Figuring out what an Amniotic Fluid Embolism (AFE) actually was pretty daunting and more often than not written in a very scientific and slightly terrifying way rather than from the perspective of someone who had actually gone through it. In the interest of full disclosure, I am not a medic, but I am a vet – so my knowledge of anatomy and physiology and how it can all go wrong is pretty good, but this is not meant to be some kind of peer reviewed summary of AFE’s, it is purely what I have learnt to understand what happened to me, in the hope it might help others to better understand what an AFE does to you.

An Embolism is classical something foreign that enters your blood stream, typically air or blood clots that then get ‘stuck’ somewhere causing diseases – think Pulmonary Embolism’s, where blood clots get stuck in your lungs causing them to fail. Historically, this is what an Amniotic Fluid Embolism was thought to be – where amniotic fluid (or hair/cells from the foetus) got into your blood stream whilst or just before/after you gave birth and got ‘stuck’ somewhere. It is now thought that amniotic fluid and foetal hairs/cells entering the mothers circulation during labour is actually fairly normal, but not everyone suffers from an AFE… This is because they now think that an AFE is actually because of a massively abnormal inflammatory response to this ‘foreign material’ – think of it essentially as a massive and uncontrolled allergic reaction.

Once your body starts with this allergic-type reaction it is very difficult to control. Your body is producing all sorts of chemicals in a very uncontrolled way which are perpetuating this allergic response and making the symptoms worse and worse. The actual mechanisms behind all of this are extremely complex, but it is this uncontrolled response that causes the first signs of an AFE – leading to your cardiovascular and respiratory systems collapsing, seizures and massive haemorrhages.

In the majority of AFE cases, people enter a state known as Disseminated Intravascular Coagulopathy, or DIC. This in itself is an extremely complex and life threatening process, where your body is using up what it needs to enable the blood to clot, faster than it is producing them – this means that your body becomes unable to stop itself from bleeding. The combination of the collapse of your cardiovascular and respiratory systems, alongside the processes of DIC makes treating an AFE extremely complex and challenging. The doctors essentially have to work to keep your heart and lungs working – typically through prolonged CPR, all whilst trying to correct the blood clotting issues and stop the bleeding. This is why people who suffer from an AFE typically require such aggressive treatment and massive blood transfusions to keep them alive whilst the doctors work to stop the bleeding.

In the majority of cases, immediate treatment involves a hysterectomy, to try and stop the source of the bleeding but also because once you have lost a significant amount of blood during child birth, your womb is likely to have sustained an unrecoverable amount of damage. Vascular surgery is also often required to try to and further isolate the bleeding. Losing such massive volumes of blood is a an extreme insult for your body to endure, and affects so many different parts of your body in so many different ways. This is why the survivability and long term effects of an AFE are so variable and dependant on so many factors. In the immediate future your body needs time to just try and get itself back together, without having to do the ‘normal’ things – like thinking and breathing for itself. This is why AFE patients are typically kept in a coma and can take time to regain consciousness and to allow the doctors to determine the extent of the damage that has been sustained.

The severity and complexity of what an AFE does to your body is extreme. I think my veterinary understanding of what actually happened to me has helped me to process things, but the magnitude of it still has the capacity to take my breath away. I am thankful literally every day for the fast acting and thinking of the medical team that looked after me, but also for the fight and determination that was deep in my subconscious. I will never forget or underestimate what my body has been through. The fact that I am here writing this is without a doubt the biggest achievement of my life!

Education and understanding of extreme complications around child birth is an area that I think is massively overlooked. I have had enough experience of extreme obstetric emergencies (albeit with cattle and sheep…) that I felt reasonably prepared for how extreme a ‘normal’ labour could be. But despite attending courses and reading up on things, I had no idea complications like an AFE existed. This is not about terrifying people about these situations, but it is about raising awareness that things can go this wrong and being mindful of people’s experience and the life long impacts they can have.

Although based in the USA, the Amniotic Fluid Embolism Foundation has some really useful and well put together resources to better understand AFE’s – https://afesupport.org/what-is-amniotic-fluid-embolism/.