Rare complication threatens mother, child; NRMC saves both

2/21/2018

A couple hoping for a home-birth experienced troublesome symptoms and came to Nevada Regional Medical Center for help. Staff quickly realized the mother and child were in mortal danger and pulled out all the stops to save them both. This is their story, written by Dr. Jennifer Conley, told from the perspective of both patient and doctor.


Observations of Tracy and Shannon Simmons

Tracy Simmons was nearing her due date and expecting a normal uncomplicated delivery experience. She developed concerning symptoms on Dec. 8, 2017, and credits her husband Shannon and her midwife Amy Sparks, CPM, with encouraging her to seek care and then to remain at Nevada Regional Medical Center. She was initially reluctant to be admitted and was not inclined to stay because she desired a home birth experience. She has no recollection of becoming seriously ill and has had to rely on others’ accounts to understand the story of her harrowing experience.

Tracy’s husband Shannon remembers the onset of her illness and the response that occurred but he had difficulty grasping the gravity of the situation. He did realize hospital personnel were moving very quickly, he observed Dr. Bill Turner rushing by and he heard requests from the operating room for blood products. He was aware that there was more staff involved in Tracy’s care than would normally be expected. He began to understand after a few days in the ICU that Tracy and their daughter Amelia were indeed survivors of a life-threatening situation.

Amelia and Tracy were both stabilized at NRMC and then individually transferred by helicopter, Amelia to Children’s Mercy Hospital and Tracy to Truman Hospital in Kansas City. Tracy’s trauma surgeon told her she was the sickest person in Truman Hospital for two days and yet she survived.

Tracy and Shannon have expressed a desire to do two things, acknowledge NRMC staff and physicians for the work they did and give glory to God. Tracy notes that a small town hospital cannot survive without the support of its community. She had heard many negative opinions about NRMC and its physicians over the 12 years she has lived in Nevada. She understands that NRMC pulled out all the stops for her and gave her all it could give. She feels that she has met small town doctors with big hearts. She recalls fondly that her first greeting at NRMC was a big smile from Bridget Shaw RN who told her that “Every mom who comes onto this unit deserves to be greeted with a friendly smile.” She had a longer stay at Truman Hospital after her transfer but is certain that the care she received at NRMC was just as good as she experienced at Truman.

Tracy and Shannon see the hand of God throughout this experience. Tracy had initial symptoms that brought her to the hospital so that she could receive rapid care when it was needed. Shannon and Amy had the judgment to encourage her to seek care and remain in the hospital. The surgical crew arrived and were able to begin her surgery very quickly. Three people who were not on-call responded immediately to requests for assistance and were able to provide significant benefit to Tracy and Amelia. They believe that God used people as his instruments and added supernatural results as well.


Physician’s Perspective

Preparation for the unexpected is one of the critical components of rural family medicine with obstetrics. We are fortunate to have mostly routine and straightforward delivery experiences and vigorous newborns. We are always aware, however, that the normal may suddenly take a turn into the critical. This is the case with Tracy’s labor and delivery experience. We believe she experienced an amniotic fluid embolism, a rare and often fatal complication of childbirth. This condition is so uncommon that we had never before observed it during training nor in more than 15 years in private practice.

We had no reason to suspect this would occur and as a result were forced to react automatically with our training and systems already built in place to give us the ability to provide her care as quickly as we could. We were able to deliver Amelia through an emergency C-section 15-20 minutes after the onset of symptoms as a result of immediate recognition of distress by OB nursing staff and Dr. Heather Russell and the rapid response of the surgical call team and Dr. Jennifer Conley from home on a Saturday afternoon. Our nursing staff, nurse anesthetist Steve Marquardt CRNA, surgical crew and lab staff were able to perform admirably under adverse conditions. We were fortunate to have the surgical expertise of Dr. Bill Turner and Dr. Amanda Turner and the NICU experience of Tara Garrett RN immediately although none of them were on call. We were able to request a transfer crew from Children’s Mercy by helicopter which arrived within one hour of the delivery and utilized our local air transport service for Tracy after her surgery was complete.

The traumatic situation caused another life-threatening complication for Tracy, Disseminated Intravascular Coagulopathy, which causes blood to stop clotting normally. As a result, she experienced massive blood loss and continued to do so after her surgery was completed. We transfused numerous units of blood products including some sent by courier from Springfield during surgery. Tracy’s surgery was more than 3 hours in length. A typical cesarean section takes about 30 minutes.

Amelia required resuscitation at birth including chest compressions, placement of an endotracheal tube for respiratory support and an intravenous catheter in her umbilical vein. She was given epinephrine to cause her heart to start beating again. We believe she was in distress from the moment Tracy’s symptoms began but she responded to resuscitation soon after she was born. Those of us who work in the labor and delivery department train routinely in the Neonatal Resuscitation Program and are able to provide that care effectively when it is needed.

Twenty-four employees of NRMC and four physicians were directly involved in the care of Tracy and Amelia and all of us are amazed at how well they have both recovered from this experience. We had good reason to fear that neither would survive. It gives us great joy to see them become healthy.

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