Do you know about AFE?


Photo by Sarah Mihalko

Sarah had an Amniotic Fluid Embolism (AFE) while in labour.

Holly Edwards-Smith, Reporter

Amniotic Fluid Embolism’s (AFE) are a rare and life-threatening condition predominantly affecting woman in labour and during birth.

It occurs when fluid from the amniotic sac (the fluid surrounding the baby) enters the mother’s blood stream. The condition is unpreventable and often unpredictable, with symptoms often mis-or undiagnosed.

20 years ago the mortality rate of the condition sat between 60-80% in Australia and New Zealand. Although still considered an obstetric emergency, medical advancements have resulted in the rate now sitting at approximately 20%.

In Western Australia an AFE occurs about once in every 15,000 to 20,000 births, according to St John of God Hospital. That’s around twice a year.

When the fluid enters the bloodstream, it can subsequently enter the mother’s lungs leading to a build-up of fluid. AFE can cause heart failure, seizures, anaphylactic shock and quickly become fatal.

Head of Obstetric Anaesthesia at St John of God Subiaco Hospital, Clinical Professor Nolan McDonnell has spent 14 years in obstetrics and assisted in four cases of AFE.

Professor McDonnell told NewsVineWA about his personal experience with women affected saying: “two of the women presented very quickly and within a few minutes went into cardiac arrest”.

Amniotic Fluid Embolisms present in different ways, symptoms can include shortness of breath, dizziness and heart palpitations. McDonnell explained that there is “variety in the severity of reactions with this condition”.

There is limited research on the condition as “its rarity and unpredictable nature makes it hard to study,” McDonnell added.

There is no known cause or established risk factors associated with AFE – it is believed to be an immune response to the amniotic fluid. McDonnell explained “we could inject amniotic fluid into a mother’s bloodstream and there would likely be no reaction but in very few cases an AFE will occur”.

Sarah Mihalko experienced an AFE first hand in October 2017 while pregnant with her first child.
In an interview with NewsVineWA she said the experience was “horrible”, and described how during labour she realised something wasn’t quite right.

“I felt like I couldn’t breathe when I was pushing. Then I went unresponsive.”

McDonnell says that AFE’s are “associated with very poor outcomes for the baby if the condition presents while they are in-utero”.

Sarah and her son, Aaron, survived the ordeal which led to her undergoing an emergency C-section.
Sarah described the difficulties she faced after childbirth. “[I couldn’t see him] until he was 10 days old because he had to go to a different facility for complications.”

Jillian Stevenson suffered an AFE shortly after the birth of her daughter at St John of God (SJOG) Hospital in Subiaco. Jillian and Sarah both suffered very serious AFEs, however, their responses to the amniotic fluid were very different and shows how unpredictable the condition can be.

Jillian told NewsVineWA her body had begun forming abnormal clots inside her blood vessels. The clots can lead to large scale internal bleeding in other parts of the body, which led her to collapse.

“I was rushed to surgery and operated on for several hours, before being transferred to ICU.”

Jillian described waking up fully intubated (with a breathing tube inserted in her mouth) as the “scariest moment”.

From her experience as a labour and delivery nurse, Sarah knew of the condition, although she added, it’s usually not “something that is taught to women.”

Similarly, despite Jillian being “pretty well informed” about risks associated with pregnancy and birth she had never heard or been told of the condition. So why was Jillian not informed of AFE’s?

Professor McDonnell doesn’t believe the condition should be addressed with pregnant women, but said it could be part of the “difficult discussion about where to have the baby”.

He continued to say that “the mother should know about the limitations of her choices”.

He added that women should have all the information about various birthing options and that health care professionals should ensure they feel “empowered” about their choice.

Jillian shared the sentiment, “I think it’s helpful to be informed of the wide variety of complications that can occur, so women can make educated, risk-conscious decisions regarding child birth.”

Continuing, she added she was thankful of the decision she made regarding the birth of her daughter.
“[I] Had a low risk pregnancy yet wouldn’t have survived the birth if it were not for the critical care resources at SJOG.”

Women can and should “hope for a smooth delivery but choose a care provider that has appropriate resources to respond if things don’t go to plan,” Jillian concluded.

Both Jillian and Sarah and their children survived their experiences with AFE but will live with it for the rest of their lives.

Sarah said she feels “blessed” that her family survived the experience and are healthy now. Although she had to have a hysterectomy three months after the embolism, leaving her and her partner devastated that they can’t have any more children and planning to try surrogacy instead.

Jillian was in recovery and in and out of hospital for six months after her AFE, because she “needed a couple of surgeries and physio”.

She now feels “very lucky as many survivors suffer with long term physical, mental and psychological effects after an AFE”.

For more information on Amniotic Fluid Embolisms you can speak to your health care provider or visit