Amniotic fluid embolism

Amniotic fluid embolism was first identified in 1926, but it still isn't fully understood today.

AFE is rare, unpredictable and unpreventable, accounting for between 5 and 10 percent of maternal mortality in the United States, and is likely triggered when amniotic fluid enters the bloodstream. However, by no means every woman who gets amniotic fluid in her bloodstream suffers an AFE.

Some estimates have AFE occurring anywhere from 1 birth in 8,000 to 1 in 30,000, with mortality running as high as 80 percent. Many women who survive AFE suffer life-altering brain damage.

A study published in the American Journal of Obstetrics & Gynecology in 2008 found AFE occuring in about 7.7 of every 100,000 births -- that's about 1 in 13,000 births, which makes it a rare event -- and still killing more than one in five mothers it strikes.

The authors of the AJOG article found associations between AFE and mothers older than 35, Caesarean births and "placental pathologies" like placenta previa, in which the placenta attaches low in the uterus, where it can cause hemorrhaging and other complications during a pregnancy.

However, the study did not find an association with artificial induction -- the use of drugs like Pitocin to start or hurry up labor.

AFE displays a cascade of symptoms that can include cardiac arrest and disseminated intravascular coagulation, or DIC for short. During a DIC, a person's clotting factor is deployed all at once, after which hemorrhage can ensue. A mother can die from these events and so can a baby who is still in the womb -- the saddest birth story of all.

A change of course

Robbie and Susan Goodrich had been married three years when she died of an amniotic fluid embolism during the birth of her son Charles Moses last year.

The couple had been full of plans. Robbie would ramp up his career so that Susan could scale hers back to spend more time with the children. Now he's going back to work after a year's leave of absence, as a single father.

Moses Goodrich

Moses Goodrich

During a phone interview, Goodrich said, "I'm throwing myself into my work, so I can go home and be with the kids."

Goodrich said, "I have to re-invent myself as a widower, with two kids in diapers. I'll do what has to be done to put bread on the table, but it's just me now.

"I know that the process isn't over. I have to do everything that has to be done emotionally to deal with the loss of Susan. I have to accept that it won't be the same me or the same life," he said.

On Dec. 6, Moses took his first steps.

On Dec. 10, the family celebrated Susan's birthday the way they usually had. They cut down a tree for Christmas, went snowshoeing, made Susan's favorite tapas.

"We celebrate her birthday. Her death day coincides with Moses' birthday but we celebrate Moses and the life that she gave on that day.  We celebrate who she was and how she lived and not the accident of her death," Goodrich said. "Though that's easier to say than to do."

Photo courtesy of Robbie Goodrich

The Goodriches one year later

Charles Moses Goodrich celebrated his first birthday on Sunday with several of his "moms," the women who joined together to breastfeed the little boy after his mother, Susan, died of an amniotic fluid embolism hours after his birth, one year ago today.

Robbie Goodrich, Moses' dad, hosted the "moms" and their husbands and children for an afternoon party at the YMCA in Marquette, Mich., for games, swimming, pizza and cake. Moses' 2 1/2-year-old sister, Julia, had chosen the theme for the party, "Candy, Candles and Candy Canes." There were two cakes, one made up of lavishly frosted cupcakes and the other in the shape of the number 1, striped with red M&Ms to look like a candy cane, Goodrich said.

The Goodriches, Moses' "moms" and their families

"It's a very severe winter here," Goodrich said of Marquette, a city of 20,000 in Michigan's Upper Peninsula. "The moms said they were glad to get the kids out of the house. Moses had a great time going from mom to mom. He was in hog heaven." (Robbie Goodrich, who provided this photo, is in a blue shirt under the painting on the wall, holding Moses, in a red shirt with blue sleeves.)

People magazine featured the Goodriches in a story last June about the remarkable "cross-nursing" collective that formed to honor Susan Goodrich's desire that her son be breastfed for the first year of his life. Seeing Goodrich struggle to buy breast milk in Moses' first days, family friend Laura Janowski offered to nurse the infant, and the collective grew from there.

Moses was weaned about a month ago, before the Goodrich family went to Virginia for the Christmas holidays, Goodrich said.

In all, 26 women nursed Moses, some coming once or twice, others coming regularly at a set time. Carrie Fiocchi came daily at 9 a.m.; Kyre Fillmore came at lunchtime from the first week until Moses was weaned, Goodrich said.

After a year's leave of absence from his job as a history professor at Northern Michigan University, Goodrich went back to work today.

He had re-arranged his life so that Moses could be breast-fed because "it seemed like the right thing to do for Moses, not only to kickstart his good health, but also for the nurturing, the being held for hours and hours. It turned out that having moms and kids come to the house was great for Julia, too, and it was good for me -- that support. I'm sad that it's over," Goodrich said.