LOUISVILLE, Ky. (AP) – Bekah Bischoff planned a picture-perfect delivery. She monogrammed and appliqued little outfits for the son she was carrying and for her 2-year-old daughter – one saying "big sister," the other, "little brother." She figured they’d wear the outfits while posing with her husband for a hospital bedside photo.
Instead, she nearly died bringing life into the world.
"There’s no pretty, cute pictures of my daughter kissing her brother the first time that she met him," lamented the 32-year-old Louisville mom, who gave birth to her son, Henry, in 2012. "I didn’t get that dream that every woman wants after they have a baby. At that point, we were just trying to keep me alive."
Bischoff is one of 50,000 American women who nearly lose their lives each year around the time of childbirth. USA TODAY Network is investigating the nation’s sky-high rates of maternal deaths and near-misses – which Lori Freeman, CEO of the Association of Maternal & Child Health Programs, called "tragic" and "unacceptable."
"Maternal mortality is just the tip of the iceberg," said Michael Kramer, a social epidemiologist at Emory University. "There are many-fold more severe maternal morbidities," when women almost die.
Bischoff suffered a potentially deadly complication called HELLP syndrome, often linked to the more widely known condition preeclampsia, which causes high blood pressure, swelling and protein in the urine. The Preeclampsia Foundation estimates that HELLP afflicts 48,000 American women each year and can lead to organ failure and death.
For Bischoff, a teacher, the first sign of trouble came when she was five months along with Henry. She felt almost completely drained of energy while walking with her daughter, Ady, in the Lexington neighborhood where they lived at the time. She’d suffered mild preeclampsia during her first pregnancy, but this seemed different.
"I couldn’t put my finger on it, she said, "but something just wasn’t right."
Bischoff also noticed she was gaining more weight than she thought she should. When she mentioned her concerns to her obstetrician’s staff, she recalled a nurse saying she was probably retaining fluid after hanging out by the pool.
"I felt like any time I would ask a question, I was often told that it was normal … that it was all in my head," she said. "I wish I would have fought harder for someone to listen to me."
Paula Payton, a physician assistant who treated Bischoff during her first pregnancy, said she understands why medical providers don’t always catch preeclampsia and HELLP syndrome immediately. Both can cause vague symptoms that don’t necessarily raise alarm.
Bischoff said her obstetrician’s instincts probably saved her life.
At 36 weeks’ gestation, Bischoff went for a routine checkup. She didn’t feel well and her blood pressure tested high, so Dr. Magdalene Karon decided to run tests for things like elevated liver enzymes and low blood platelet counts.
"With HELLP syndrome, patients may say, ‘I just really don’t feel good. I just feel terrible,’" Karon said. "How do you make a diagnosis from that?"
At home, Bischoff felt sick all night. Even a soothing shower didn’t help.
She called Karon’s office to check on her lab results. Payton, who was working in the same office, told the receptionist: "Get her to the hospital right now."
The receptionist told Bischoff: "Baby, it’s not good."
At that point, fear took hold.
"I remember looking at my daughter and thinking, ‘I hope I see her again,’" Bischoff said.
Doctors at KentuckyOne Health’s St. Joseph East in Lexington started her on magnesium sulfate to prevent a seizure. They gave her steroids to raise her platelets, the tiny blood cells that help in clotting.
No one told her exactly what was happening, she said, until a doctor mentioned HELLP syndrome and family members began frantically searching the internet. Even a nurse had to look it up, she said, "which was really scary."
Nurses there "probably don’t see that much of it," Karon said, adding that the delivery team treated her swiftly and aggressively.
Throughout the birth, Bischoff felt like she had the flu. She refused an oxygen mask because she thought it meant she was dying. Then her mother held her hand and explained the oxygen was for the baby, whose cord was wrapped around his neck.
Bischoff put on the mask and rallied.
"When everything else in my body was shutting down, I fought with everything in my body to get him into this world," she said. "I pushed two times, and there he was."
As soon as Henry arrived, she recalled, the medical staff gravitated toward him and away from her.
"I remember looking around and thinking, ‘I’m still here.’ "
Henry was fine, but Bischoff still felt sick and exhausted. She wept when a nurse later explained all that had happened.
For her husband Joseph, a 33-year-old architect, the seriousness of the situation didn’t sink in until days later. During the delivery, he said, doctors and nurses were so calm and collected he never thought his wife could die.
"Then I realized, ‘Wow. She came so close,’ " said Joseph. "God is good. This is a miracle."
Bischoff spent five days in a postpartum unit, still so sick she couldn’t hold Henry for much of the time. Her blood pressure stayed high despite various drugs the doctors tried. At home, she was on bedrest for six weeks.
Doctors told her it would be too dangerous to have another child – a bitter warning because she had struggled to conceive.
"I wanted a house full of children," Bischoff said. "God said no."
Five years after Henry’s birth, Bischoff lives with physical reminders of her ordeal. She’ll likely take blood pressure medication for the rest of her life. She later had a hysterectomy and now suffers from osteoporosis, which can be caused in part by low estrogen levels after that procedure.
Bischoff and her husband are extremely grateful for their children, now 5 and 7. But memories of the traumatic delivery continue to haunt her, returning each year around Henry’s birthday. And they’re reinforced by every smiling mom-and-baby post on Facebook.
"Just because my story ended happy doesn’t mean it hasn’t left wounds behind," Bischoff said. "It’s still something that I grieve."
It’s also something she shares, hoping, perhaps, to save a life. She advises pregnant friends and relatives to "listen to your body and trust your instincts" even when medical professionals say things seem normal. Payton wholeheartedly agrees, saying: "If you think something’s wrong, shout it to the hilltops."
"Ask and keep asking, even if they think you’re crazy," Bischoff said. "No one else knows your body more than you do."
What is HELLP syndrome?
HELLP syndrome is a life-threatening pregnancy complication usually considered a variant of preeclampsia. Both are most likely to occur during the later stages of pregnancy, or sometimes after childbirth.
HELLP stands for:
H (hemolysis, or the breaking down of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count)
HELLP syndrome can be difficult to diagnose. Symptoms include nausea, vomiting or indigestion with pain after eating; abdominal or chest tenderness; upper right side pain (from liver distention); shoulder pain or pain when breathing deeply; bleeding; changes in vision and swelling.
Most often, treatment is delivery of the baby. Many women require steroids and transfusions of a blood products.
Source: Preeclampsia Foundation
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Information from: Courier Journal, http://www.courier-journal.com
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