Bearing Witness to a Miracle: AFE on the Farm

I don’t typically share my clients’ birth stories. As a doula, I bear witness, hold space and keep stories, but I don’t share those stories with anyone outside the birthing team. However, I feel like this birth story needs to be told. So with permission from my client, I present to you the birth that shook me to the core and had me in bed for three days straight.

While you read this, keep in mind that this is the story as experienced through my lens, and every single person in that room will give a variation of this story as seen through their lens. Part of my doula work involves documenting the events that take place during a birth, and then gifting a keepsake story back to the parents. I’m not overly concerned with the technical stuff that a midwife would document, like heart rate, temperature, blood pressure etc., but I do pay attention to words, feelings, expressions and moments, and then make sure to write it all down within the week following. So this story has been written for two years, but sat silently on my computer… until now.

This is a long story, so grab a warm cup of coffee and get cozy. The names have been changed to protect the privacy of those involved.

It all began November 2015. My doula client, Dee, had just been approved for a homebirth, and was over-the-moon excited to have the birth that she wanted so badly. This was her third baby, and her birth was set to take place on her farm about 2.5 – 3 hours from where I live. Originally she was planning on driving in to Calgary for the birth, but her midwife agreed to go to her, so in early November the plans changed. I also agreed to travel to the farmhouse to support her through this birth.

On Thursday, November 19th I received a text message from Dee indicating that she may be in early labour. She was having regular contractions, although they didn’t feel very painful at all. She doubted that she was even in labour. Her midwife, Casey was in the area, so she stopped by the farm to check Dee’s cervix. She was nearly 5 cm dilated. Dee had made it to 5cm without experiencing much pain at all. I thought I should probably get out there, but waited patiently for her to give me the go ahead.

A few hours later, around 9:30 pm, I decided to head out to the farm. I was keeping in touch with Dee via text, and she told me that Casey had checked her again and she was at 6cm. She still didn’t feel much pain at all though, which makes me think that Dee must be some sort of superhuman who doesn’t experience pain the same as the rest of us minions.

The farm is about a 2.5-3 hour drive from my house. All along the way, I was getting updates from Dee about how she was feeling and what she was up to. At 10:59pm, Dee texted me two words: “Water Broke.” I stepped on the gas, navigating my way through rural Southern Alberta, and did not receive another update. I was pretty close, but it still took me half an hour to get there. I knocked on the door at 11:28pm. I knocked on the door again… nothing.

I decided to let myself in, as that is typically what I’d do if a birth is in progress and I’m expected. I found out afterwards that neither Casey nor Dee’s husband Joe had known I was on my way, which was a little funny. When I walked in, I heard someone shuffling around in the kitchen, so I said Hi. I got a very quick and slightly stern “Hi” in response, and brushed it off as typical birth stress. I let myself in, put my things to the side and listened quietly to see how the team was doing. That is when I heard Casey say, “Push.” I thought, What?! No way, pushing already… how is this even possible?! That is when I peeked in the room.

I peeked in and very quietly asked how everything was going; I knew immediately that it was not going well at all. I threw off my coat and ran to Dee and Joe’s side. Joe was supporting Dee on the bed, holding her up and keeping her as comfortable as possible. Casey was instructing Dee to push the baby out, and Dee was in a lot of distress. I would later learn that Dee had passed out right after her water broke, and everything had subsequently gone into emergency mode. She was in the middle of an Amniotic Fluid Embolism (AFE).

According to the AFE Foundation, “AFE is characterized by acute and rapid collapse of mother and/or baby as a result of an allergic-like reaction to amniotic fluid entering the maternal circulatory system…It is important to note that many laboring mothers have amniotic fluid or fetal debris enter into their circulatory system and do not suffer such a response. It is most generally defined as a two-phase response:

The first phase is characterized by rapid respiratory failure and cardiac arrest. It is noted most fatalities from AFE occur during the first phase.

The second phase is known as the hemorrhagic phase. The mother begins to bleed profusely at the wound site; typically at the site of placental attachment or cesarean incision. Disseminated intravascular coagulopathy (DIC) or consumptive coagulopathy develops, which prevent coagulation.” It is the leading cause of maternal death globally. You can learn more about it here.

What I have been told is that after Dee’s water broke, she went to the bathroom and felt dizzy. Casey heard a kerfuffle in the bathroom and walked in to find Dee face down on the floor. She instructed Joe to call 911 immediately and they got Dee onto the bed prior to me arriving. I just tried to take it all in and make sense of everything in tiny pieces. Dee was having a hard time with her vision because of what had happened and kept informing us that she could not see. I held Dee’s hand and used my voice to keep her present, trying to get her to focus on my face or at the very least, my voice.

At one point, Dee said, “Casey, is everything okay?,” and I looked at Casey. Casey had a concerned look on her face, serious but caring eyes, and simply said, “Dee, you have to push your baby out right now.” This is when the gravity of the situation really hit me (remember, I didn’t know it was AFE yet, or even what had happened at all), and I switched to push mode. I looked Dee in the eyes and told her she had to push her baby out right now. I have never told anyone that before, so it was a shift in character for me. Dee was certain she couldn’t do it, and I looked in her eyes again, and said, “You have to… right now.” It was like the ‘Take Charge Effect,’ except far more extreme. You know what though? It worked. Dee looked me in the eyes, understood what we were saying, and pushed with everything she had. At this point, contractions had completely stopped and according to Casey, the baby’s heart rate was dropping. She was still only 6 cm dilated, and she pushed that baby out. It was both amazing and terrifying at the same time.

This is where things get a little intense. I know, you’re probably thinking, “Wasn’t that already intense?!” Well, yes… it just got more intense you could say. When the baby came out, he had amazing pink colour, but he was not breathing at all and was completely limp. I remember looking at him and thinking, Wow, that is some amazing colour for a baby who is so apparently lifeless. Casey caught the baby and was looking for a place to lay him, so I suggested he should go on Dee’s belly. For a brief moment, he lay on Dee’s belly, and I told her to touch him. Dee touched her baby immediately after birth… this is the stuff I make note of as a doula. Casey cut the baby’s umbilical cord, and we took him to the floor to do neonatal resuscitation.

Casey calmly told me to grab her bag and instructed me on which tools to open for her. My hands were shaky, but I managed to open the packages. Casey went to work on baby and I phoned 911 again to inquire as to when they would be there, as the situation had escalated significantly. They had a lot of questions and wanted to keep me on the line while the EMS was en route, but I had to put the phone down to assist Casey. While Casey was attempting to get some oxygen into baby’s lungs, I was rubbing his tiny little feet and giving him a pep talk. The memory of rubbing those tiny feet is burned into my brain.

We worked for what felt like forever on that baby. Casey ended up inserting a laryngeal mask airway (LMA) and moved me from birth doula, calgary, yycbaby’s feet to his head. I took over with the LMA bag compressions, and Casey did chest compressions. Casey would count, “1, 2, 3,” and I would squeeze the bag. Dee was crying on the bed, asking how her baby was, exclaiming that she could not lose this baby. I can’t remember exactly how we responded to Dee’s inquiries, but I know I was being very careful not to say anything that indicated things would be okay, because frankly, they may not have been. However, we did reassure her that we were doing everything we needed to do at that moment. We continued CPR and talking to baby until the volunteer fire department and the paramedics arrived. The paramedics took over, and they were absolutely amazing alongside the fire department. Casey told them that they needed to intubate the baby, and they began the process. The paramedics massaged the baby’s heart, and he made a little sound. Two sounds to be exact. Those were the sweetest sounds I heard that night, and they provided Dee and Joe with some hope.

Once the EMTs took over with the baby and were taking him to the ambulance, I got back to Dee. She was so worried about baby, we really had to work to keep her calm. I would look in her eyes and tell her to breathe with me, and she did. Even though her world was falling apart all around her, she breathed with me and stayed as calm as possible. I am still blown away by this.

Dee was hemorrhaging, so Casey instructed me to put pressure on her fundus until the EMS were ready to take her to the ambulance. They carried her off to the ambulance as I watched in disbelief. Casey went in the ambulance with Dee, and Joe was going to follow afterwards, as was I. I sent Joe on his way and I stayed behind to clean what I could. This is the part that doesn’t make it in the keepsake birth story: The farmhouse was looking like a scene from Dexter. I took down the unused birth pool, cleaned the carpets as well as I could, collected all the towels and bloody sheets, scrubbed the bed mattress, and bagged all the garbage. I cleaned the path of blood left from the bedroom to the front door, and hoped that I didn’t miss a spot to be found later.

Immediately after cleaning up, I made my way to the nearest hospital (which was about 20 minutes away, towards my house). When I arrived, the hospital staff informed me that the EMS team had decided to take Dee to a bigger hospital nearly an hour in the opposite direction. I phoned Joe, who discovered the same thing shortly before myself, and then I headed towards the larger centre. I drove for about 40 minutes, and when I was about 10 minutes away, my phone rang. It was Casey, and she let me know that I should just go home. There was nothing I could do, and Dee was in the process of receiving a lifesaving emergency hysterectomy after losing so much blood.

I turned around on the highway and began my 3 hour drive back home. I was in shock and could not believe what was happening. Baby was flown to the Foothills Hospital in Calgary, and put on the cold table. Dee was flown there shortly after, once the hospital she was at ran out of blood to use. Baby was on the cold table and Dee was in recovery. And we waited.

The next few days were scary. No one knew if baby was going to be okay, and Dee was recovering from major surgery. I encapsulated Dee’s placenta and made a keepsake print for her. At that time, I wasn’t sure if baby was going to live or not, so I waited to finish the print with a quote. They were going to start warming him up very slowly on Monday, November 23rd at 3:00am, and then we would have a better idea of how he was and how his brain had weathered the whole ordeal.

It turned out that something pretty magical was happening, because baby’s MRI results came back perfect. Three teams of specialists looked over the results and all declared that they were perfect results. “Perfect.” Not only that, but Dee was recovering well and managed to exclusively breastfeed her baby. This was nothing short of a miracle.

breastfeeding, calgary

Once I received the good news via a tear-filled phone call with Dee, this was the quote I chose for the placenta print:

“Never lose hope, my heart, Miracles dwell in the invisible” ~Rumi

placenta, calgary

I made all three prints with the one placenta

Baby D is legit a miracle baby. He beat all the odds and has spent the last two years showing the world how strong he is. And Dee is a miracle mama. She still suffers some long term effects from the AFE, and her path to healing is ongoing. She does not have any memory of the events that took place, which is one of the reasons I wanted to share this story. I am still in touch with Dee, and cherish her friendship immensely. Last year near the birth date, Dee and Joe organized a fundraiser for the volunteer fire department, and it was a huge success. They raised somewhere around $20,000, and half of that came from a single anonymous donor who wanted to purchase a ‘Jaws of Life’ for the unit. The rest was to be used for infant CPR mannequins. Dee and Joe gifted me with a piece of art made from their fence that was decorated with a set of painted angel wings. It hangs prominently in my living room, right beside my needlework uterus.

birth doula, yyc, calgary

I sit here, two years later, still in awe of what happened that night and the days, weeks, months (even years) that followed. I have an immeasurable  amount of respect for the midwife Casey, who acted quickly and calmly, even though I know she did not feel calm. Her knowledge and quick action no doubt saved both baby D and Dee’s lives. I am also so incredibly thankful for the volunteer fire department and the paramedics. They brought with them a loving energy and the skills needed to save baby D and Dee. They acted quickly and took the time to listen to Casey and work collaboratively. I’m thankful for my colleague who answered her phone at 3:00am and listened to me debrief as I drove home, and for my partner who fed me, hugged me and cared for me for the three days that I basically couldn’t get out of bed. And lastly, I’m thankful that the universe brought Dee and myself together and chose me to be there that night. It confirmed my calling to midwifery, as I found a strength in myself that I actually didn’t know I had. Yes, I can and will handle emergencies.

 

Edited to add:

I think it’s important to note two things that went unmentioned in the original blog post.

  1. The midwife diagnosed the AFE, and none of the doctors would believe her. She was treated very poorly in the hospital, as if she had done something wrong, when in reality she was a mo’fuggin’ miracle worker. Later, the AFE was confirmed, although I’m not sure if the doctors apologized for their treatment or not. Regardless, here’s to knowledgeable midwives who know what the what is up!
  2. Even if my client had planned a hospital birth, she would not have gone to the hospital by the time the AFE happened. Labour was not painful and contractions were not close together. The only indication that might have made her head to the hospital was the water breaking, but we all know what happened after that. I say this because I don’t want this story to deter you from choosing a home birth. The stats on home birth vs. hospital birth remain the same, and home births are safe for low risk pregnancies (which my client was). Check out this article if you want to read more about that.

By | 2017-12-01T17:59:29+00:00 November 21st, 2017|AFE, Doula, Labour and Delivery, Midwifery|3 Comments

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3 Comments

  1. Lee November 26, 2017 at 2:16 am - Reply

    Thank you for sharing this story. What a scary experience for everyone involved and a great outcome. Andi, you are amazing.

  2. Jaime Leigh January 21, 2018 at 7:17 pm - Reply

    Wow, that is an incredible birth story. A pivotal moment in each one of your lives im sure. Cheers to you for being exactly what was needed in those heart wrenching, terrifying, AND beautiful, miraculous moments . *much love from one birth worker to another* <3

  3. Rosemary June 7, 2018 at 7:40 pm - Reply

    I just found your blog on google, I’ve recently made the decision to become a doula but am still in the stage where I am researching and making sure it seems like a good fit for me so I’m trying to read everything I can about it. This story brought me to tears and was very moving and inspiring. Thank you for writing this

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