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Her Survival Was a “Christmas Miracle,” but the Disaster Was Man-Made

Many of you will have read the story of the woman laboring on Christmas Eve who suddenly went into respiratory and cardiac arrest in front of her horrified husband. She recovered shortly after her son was delivered by emergency cesarean, and the baby, too, was successfully revived. As the MSNBC article tells the tale:

After their miraculous recovery, both mother and the baby, named Coltyn, appear healthy with no signs of problems, Martin [the obstetrician who responded to the Code Blue and performed the emergency cesarean] said. She said she cannot explain the mother’s cardiac arrest or the recovery. “We did a thorough evaluation and can’t find anything that explains why this happened,” she said. Mike Hermanstorfer credits “the hand of God.”

However, an ABC video interview with Tracy and Mike Hermanstorfer and Dr. Martin provides details that call into question the hospital’s failure to find an explanation. I have transcribed the relevant section.

Tracy: [Tracy was being induced for her third child because membranes ruptured.]The pains [with Pitocin] were a lot harder than I remembered. We decided to go ahead and do the epidural for the very first time. . . .

ABC: Mike, you were holding her hand as Tracy got the epidural. . . . When did you start to notice that there was a problem occurring?

Mike: Well, we had her sitting up when they were doing the epidural and afterwards she lay down and said that she was tired and that’s when the whole nightmare started.

ABC: What happened?

Mike: She started going numb and everything in her legs . . . and she laid down to close her eyes and take a little nap . . . and she wasn’t waking up.

ABC: When did you notice that her breathing was shallow or her color was blue?

Mike: Well, I felt her hand—I was holding her hand—and it started getting cold and I looked down at her fingertips and her fingertips were blue and one of the nurses noticed that the color in her face was completely gone. She was as gray as a ghost.

ABC: Code Blue was declared, a scary thing in any hospital. [Dr. Martin arrives in response.]

Dr. Martin: . . . When I ran into the room, the anesthesiologist had already started breathing for Tracy. There were preparations already being made to start a resuscitation should her heart stop. About 35 to 40 seconds after I got in the room, her heart did stop and we started making preparations to do an emergency cesarean delivery right there in the room in the event that we were not successful in bringing Tracy back. Unfortunately, in most of these situations, despite the best efforts of the team, Mom is often not able to be revived, so we anticipated that possibility and when it became clear that Tracy was not responding to all the work that the team was doing on her, we had to make that difficult decision to do the cesarean section, primarily in an effort to give Coltyn the best chance at a normal survival and also hoping that it would allow us to do a more effective resuscitation on Tracy, and fortunately, she cooperated and we got a heartbeat back immediately after delivering Coltyn.

So, according to Dr. Martin, Tracy is an example of how things can go suddenly and horribly wrong for no discernable reason in a healthy woman having a normal labor. All I can say is that Dr. Martin must have slept through the class on epidural complications. Tracy’s story is the classic sequence that follows what anesthesiologists term an “unexpectedly high blockade,” meaning the anesthesiologist injected the epidural anesthetic into the wrong space and it migrated upward, paralyzing breathing muscles and in some cases, stopping the heart. High blockade happens rarely, and even more rarely does it result in full respiratory and cardiac arrest—one database analysis of 11,000 obstetric epidural blocks reported a rate of 1 in 1400 women experiencing a high block and 1 in 5500 requiring intubation, and no woman experienced cardiac arrest. It does happen, though, and I am willing to bet that high blockade and its sequelae happened to Tracy.

The moral of the print version would be: have your baby in a hospital where you can be saved should this happen to you. The video interview, however, reveals a different picture. The real moral of the tale is that the safest and healthiest births will be achieved by avoiding medical intervention whenever possible. Induction of labor is by no means always necessary when membranes rupture and certainly not immediately. If Tracy had been allowed to start labor on her own, which, considering that this was not her first baby, she would likely have done within a few hours, she probably wouldn’t have wanted the epidural any more than she did for her first two children. Tracy almost certainly would have gone home the day after Christmas after another uneventful, unmedicated vaginal birth. Instead, she is recovering from surgery, and she and her husband have the emotional trauma of her and her son’s near miss experience to deal with. Along with the Hermanstorfers, we can thank God for the prompt actions of the hospital team, but the safe money says they were rescuing her from a disaster they themselves had caused.

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  1. January 9th, 2010 at 14:11 | #1

    @Nicholas Fogelson
    Although it may not have been in this post, this article says “Her first two births were natural, she said, but this time she received drugs to speed up labor and control pain.”

    It’s possible that her water broke, she went to the hospital, where she was put on Pit to either start contractions (assuming her ctx had not yet started), or to strengthen them. If the Listening to Mothers Survey can be extrapolated, it is more likely than not that she was put on Pitocin, since 53% of women reported being augmented with Pitocin.

  2. January 9th, 2010 at 19:42 | #2

    Nicholas Fogelson :
    @Amy Tuteur, MD
    I’m also not sure where Henci got the idea that she was on pitocin. That’s nowhere in there. The woman presented in labor, and was not induced. Perhaps she was more painful because she was abrupting, leading to an AFE. That would actually make some kind of sense.

    Excuse me… but it is clearly stated in the INTERVIEW of the husband that his wife was on Pit…

    “Tracy: [Tracy was being induced for her third child because membranes ruptured.]The pains [with Pitocin] were a lot harder than I remembered. We decided to go ahead and do the epidural for the very first time. . .”

  3. avatar
    IndianaFran
    January 10th, 2010 at 13:45 | #3

    “I’m also not sure where Henci got the idea that she was on pitocin. That’s nowhere in there.”

    Yes, it’s in there. In the second ABC video, when asked if this labor was different, the mom absolutely refers to “when they started the pitocin”.

    “Perhaps she was more painful because she was abrupting, leading to an AFE. That would actually make some kind of sense.”

    If she was abrupting, wouldn’t the surgeon who did the CS find some evidence of that? I know the circumstances of the CS were unusual, no time for routine anatomical notes, etc, but if there was something unusual about the placentation, wouldn’t the surgeon would have noticed that?

  4. January 10th, 2010 at 22:18 | #4

    @IndianaFran
    We have no idea what they saw. And anyway, nothing looks the same when the mother is dead. There is almost no blood loss from surgery since the mother’s heart is not pumping.

    See a detailed description by Dr Chukwuma Onyeije and myself at my blog: http://academicobgyn.com/2010/01/10/an-obstetrical-analysis-of-the-christmas-miracle/

  5. avatar
    FangedFaerie
    January 11th, 2010 at 00:17 | #5

    So our minority (or in other words our lower class) population affects our maternal mortality rate, but not our perinatal mortality rate? That’s interesting, and again, to me, disturbing. Further, is this part of the reason our infant mortality rate is worse than it should be? And why would “whiteness” alone account for this? Even in very white countries, there are lower socioeconomic classes.

    The whole thing has me thinking, and puzzling.

  6. January 11th, 2010 at 09:37 | #6

    @FangedFaerie

    “Whiteness” or “Blackness” is not the issue. Lower socioeconomic class, whatever the color, creed, or nation, is associated with higher rates of maternal, neonatal, and infant mortality. This cannot be applied to individuals within a particular group, just but is observed in groups in general.

  7. avatar
    Dr. John Pepelnjak
    January 11th, 2010 at 14:26 | #7

    Bothered by the media hype of a over-processed birth and subsequent near disaster, I find more facts being misrepresented by Dr. Amy.
    Here is just one study and there are several more. The empowered woman is brilliant at birthing a child not any doctor or hospital.

    Meta-analysis of the safety of home birth
    Birth 1997 Mar;24(1):4-13; discussion 14-6
    Olsen O

    What is the relative safety of homebirth compared with hospital birth? Ole Olsen, a researcher from the University of Copenhagen, recently examined several studies of planned homebirth backed up by a modern hospital system compared with planned hospital birth. A total of nearly 25,000 births from five different countries were studied.

    The results: There was no difference in survival rates between the babies born at home and those born in the hospital. However, there were several significant differences between the two groups. Fewer medical interventions occurred in the homebirth group. Fewer home-born babies were born in poor condition. The homebirth mothers were less likely to have suffered lacerations during birth. They were less likely to have had their labors induced or augmented by medications or to have had cesarean sections, forceps or vacuum extractor deliveries. As for maternal deaths, there were none in either group.

  8. January 11th, 2010 at 15:51 | #8

    “Meta-analysis of the safety of home birth”

    That study is out of date, a meta-analysis and has been superceeded by other more detailed studies.

    There is no question that the existing scientific evidence shows that homebirth with an American homebirth midwife nearly triples the neonatal death rate. The recent Canadian and Dutch studies which claim to show that homebirth is as safe as hospital birth took place in healthcare systems where midwives have far more training, where homebirth eligibility criteria are very strict, and, in the case of The Netherlands, where there is a dedicated transport system for homebirth transfers.

  9. avatar
    FangedFaerie
    January 11th, 2010 at 17:58 | #9

    Dr. Amy stated: “The countries that have better rates of maternal mortality than the US are generally whiter, often far whiter.”

    As I pointed out, there are lower socioeconomic strata even in countries that are “far whiter” than we (the U.S.) are. What no one has yet addressed is just how wide the health gap, as a result of poverty, may be between our white (richer) population and our minority (poorer) population. If our lowest strata is worse off than the lowest strata of a country without non-whites, then Dr. Amy’s comment would make more sense.

    However, in OUR country, our maternal and infant mortality have been reported as poor, but Dr. Amy is arguing that our perinatal mortality rate is good. I am thus puzzled about how all the variables are interacting here.

    If Dr. Amy is correct, I think it implies some interesting things about our medical system, especially given that overall, perinatal mortality is generally worse than maternal mortality, regardless of most other factors. This makes intuitive sense, given that the mother is an adult with a fully developed immune system, and so on.

    I’d like to hear Dr. Amy’s thoughts on it, but I don’t want to wander too far from whatever the topic was supposed to be.

  10. avatar
    Carol Van Der Woude
    January 11th, 2010 at 22:28 | #10

    In the United States we put most our maternal-infant health care dollars into labor and delivery. Labor and delivery is excessively managed. We should be focusing more on the prenatal and postnatal time periods. Diet, control of diabetes, adequate rest and nutrition need more attention, especially in the poorer population. In the postnatal time period the big problems are infection and hemorrhage. It seems to me that we need to focus more attention on the baseline health of women, nutritional education, prenatal support and post natal care. Midwives are well suited to providing this type of care.

  11. avatar
    Marjorie
    January 12th, 2010 at 18:28 | #11

    I do think that having a homebirth is more dangerous in the event of a catastrophic emergency. Of course!

    However women have to balance the very small risk of death for themselves and their baby at home against the very high risk of unwanted and generally non-medically indicated interventions, including multiple vaginal exams, and especially uterine stimulants.

    That women describe their births as rape is very telling.

    That the current minorities are dying because of poor care and not overall poor health is very telling.

    That Obs attempt to defend their rapine actions in the name of the unpaying customer- the fetus – is very telling.

    That most babies are forced into the world between Moday and Friday, from 9am-5pm, is very telling.

    That VBAC bans are in place because it’s too risky to pit a VBAC labor without immediate access to a theater, and pit those labors they do despite doubling the risk of rupture, is very telling.

    That a dead baby in hospital is an act of God and a dead baby at home is a crime is very telling.

    F&*% me with a spoon sideways, but why the heck are my tax dollars going to Obs and not Midwives? I want Medicare moms seeing midwives unless the midwife refers them to an Ob! I want my insurance to cover midwifery care and to see midwives delivering at home or in hospital.

    CAUTION! OBSTETRICIAN! BREAK GLASS ONLY IF NEEDED!

  12. January 12th, 2010 at 19:20 | #12

    Any citations to offer or do you think we should accept your personal opinion as fact?

  13. avatar
    Marjorie
    January 12th, 2010 at 19:34 | #13

    “We?” Dizzy and turned around much?

  14. January 12th, 2010 at 22:46 | #14

    I take it that means that you don’t have any citations. That’s not a surprise.

  15. avatar
    Marjorie
    January 13th, 2010 at 00:13 | #15

    Pot and kettle.

  16. avatar
    cinnemonn
    January 13th, 2010 at 10:48 | #16

    exactly Marjorie.

  17. avatar
    Katherine
    February 5th, 2010 at 09:03 | #17

    So I’m wondering why anyone responds to “Amy Tuteur, MD”. If you give her anecdotal, non-scientific real language “she” asks for science. If you give “her” science she asks for something other than gobbletygoop. Those of us who have done it both ways (in hospital and at home) know what we know. That we don’t need “her.” (“her” being a pronoun representing all OBs who do anything other than hang out in the doctors lounge waiting for us to become an emergency – or coming into a hospital room after WE HAVE done all the work then slicing open our nether regions, ripping out our babies and patting themselves on the back for delivering another baby – completely ignoring us or in favor of “the machine that goes BEEP!”)

    Let’s give “Any Tuteur, MD” the respect “she” deserves and ignore her.

  18. avatar
    Rachel Humphrey
    March 29th, 2011 at 10:26 | #18

    This is why unless it’s a medical reason I don’t think that epidural should be given. I think if your a baby you shouldn’t be able to have baby. You should only be able to get one if you have been in labor for a long long time and your actually not able to push the baby out anymore. They are making is possible. Hospitals shouldn’t be able to choose to give them one and the patient shouldn’t be able to choose to have one or a C-Section. If you don’t want to go through a labor you shouldn’t get pregnant.

  19. avatar
    Rachel Humphrey
    March 29th, 2011 at 10:38 | #19

    My hospital forced a C-section on me. I was 2mo. pregnant when they suggested it. I said “NO” Then I was late to deliver. (this was my sec. baby, my first was all natural) I went in to be checked. My water hadn’t broken, I wasn’t even slightly ready. No contractions, no dilation. I just wanted to be induced. My first had to be induced. But they refused saying he was breach, my water was gone and I was ready. NOW I knew better than that. But was worried if i didn’t do what they wanted I might risk my babies life. So I did it. But quickly regretted it. The needle sent busts of lightening through my body. When I was about to go home I got spasms for about 5 min. for no known reason. From than on my back hasn’t been the same. I can totally tell the difference. My belly still hurts from time to time. I can’t have pressure on my bell at all anymore. My son can’t set on my belly it hurts too much. I hate it, I wish I hadn’t opted out. But Dr. know the have the upper hand and want more money. My daughters all natural delivery cost military insurance $4000. That included her 24hr stay and the delivery. My sons anesthesiologist alone cost $4000. not counting his stay after words of 3 days and the C-section.

Comment pages
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  1. January 2nd, 2010 at 12:35 | #1
  2. January 2nd, 2010 at 21:44 | #2
  3. January 3rd, 2010 at 11:13 | #3
  4. January 3rd, 2010 at 11:28 | #4
  5. January 3rd, 2010 at 15:29 | #5
  6. January 4th, 2010 at 15:24 | #6
  7. January 5th, 2010 at 22:18 | #7
  8. January 8th, 2010 at 04:05 | #8
  9. January 8th, 2010 at 21:44 | #9
  10. January 10th, 2010 at 21:41 | #10
  11. December 30th, 2010 at 13:45 | #11
  12. September 20th, 2011 at 12:09 | #12