Crash C-Section on Dead Mom with Miraculous Result
Posted by realityrounds on December 29, 2009
Happy endings are certainly needed now-a-days, and this story has one. As reported by ABC news, Tracey Hermanstorfer of Colorado went into a complete cardiac arrest (no pulse, no blood pressure, cyanotic) during labor with her third child. It is being reported that Tracey was being prepped for a “catheter” (epidural, my guess), when she became unresponsive and in complete arrest. Her doctor performed an emergency C-Section right in the room (no anesthesia, pour betadine over the abdomen, and cut) and placed the lifeless infant in the father’s hands. Within seconds of delivery, mom’s vital signs came back, and the baby started to show signs of life right in his dad’s hands. Tracey’s doctors state they have no idea why she went into a complete arrest, and are even more stunned that she recovered. This is truly an amazing story…….and of course…..I have many questions.
I have unfortunately been in Crash C-sections on “dead” moms before. Most often, we have a reason for the code right away. One mom was a severe alcoholic. She was crashed, and during the section her liver essentially disintegrated due to cirrhosis. She eventually died in the ICU, and her baby died of Fetal Alcohol Syndrome in the NICU. Another mom presented in the ER in full arrest. She was slashed right in the ER. unfortunately both her and her baby died. Turns out she had a severe cardiomyopathy. Another mom had a very normal labor, just like Tracey’s, and crashed out of the blue. She was progressing normally. It was her third child and all was going well. All of a sudden she crashed. She was rushed to the OR and both her and her baby were fine. The tentative diagnosis: amniotic fluid embolism. A rare condition, and an even rarer condition to survive.
We may never know why Tracey coded during labor. Some differential diagnosis that I can think of are a highly placed epidural (this can cause respiratory depression and paralysis), and amniotic fluid embolis (very rare, and even rarer to survive), a pulmonary embolism, and undiagnosed congenital heart defect.
Another issue that makes me pause is the fact that they placed the depressed neonate in the father’s hands. Why they did not immediately begin neonatal resuscitation on this infant under a radiant warmer is beyond me.
So, what are your theories on what happened to this mom?
RR
Aron said
(not a medical professional…yet…so take this question for what it’s worth) Could the doctor have handed the baby off to dad because everything happened so fast there just weren’t enough people in the room yet to do anything else?
And by the way, whoa! I imagine every medical head in that room was gray by the end of the day. My heart rate is up just thinking about being the nurse in such a moment.
One more by the way, can you imagine being the mom and regaining consciousness after all that??? It had to be like a nightmare for her, not to mention her husband.
A round of counselling for everyone.
realityrounds said
It is possible the baby was given to Dad out of panic and confusion. It certainly is not orthodox to do so, but than again, neither is doing a C-Secion out of the OR!
Not to sound crass, but I would be shitting bricks if I was a nurse in on this case. I am generally very calm in emergencies….but whoa!
Counseling would be a very big must. She is at risk for PTSD and PPD.
Crystal said
Ewww…this story gave me the heebie-jeebies when I first read it a couple of days ago. I’m not sure that I’m comfortable with someone “gutting” a woman like a dead-fish when she takes ill while pregnant. There was another story of the lady hit by a car in the Midwest, and they did the same thing, but of course 9 out of 10 times the baby dies anyway and in that case both the baby & mom died. It scares me to think, that if I’m injured while pregnant, my life will not be valued and no one will make much effort to save my life and revive me. Instead, all energies go into cutting out the fetus on the slim chance that it may survive.
This story is rare, but the precedent it sets is dangerous.
realityrounds said
Crystal,
Ewww is right! A very disturbing story. As far as “gutting” the mom to save the baby, it is actually (usually) the opposite. Again, I hope I am not sounding too crass, but babies die and it is very sad, but it happens. When a mom dies it is a very rare TRAGEDY. It feels unforgivable. By “gutting” the mom we are trying to SAVE her. The pregnancy could be what is killing her. Am I making sense?
*L&D nurses and docs, please chime in*
drp said
CPR (cardiopulmonary resuscitation) is thought to be ineffective in pregnancy because the weight of the uterus on the vena cava impedes adequate return to the heart. So if you don’t get the mother back after 4 or 5 minutes of CPR, you empty her uterus in order to try to make maternal resuscitation succeed. (ABCD => Airway/Breathing/Circulation/Delivery) It’s only secondarily a baby-salvage procedure.
MomTFH said
Fascinating. In a very very sad way.
Emily said
Is it possible that the baby was handed to the dad because everyone thought both mother and child were dead? In which case it would have been compassionate to hand the child’s body to the father.
realityrounds said
That was actually the first thought that popped in my head. However, everything happened so fast there is no way they could know for sure that the baby was dead. Also, they would not do a crash C-section on a “surely” dead mom and baby. We also do not do Crash C-sections on IUFD’s. We would code the baby, and if the baby unfortunately died, we would then hand the baby to dad to hold.
Kathy said
My first thought was the same as Aron’s — that the baby was basically thrust into the dad’s hands while the few medical people in the room were tending to the mom… but why cut the baby out of a dead mother if you’re not going to try to save the baby? and if you’re going to try to save the baby, why not work on resus?
The article confused me a bit — saying both that the baby revived in the dad’s arms, and also that doctors worked to revive the baby — perhaps both happened? The OB and nurse were working on the mom, and the baby was handed off to the father, where others (NICU nurse? perinatologist?) started working on the baby while still in the father’s arms?
Certainly a very tense situation, where the immediate reaction may not always be the most “logical” when viewed from afar as an armchair quarterback. I think all of us have done things that, when we thought about it later made us say, “WHY did I do THAT??”
Kathy said
This longer interview has the doctor who cut the C/s saying that she handed the baby to the NICU team, so maybe the earlier report had it wrong?
However, this GMA interview also says that this 7lb 4oz baby was “7 weeks early,” and although the mom doesn’t correct that, she does look a bit confused and mouths, “7 weeks?” at one point, so I think that is mixed up. It seems unlikely that labor would have been augmented at 33 weeks, rather than an attempt at it being stopped; plus, it seems unlikely that a 33-weeker would have been discharged within days.
Kathy said
forgot the link! http://abcnews.go.com/gma
Valerie said
Maybe they handed the baby to the dad because they did not think it was dead. And the dad just took what was handed to him, distracted by the activity with his wife. Only after a few seconds did the dad realize what he was holding or was aware when baby started squirming. I wonder if baby was never dead just blue (low apgar baby – 2 or 3 at 2minutes). Low apgar babies can arouse and start bellowing once they get a breath!
Dawn said
I am not a medical person, but am a mom of 6 and have had baby have decels and I had dizziness when on my back. I wonder if she had her blood vessels pressed and then when baby was out, the blood could flow again? If she had a catheter put in, was she on her back flat? Is that the standard? Maybe this started the whole process, and then she laid back again, causing the cardiac arrest due to lack of blood flow?
Labor Nurse, CNM said
This story sounds very fishy to me. I highly doubt they just handed over the baby to the father. Another report I heard states that they were resuscitated the infant in the father’s arms…again, hard to believe. Some here have suggested that perhaps in the chaos and lack of clinical staff the baby was just thrown into the dad’s arms, but I’d put money on every single labor and delivery staff member was in that room.
My guess is on a high spinal effect from an epidural, or perhaps the test dose was accidently shot into a blood vessel. And what doesn’t make sense to me is that the obstetrician and nurses and others on the OB team didn’t start a code blue on the mother while prepping her for a c-section. I guess the press is going to leave out the details that would make this story seem more believable to those who have the medical knowledge to understand more fully the actual situation.
I’ve worked in several hospitals, most of them tertiary care centers who are used to high risk, high stress, and high volume style obstetrics. Every place I’ve ever worked addressed the issue of what to do if the mom “codes”. Every place had the policy to call the code blue, begin maternal resuscitation while simultaneously prepping her for a c-section in the OR. Only one place recommended that a c-section be down out of the OR, which was in an office and no immediate access to a c-section.
The goal in each birth is a healthy mom and baby, but when the you-know-what hits the fan, the first goal is saving the mother. Physiologically, this is what her body will try to do anyhow, as her oxygenated blood will automatically be shunted to brain and heart when it’s compromised. Doing a crash section on a viable gestation/fetus is a last ditch effort in saving the baby, but the likelihood of saving both in such dire circumstances is a stretch.
Someone at work today was just saying that the doctor’s description during her interview on the news was weird. The physician describes something like (and I am ad-libbing here): “She had no pulse, no respirations, and was blue…so we just did the c-section.” This, if literal, is true…makes me very, very nervous that they made no effort to resuscitate that woman.
Also, I realize anyone can be critical of any situation they didn’t attend, but these are my thoughts on the situation.
Labor Nurse, CNM said
*make that third paragraph, last sentence to read “…immediate access to an OR”.
Kathy said
Perhaps this hospital was not so ready/equipped to handle it? — perhaps it’s a more rural hospital without such firm procedures in place?
In the interview (see above link on Good Morning America to watch it), the doctor says that they tried to resus the mother for a few minutes, and then when that didn’t appear to be working, just sectioned her — like what “drp” says in another comment.
First, it’s important to remember that journalists are in large part ignorant of a lot of medical lingo, jargon, and practices, so I almost *expect* them to get the facts wrong with some regularity. Note that this 7lb baby is said to be “7 weeks early,” which is highly unlikely given the baby’s weight, short hospital stay, and that they were speeding up her labor instead of trying to stop it (also check out the mom’s surprised reaction when she hears the interviewer say that the baby was 7 weeks early).
From what I’ve read in published reports, the interview, and in comment-conversations like this, it appears that the mother coded right after getting an epidural, because the anes. was still in the room and began bagging her to keep her oxygenated. A code was called and the first available doctor rushed in (not the woman’s doctor) and began trying to resuscitate her in the room. When several minutes of that failed, since they didn’t rush her to the OR while trying to resus her, they cut open the apparently dead woman there in the L&D room, to try to save the baby without taking even more time moving to an OR. The doc says she handed the baby off to a neonatologist in the room, the woman’s vitals returned (maybe the weight of the baby off the blood vessels?), and they rushed to the OR to complete the section and stabilization efforts, while other doctors and nurses were working on the baby.
realityrounds said
Just watched the ABC news link, thanks Kathy. I completely agree with Labor Nurse, CNM, this story is very fishy. I am certainly not trying to be a “Monday morning quaterback,” but pregnant women (usually) do not code out of the blue. She coded after her epidural was placed. My guess is it was placed to high, or placed in a blood vessel. Also, that baby is NOT a 33 weeker. No way, no how. WTF?
Aron said
A guess regarding the “7 weeks early” weirdness, I wonder if the interviewer heard mom say “I was thirty-seven weeks along” and somehow twisted that around in her head to be 7 weeks early. Clearly she didn’t have her facts straight, but I could imagine her brain latching on to just the words “…seven weeks” and spitting them back out again in the entirely wrong context. Sadly not surprising in a journalist.
Jill said
Thank you so much for posting this story for discussion. It has been bugging the heck out of me ever since I heard about it. I agree with you, I am no medical professional but it seemed so strange that a pregnant woman in labor would just suddenly “die” for no apparent reason. Now, this is my extreme skepticism of maternity care talking here, but I figured deep in my cynical little heart that they must have done something that caused her to code. I’ve heard of women reacting like this to a badly done epidural, so I’m glad this is one of your theories and now I don’t feel like such a jaded ass.
pinky said
The first thought I had was, “that can’t be true.” And you can do cpr on a pregnant woman. We were taught to displace the uterus a bit in ACLS. Of course it will be more effective without the gradid uterus. Also you only have 10 minutes to get the baby out. If the mother is really really dead, why would you waste time getting to the OR?
Nicole - YourBirthRight said
Ahhhh more discussion on the Miracle Mom. I just left the convo over on my blog and was given a link to your post.
Its such a strange story ultimately we all know the media has done a poor job of reporting the facts in order to bring to the public a sensationalized “Christmas Miracle Story” GMA ran out to get the first scoop and got all kinds of info wrong and messed up!
You all have already made the points I have been commenting on and speaking about in this case… the 33 weeker that weighed in at greated than 7 pounds. Yea right… The infant being placed in his father’s arms. WTH!! The lack of acknowledgement that the epidural is a likely culprit. The media leaves out vital info again! (someone yesterday mentioned if this had been a home birth they would be ripping the midwife up instead of celebrating the Miracle)
I speculate that there are four things that could have happened…. She got TOO MUCH medicine, the medicine went into the WRONG SPOT, she got the WRONG MEDICINE, or she had an ALLERGIC REACTION.
When she mentioned a catheter being placed, I initially did think about the epidural cath but then realized she also said she was laying down which then made me think it was a urinary catheter. If she was flat on her back immediately after her epidural placement that could have caused her to have a servere HYPOtensive episode resulting cardiac arrest. Hypotension does happen with many epidural placements so perhaps she was getting hypotensive and laying her down made took it to the bottom! I always do BPs during epidural placement but through my travels have worked in facilities where they don’t monitor the BP so closely. *smh* Who knows. This is very interesting. I wish there was some way to get more facts!
Jill said
Very good point Nicole…if this had happened at home (highly unlikely, since there are no epidurals in a midwife’s bag and they don’t usually stick women flat on their back), everyone would be going “OMG why weren’t they in a HOSPITAL?? See?? Birth is DANGEROUS!” :eyeroll:
Labor Nurse, CNM said
Jill, so true, you took the words right out of my mouth with your last sentence! Eyeroll included.
Erin said
I absolutely agree that this story was fishy. Journalists were rushing to write a “feel good” Christmas story and left out all of the medical details.
Kathy said
You can read Henci Goer’s take on this — she says it sounds like a classic case of an epidural placed too high, although it rarely (almost never) causes a cardiac arrest. I’m wondering if the hospital is doing a bit of CYA and playing dumb, so that the mother and family are just happy they’re safe, rather than p*$$ed off that mother and baby nearly died from epidural complications.
Kathy said
Cr@p, I hate it when I mess up links! http://www.scienceandsensibility.org/?p=903
Krista said
You know, my reaction to the baby in the dad’s arms was… WOW, maybe that is what saved the baby? Not a very scientific view of course, but thinking of a situation with a friend when she gave birth to a blue baby, apgars of zero… and the midwife told her that she needed to hold and talk to the baby while she did her resuss on her. Baby turned out to be fine and whether true or not, all involved really felt that being in the arms of that loved one, talking to them, was a factor in baby “coming back”. Possibly whisking that baby away to a warmer with nothing but strangers around it would have had a different outcome? Just pondering aloud.
Kathy said
My friend’s baby was that way — born not breathing, and the staff was trying to get her started; the mom tore pretty badly and couldn’t get to her, so she told the dad to go over and start talking to the baby — as soon as he started talking to her, she started breathing. She’s been a “daddy’s girl” ever since!
L.R. said
Great discussion here! Man, though, I’m gonna puke if I see this story crossposted/emailed as a “Christian inspirational” piece one more time. I’m in my second trimester and it’s giving my freaking nightmares. It does NOT make me think “awww puppy cuddles and divine lurrrve” but rather “HOLY SHIT!!!”
Jennifer said
I noticed this story becuase it was the same hospital that I gave birth in (c-section, 34 weeker) last year. Its not a rural hospital – its a very nice, well-equipped hospital with a great NICU. Just commenting because someone asked if the hospital was perhaps a rural hospital.
emjaybee said
Well, and if it had been a hospital unequipped to handle a mom who codes, why would it be handling births at all? Codes happen, even if rarely.
The 7 weeks early thing threw me too, glad to see it discussed, because I could not figure out why a mom w/ a history of two non-augmented births, and what seemed to be an early labor, would need augmenting anyway..being cynical, I wonder if choice to use pit (and thus epidural) was not influenced by it being a holiday. I hope not of course, but, there’s definitely more to this story.
kitchrn said
This story is on CNN right now, the family is telling their story to Anderson Cooper.
kitchrn said
Anderson Cooper interviewed Dr. Sanjay Gupta about this story. Dr. Gupta was being diplomatic of course, but said that just because the woman went into cardiac arrest does not mean that she was clinically dead. She was being ventilated and had compressions performed from the very beginning of the code. He said an amniotic embolism or PE was a possibility, but no one really knows for sure what caused the arrest. Mom is doing just fine now.
The father states that the baby was placed in his arms while the team continued to work on the baby, and he was limp for about a minute before he “came to”. Although placing the baby in the father’s arms for resucitation is a bit unorthodox, it is certainly not unusual for a baby delivered in an emergency C-section to be a bit limp and blue at first and require a little support before they pink up and cry.
I do agree with the previous comments on this point: the hospital is lucky that at this point, the family is considering the event “a Christmas miracle”!