The U.S. has the worst rate of maternal deaths in the
developed world, and 60 percent are preventable. The death of Lauren
Bloomstein, a neonatal nurse, in the hospital where she worked illustrates a
profound disparity: The health care system focuses on babies but often ignores
their mothers…
Inductions often go slowly, and Lauren’s labor stretched
well into the next day. Ennis talked to her on the phone several times: “She
said she was feeling okay, she was just really uncomfortable.” At one point,
Lauren was overcome by a sudden, sharp pain in her back near her kidneys or
liver, but the nurses bumped up her epidural and the stabbing stopped.
Inductions have been associated with higher cesarean-section
rates, but Lauren progressed well enough to deliver vaginally. On Saturday,
Oct. 1, at 6:49 p.m., 23 hours after she checked into the hospital, Hailey Anne
Bloomstein was born, weighing 5 pounds, 12 ounces. Larry and Lauren’s family
had been camped out in the waiting room; now they swarmed into the delivery
area to ooh and aah, marveling at how Lauren seemed to glow.
Larry floated around on his own cloud of euphoria, phone
camera in hand. In one 35-second video, Lauren holds their daughter on her
chest, stroking her cheek with a practiced touch. Hailey is bundled in
hospital-issued pastels and flannel, unusually alert for a newborn; she studies
her mother’s face as if trying to make sense of a mystery that will never be
solved. The delivery room staff bustles in the background in the low-key way of
people who believe everything has gone exactly as it’s supposed to.
Then Lauren looks directly at the camera, her eyes brimming.
Twenty hours later, she was dead…
Larry Bloomstein’s first
inkling that something was seriously wrong with Lauren came about 90 minutes
after she gave birth. He had accompanied Hailey up to the nursery to be weighed
and measured and given the usual barrage of tests for newborns. Lauren hadn’t
eaten since breakfast, but he returned to find her dinner tray untouched. “I
don’t feel good,” she told him. She pointed to a spot above her abdomen and
just below her sternum, close to where she’d felt the stabbing sensation during
labor. “I’ve got pain that’s coming back.”…
An hour after Hailey’s birth, the reading was 160/95; an
hour after that, 169/108. At her final prenatal appointment, her reading had
been just 118/69. Obstetrics wasn’t Larry’s specialty[orthopedics], but he knew
enough to ask the nurse: Could this be preeclampsia?...
As Larry suspected, Lauren’s blood pressure readings were
well past the danger point. What he didn’t know was that they’d been abnormally
high since she entered the hospital— 147/99, according to her admissions
paperwork. During labor, she had 21 systolic readings at or above 140 and 13
diastolic readings at or above 90, her records indicated; for a stretch of
almost eight hours, her blood pressure wasn’t monitored at all, the New Jersey
Department of Health later found…
According to Lauren’s records, Vaclavik did order a
preeclampsia lab test around 8:40 p.m., but a nurse noted a half-hour later:
“No abnormal labs present.” (According to Larry, the results were borderline.)
Larry began pushing to call in a specialist. Vaclavik attributed Lauren’s pain
to esophagitis, or inflammation of the esophagus, which had afflicted her
before, he said in his deposition. Around 10 p.m., according to Lauren’s
medical records, he phoned the on-call gastroenterologist, who ordered an X-ray
and additional tests, more Dilaudid and different antacids — Maalox and
Protonix. Nothing helped.
Meanwhile, Larry decided to reach out to his own colleagues
in the trauma unit at Cooper University Hospital in Camden. In his training,
perhaps the most important lesson he’d learned was to ask for help: “If there’s
a problem, I will immediately get another physician involved.” By chance, the
doctor on call happened to be a fairly new mother. As Larry described Lauren’s
symptoms, she interrupted him. “You can stop talking. I know what this is.” She
said Lauren had HELLP syndrome, an acronym for the most severe variation of
preeclampsia, characterized by hemolysis, or the breakdown of red blood cells;
elevated liver enzymes; and low platelet count, a clotting deficiency that can
lead to excessive bleeding and hemorrhagic stroke.
Larry’s colleague urged him to stop wasting time, he
recalled. Lauren’s very high blood pressure, the vomiting, and the terrible
pain radiating from her kidneys and liver were symptoms of rapid deterioration.
“Your wife’s in a lot of danger,” the trauma doctor said….
The last 16 hours of Lauren’s life were consistent with that
grim pattern. Distressed by what the trauma doctor had told him, Larry
immediately went to Lauren’s caregivers. But they insisted the tests didn’t
show preeclampsia, he said. Not long after, Larry’s colleague called back to
check on Lauren’s condition. “I don’t believe those labs,” he recalls her
telling him. “They can’t be right. I’m positive of my diagnosis. Do them
again.’”…
Just after midnight, her blood pressure about to peak at
197/117, Lauren began complaining of a headache. As Larry studied his wife’s
face, he realized something had changed. “She suddenly looks really calm and
comfortable, like she’s trying to go to sleep.” She gave Larry a little smile,
but only the right side of her mouth moved.
In an instant, Larry’s alarm turned to panic. He ordered
Lauren, “Lift your hands for me.” Only her right arm fluttered. He peeled off
her blankets and scraped the soles of her feet with his fingernail, testing her
so-called Babinski reflex; in an adult whose brain is working normally, the big
toe automatically jerks downward. Lauren’s right toe curled as it was supposed
to. But her left toe stuck straight out, unmoving. As Larry was examining her,
Lauren suddenly seemed to realize what was happening to her. “She looked at me
and said, ‘I’m afraid,’ and, ‘I love you.’ And I’m pretty sure in that moment
she put the pieces together. That she had a conscious awareness of … that she
was not going to make it.”
A CT scan soon confirmed the worst: The escalating blood
pressure had triggered bleeding in her brain. So-called hemorrhagic strokes
tend to be deadlier than those caused by blood clots. Surgery can sometimes
save the patient’s life, but only if it is performed quickly…
“The obstetrician just said, ‘She’s going to be all right,’”
Linda Bloomstein said. “And Larry was standing behind him, and I saw the tears
coming down, and he was shaking his head, ‘No.’”
Around 2 a.m., the neurosurgeon finally confirmed what the
trauma doctor had said four hours before: Lauren had HELLP syndrome. Then he delivered
more bad news: Her blood platelets — essential to stopping the hemorrhage —
were dangerously low. But, according to Larry, the hospital didn’t have
sufficient platelets on site, so her surgery would have to be delayed. Larry
was dumbfounded…
The neuro team did another CT scan around 6 a.m. Larry
couldn’t bring himself to look at it, “but from what they’ve told me, it was
horrifically worse.” While Lauren was in surgery, friends began dropping by,
hoping to see her and the baby, not realizing what had happened since her
cheerful texts the night before. Around 12:30 p.m., the neurosurgeon emerged
and confirmed that brain activity had stopped. Lauren was on life support, with
no chance of recovery.
https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system
Video at link
Video at link
Courtesy of: http://www.foxnews.com/health/2017/05/21/nurses-childbirth-death-brings-questions-about-whether-new-moms-being-ignored.html
See: http://childnervoussystem.blogspot.com/2015/04/why-preganant-women-in-mississippi-keep.html
See: http://childnervoussystem.blogspot.com/2015/04/why-preganant-women-in-mississippi-keep.html
Lauren’s death, Larry finally admitted to himself, could not be dismissed as either inevitable or a fluke. He had seen how Lauren’s OB-GYN and nurses had failed to recognize a textbook case of one of the most common complications of pregnancy — not once, but repeatedly over two days. To Larry, the fact that someone with Lauren’s advantages could die so needlessly was symptomatic of a bigger problem. By some measures, New Jersey had one of the highest maternal mortality rates in the U.S. He wanted authorities to get to the root of it — to push the people and institutions that were at fault to change.
ReplyDeleteThat’s the approach in the United Kingdom, where maternal deaths are regarded as systems failures. A national committee of experts scrutinizes every death of a woman from pregnancy or childbirth complications, collecting medical records and assessments from caregivers, conducting rigorous analyses of the data and publishing reports that help set policy for hospitals throughout the country. Coroners also sometimes hold public inquests, forcing hospitals and their staffs to answer for their mistakes. The U.K. process is largely responsible for the stunning reduction in preeclampsia deaths in Britain, the committee noted its 2016 report — “a clear success story” that it hoped to repeat “across other medical and mental health causes of maternal death.”
The U.S. has no comparable federal effort. Instead, maternal mortality reviews are left up to states. As of this spring, 26 states (and one city, Philadelphia) had a well-established process in place; another five states had committees that were less than a year old. In almost every case, resources are tight, the reviews take years and the findings get little attention. A bipartisan bill in Congress, the Preventing Maternal Deaths Act of 2017, would authorize funding for states to establish review panels or improve their processes…
The DOH examined Lauren’s records, interviewed her caregivers and scrutinized Monmouth’s policies and practices. In December 2012 it issued a report that backed up everything Larry had seen firsthand. “There is no record in the medical record that the Registered Nurse notified [the ob/gyn] of the elevated blood pressures of patient prior to delivery,” investigators found. And: “There is no evidence in the medical record of further evaluation and surveillance of patient from [the ob/gyn] prior to delivery.” And: “There was no evidence in the medical record that the elevated blood pressures were addressed by [the ob/gyn] until after the Code Stroke was called.”
The report faulted the hospital. “The facility is not in compliance” with New Jersey hospital licensing standards, it concluded. “The facility failed to ensure that recommended obstetrics guidelines are adhered to by staff.”…
Some of the changes were strikingly basic: “Staff nurses were educated regarding the necessity of reviewing, when available, or obtaining the patients [sic] prenatal records. Education identified that they must make a comparison of the prenatal blood pressure against the initial admission blood pressure.” And: “Repeat vital signs will be obtained every 4 hours at a minimum.”…(continued)
(continued)Modeled on the U.K. process, the California Maternal Quality Care Collaborative is informed by the experiences of founder Elliott Main, a professor of obstetrics and gynecology at Stanford and the University of California-San Francisco, who for many years ran the OB-GYN department at a San Francisco hospital. “One of my saddest moments as an obstetrician was a woman with severe preeclampsia that we thought we had done everything correct, who still had a major stroke and we could not save her,” he said recently. That loss has weighed on him for 20 years. “When you’ve had a maternal death, you remember it for the rest of your life. All the details.”…
ReplyDeleteInstead of the common practice of “eye-balling” blood loss, which often leads to underestimating the seriousness of a hemorrhage and delaying treatment, nurses learned to collect and weigh postpartum blood to get precise measurements. Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year; hospitals that didn’t use the protocol had a 1.2 percent reduction…
CMQCC’s preeclampsia toolkit, launched in 2014, emphasized the kind of practices that might have saved Lauren Bloomstein: careful monitoring of blood pressure and early and aggressive treatment with magnesium sulfate and anti-hypertensive medications. Data on its effectiveness hasn’t been published.
https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system