Fascinated with blood

I'm embarking on a series of posts about blood. I can't help it. I'm fascinated with blood.

The final classic symptom of amniotic fluid embolism is disseminated intravascular coagulation (DIC). When I suffered an AFE during the birth of my younger daughter, I was nothing but classic.

Edward Cullen
Also fascinated by blood

I hemorrhaged to the point where all the blood ran out of my body three times over. I didn't die from this event because I received a total of 87 units of blood and blood products — whole blood, plasma, cryoprecipitate and extra clotting factor.

I am alive to tell our birth story because thoughtful strangers had donated their blood, a large stockpile of blood was five minutes away when I needed it, and because a whole raft of people had done the work over centuries to figure out how to make someone else's blood work in my body.

And, by 1997, the blood supply had been made safe again, after a horrific tainting with the HIV/AIDS virus.

The bill for my daughter's birth, including two surgeries (a Caesarean section and separate hysterectomy performed to stop the bleeding), a stint for the baby in the high-risk nursery, a night for me in the intensive-care unit and an additional four days in the hospital, was $100,000 all those years ago.

Blood accounted for $13,000, more than 10 percent of the total.

Blood was a major factor in giving our birth story a happy ending. Fascinating!

Being there

There is more than one way of looking at this, I know, but I believe I cheated death when I survived an amniotic fluid embolism during my younger daughter's birth in 1997. These extra 13 years, and counting, seem like a stupendous lagniappe tacked onto the lifetime I was meant to have.

That might be why, every so often, an event comes along that reduces me to a heap of gratitude for the medical advances, the professional competence, the technology — and the luck — that saved me. My older daughter's college graduation last week was one of those events.

Nora's graduation
Nora

Nora had just turned 10 when Maeve was born. She had not enjoyed being an only child, and was thrilled about the prospect of welcoming a new baby into our family. I had spent 4 1/2 months on bedrest, punctuated by a couple of terrifying bleeding incidents, which Nora had suffered through along with her dad and me. We were all relieved when the pregnancy reached term, and I went into Prentice Women's Hospital for a scheduled induction.

That fall Friday was a holiday from school, and Nora was off picking apples with friends in a far suburb, hoping that when she came home she would meet her new sister or brother.

She came back instead to a phone call from her dad, telling her about Maeve, who by that time was swaddled up in Prentice's high-risk nursery. Nora wanted to talk with me, but her dad said I had had a rough time and couldn't come to the phone. At the time he was talking with her, he still didn't know if I would live or die.

What if I hadn't survived? Both my girls would have been motherless, but Maeve wouldn't have known anything else. Nora would have suffered a devastating loss.

That didn't happen, of course. Because I have been there these 13 years, I know the scrapes Nora has been through, the joys, the disappointments, the accomplishments. Success in school never came easily to her, but last week, she graduated cum laude from DePaul University in Chicago.

I don't want to take credit for Nora's successes, but I do believe that mothers make a difference in their children's lives. I am proud of the wonderful young woman my daughter has become, and I am grateful that I have been there to see it.

Two months, 25 blog posts!

Bring on the party hats!

I started my blog on Jan 3, full of trepidation about whether I would be able to keep up with posting three times a week about pregnancy, childbirth, medical history, maternal mortality, etc. After all, I have a job, a family, a dog, and on and on.

But I can do this! And I've learned a lot!

Rubber Ducks

What's next?

My most popular post so far was "Birth in Haiti." You could've knocked me over with a feather.

My own favorites were the two posts I wrote after interviewing Robbie Goodrich, who lost his wife, Susan, last year to amniotic fluid embolism. Robbie was kind enough to talk with me while planning a big birthday celebration for his son, Charles Moses, and honoring Susan's memory on the anniversary of her death.

Career adviser Penelope Trunk tells bloggers not to succumb to the temptation to start that second blog. Penelope, you read my mind! I have been thinking how much fun it would be to lighten up a little, loosen up the voice, write about something else besides the point in childbirth at which bliss and safety concerns intersect.

But you know what? Penelope is right. "Birth Story" is my topic, because for 12 years, since I survived an amniotic fluid embolism during my younger daughter's birth, I have been fascinated with extreme childbirth. So I am going to stay with the difficult stories, the life-saving innovations and all those mixed emotions.

I enjoy the immediacy of blogging, and "meeting" other bloggers, many of whom are moms as well. I've settled into a Monday/Wednesday/Friday publishing schedule. And I'm still finding my voice.

So now we'll embark on the next leg of the journey. Maybe every couple of months I'll drop in a totally irrelevant picture like the one above and celebrate a little, just like today!

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