When the Baby Screams Out the Only Way It Can

by Larry Puls @larrypulsauthor 

Uterine Rupture, Cesarean Hysterectomy

It was 2:45 in the afternoon. Labor had been progressing since eight that morning, an elective induction for being a week late. I was in my office seeing patients, having never met this patient with the seemingly normal labor. Epidural in place. Check. Husband by his wife’s side. Check. Nursery was awaiting them back home. Check.

The labor contractions were regular and strong. There was a smile on the patient’s face—epidurals are amazing. But the progress of labor had slowed. The cervix had not dilated any over the last two hours. Otherwise, everything was stable.

Then something unexpected happened. As if a switch had been flipped, the patient was flooded by a wave of lightheadedness. Nurses were at her bedside. Initially, nothing seemed to have changed. A repeat blood pressure revealed a subtle but possible drop in her numbers. And then as if adrenaline had been injected into the patient, her heart rate went up—and then the child’s. Maybe the baby was screaming the only way it could, by raising up its heart rate.

I was still in my office. The first call to her obstetrician went out—she arrived in minutes. Another blood pressure was taken, and this time the changed measurement was not subtle, but real. The baby’s heart rate became even more frantic. Something wasn’t right. The mother was numb from the waist down given the epidural, so she couldn’t feel anything—except her swimmy head.

A rapid ultrasound did not make the diagnosis but suggested something ominous. Was the baby where it was supposed to be? A multitude of possible diagnoses were flooding into the mind of the physician. And all those thoughts came to one conclusion. Something need to be done to expedite delivery, and it needed to be done now.

Arriving back in the delivery suite, the baby’s heart rate was at its highest level yet. The baby was now screaming louder—though not a sound was heard. And the mom was becoming growingly unstable. The knife landed on the abdomen. Upon opening the abdomen, blood was everywhere. It was outside the uterus, around the bladder, and filling all the nooks and crannies of the belly. And upon opening the uterus, a disastrous surprise was found. The child was not totally there—only its feet. The uterus had ruptured through the back wall and ejected the small boy into the mother’s abdomen through a large, and now bleeding hole—or maybe it was more of an exsanguinating hole. The cord was tied and cut, the baby extracted as quickly as possible, handed off to the neonatal nurses, and the attention rapidly turned to saving this mother’s tenuous life.

Two liters of free blood was soaking the inside of her abdomen. Lifting the uterus up to see its backside, revealed a myriad of large vessels just pumping away. Squirting, dripping, leaking. One clamp, then two, eventually turning into twenty clamps, and the tide was slowed—but by no means stopped. My phone rang. I dropped everything, flew down the immensely long hall, and arrived up on the labor and delivery suite. Coming in reminded me of a trauma ward. Blood filling the canisters. Red stains all over the floor. Sweat pouring off the surgeon’s masks. And tension permeated the air.

We stitched and sewed. Ideas about how to reconstruct the uterus were tossed about. But the blood pressures were still on the brink of collapse. Her heart rate was twice normal. The ability of her blood to clot was slipping away, even though we were trying to correct that with blood products. The only conclusion was that if we wanted a live mother, we would have to sacrifice her reproductive capabilities by a doing an emergency hysterectomy. With the greatest speed we could muster, we tied and cut and sewed and tied some more. Professionals all over the room doing all the things they do. Anesthesia giving the needed blood products. The nurses providing all the support needed to accomplish a thousand tasks simultaneously. And the surgical team, agonizing over every lost drop of blood.

The uterus came out, ragged and blown apart. Her blood pressure found stability—after twenty units of blood, a thousand prayers, and a little good fortune. And the child? He eventually met his mother.

When the Baby Screams Out the Only Way it Can, Larry Puls, (Click to Tweet)