December 28, 2011
An OB Nightmare: Mom Dies after Giving Birth to Twins
It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.
Snyder accompanied his wife to the hospital and witnessed the birth of his babies. Then Friedman began to bleed. And bleed. And bleed. At 9:30 p.m., she became yet another U.S. maternal mortality statistic.
At least 2 women die from complications of childbirth in the US daily. Some celebrities such as Christy Turlington Burns have become a Maternal Health Advocate as a result of first-hand experience. She had a near-miss childbirth experience but lived to tell the story. Many women, including Friedman, don’t. The American Congress and College of Obstetrician-Gynecologists (ACOG), will have both Burns and Tonya Lewis Lee, the wife of renowned director, Spike Lee as spokeswomen on the topic of maternal mortality at the 2012 Annual Conference in San Diego. However, we need much more. There are obstetricians who have worked on the front-lines managing high-risk patients for years who can’t get a seat on ACOG’s policy committees and it is frustrating. Here are a few questions that should be asked at the hospital where Friedman expired:
- She had a short stature with a uterus stretched to the max with two babies. Was the possibility of hemorrhage considered?
- When her blood pressure became elevated, was it controlled prior to doing the C. Section knowing the risk of possible HELPP Syndrome that is associated with pre-eclampsia?
- Was there an OB Rapid Response Team?
- Was a Bakri balloon used once the bleeding couldn’t be controlled with uterine massage or meds?
- Was the prospect of a problem anticipated BEFORE it occurred or was there chaos trying to find appropriate meds and equipment as the tragedy unfolded?
Pregnancy is not a benign act contrary to what most people believe. Things can and do happen, most often when the hospital staff is unprepared and ill-equipped to handle an emergency. My heart bleeds for Jay Snyder. He is 41 years old, a new father and now a widow who must take care of two beautiful children, who will never know their mother. With all due respect ACOG, talk is cheap. More action must be taken to stop this.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do…
Ellen P. said,
December 28, 2011 at 11:52 am
All twin deliveries are high-risk, right? And this mom was of “advanced maternal age” too, right? This story is horribly tragic.
drlindagalloway said,
December 28, 2011 at 12:06 pm
You’re very perceptive, Ellen. That’s exactly the point and glad you picked it up.
OB doc said,
December 31, 2011 at 11:58 am
1. She had a short stature with a uterus stretched to the max with two babies. Was the possibility of hemorrhage considered?
The possibility of hemorrhage is ALWAYS considered by every OB before, during and after every delivery.
2. When her blood pressure became elevated, was it controlled prior to doing the C. Section knowing the risk of possible HELPP Syndrome that is associated with pre-eclampsia?
The risk of HELPP Syndrome is always considered with a patient diagnosed with pre-eclampsia.
3. Was there an OB Rapid Response Team?
Unknown.
4. Was a Bakri balloon used once the bleeding couldn’t be controlled with uterine massage or meds?
Not every every hospital has a Bakri balloon.
5. Was the prospect of a problem anticipated BEFORE it occurred or was there chaos trying to find appropriate meds and equipment as the tragedy unfolded?
This is a repeat of questions 1. Post partum hemorrhage is an OB emergency which is well rehearsed in OB residency programs and even while in practice at in many hospitals.
drlindagalloway said,
December 31, 2011 at 12:40 pm
Every hospital SHOULD have a Bakri balloon as part of their armamenterium given that they have successfully treated 80% of post partum hemorrhage according to NIH quoted literature. Here is the abstract of the study:
Use of Bakri balloon in post-partum haemorrhage: a series of 15 cases.
Vitthala S, Tsoumpou I, Anjum ZK, Aziz NA.
Source
Department of Obstetrics and Gynaecology, The Royal Oldham Hospital, Oldham, UK. srivitt@gmail.com
Abstract
BACKGROUND:
Post-partum haemorrhage (PPH) is a major complication of delivery. Hysterectomy is commonly performed when medical treatment of PPH fails. We assessed the effectiveness of Bakri balloon tamponade, a non-surgical technique in the management of PPH.
AIM(S):
Our objective is to report our experience in the use of Bakri balloon in treating PPH.
METHOD:
A retrospective study of 15 patients who underwent Bakri balloon insertion after unsuccessful medical management of PPH.
RESULTS:
Fifteen cases of PPH were managed with Bakri balloon insertion. It was effective in all cases of PPH after vaginal delivery and in four cases of caesarean section; the overall effectiveness was 80%.
CONCLUSION:
Insertion of Bakri balloon is a simple alternative procedure in the management of PPH. It should be consider before any further surgical intervention including hysterectomy. Junior doctors and midwives can effectively apply it. It can be used during transfer or while waiting for a surgical procedure to reduce blood loss.
While most residency programs might have rehearsed it, obviously the hospital that Ms. Friedman died in, could have done a better job. We, as obstetricians, need to stop making excuses and admit when there is room for improvement. If we remove our egos from practice, many preventable errors could be avoided.
Thank you for your comments.
dr-lasermed said,
January 1, 2012 at 7:00 pm
As the mother of triplets, I can say that I knew I had a high risk pregnancy from day one. My doctors were concerned the entire pregnancy about my blood pressure and my blood count. I was concerned enough to be sure to deliver at a level III hospital where all of these things could be dealt with if any of them occurred.
Fortunately, even though I was 38, my blood pressure never went up. I went into labor at 35 weeks. I had a cesarean for presentation problems. I never developed anemia. My babies had issues with feeding, as they sometimes do at that gestational age, but went home at 9 days of age. They are now 17 years old and healthy.
Being prepared and proactive is what OB docs do. It helps that I was and am a board certified OB / GYN when I was pregnant with my guys. I researched everything as the pregnancy progressed, asked all the questions I needed to, and had a great outcome.
No egos – just whatever was best for the babies. Lots of bedrest, good nutrition, water, frequent visits….. It can be done
drlindagalloway said,
January 2, 2012 at 12:20 pm
How blessed you are to have successfully delivered triplets who are now almost adults and thriving. However, please do not discount your occupation as a physician. An ob-gyn physician at that. My goal; my prayer is that ALL patients receive the same level of expertise, commitment and empathy that you did. Thanks again for reading the blog and for your informative comments.
Captain Obvious said,
May 19, 2012 at 2:42 pm
I would hope every OB would recognize twins as a high risk pregnancy. She should have been typed and crossed blood or at least typed and screened. Two pediatricians and two OBs should be in attendance. Uterotonics like pitocin should automatically be given and hemabate, and cytotec should be immediately available. Uterine packing can still be used if a Bakri is not available. Hysterectomy could always be done if arterial vessel ligation is not one of the doctors proficiencies. Recombinant factor VII is even available, although expensive. But mortalities will still occur. Drills should be performed in hospitals with total buy in by all physicians.
Having said that, and after reading your post, why do women still want to deliver twins at home? Why does any woman want to deliver at home? Can a CPM do any of this? Does Ricki Lake know the answer? She is makIng a lot of money convincing women it is safe. Losses are so sad. We can do better, if help and interventions are at our immediate availability.
drlindagalloway said,
May 20, 2012 at 10:48 pm
Yes, we can do better. Your messages says it all. Thank you for taking the time to read and respond.
vert vemor said,
September 22, 2012 at 11:21 pm
Thank You for for ALLLLLLLL of the above..
I find writings like these, very helpful, ver informative, very positive in saving lives of “mothers” around the world. we all were delivered from “wombs”. our mothers were alllllll at some point ,a potinal risk of “dying” of bleeding during labour or after birth.thank you for educating alllllll providers on what to do when haemorrhage..life-threatning haemorrhage knocks the door of death. you are the candle which lights up the road for a safe childbirth . keep up the positive free for all wisdom. your wisdom is a blessing. you are angels of of life.
this is to say thank you from Exeter UK.
drlindagalloway said,
September 23, 2012 at 10:43 pm
Thank you so very much! Your comments inspire me to continue writing. Please share the blog with your friends and “liking” me on Facebook helps. Here’s the link: https://www.facebook.com/SmartMothersGuide You can also pick up a copy of The Smart Mother’s Guide on my website http://www.smartmothersguide.com
Thanks again.