U.S. Hospitals Struggle To Protect Mothers When Childbirth Turns Deadly

Jul 5, 2017
Originally published on July 5, 2017 6:24 pm

A joint NPR and ProPublica investigation finds the U.S. medical system can be unprepared when the complications of childbirth turn deadly. NPR reports on healthy mothers who developed one highly treatable complication — preeclampsia — and how it killed them.

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KELLY MCEVERS, HOST:

NPR and ProPublica have spent months investigating why it is that the number of mothers dying from complications of pregnancy and childbirth has been rising in the U.S., why that death rate is now higher than any other industrialized nation, why American women are three times likelier to die than women just across the border in Canada.

ROBERT SIEGEL, HOST:

As NPR's Renee Montagne and ProPublica's Nina Martin have reported, 60 percent of these deaths could have been prevented. Today we hear about a woman who had a complication unique to pregnancy and childbirth. Renee looks at what her experience tells us about the system that allowed her to die.

RENEE MONTAGNE, BYLINE: This is the story of Lauren Bloomstein. We heard it one rainy day in the New Jersey home of Larry Bloomstein looking onto a child's playroom filled with princess dresses and a big plush unicorn.

LARRY BLOOMSTEIN: Come here.

MONTAGNE: Hi, cutie.

HAILEY BLOOMSTEIN: Hi.

BLOOMSTEIN: Can you say hi?

HAILEY: Hi.

MONTAGNE: Hi.

BLOOMSTEIN: I have a question for you. Where did you get these beautiful green eyes?

HAILEY: Mommy Lauren.

BLOOMSTEIN: From Mommy Lauren, yeah.

MONTAGNE: Hailey knows Lauren through stories and photographs. A favorite of Larry's shows Lauren, slender and tan, standing in the foam of a pale blue sea with a barely swelling belly.

BLOOMSTEIN: Lauren loved the beach.

MONTAGNE: Etched in the sand is the name Hailey.

BLOOMSTEIN: She looks, I'd say, like the happiest and most alive the whole time I knew her. I remember her talking to Hailey through her tummy. I remember, like, 28 weeks saying, just don't come out too soon.

MONTAGNE: As a neonatal nurse at a large medical center near the Jersey Shore, Lauren knew how vulnerable preemies can be.

BLOOMSTEIN: So she made it all the way to 40 weeks, like, really no problem. She was entirely, entirely healthy.

MONTAGNE: What neither she nor Larry, an orthopedic surgeon himself, considered was that Lauren might not survive her own baby's birth. Yet as we've reported, every day in America on average, two or three women die from pregnancy-related causes. Complications include hemorrhage, blood clots, infection, heart failure and the syndrome that killed Lauren Bloomstein, preeclampsia, a disorder of the placenta, the organ that delivers oxygen and nutrients to the fetus. There are an array of symptoms - persistent swelling and headache and dangerously high blood pressure. Preeclampsia affects about 5 percent of all pregnant women in America. It's highly treatable, but it can turn deadly if that treatment comes too late.

In Lauren Bloomstein's case, her medical charts during labor record high blood pressure readings, though her nurses did not alert her doctor. And in a home video taken minutes after birth, Lauren is glowing, tearing up in wonder at her tiny newborn. Then Hailey was whisked away to be weighed and measured. Lauren would never see her again.

BLOOMSTEIN: Lauren didn't touch any of the food that they brought her, and she started describing, like, really one of the worst pains she's ever felt, and she was pointing with one finger right in the center of, like, the bottom of her sternum. And she didn't know how to get rid of that pain.

MONTAGNE: Lauren's blood pressure had begun spiking, and that upper gastric pain - it's a key symptom of severe preeclampsia. Yet her medical records show her obstetrician ordering a common antacid. Acid reflux, heartburn is a leading misdiagnosis when it comes to preeclampsia.

BLOOMSTEIN: Being around patients in a hospital, you can tell when someone looks sick. And she looked really bad, and I wasn't sure what to do because the OB seemed confident that this was nothing, and I was not trying to overstep my bounds and assume the system knew what it was doing.

MONTAGNE: Untreated, Lauren's preeclampsia progressed to a far more dangerous syndrome. Known by the acronym HELLP, it can lead to kidney and liver failure after a breakdown of blood cells and a dramatic loss of the blood's platelets, which help stem bleeding. Lauren's medical records show her writhing in agony for hours as the doctors treated her pain but failed to accurately put together her symptoms. Finally this - patient states, quote, "do anything to stop this pain." Larry was by now frantic that Lauren's high blood pressure wasn't being treated. Her obstetrician responded with a call for morphine.

BLOOMSTEIN: I was like, you know, maybe another doctor should see her. But while I'm talking to Lauren, I looked at her face, and I realized that she is not moving her whole face. She just suddenly looks really calm and comfortable. And I'm like, Lauren, smile for me. And when she smiled, only the right side of her face - only the right side went up. So then I actually said to the OB, you have to call a neurosurgeon. And he didn't know why. He asked me, why? And I was like, 'cause she's had this blood pressure for so long that's so high, she now has a stroke. She burst a blood vessel in her brain. She has a huge bleed. It needs to be evacuated.

And the obstetrician was like, you know, she just got morphine; this is going to be some weird, adverse reactions to the morphine. It's not going to be a stroke. And I was thinking, like, I don't see how that's going to be true, but I'll pray for a miracle here. And I remember watching her CAT scan come up on the screen, and there's an enormous bleed in her brain. So it's like - I was like, all right, well, we'll still have her. She might be paralyzed. She might be partially paralyzed, but we'll see.

MONTAGNE: Eleni Tsigas has been hearing stories like this for 20 years after she was rushed to the hospital with severe preeclampsia. She survived. Her baby did not.

ELENI TSIGAS: It was a perfectly normal pregnancy until it wasn't.

MONTAGNE: Tsigas now heads the preeclampsia foundation focused on a complication many say should never lead to the death of a mother. Preeclampsia kills up to 70 women in the U.S. each year. Great Britain once had similar statistics until it instituted a system of uniform responses, the kind of protocols not followed in Lauren's case. With British medical teams basically on high alert for preeclampsia, Britain brought its numbers down to nearly zero, on average one death a year.

TSIGAS: It's the disorder of the placenta, right? And when it's not functioning properly, it's going to affect both mom and baby. And what a lot of science is really trying to push for now is understanding what is it that's breaking down in the placenta that causes this to happen?

MONTAGNE: Even though it's little understood what causes the placenta to become dysfunctional, there are drugs for the high blood pressure and seizures associated with it. Traditionally one important treatment is simply giving birth. But the widely held notion that expelling the placenta is the cure is a myth.

TSIGAS: And the problem with that myth that delivery is the cure is it mentally, emotionally, intellectually - like, it just releases you from, like, anything else that could go wrong is not going to go wrong. And that's not true.

MONTAGNE: In a 2015 deposition after her death, Lauren Bloomstein's own obstetrician was asked how to treat or cure preeclampsia. Twice he answered delivery, the third time, quote, "delivery is the only cure." In fact 80 percent of all deaths from severe preeclampsia occur after birth, as happened with Lauren. It wasn't until after a code stroke was called that the most basic treatment for severe preeclampsia, magnesium sulfate, was initiated.

Lauren had finally gotten the correct diagnosis, but now she needed surgery to relieve the pressure on her brain caused by the bleed and also a much higher level of platelets. Remember; they help clot the blood. As a surgeon, Larry new platelets could be transfused, and yet...

BLOOMSTEIN: They had none. They were able to call to another hospital and have platelets brought, but that takes all night. And in the meantime, Lauren has this bleed. So we just sat overnight.

MONTAGNE: And by the time the platelets arrived the next morning, it was too late.

BLOOMSTEIN: She did something called doll's eyes where they - if you take someone's head and basically turn it side to side and the eyes just move with the head and don't deviate, it's the beginning of brain death. And I remember watching him - sorry - do that to her. And so they took her to the operating room, and the neurosurgeon - they operated for I think about four hours, and when he came out, he said that she's still alive. She's on - basically on life support, but she's braindead. So at that point, we decided to withdraw care. And then I brought Hailey in one last time. And I just put Hailey in Lauren's arms. Then they withdrew care, and she passed away.

MONTAGNE: Days later, Larry held Hailey in his arms when they buried Lauren. He never returned to live in the red brick house they had just bought. When Hailey was nearly three, Larry remarried, and he and his wife Carolyn had another daughter. Yet on a day devoted to Hailey's birth and Lauren's death, it's clear the hurt is always there.

BLOOMSTEIN: I can't. Like, I literally can't accept it. The amount of pain she must have experienced in that exact moment when she finally had this little girl - I can't fathom it. The timing is just so incredibly cruel.

MONTAGNE: NPR and ProPublica found many of the mistakes that lead to maternal death stem from a medical system that bases care on the idea that it's rare for a woman to die in childbirth. It's a system where funding and resources are directed mostly at saving babies.

BARBARA LEVY: The assumption is pregnancy and delivery is a normal process, and bad things don't happen.

MONTAGNE: Dr. Barbara Levy handles health policy at the American College of Obstetrics and Gynecologists.

LEVY: But we worry a lot about vulnerable little babies, and we don't pay attention I think to those things that can be catastrophic for women.

MONTAGNE: And those catastrophes are not a thing of the past. In May, not far from Larry Bloomstein, Joe Dellavalle watched his wife, Jessica, die in terrible pain nine days after giving birth in an emergency caesarian to their third child, a daughter, stillborn. Doctors told them her placenta had torn away from the womb due to severe preeclampsia HELLP, a syndrome neither Jessica nor Joe had ever heard of.

JOE DELLAVALLE: We were asking a lot of questions. You know, what is happening? Why is she so swollen? And then every single day, either the OB team - each one explained to us that the baby had come out of her system, and you know, that was the cure, and it was just a matter of days until the HELLP syndrome worked its way through her system.

MONTAGNE: Jessica was advised early on to chew gum to get rid of gas. For days she was given pain medication, abdominal surgery, an array of treatments without addressing the syndrome that she would die of.

DELLAVALLE: I was just stunned that we lost her. I can't - I think that, you know, Jessica and I and the children could have moved on from the baby, so we would have grieved together as a family. But losing my wife is a completely different story. To me, it's so much more impactful to not only me but my children to lose Jessica.

MONTAGNE: Jessica Dellavalle's Facebook page is a poignant reminder of what has been lost. A little girl and boy smile shyly out from behind their mother's pretty profile photo. And her very last post at the end of a seemingly perfect pregnancy - a do-it-yourself video on how to fashion cupcake liners - yellow and pink and lavender - into a bright bouquet for Mother's Day. Renee Montagne, NPR News.

(SOUNDBITE OF AKIRA KOSEMURA'S "INSIDE RIVER #1") Transcript provided by NPR, Copyright NPR.