14 year-old mom survives a delivery room emergency- An Amazing Childbirth Story

The young mother was not at all prepared for what was about to happen to her. Unfortunately, neither were her doctors.

It was my first time in the delivery room at the University Hospital. The doctor “training” me was an intern with 3 weeks experience. Our combined knowledge and experience would have filled a page and a half in a medical textbook. But there we were, attending the delivery of a 14 year old girl. That is not a typo. The mom had gotten pregnant as an 8th grader. She was from Mexico and spoke no English at all.

The birth of the baby was routine, and the intern performed the delivery of the baby without any difficulty. The umbilical cord was quickly cut and clamped and the baby handed off to the nurse.

The intern then turned to me, “Want to deliver the placenta?” It wasn't a hugely difficult medical procedure, but third year medical students take what they can get.

“Sure!”

I switched positions with the intern and grabbed hold of the clamped umbilical cord. I gently pulled downward. Nothing happened. I continued to pull for a few minutes. Seeing no progress, the intern instructed, “Pull harder.” So I did. Still no progress. The intern repeated the instruction. A few minutes more, still no progress. I thought I as pulling pretty hard, but according to the intern I wasn't as she instructed me to increase the downward traction even more.

Finally the amount of visible cord began to lengthen, indicating the placenta was on its way out. But what appeared between the mother's legs did not look to me like a placenta at all. It was big and round and purple, with lots of veins. It looked like a martian head. (If martian heads actually existed and came out in delivery rooms!)

“Oh my God! What is that?” exclaimed the intern who was watching me. As she verbalized the question the answer came to me, the words came out of my mouth simultaneously with the realization of what it was-

“It's the whole d--- uterus!”, I said as quietly as I could.

I had pulled the cord so hard that the girl's uterus had turned inside out and come out with the placenta still attached. The uterus was now located outside of her body. I lacked experience, but I was pretty sure that this was NOT a good thing. (I later learned how bad it actually was. If the placenta detached while the uterus was out, the uterus could not contract down to stop the bleeding and the mother could bleed to death. If the uterus contracted with the placenta still attached, it would take a lot of medication and skill to safely put it back. It was a race against time.)

“What do we do now?” I whispered.

“I don't know!” was the intern's non- reassuring reply.

The nurse, who actually had experience, reacted quickly and called for the senior doctor on the OB unit. The doctor arrived quickly, and surprised me by rapidly pushing the intern aside. She then used her balled fist to forcefully shove the uterus back inside. I vividly remember repeatedly seeing the outline of the doctor's fist through the mother's abdomen as the doctor worked to make certain that the entire uterus had completely returned to its correct position, and would stay there.

I also remember wondering- what is this young mother thinking? She was alone. There were no family members with her in the room. She was in a foreign place surrounded by doctors and students she did not know, speaking a language she did not understand. She had to have felt significant pain given the pounding pressure of the doctor's hand inside her body, and she did not even know why. Things happened so quickly no one had taken the time to explain. And- she was only 14 years old.

14 years old... about the same age that Mary was when she gave birth to Jesus. We have sanitized the Christmas story and ignored the pain of childbirth, the bleeding after the placenta released, the cramping that came as she nursed her baby, and the vulnerability of that young family. Mary was in an unfamiliar city, alone except for Joseph, her young husband. Shortly after the birth shepherds arrived, strangers intruding on her first moments with her son, relating an incredible story of an angelic announcement. What was Mary thinking?

The story of the young girl in the delivery room reminds me that Mary's experience was not all halos and choirs. Childbirth, especially to a young woman in a strange place, can be a frightening experience!

- Bart

This is the 4th of Six Amazing childbirth stories. you can read the previous ones in our archives, and subscribe to the blog to have coming posts delivered straight to your inbox. 

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The Baby is Healthy, but the Doctor Needs Surgery- An Amazing Childbirth Story

Moments before delivery, the concerned mom paused to ask the doctor, "Are you okay?"

Very few woman choose natural childbirth, mostly because it hurts really bad and epidural pain relief is safe and effective. This patient was the exception. She was determined to deliver her baby naturally, no medications at all. As a result during labor she could move and position herself as she pleased.

When it came time to begin pushing, she asked the nurse if she could squat at the end of the bed so she could push more effectively. The nurse and I found a "squat bar," attached it to the bed and helped her position herself for the final stages of labor.

Between contractions she rested, and then with each labor pain she lowered herself into a deep squat, hung on to the bar and pushed, her lower half a few feet off of the floor. While this was an effective pushing position it made it difficult for me to monitor her progress! I needed to kneel to perform an exam. When I thought the moment of birth was near, I again squatted down to check the baby's head position as she pushed.

As I settled into the squat, I suddenly felt searing pain as the reconstructed anterior cruciate ligament in my left knee exploded, my leg buckled and gave way beneath me. I felt myself falling and, almost in slow motion, I stumbled forward. In a panic I reached out my hand and grabbed the delivery table to catch myself, stopping my face mere inches from experiencing an embarrassing head on collision with the baby. (Not sure how I would have explained that to the dad!). The baby's head was "crowning" meaning the top the head was just emerging and delivery was moments away!

I gathered myself, balancing on my good leg. Pain had drained color from my face and I felt droplets of cold sweat appear on my forehead. The contraction ended and the mother looked at me with a concerned look on her face and asked, "Doctor, are you okay?" I wasn't, but it didn't matter. It was time.

I turned to the nurse, "Can you check and see if there are any other doctors on the floor?" I was not sure I could complete the delivery. The nurse picked up the phone and called the nurse's station. She turned back to me, shaking her head, "No one is here but you."

I took a deep breath and replied, "I think I am going to need a stool!"

The nurse wheeled a stool over and lowered the bed so I could be seated while the baby was born. Within a few minutes the baby arrived, fortunately without any difficulty or complications. Once I was sure mom and baby were fine, I hobbled out of the room. Leaving behind a happy family and a memorable story!

I was not at my best, but I was the only doctor available. There were no other options. It was an “Apollo 13” moment, failure was not an option!

I wonder if maybe Mary's husband Joseph didn't feel similarly incapable the night Jesus was born. Young, inexperienced and alone, there were no other options available. A teen-aged mother and a young man had no choice but to trust God and do their best.

Isn't that life in a nutshell? So many times we find ourselves in challenging circumstances, overwhelmed and seemingly alone. In those moments trusting God is so crucial. We must do the best we can, knowing that the God who "delivers" will "deliver" us again.

- Bart

This post was originally published 2 years ago, I share it again this Christmas in the hope that it will give perspective as we approach again the season of the year in which the Savior was born. Feel free to share it with others, or offer comments below.

6 amazing childbirth stories

Reflecting back on amazing birth stories seems appropriate as we approach the day we celebrate the most amazing birth ever. Here is the first of 6 of these stories-

It was 1991. I had been a doctor for 15 months, only 3 months of which I had spent delivering babies. I had delivered about 50 babies and been involved in 30 or so C-sections. Not exactly a long and glowing resume.

Nevertheless, I was the resident physician covering the labor and delivery unit. There were experienced Obstetricians on call who were less than 30 minutes away and occasionally in the hospital, but if and when an emergency happened I was the designated first responder.

Although I was inexperienced, I had worked hard learning protocols for emergencies in childbirth. I was determined- If there ever was a bad outcome, it would not be because I wasn't ready.

It was mid afternoon when the call came from the emergency room. The charge nurse answered the call, her face quickly turning serious.

“Bart,” she said, “We have a 27 weeker coming in by ambulance with a prolapsed cord.”

I headed for the elevator that would take me to the emergency room on the first floor. In the 3 minutes it took me to descend I reviewed what I knew. A cord prolapse meant that the amniotic membrane (Bag of waters) had ruptured, and that as the fluid flowed out it had carried the umbilical cord with it outside of the vagina. If the head descended (as it does in labor) the cord would be pinched and the blood supply cut off. The baby could die. The woman was also 27 weeks pregnant, 3 months early, only a few weeks past the age of development where babies can survive outside the womb. If we could save the baby, it would have a difficult road ahead of it.

The elevator door opened and I hurried into the ER, past the nurses station and into Trauma Room 1, where an ER doctor, several nurses and EMTs scurried around the patient, measuring vital signs. The ER doctor saw me come in, “I didn't feel a pulse in the umbilical cord,” he said, implying that the baby may already be gone. (Only later did I consider how frightening those words must have been to the mother).

I was the youngest and least experienced person in the room, but I called to a nurse- “Get me a doppler!” (the ultrasound device for listening to a baby's heart beat.) The nurse applied the device to the mother's abdomen, and the rapid sounds of a heart beat were audible above the commotion.

“Heart rate 140!” the nurse called in my direction. I barked out another order, “What is the mom's pulse?” I wanted to make sure it was not 140 as it would be a grave error to perform an emergency C-section only to discover that the baby was gone and the pulse we heard was the mother's.

“Mom's pulse is 90!” replied the nurse.

“Let's go- now!” I said and grabbed the rail on the gurney. The ER doctor watched as I took over, more than a little surprised at me taking charge. A few nurses joined me and we headed for the elevator to the OB floor. When we arrived on the floor the charge nurse was waiting for us. She had grabbed an OB as he was walking by the nurse's station and then called for an anesthesiologist. They were standing at the door of the operating room, ready. We wheeled the mom straight into the OR and started the C-section in minutes. The baby was delivered just 17 minutes from the time the mother had first arrived in the emergency room. The neonatologist (high risk baby doctor) was on the scene and the baby was stabilized. Both mom and baby were okay.

Two days later the mom was visited by the director of my Family Practice residency program. He learned that she worked at UCLA Medical Center in a specialty department and did not have a high regard for Family doctors, for one of her first questions was, “How did a second year Family Practice resident know what to do like that?”

In her mind, experts in handling OB emergencies had to have a certain pedigree and experience. She knew what their resumes looked like, and they didn't look like mine. She could not believe that the doctor who had acted quickly to save her baby was a mere family practice resident. 

This episode reminds me of the greatest birth story ever- so many people had decided in their minds that the Messiah would come in a certain way, with fanfare and glory. They didn't expect a poor young virgin to give birth in a stable, and as a result they missed it. Isn't that how God works? In unexpected ways and through unexpected people?

-Bart

If you like this story- share it! If you don't want to miss any of these stories, you can subscribe to the blog and get them all in your inbox. Just check the link on the right of the home page, or at the bottom of your mobile screen.  This post was previously posted in 2013.

Home Births, Hospital Deaths

By the time she arrived at the Emergency Room she had already lost a lot of blood. She was rapidly transferred from the ambulance to an ER bed and within a matter of minutes the life-saving transfusion was started. Had she waited just minutes longer to call for help she may not have survived. Her new baby would have been motherless.

For the doctors in the emergency room the treatment was common, a matter of routine. The reason for her brush with death was not. Post-partum hemorrhages are usually handled on the maternity floor, not in the emergency room. If her baby had been delivered in the maternity floor the bleeding would have been handled faster and the transfusion averted. Unfortunately she had chosen to avoid the maternity floor and have her baby at home. Her decision almost cost her life.

It was a decision that I had repeatedly and strongly argued against. I was her doctor for the first 4 months of her pregnancy. She had made it clear that she wanted a “natural” experience and I had promised her that this could be done in the hospital. I understood that many women preferred a natural delivery and had extensive experience managing natural childbirth. I was confident that her wishes could be honored and promised her they would. When she made the decision to deliver at home I had to resist and released her from my care. From my perspective as a doctor and as a father choosing home birth was and is one of the most selfish choices a woman can make.

Home birth goes against the two values that define obstetrical practice- Protect the health of the mom. Protect the health of the baby. These values guide all obstetrical care. The maternity unit is the only place in the hospital where the health care team begins with healthy patients and then works to keep them that way, so bad outcomes are especially tragic. Everything done by the nurses and doctors is directed at early identification of problems and preventing complications. The only acceptable outcome is a healthy mom and a healthy baby and no action or decision that makes that outcome less likely is tolerated.

While the goal of healthy mom and healthy baby is non-negotiable there is plenty of room for maternal choice during the course of labor and delivery. Birth positions (sitting, squatting, lying down), analgesia choices (epidural, narcotic or none at all), eating during labor, avoidance of IV lines and episiotomies, early nursing and skin to skin contact were all a part of births I attended. I often bent over backwards to meet the mother’s needs even if it meant spending extra hours in the hospital. My willingness to honor maternal wishes had one limit- I would not do anything that put the baby at risk. This is why I opposed home delivery.

In spite of opposition from the medical profession home birth seems to be making a comeback. While there are many possible explanations for the trend the facts support the conclusion that the choice to deliver at home is less about love and health and more about personal feelings and selfishness.

The patient who nearly died of a hemorrhage gave reasons for desiring a home delivery that were typical. She wanted a natural delivery and the experience of delivering at home in a supportive and comfortable environment. These desires seem worthy but they are not, for both place the feelings of the mother ahead of the health of the baby. Babies have no recollection of the room in which they are born, do not grow up feeling more loved and desired because the lights were low and the bed was soft. The baby does not care. Home deliveries are all about what the mother wants and not about what is best for the child. Is this not the very definition of selfishness?

The argument against home delivery is simple. It needlessly places the baby’s life at risk. While the risk is not massive (life threatening complications are rare in most pregnancies) the risk is always present. The American College of Ob-Gyn estimates that newborn mortality in home births is triple that of babies born in a hospital. Why would a loving mother make a choice that needlessly increased the chance that harm would come to her child? What warm feeling or joyous experience can justify that risk?

Current research suggests that as many of one in three women attempting home delivery will need urgent transport to a hospital due to a complication in labor. The transfer rate is lower for women who have previously delivered vaginally but it is still significant. Like every physician who has practiced obstetrics for any length of time I can share a number of stories where being in a hospital delivery room saved the life of a mom or baby.

Consider this analogy- If a young mom announced that she was foregoing the use of an infant car seat because she wanted the child to be in her lap while she drove she would be reported to the authorities. Her arguments that it made her feel close to her child, that bonding was important and that the risk of accident was low would fall on deaf ears. It would not matter that she was a safe driver and that because of cell phones medical help was never more than a few minutes away. Everyone would agree that it was irresponsible and selfish to risk the life of her child in such a way. How is this different than choosing to deliver a baby at home?

I have heard that home birth is gaining in popularity, part of the recycled fad of interest in all things “natural.” I doubt this post will change the minds of those who do not trust the knowledge or intentions of the medical profession but there is one thing of which I am certain. When it comes to the place of birth the baby does not care about the experience. No one remembers their birth experience.

Everyone remembers when a baby dies.

-          Bart

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