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If Childbirth Is so Routine, Why Are so Many Mothers Dying?

“‘With our technology, every single time a woman dies [in childbirth], it’s a medical error.'”

In May of this year, ProPublica joined forces with NPR to tell the story of Lauren Bloomstein, a NICU nurse at Monmouth Medical Center in Long Branch, New Jersey.  After years of taking care of thousands of new babies, Lauren and her husband, orthopedic trauma surgeon Dr. Larry Bloomstein, were finally about to bring their own child into the world. 20 hours after delivering their daughter, Hailey, Lauren Bloomstein was gone. Her cause of death was complications due to HELLP syndrome, a rare pregnancy-related condition considered to be a severe variant of Preeclampsia. In the hospital where she had tirelessly worked to save others, physicians and nursing staff ultimately failed her. A first-time mother who had lost her own mom as a child was dead at just 33 years old.

HELLP Syndrome & Preeclampsia: What Are They?
According to the Preeclampsia Foundation, Preeclampsia is a pregnancy and postpartum condition that “affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms.” The postpartum period is typically confined to the 6 weeks following childbirth.

HELLP Syndrome, like Preeclampsia, can be marked by elevated blood pressure and protein in the urine (proteinuria). However, elevated bp and proteinuria do not need to be present to have a diagnosis of HELLP. Other possible symptoms are similar to Preeclampsia: swelling, headaches, dizziness, visual difficulties, tingling of the extremities, nausea, fatigue. One symptom that distinguishes it from Preeclampsia is pain in the upper right quadrant (abdomen), a red flag that HELLP may be present. Many expectant and new mothers suffering from HELLP complain of heartburn or acid reflux, leading doctors to a misdiagnosis of gastritis, gall bladder issues, or strictly just acid reflux.

The condition is an acronym for Hemolysis (the breaking down of red blood cells), Elevated Liver enzymes and Low Platelets. HELLP is said to have a global maternal mortality rate of 25%.

A Series of Costly Mistakes
Dr. Larry Bloomstein describes in depositions how he knew within 90 minutes of delivering their child that something was not right with his wife. As do most doctors who find themselves as patients, he said he was trying to avoid overstepping his bounds. He describes his wife’s climbing blood pressure, vomiting, and unbearable epigastric pain as her liver began to swell, all hallmark symptoms of HELLP syndrome. When he questioned his wife’s OB-GYN about the symptoms, Dr. John Vaclavik, he brushed the discomfort off, saying she had heartburn and that her rising bp was not a cause for concern. He then prescribed antacids. Her husband, beginning to suspect Preeclampsia, asked Dr. Vaclavik to run a blood and enzyme panel to screen for the condition. A nurse charted that nothing abnormal was noted in the test results.

However, seeing his wife’s blood pressure climb and witnessing the level of pain she was in, he called his own colleagues at another New Jersey hospital and spoke to a fellow trauma physician, a new mother. Immediately the doctor told Lauren’s husband to demand that her medical team rerun a battery of tests to evaluate her for Preeclampsia and HELLP Syndrome. According to Dr. Bloomstein, his colleague said “You can stop talking. I know what this is.  Your wife’s in a lot of danger.” Dr. Bloomstein went back to his wife’s medical team and questioned them on the results. In his deposition he said he told them he didn’t believe the initial labs and asked them to rescreen her. As Lauren lay suffering, a nurse also removed her blood pressure cuff because it was causing her more discomfort. The nurse said that her thinking was that if her patient’s blood pressure was already high, what was the point in continually taking it? Medical records later revealed that in the 20 hours that Lauren lay dying from a condition dependent on resolving high range blood pressure, medical staff did not even attempt to take hers for a period of nearly 8 hours. 

Around midnight, staff finally retook Lauren’s blood pressure after she began complaining of a headache. Her blood pressure had climbed to 197/117, after entering the hospital with a bp of 147/99. According to Lauren’s records, she had maintained normal blood pressure readings for the duration of her pregnancy. Admitting her to the hospital with an elevated reading should have automatically triggered additional screening for Preeclampsia and HELLP.

At 2 am, a CT scan revealed that her elevated blood pressure had caused a hemorrhagic stroke. If she had survived, she would have been paralyzed, partially or fully, depending on how quickly a neurosurgeon could intervene. One of the keystones of HELLP is low platelets, a tiny cell in the blood that helps it clot. Too low of platelets can lead to excess blood loss, a condition which complicates and can prevent surgery. Monmouth Medical Center did not have enough platelets for Lauren, so a brain surgery had to be delayed for several hours until the supply arrived. Surgery began in the early morning hours and by mid-afternoon the next day, the surgeon came out to tell Larry that Lauren had no brain activity and that she was on life support. Lauren’s fellow NICU nurses brought her baby down to her and laid her in her mother’s arms for one last time. 3.5 hours later, Lauren Bloomstein was dead, leaving behind her husband, her infant daughter, her family, and many colleagues and friends who deeply loved her.

“A Slow-Motion Train Wreck”
The article quotes a member of the Council on Patient Safety in Women’s Health Care as saying “It’s never just one thing. It’s always a cascading combination of things. It’s a slow-motion train wreck.” Lauren Bloomstein’s death was just that. Her doctor, John Vaclavik, said he traditionally didn’t consider Preeclampsia as a possible diagnosis until a mother’s blood pressure was 180/110, an incredibly high reading considering that the medical standard in the United States and United Kingdom is to evaluate a pregnant or new mother for Preeclampsia if her reading exceeds 140/90. The only cure for Preeclampsia or HELLP is delivery of the fetus. However, both conditions can still persist after the infant has been delivered and in rare cases, the condition can present itself for the first time after the baby has been delivered. The use of magnesium sulfate in the postpartum period of a woman with diagnosed or suspected Preeclampsia or HELLP is considered the current medical standard to help prevent seizures and strokes. Lauren Bloomstein was not given this potentially life saving medication at any point during her treatment at Monmouth Medical Center. The hospital also failed to maintain an adequate supply of platelets, a shocking revelation considering that it is large medical center that routinely delivers babies and performs emergency and scheduled surgeries.

Lauren Bloomstein’s husband, a doctor himself, decided to sue the Monmouth Medical Center and Dr. Vaclavik after realizing that for two days, Lauren’s caretakers failed to recognize and respond to a relatively well-known pregnancy complication. Her case had a traditional presentation: Rising blood pressure, nausea, vomiting, upper right abdominal pain, and later, a severe headache. In talking with friends of his about Lauren’s death, some of whom are also physicians, Larry Bloomstein said they told him “‘We can’t accept that. With our technology, every single time a woman dies [in childbirth], it’s a medical error.’”

More Maternal Deaths in the U.S. Than Any Other Developed Country 
Sadly, medical error and maternal death is more common in our country than in any other developed country in the world. The CDC estimates that 60% of these maternal deaths are preventable. How is this possible in the United States, the same country that now has the lowest infant mortality rate we’ve ever seen?

ProPublica and NPR examined possible reasons behind our high death rate and concluded that the focus of funding, research, and education in the field of maternal-fetal medicine is mostly centered on improving outcomes for infants. Very little funding is dedicated to understanding and preventing postpartum death from hemorrhages, infections, Preeclampsia, HELLP Syndrome, and cardiac conditions such as postpartum cardiomyopathy. By contrast, when a women dies during or following childbirth in the United Kingdom, an investigative panel examines medical records, holds interviews and public inquests, and demands answers. Their rate of maternal death, along with Canada, France, Germany and most other developed countries, has declined since 2000, while ours has steadily increased.

Childbirth injuries and death are on the decline for infants, but not for mothers, who often get lost in the shuffle of the excitement and care of a newborn. Childbirth in and of itself is a traumatic experience for the female body and oftentimes women having symptoms such as heartburn, pain, nausea, and vomiting are written off as suffering from typical labor and postpartum symptoms. The role of a qualified OB-GYN and labor and delivery staff is to be educated on the symptoms of atypical distress in a laboring or postpartum mother and to respond quickly. Outcomes for women suffering from many conditions present during labor, delivery and the postpartum period can be dramatically increased if medical intervention is received quickly.

Levin & Perconti: Chicago Maternal Injury and Wrongful Death Attorneys
If you or someone you love has experienced any significant injury resulting from a doctor, nurse, or midwife’s failure to recognize and treat symptoms related to Preeclampsia, HELLP Syndrome, an infection or hemorrhage, postpartum cardiomyopathy or any other of the serious disorders that can impact expectant and new mothers, please contact us for a free consultation. There is a time limit to filing medical malpractice cases in Illinois, so it is important to file a lawsuit as soon as possible to avoid falling outside the statute of limitations.

Our Chicago medical malpractice attorneys have successfully tried and settled numerous maternal death and injury cases in Chicago and throughout Illinois, including a $5.35 million dollar settlement for a Chicago mother who died from postpartum cardiomyopathy one month after the birth of her first child.

 

To read the ProPublica/NPR article, please click here.