First-time mothers are often nervous before their babies are born. Experienced mothers are a little more comfortable because they know what to expect. For Courtney Johnson, a 35-year-old from Chesterfield, she was an experienced mother but was nervous because she knew something wasn't right.
"I kept telling my family that things didn't feel the same as they did my first pregnancy, but no one believed me. I knew something was wrong," says Courtney. "Call it a mother's intuition. I knew something was wrong."
Courtney was cared for by OB/GYN Maternal-Fetal Medicine Specialist Dr. Michael Paul at Missouri Baptist Medical Center throughout this pregnancy. Courtney was diagnosed with a blood clotting disorder and experienced four miscarriages after the birth of her daughter in 2016. She had the best team and very specialized care in a world-class medical facility to ensure she and her baby were healthy and happy. On the day of Courtney's delivery, everything was running very smoothly until the baby was delivered. Dr. Paul and Dr. Nicole Durko, Director of Obstetrical Anesthesia at Missouri Baptist Medical Center, noticed Courtney’s anxiety and shortness of breath. Dr. Paul and Dr. Durko used their instincts and years of experience to let them know that something was not quite right. Courtney was suffering from an amniotic fluid embolism (AFE).
"There was something that both Dr. Durko and I recognized right after the baby was delivered," said Dr. Paul. "Courtney was reporting clouded vision, and her blood pressure was erratic; she was also not interested in the baby. Based on what Courtney was telling us, it was one of two things, a uterine rupture or an amniotic fluid embolism. That is when she went into cardiac arrest. Courtney was definitely suffering from an amniotic fluid embolism, and we needed to act quickly."
AFE is a life-threatening and unexpected birth complication that can affect both mother and baby. It is characterized by acute and rapid collapse of the mother and/or baby because of an allergic reaction to amniotic fluid entering the maternal circulatory system. Many laboring mothers have amniotic fluid or fetal debris entering their circulatory system and do not experience this response.
AFE has two phases; the first is characterized by rapid respiratory failure, which could lead to cardiac arrest. This presented in Courtney as shortness of breath shortly after delivery and escalated into cardiac arrest. The second phase is known as the hemorrhagic phase. The mother begins to bleed profusely at the wound site, typically at the site of the placental attachment or cesarean incision. Disseminated intravascular coagulopathy (DIC) or consumptive coagulopathy develops, preventing blood clotting and creating the need for transfusing blood and blood products.
Courtney and her husband Ryan's baby boy, RJ, was born, but Courtney was unresponsive and quickly needed help. The onsite delivery team worked fast to provide the necessary medications Courtney needed to prevent any neurological damage and help her body fight. Then Courtney’s body went into phase two and began to hemorrhage badly.
The multi-disciplinary team working to help Courtney grew by the minute, using various medications to help her blood clot, the ICU helping provide the highest level of medical support, the Cardiothoracic team ready to put her on bypass, the Interventional Radiology team for embolization, the Blood Bank on standby for additional needs, and even around the clock prayers for the young mother to pull through.
“Courtney was losing blood faster than we could replace it,” said Dr. David Weinstein, Chief of Obstetrics and Gynecology at Missouri Baptist Medical Center. “Our Blood Bank responded to our urgent call for many different blood products in record-breaking time. We were very determined to keep her with us. The immediate recognition of the signs of AFE by Drs. Durko and Paul and the rapid response to this emergency by the entire staff were incredible. I am so proud to work with such an exceptional group of physicians and nurses. The response of the entire MoBap team was truly amazing and is what saved Courtney’s life.”
After four hours, more than 50 medical professionals, and 33 blood products, the bleeding was finally under control.
The next day, Courtney woke up in the ICU, not in a post-partum room with her new baby. She was intubated. Dr. Durko was in Courtney’s room checking on her patient. Courtney motioned for something to write; she could not speak. She wanted to thank her for believing her when she told Dr. Paul and her about her uneasiness with the pregnancy and how she felt that something was not right. It is a note that Dr. Durko keeps with her as a reminder to watch for the small things.
AFE is extremely rare. It occurs in 1 of every 40,000 births in North America. Of those that experience AFE, only 50% survive, and it is considered the leading cause of maternal death globally, usually within the first hour of symptoms. Because of its rare occurrence and low survival rate, not much is known about AFE.
"I am forever grateful for everyone who helped me and my son survive that day," says Courtney. "I cherish every moment I have here with my children, family, and friends. And I hope that on July 31, those of you who helped save my life are there so I can properly thank you in person for the gift you have given me."
Courtney and Ryan live in Chesterfield with Sammie (4) and RJ (17 months). They are huge advocates for AFE Foundation and Missouri Baptist Medical Center.
Courtney arranged for the American Red Cross to come to Missouri Baptist Medical Center for a public blood drive on July 31 to help address the blood shortage in our region. More than 150 donors came out to support her and help save more than 378 lives in St. Louis and the surrounding areas.