a baby the news came as a shock, deaths from childbirth being relatively rare in Australia.

In fact while Australia has one of the highest rates of caesarean births in the world with 32 per cent of all births delivered through a caesarean section, Australia is also one of the safest countries in the world in which to give birth or to be born, with substantial decreases in maternal mortality rates over the past century.

The rate stabilised in the 1980s to approximately 10 deaths per 100,000 live births.

It is estimated one to two per cent of women giving birth by c-section die from or after c-section.

This risk is four to 12 times higher than in vaginal birth. However World Health Organisation statistics the most dangerous form of childbirth is vaginal operative delivery, which includes using forceps or a vacuum to assist in delivery, it is a is  though a more rare form of childbirth.

According to the Australian Institute of Health and Welfare in 2006–2010 in Australia, there were 99 maternal deaths that occurred within 42 days of the end of pregnancy.

• The leading causes of direct maternal deaths were amniotic fluid embolism (9), thromboembolism (8), obstetric haemorrhage (7) and eclampsia (6), and, when combined, accounted for more than three-quarters of all direct maternal deaths.
• There were 15 deaths due to cardiac disease, the leading cause of indirect maternal death. Preconception counselling and assessment for women with cardiac disease and referral to appropriate multidisciplinary tertiary services is essential.
• There were 13 deaths due to psychosocial causes, including 9 due to suicide.
• Five non-obstetric haemorrhage deaths resulted from rupture of a splenic artery aneurysm.
• There were three deaths due to ectopic pregnancy in 2006–2010.
• Seven pregnant women died in motor vehicle accidents.
• Three women died from epilepsy.

A World Health organisation study, that looked at risks from caesarean sections, found that most caesarean sections (15.8 percent of births) were begun during labor, as opposed to before it starts.

The study found that the later procedures—both elected (0.5 percent) and medically required (15.3 percent) carry the most risks for adverse outcomes. The study compared outcomes from nine countries - Cambodia, China, India, Japan, Nepal, the Philippines, Sri Lanka, Thailand and Vietnam and found that with these surgeries came an increased risk of maternal death, infant death, admission into an intensive care unit, blood transfusion, hysterectomy or internal iliac artery ligation (to control bleeding in the pelvis) compared to spontaneous vaginal delivery.

However despite the increased risks associated with caesarean deliveries, no mothers or babies in the study died after an elected caesarean before hospital release.

The last death during a c-section occurred in 2012 in at Sunshine Hospital in Victoria. At the time the hospital said that in some high risk pregnancies there are circumstances in which "despite every possible precaution, complications do occur,"

"In this instance, we mobilised a senior team of anaesthetists and obstetricians to manage the caesarean and when complications arose, an additional team of our most senior anaesthetists and obstetricians were immediately on hand and provided every possible support. Tragically, it was not possible to prevent the death of the mother despite the best efforts of all concerned" the hospital's statement read.

Women need to know they have a choice. Image via IStock.

Sadly the death of Amanda Sheppard is being overtaken by those opposed to c-section births and used as a way to make women feel fearful of their birthing options.

Dr Porter says that before undertaking any operation , as doctors, they "weigh up risks such as underlying maternal disease, likelihood of bleeding, infection, damage to another organ, blood clots and anaesthetic risks from epidurals, spinals and general anaesthesia."

He says, "we know deaths occur on our roads but we still drive."

"Women should not be worried by these numbers, or this rare complication as most caesarean sections are generally  low risk operations and they should be encouraged to talk to their doctor about their individual circumstances."

A GoFundMe page to assist Amanda Sheppard's husband and baby has been set up and can be accessed here.