An Auckland woman who contracted a disease spread by cats believes that, if it weren’t for New Zealand’s “laid-back” approach to maternity care, her unborn child could be alive today.

She said her son’s illness was preventable and had created a “lifelong scar” she did not want any other woman to experience.

Lana* lost her baby near the end of last year. It was her first pregnancy.

After the standard 20-week anatomy scan, she was surprised to be told her next scan would not be for another 10 weeks. She contacted multiple clinics asking if she could pay to have another scan in between but was told she could not have an ultrasound without a referral from her midwife with a valid reason.

“Ten weeks, I feel, is a long time for things to go wrong,” she said.

At about 24 weeks, she began having pain around her liver but was told it was probably the growing baby pressing on her organs.

Eventually, the pain became so bad she went to a hospital emergency department, where she had blood tests and was checked for pre-eclampsia but did not have a scan.

When Lana was 30 weeks pregnant, she woke in the night to her waters breaking.

An ultrasound in hospital revealed her baby’s brain was two or three times larger than it should have been.

A foetal medicine specialist explained the baby had suffered heart, liver and lung failure and that, if he survived, he would likely be blind and deaf as well as having breathing difficulties and significant cognitive and motor delays.

Lana and her partner made the painful decision to terminate the pregnancy.

“My partner and I were very much on the same page, very afraid if my labour was to suddenly start and this baby was born earthside he would suffer so much,” she said.

Lana believes New Zealand should have more routine scans and screening for pregnancy. Image / Paul Slater

She was told the baby had contracted toxoplasmosis.

She had stayed away from cats and been careful to follow all food guidelines for pregnant women. She suspects she may have caught the disease from takeaway food.

Lana was now doing “as well as I could for someone who’s lost a child”, and had connected with many other women whose babies had died in utero.

“We all lost children to different causes,” she said.

The common thread was that many felt there was a “laid-back” attitude towards maternity care in New Zealand, with fatal symptoms being “normalised” as simple pregnancy woes.

Lana said that, in her home country of Taiwan, pregnant women routinely had 12 ultrasounds.

She was surprised there was no screening for toxoplasmosis in blood tests at the beginning of a pregnancy. In other countries, women who did not have antibodies for the infection were then screened once a month and could be given medicine if they contracted it before it spread to the baby, she said.

“I felt like there were lots of missed opportunities.”

Had she been screened or scanned more often, Lana believes there was a high chance her baby might not have contracted toxoplasmosis or could have received treatment before it was too late.

“We could have saved him but we will never know because I was never even given that chance.

“I think, unfortunately, many of us, especially women, learn about the complexity of pregnancy itself too little too late – and we’re relying on a very time-poor and underfunded public medical system.

“Losing a child, especially to a preventable cause, is a lifelong scar I don’t want more women to have.”

University of Auckland associate professor Mark Thomas, who worked as an infectious disease physician at Auckland Hospital for more than 30 years, said toxoplasmosis could be found in any community with cats.

Cats carry toxoplasmosis in their intestines. Their faeces hold toxoplasma gondii eggs, which can survive for months.

Lana holds her son's 12-week ultrasound images and a teddy bear she was given after his death. Photo / Sylvie Whinray

The infection can be spread to humans through contact with cat faeces or by consuming undercooked meat.

As cats wander fields and spread their faeces, the eggs can be eaten by cattle and infect their meat. If humans then eat this meat without thoroughly cooking it, they can catch the infection.

Thomas said meat needed to be cooked until there was no red blood left to ensure toxoplasmosis was not passed on.

Infected people might not show any symptoms and, if they did, the symptoms could often be vague and mild, including aches, swollen lymph nodes and general unwellness.

It could take a couple of weeks for the infection to spread through the body and another one or two weeks to cross the placenta and infect a foetus, Thomas said.

A study by doctors at Auckland Hospital in 2004 assessing blood samples from women at the start of their pregnancies showed 33% already had toxoplasmosis antibodies.

If someone had been infected earlier, antibodies would remain and they would not be at risk of transmitting a future toxoplasmosis infection to an unborn baby, Thomas said.

But for those who had not had toxoplasmosis before, there was a small chance they could contract it during pregnancy and pass it on to their baby.

Some countries screen for toxoplasmosis at the start of the pregnancy. If a woman does not have antibodies, she will be tested monthly in the hope that an infection can be caught and treated quickly before spreading to the baby.

This was not done in New Zealand, partly because it was inconvenient and expensive, Thomas said.

Data from other countries that screened for the infection suggested that, if the mother took medications after being diagnosed during pregnancy, this could prevent or lessen the severity of the disease for the baby. However, there had been no “gold standard” double-blind study, he said.

Lana said she was never given the opportunity to protect her baby from toxoplasmosis. Photo / Sylvie Whinray

Of the small number of babies who contracted toxoplasmosis in utero, 5% died and 10% had recognisable symptoms caused by the infection.

Claire MacDonald, midwifery adviser at the New Zealand College of Midwives, said local guidelines recommended two ultrasounds, one at 12-13 weeks and an anatomy scan at 19 weeks or more.

Further scans were recommended when there was a risk factor or when a concern was raised.

“Ultrasound scans are a useful clinical tool for several clinical indications, but research evidence does not support routinely increasing the number of ultrasound scans used in each woman’s pregnancy as a way of improving clinical outcomes.

“Aotearoa does not have the capacity to offer more ultrasound scans – in some regions even getting two scans is difficult. The college has been raising concerns about the need for government investment to increase equitable access to scans for pregnant women for several years.”

Dr Mark Thomas, of the University of Auckland, said New Zealand did not screen for toxoplasmosis at the start of pregnancy, partly because it was inconvenient and expensive.

New Zealand’s practice of not screening routinely for toxoplasmosis aligned with the United States, Canada, the United Kingdom and some European countries, she said.

The need for monthly tests was one reason for this. Interpreting the results of the screening was also complicated and false positives were common, “which creates significant unnecessary worry for pregnant women”.

New Zealand’s maternity system was informed by guidelines co-developed by midwives, obstetricians, GPs and anaesthetists, and endorsed by the professional colleges representing these specialist groups, she said.

How to lower the risk of catching toxoplasmosis

Toxoplasmosis can come from:

• - eating unwashed vegetables, undercooked meat or ready-to-eat meats such as salami or ham
  drinking raw (unpasteurised) milk
• - cross-contamination of your hands or food after gardening in areas where there are cat faeces, or from direct contact with cats.

You can minimise your risk by:

• - washing fruit and vegetables well, cooking meat well, avoiding ready-to-eat meats and raw milk
• - washing your hands well after handling raw produce, gardening, touching or cleaning up after animals
• - If possible, ask someone else to empty your cat’s litter tray, or wear gloves to do it.

Melissa Nightingale is a Wellington-based reporter who covers crime, justice and news in the capital. She joined the Herald in 2016 and has worked as a journalist for 10 years.