B.C.’S haven for sick moms
The day after giving birth to her first child should have been one of the best days of Lindsay Epp’s life. Yet for the Ladner mother “it was the worst day of my life. It was horrible.”
Instead of cuddling her newborn baby girl, Anna Marie Grace Epp, mother and baby were split apart due to separate medical emergencies.
Epp developed a life-threatening condition called HELLP syndrome and was sent to the intensive-care unit at St. Paul’s, while her daughter struggled to breathe and was transferred to B.C. Children’s Hospital.
Epp had already been at St. Paul’s on bedrest for weeks due to high blood pressure and a risk of pre-eclampsia, a form of hypertension. Her baby was delivered prematurely by C-section at 34 weeks and was sent to the neonatal intensive-care unit.
But because her lungs were so immature, she needed to go on a ventilator, which required a transfer to a higher-level NICU at Children’s Hospital (a Level 3 NICU; St. Paul’s is Level 2).
That same day, her mother’s systems started to fail. HELLP syndrome involves a cascade of symptoms: hemolysis (the breakdown of red blood cells), elevated liver enzymes and low blood platelet count. The condition occurs in just one or two of every thousand pregnancies. Women often present with simple headaches, nausea and vomiting, but the condition can lead to hemorrhaging and liver failure.
With the expertise of St. Paul’s staff, Epp was stabilized and discharged on Aug. 4, finally able to travel to visit her daughter. Her baby’s breathing improved enough for her to come back to St. Paul’s four days later.
Only Epp’s health trials weren’t over. On Aug. 10, she suffered excessive postpartum bleeding and had to undergo an emergency procedure.
“It’s a tough one,” chief maternity resident Dr. Mina Wesa says of the need to separate sick mothers from their infants. “A big part of our discharge planning and the goal of our patient care is minimizing the separation between mom and baby.”
Watching Epp calmly rock her four-pound, five-ounce girl and caress her wispy gold hair in the NICU days later, it’s hard to imagine the tribulations they suffered to be together.
“She was worth every moment of horribleness,” Epp says, gazing at her fragile daughter adoringly. Having her safe, she says, “is an incredible joy. There are no words. I would do it all again in a heartbeat for her.”
As frightening as Epp’s ordeal sounds, treating desperately sick mothers like her is routine at St. Paul’s.
“We take care of the high-risk mothers in the province,” explains maternity and NICU operations leader Jackie Koufie.
There is certainly no shortage of cases. In their daily morning meeting, maternity doctors and residents troubleshoot the pregnancies of women with multiple complications, among them patients with heart disease, diabetes, arthritis and pacemakers. The residents speak in cryptic code; acronyms fly. It sounds every bit like the script of a medical drama.
But these cases are very real and in some cases these mothers’ conditions are life and death matters.
To deal with them, St. Paul’s has established a number of specialized clinics that bring specialist care and additional oversight to bear on their pregnancies.
Among them are innovative cardiac obstetrics and renal obstetrics clinics, where patients are referred from across the province.
“It’s very frequent that patients with heart disease have been told that they can’t become pregnant,” says cardiac obstetric clinic direc-
tor Dr. Marla Kiess, who founded the program in 2004. “And that’s generally not the case.”
Obstetrician Dr. Elisabet Joa established a similar clinic for renal patients in 2010 with nephrologist Dr. Monica Bruner, helping about a dozen women dialysis patients and transplant recipients achieve healthy pregnancies each year.
Maternal fetal medicine consultant Dr. Duncan Farquharson monitors women with conditions such as obesity, diabetes, advanced maternal age, a history of miscarriage, genetic conditions and hypertension, as well as those with heart and kidney issues.
“I rarely get the simple consultations. Most patients who see me have three or four medical problems,” says Dr. Farquharson, who has spent 30 years in obstetrics.
Many of the women he sees are alive due to advances in fetal medicine a generation ago.
“We see so many women now who would not have been able to achieve a pregnancy 20 years ago,” he says. “Now some of those fetuses I saw are becoming moms, so full circle.”
As part of their care plan, almost all these high-risk mothers will visit the fetal monitoring clinic, where nurses attach sensors to their bellies and listen to their babies’ heart rates to ensure they are faring well despite their mothers’ health issues. Patients visit regularly, in the most serious cases even several times a week, to give clinicians the assurance they need.
“These ladies are the ones who have pregnancy-induced complications, for example, gestational diabetes, gestational hypertension, obese patients, post-dates patients . . . it’s a very busy clinic,” says nurse Roman Djene.
Because of its high-risk patients, the clinic can be a highstakes environment.
One woman, Djene said, came in for routine fetal monitoring at 34 weeks on her lunch break. Her strips were abnormal and she needed a STAT C-section. So much for returning to work.
Desiree Gano likely owes her life to the specialized care at St. Paul’s.
The 39-year-old mother had a baby boy, Jonree Nathan Gano, via C-section at 35 weeks earlier this month, and she’s still recovering. But she’s not in the maternity ward. She’s in the cardiac care unit, on a careful cocktail of medication that is keeping her potentially life-threatening condition — pulmonary hypertension — in check.
She was diagnosed after complaining of shortness of breath in July. Her condition can be fatal for pregnant women and their babies, and Gano, who had no history of heart disease, is extremely lucky it was caught.
“I was shocked,” Gano said of her diagnosis, which will require follow-up care. “My first pregnancy was normal, no problems.”
The nurse brings in her fourpound, nine-ounce baby from the NICU for his feeding and Gano carefully holds a tiny bottle to his lips, cradling him in her arms, which are still covered in IVs.
“You’re a good boy, my baby” she murmurs down at him as he sucks. Then she turns him over and gently pats his back until he gives up an adorable burp. Gano smiles. “He’s cute.”
“I rarely get the simple consultations. Most patients who see me have three or four medical problems.”
— Dr. Duncan Farquharson