Maternal Mortality in the USA: The Last Person You’d Expect to Die in Childbirth

Preface by TLB: This is so sad on so many levels. You would expect the the nation that claims to be the most technically advanced, spends more on healthcare than the next 3-4 nations combined, and boast the best healthcare (is this a joke?) on the planet, would not suffer this level of catastrophic incidences … especially when it is a stated fact that up to 60 percent of these incidences are avoidable/preventable!

But you must also consider that a Study in the Journal of Patient Safety states that between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death (the worst stats in the entire developed world). This is unconscionable … but a reality in America today.

Someone please tell us what the hell we are spending all this money on?

Please continue reading this sad but vital article on Maternal Mortality, it should be a serious wakeup call for all who are pregnant or planning to be in the near future …


The Last Person You’d Expect to Die in Childbirth

By: Nina Martin, and Renee Montagne

AS A NEONATAL INTENSIVE CARE NURSE, Lauren Bloomstein had been taking care of other people’s babies for years. Finally, at 33, she was expecting one of her own. The prospect of becoming a mother made her giddy, her husband Larry recalled recently — “the happiest and most alive I’d ever seen her.” When Lauren was 13, her own mother had died of a massive heart attack. Lauren had lived with her older brother for a while, then with a neighbor in Hazlet, New Jersey, who was like a surrogate mom, but in important ways she’d grown up mostly alone. The chance to create her own family, to be the mother she didn’t have, touched a place deep inside her. “All she wanted to do was be loved,” said Frankie Hedges, who took Lauren in as a teenager and thought of her as her daughter. “I think everybody loved her, but nobody loved her the way she wanted to be loved.”

Other than some nausea in her first trimester, the pregnancy went smoothly. Lauren was “tired in the beginning, achy in the end,” said Jackie Ennis, her best friend since high school, who talked to her at least once a day. “She gained what she’s supposed to. She looked great, she felt good, she worked as much as she could” — at least three 12-hour shifts a week until late into her ninth month. Larry, a doctor, helped monitor her blood pressure at home, and all was normal.

On her days off she got organized, picking out strollers and car seats, stocking up on diapers and onesies. After one last pre-baby vacation to the Caribbean, she and Larry went hunting for their forever home, settling on a brick colonial with black shutters and a big yard in Moorestown, not far from his new job as an orthopedic trauma surgeon in Camden. Lauren wanted the baby’s gender to be a surprise, so when she set up the nursery she left the walls unpainted — she figured she’d have plenty of time to choose colors later. Despite all she knew about what could go wrong, she seemed untroubled by the normal expectant-mom anxieties. Her only real worry was going into labor prematurely. “You have to stay in there at least until 32 weeks,” she would tell her belly. “I see how the babies do before 32. Just don’t come out too soon.”

When she reached 39 weeks and six days — Friday, Sept. 30, 2011 — Larry and Lauren drove to Monmouth Medical Center in Long Branch, the hospital where the two of them had met in 2004 and where she’d spent virtually her entire career. If anyone would watch out for her and her baby, Lauren figured, it would be the doctors and nurses she worked with on a daily basis. She was especially fond of her obstetrician-gynecologist, who had trained as a resident at Monmouth at the same time as Larry. Lauren wasn’t having contractions, but she and the OB-GYN agreed to schedule an induction of labor — he was on call that weekend and would be sure to handle the delivery himself.

Inductions often go slowly, and Lauren’s labor stretched well into the next day. Ennis talked to her on the phone several times: “She said she was feeling okay, she was just really uncomfortable.” At one point, Lauren was overcome by a sudden, sharp pain in her back near her kidneys or liver, but the nurses bumped up her epidural and the stabbing stopped.

Inductions have been associated with higher cesarean-section rates, but Lauren progressed well enough to deliver vaginally. On Saturday, Oct. 1, at 6:49 p.m., 23 hours after she checked into the hospital, Hailey Anne Bloomstein was born, weighing 5 pounds, 12 ounces. Larry and Lauren’s family had been camped out in the waiting room; now they swarmed into the delivery area to ooh and aah, marveling at how Lauren seemed to glow.

Larry floated around on his own cloud of euphoria, phone camera in hand. In one 35-second video, Lauren holds their daughter on her chest, stroking her cheek with a practiced touch. Hailey is bundled in hospital-issued pastels and flannel, unusually alert for a newborn; she studies her mother’s face as if trying to make sense of a mystery that will never be solved. The delivery room staff bustles in the background in the low-key way of people who believe everything has gone exactly as it’s supposed to.

Then Lauren looks directly at the camera, her eyes brimming.

Twenty hours later, she was dead.

THE ABILITY TO PROTECT THE HEALTH OF MOTHERS AND BABIES in childbirth is a basic measure of a society’s development. Yet every year in the U.S., 700 to 900 women die from pregnancy or childbirth-related causes, and some 65,000 nearly die — by many measures, the worst record in the developed world.

American women are more than three times as likely as Canadian women to die in the maternal period (defined by the Centers for Disease Control as the start of pregnancy to one year after delivery or termination), six times as likely to die as Scandinavians. In every other wealthy country, and many less affluent ones, maternal mortality rates have been falling; in Great Britain, the journal Lancet recently noted, the rate has declined so dramatically that “a man is more likely to die while his partner is pregnant than she is.” But in the U.S., maternal deaths increased from 2000 to 2014. In a recent analysis by the CDC Foundation, nearly 60 percent of such deaths were preventable.

While maternal mortality is significantly more common among African Americans, low-income women and in rural areas, pregnancy and childbirth complications kill women of every race and ethnicity, education and income level, in every part of the U.S. ProPublica and NPR spent the last several months scouring social media and other sources, ultimately identifying more than 450 expectant and new mothers who have died since 2011. The list includes teachers, insurance brokers, homeless women, journalists, a spokeswoman for Yellowstone National Park, a co-founder of the YouTube channel WhatsUpMoms, and more than a dozen doctors and nurses like Lauren Bloomstein. They died from cardiomyopathy and other heart problems, massive hemorrhage, blood clots, infections and pregnancy-induced hypertension (preeclampsia) as well as rarer causes. Many died days or weeks after leaving the hospital. Maternal mortality is commonplace enough that three new mothers who died, including Lauren, were cared for by the same OB-GYN.

The reasons for higher maternal mortality in the U.S. are manifold. New mothers are older than they used to be, with more complex medical histories. Half of pregnancies in the U.S. are unplanned, so many women don’t address chronic health issues beforehand. Greater prevalence of C-sections leads to more life-threatening complications. The fragmented health system makes it harder for new mothers, especially those without good insurance, to get the care they need. Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.

Maternal Mortality Is Rising in the U.S. As It Declines Elsewhere

Per 100,000 live births. Source: “Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015,” The Lancet. Note: Only data for 1990, 2000 and 2015 was made available in the journal.

Yet the worsening U.S. maternal mortality numbers contrast sharply with the impressive progress in saving babies’ lives. Infant mortality has fallen to its lowest point in history, the CDC reports, reflecting 50 years of efforts by the public health community to prevent birth defects, reduce preterm birth and improve outcomes for very premature infants. The number of babies who die annually in the U.S. — about 23,000 in 2014 — still greatly exceeds the number of expectant and new mothers who die, but the ratio is narrowing.

The divergent trends for mothers and babies highlight a theme that has emerged repeatedly in ProPublica’s and NPR’s reporting. In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother’s health and well-being.

“We worry a lot about vulnerable little babies,” said Barbara Levy, vice president for health policy/advocacy at the American Congress of Obstetricians and Gynecologists (ACOG) and a member of the Council on Patient Safety in Women’s Health Care. Meanwhile, “we don’t pay enough attention to those things that can be catastrophic for women.”

At the federally funded Maternal-Fetal Medicine Units Network, the preeminent obstetric research collaborative in the U.S., only four of the 34 initiatives listed in its online database primarily target mothers, versus 24 aimed at improving outcomes for infants (the remainder address both). Under the Title V federal-state program supporting maternal and child health, states devoted about 6 percent of block grants in 2016 to programs for mothers, compared to 78 percent for infants and special-needs children. The notion that babies deserve more care than mothers is similarly enshrined in the Medicaid program, which pays for about 45 percent of births. In many states, the program covers moms for 60 days postpartum, their infants for a full year. The bill to replace the Affordable Care Act, adopted by the U.S. House of Representatives earlier this month, could gut Medicaid for mothers and babies alike.

At the provider level, advances in technology have widened the gap between maternal and fetal and infant care. “People became really enchanted with the ability to do ultrasound, and then high-resolution ultrasound, to do invasive procedures, to stick needles in the amniotic cavity,” said William Callaghan, chief of the CDC’s Maternal and Infant Health Branch.

The growing specialty of maternal-fetal medicine drifted so far toward care of the fetus that as recently as 2012, young doctors who wanted to work in the field didn’t have to spend time learning to care for birthing mothers. “The training was quite variable across the U.S.,” said Mary D’Alton, chair of OB-GYN at Columbia University Medical Center and author of papers on disparities in care for mothers and infants. “There were some fellows that could finish their maternal-fetal medicine training without ever being in a labor and delivery unit.”

In the last decade or so, at least 20 hospitals have established multidisciplinary fetal care centers for babies at high risk for a variety of problems. So far, only one hospital in the U.S. — NewYork-Presbyterian/Columbia — has a similar program for high-risk moms-to-be.

In regular maternity wards, too, babies are monitored more closely than mothers during and after birth, maternal health advocates told ProPublica and NPR. Newborns in the slightest danger are whisked off to neonatal intensive care units like the one Lauren Bloomstein worked at, staffed by highly trained specialists ready for the worst, while their mothers are tended by nurses and doctors who expect things to be fine and are often unprepared when they aren’t.

When women are discharged, they routinely receive information about how to breastfeed and what to do if their newborn is sick but not necessarily how to tell if they need medical attention themselves. “It was only when I had my own child that I realized, ‘Oh my goodness. That was completely insufficient information,’” said Elizabeth Howell, professor of obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. “The way that we’ve been trained, we do not give women enough information for them to manage their health postpartum. The focus had always been on babies and not on mothers.”

In 2009, the Joint Commission, which accredits 21,000 health care facilities in the U.S., adopted a series of perinatal “core measures” — national standards that have been shown to reduce complications and improve patient outcomes. Four of the measures are aimed at making sure the baby is healthy. One — bringing down the C-section rate — addresses maternal health.

Meanwhile, life-saving practices that have become widely accepted in other affluent countries — and in a few states, notably California — have yet to take hold in many American hospitals. Take the example of preeclampsia, a type of high blood pressure that only occurs in pregnancy or the postpartum period, and can lead to seizures and strokes. Around the world, it kills an estimated five women an hour. But in developed countries, it is highly treatable. The key is to act quickly.

By standardizing its approach, Britain has reduced preeclampsia deaths to one in a million — a total of two deaths from 2012 to 2014. In the U.S., on the other hand, preeclampsia still accounts for about 8 percent of maternal deaths — 50 to 70 women a year. Including Lauren Bloomstein.

WHEN LAUREN MCCARTHY BLOOMSTEIN WAS A TEENAGER IN THE 1990S, a neighbor who worked for a New York publishing firm approached her about modeling for a series of books based on Louisa May Alcott’s classic “Little Women.” Since her mother’s death, Lauren had become solitary and shy; she loved to read, but she decided she wasn’t interested. “Are you kidding? Go do it!” Frankie Hedges insisted. “That would be fabulous!” Lauren relented, and the publisher cast her as the eldest March sister, Meg. She appeared on the covers of four books, looking very much the proper 19th-century young lady with her long brown hair parted neatly down the middle and a string of pearls around her neck. The determined expression on her face, though, was pure Lauren. “She didn’t want sympathy, she didn’t want pity,” Jackie Ennis said. “She wasn’t one to talk much about her feelings [about] her mom. She looked at it as this is what she was dealt and she’s gonna do everything in her power to become a productive person.”

In high school, Lauren decided her path lay in nursing, and she chose a two-year program at Brookdale Community College. She worked at a doctor’s office to earn money for tuition and lived in the garage apartment that Hedges and her husband had converted especially for her, often helping out with their young twin sons. Lauren “wasn’t a real mushy person,” Hedges said. “She wasn’t the type to say things like ‘I love you. ’” But she clearly relished being part of a family again. “You can’t believe how happy she is,” Ennis once told Hedges. “We’ll be out and she’ll say, ‘Oh, I have to go home for dinner!’”

After graduating in 2002, Lauren landed at Monmouth Medical Center, a sprawling red-brick complex a few minutes from the ocean that is part of the RWJBarnabas Healthsystem and a teaching affiliate of Philadelphia’s Drexel University College of Medicine. Her first job was in the medical surgical unit, where her clinical skills and work ethic soon won accolades. “I cannot remember too many healthcare employees that I respect as much as Lauren,” Diane Stanaway, then Monmouth’s clinical director of nursing, wrote in a 2005 commendation. “What a dynamite young lady and nurse!” When a top hospital executive needed surgery, Larry recalled, he paid Lauren the ultimate compliment, picking her as one of two private-duty nurses to help oversee his care.

Larry Bloomstein, who joined the unit as an orthopedic surgical resident in 2004, was dazzled, too. He liked her independent streak — “She didn’t feel the need to rely on anyone else for anything” — and her levelheadedness. Even performing CPR on a dying patient, Lauren “had a calmness about her,” Larry said. He thought her tough upbringing “gave her a sense of confidence. She didn’t seem to worry about small things.” Lauren, meanwhile, told Ennis, “I met this guy. He’s a doctor, and he’s very kind.” Their first date was a Bruce Springsteen concert; five years later they married on Long Beach Island, on the Jersey shore.

Larry and Lauren Bloomstein met at the hospital in 2004. He liked that she was feisty and independent yet had “a calmness about her.” She told her best friend he was “very kind.” They married five years later. (Courtesy of Larry Bloomstein)

One of Lauren’s favorite books was “The Catcher in the Rye” — “she related to the Holden Caulfield character rescuing kids,” Larry said. When a spot opened at Monmouth’s elite neonatal intensive care unit in 2006, she jumped at it.

The hospital has the fifth-busiest maternity department in the state, delivering 5,449 babies in 2016. Monmouth earned an “A” grade from Leapfrog, a nonprofit that promotes safety in health care, and met full safety standards in critical areas of maternity care, such as rates of C-sections, and early elective deliveries, a hospital spokeswoman said. Its NICU, a Level III facility for high-risk newborns, is the oldest in New Jersey.

“With NICU nursing, it’s one of those things either you get it or you don’t,” said Katy DiBernardo, a 20-year veteran of the unit. “The babies are little, and a lot of people aren’t used to seeing a teeny tiny baby.” The NICU staff included nurses, neonatologists, a respiratory therapist and residents. Lauren, DiBernardo said, “just clicked.”

One of the things Lauren liked best about her work was the bonds she formed with babies’ families. Nurses followed the same newborns throughout their stay, sometimes for weeks or months. She was a touchstone for parents — very good at “calming people down who have a lot of anxiety,” Larry said —and often stayed in contact long after the babies went home, meeting the moms for coffee and even babysitting on occasion.

She also cherished the deep friendships that a place like the NICU forged. The neonatal floor was like a world unto itself, Lauren Byron, another longtime nurse there, explained: “There’s a lot of stress and pressure, and you are in life-and-death situations. You develop a very close relationship with some people.” The environment tended to attract very strong personalities. Lauren’s nickname in the Bloomstein family football pool was “The Feisty One,” so she fit right in. But she could stand her ground without alienating anyone. “She was one of those people that everyone liked,” Byron said.

ANOTHER PERSON EVERYONE LIKED was OB-GYN John Vaclavik. He had come to Monmouth as a resident in 2004, around the same time as Larry, after earning his bachelor’s from Loyola College in Baltimore and his medical degree at St. George’s University on the island of Grenada. Medicine was the family profession: Two uncles and two brothers also became doctors and his wife was a perinatal social worker at the hospital. Lauren and her colleagues thought he was “very personable” and “a great guy,” Larry said.

“She was good friends with my wife and she felt comfortable with me,” Vaclavik would recall in a 2015 court deposition.

After his residency, Vaclavik joined Ocean Obstetric & Gynecologic Associates, a thriving practice that counted numerous medical professionals among its clients. Vaclavik was a “laborist” — part of a movement that aimed to reduce the number of C-sections, which tend to have more difficult recoveries and more complications than vaginal births. In a state with a C-section rate of 37 percent, Monmouth’s rate in 2016 was just 21 percent.

The neonatal nurses had plenty of opportunity to observe Vaclavik and other OB-GYNs in action — someone from NICU was called to attend every delivery that showed signs of being complicated or unusual as well as every C-section. “We always laughed, ‘They’ll call us for a hangnail,’” DiBernardo said. Lauren was so impressed by Vaclavik that she not only chose him as her own doctor, she recommended him to her best friend. “She kept saying, ‘You have to go to this guy. He’s a good doctor. Good doctor,’” Ennis said.

In other ways, though, the NICU staff and the labor and delivery staff were very separate. The neonatal nurses were focused on their own fragile patients — the satisfaction that came from helping them grow strong enough to go home, the grief when that didn’t happen. Once Ennis asked Lauren, “How do you deal with babies that don’t make it? That’s got to be so bad.” Lauren replied, “Yeah, but we save more than we lose.”

Loss was less common in labor and delivery, and when a new mother suffered life-threatening complications, the news did not always reach the NICU floor. Thus, when a 29-year-old special education teacher named Tara Hansen contracted a grisly infection a few days after giving birth to her first child in March 2011, the tragedy didn’t register with Lauren, who was then three months pregnant herself.

Hansen lived in nearby Freehold, New Jersey, with her husband, Ryan, her high school sweetheart. Her pregnancy, like Lauren’s, had been textbook perfect, and she delivered a healthy 9-pound son. But Hansen suffered tearing near her vagina during childbirth. She developed signs of infection but was discharged anyway, a lawsuit by her husband later alleged.

Hansen was soon readmitted to Monmouth with what the lawsuit called “excruciating, severe pain beyond the capacity of a human being to endure.” The diagnosis was necrotizing fasciitis, commonly known as flesh-eating bacteria; two days later Hansen was dead. One of Vaclavik’s colleagues delivered Hansen’s baby; Vaclavik himself authorized her discharge. According to court documents, he said nurses failed to inform him about Hansen’s symptoms and that if he’d known her vital signs weren’t stable, he wouldn’t have released her. The hospital and nurses eventually settled for $1.5 million. The suit against Vaclavik and his colleagues is pending.

Vaclavik did not respond to several interview requests from ProPublica and NPR, including an emailed list of questions. “Due to the fact this matter is in litigation,” his attorney responded, “Dr. Vaclavik respectfully declines to comment.”

Citing patient privacy, Monmouth spokeswoman Elizabeth Brennan also declined to discuss specific cases. “We are saddened by the grief these families have experienced from their loss,” she said in a statement.

Monmouth Medical Center delivered 5,449 babies in 2016. Lauren Bloomstein was a nurse in its neonatal intensive care unit. (Bryan Anselm for ProPublica)

LARRY BLOOMSTEIN’S FIRST INKLING that something was seriously wrong with Lauren came about 90 minutes after she gave birth. He had accompanied Hailey up to the nursery to be weighed and measured and given the usual barrage of tests for newborns. Lauren hadn’t eaten since breakfast, but he returned to find her dinner tray untouched. “I don’t feel good,” she told him. She pointed to a spot above her abdomen and just below her sternum, close to where she’d felt the stabbing sensation during labor. “I’ve got pain that’s coming back.”

Larry had been at Lauren’s side much of the previous 24 hours. Conscious that his role was husband rather than doctor, he had tried not to overstep. Now, though, he pressed Vaclavik: What was the matter with his wife? “He was like, ‘I see this a lot. We do a lot of belly surgery. This is definitely reflux,’” Larry recalled. According to Lauren’s records, the OB-GYN ordered an antacid called Bicitra and an opioid painkiller called Dilaudid. Lauren vomited them up.

Lauren’s pain was soon 10 on a scale of 10, she told Larry and the nurses; so excruciating, the nurses noted, “Patient [is] unable to stay still.” Just as ominously, her blood pressure was spiking. An hour after Hailey’s birth, the reading was 160/95; an hour after that, 169/108. At her final prenatal appointment, her reading had been just 118/69. Obstetrics wasn’t Larry’s specialty, but he knew enough to ask the nurse: Could this be preeclampsia?

Preeclampsia, or pregnancy-related hypertension, is a little-understood condition that affects 3 percent to 5 percent of expectant or new mothers in the U.S., up to 200,000 women a year. It can strike anyone out of the blue, though the risk is higher for African Americans, women with pre-existing conditions such as obesity, diabetes or kidney disease, and mothers over the age of 40. It is most common during the second half of pregnancy, but can develop in the days or weeks after childbirth, and can become very dangerous very quickly. Because a traditional treatment for preeclampsia is to deliver as soon as possible, the babies are often premature and end up in NICUs like the one where Lauren worked.

As Larry suspected, Lauren’s blood pressure readings were well past the danger point. What he didn’t know was that they’d been abnormally high since she entered the hospital— 147/99, according to her admissions paperwork. During labor, she had 21 systolic readings at or above 140 and 13 diastolic readings at or above 90, her records indicated; for a stretch of almost eight hours, her blood pressure wasn’t monitored at all, the New Jersey Department of Health later found. Over that same period, their baby’s vital signs were being constantly watched, Larry said.

In his deposition, Vaclavik described the 147/99 reading as “elevated” compared to her usual readings, but not abnormal. He “would use 180 over 110 as a cutoff” to suspect preeclampsia, he said. Still, he acknowledged, Lauren’s blood pressure “might have been recommended to be monitored more closely, in retrospect.”

Leading medical organizations in the U.S. and the U.K. take a different view. They advise that increases to 140/90 for pregnant women with no previous history of high blood pressure signify preeclampsia. When systolic readings hit 160, treatment with anti-hypertensive drugs and magnesium sulfate to prevent seizures “should be initiated ASAP,” according to guidelines from the Alliance for Innovation on Maternal Health. When other symptoms, such as upper abdominal (epigastric) pain, are present, the situation is considered even more urgent.

This basic approach isn’t new: “Core Curriculum for Maternal-Newborn Nursing,” a widely-used textbook, outlined it in 1997. Yet failure to diagnose preeclampsia, or to differentiate it from chronic high blood pressure, is all too common.

California researchers who studied preeclampsia deaths over several years found one striking theme: “Despite triggers that clearly indicated a serious deterioration in the patient’s condition, health care providers failed to recognize and respond to these signs in a timely manner, leading to delays in diagnosis and treatment.” Preeclampsia symptoms — swelling and rapid weight gain, gastric discomfort and vomiting, headache and anxiety — are often mistaken for the normal irritations that crop up during pregnancy or after giving birth. “We don’t have a yes-no test for it,” said Eleni Tsigas, executive director of the Preeclampsia Foundation. “A lot of physicians don’t necessarily see a lot of it.” Outdated notions — for example, that delivering the baby cures the condition — unfamiliarity with best practices and lack of crisis preparation can further hinder the response.

The fact that Lauren gave birth over the weekend may also have worked against her. Hospitals may be staffed differently on weekends, adding to the challenges of managing a crisis. A new Baylor College of Medicine analysis of 45 million pregnancies in the U.S. from 2004 to 2014 found mothers who deliver on Saturday or Sunday have nearly 50 percent higher mortality rates as well as more blood transfusions and more perineal tearing. The “weekend effect” has also been associated with higher fatality rates from heart attacks, strokes and head trauma.

According to Lauren’s records, Vaclavik did order a preeclampsia lab test around 8:40 p.m., but a nurse noted a half-hour later: “No abnormal labs present.” (According to Larry, the results were borderline.) Larry began pushing to call in a specialist. Vaclavik attributed Lauren’s pain to esophagitis, or inflammation of the esophagus, which had afflicted her before, he said in his deposition. Around 10 p.m., according to Lauren’s medical records, he phoned the on-call gastroenterologist, who ordered an X-ray and additional tests, more Dilaudid and different antacids — Maalox and Protonix. Nothing helped.

Meanwhile, Larry decided to reach out to his own colleagues in the trauma unit at Cooper University Hospital in Camden. In his training, perhaps the most important lesson he’d learned was to ask for help: “If there’s a problem, I will immediately get another physician involved.” By chance, the doctor on call happened to be a fairly new mother. As Larry described Lauren’s symptoms, she interrupted him. “You can stop talking. I know what this is.” She said Lauren had HELLP syndrome, an acronym for the most severe variation of preeclampsia, characterized by hemolysis, or the breakdown of red blood cells; elevated liver enzymes; and low platelet count, a clotting deficiency that can lead to excessive bleeding and hemorrhagic stroke.

Larry’s colleague urged him to stop wasting time, he recalled. Lauren’s very high blood pressure, the vomiting, and the terrible pain radiating from her kidneys and liver were symptoms of rapid deterioration. “Your wife’s in a lot of danger,” the trauma doctor said. (She didn’t respond to ProPublica’s and NPR’s requests for comment.)

EARLIER THIS YEAR, an analysis by the CDC Foundation of maternal mortality data from four states identified more than 20 “critical factors” that contributed to pregnancy-related deaths. Among the ones involving providers: lack of standardized policies, inadequate clinical skills, failure to consult specialists and poor coordination of care. The average maternal death had 3.7 critical factors.

“It’s never just one thing,” said Roberta Gold, a member of the Council on Patient Safety in Women’s Health Care, whose daughter and unborn grandson died from a pregnancy-related blood clot in 2010. “It’s always a cascading combination of things. It’s a slow-motion train wreck.”

The last 16 hours of Lauren’s life were consistent with that grim pattern. Distressed by what the trauma doctor had told him, Larry immediately went to Lauren’s caregivers. But they insisted the tests didn’t show preeclampsia, he said. Not long after, Larry’s colleague called back to check on Lauren’s condition. “I don’t believe those labs,” he recalls her telling him. “They can’t be right. I’m positive of my diagnosis. Do them again.’”

Meanwhile, Lauren’s agony had become almost unendurable. The blood pressure cuff on her arm was adding to her discomfort, so around 10:30 p.m. her nurse decided to remove it — on the theory, Larry said, “We know her blood pressure is high. There’s no point to retaking it.” According to Lauren’s records, her blood pressure went unmonitored for another hour and 44 minutes.

Larry had given up on getting a specialist to come to the hospital so late on a Saturday night, but he persuaded Vaclavik to call in a general surgical resident. Around 11:55 p.m., according to the nurses’ notes, Lauren begged, “Do anything to stop this pain.” Vaclavik prescribed morphine, to little effect.

Just after midnight, her blood pressure about to peak at 197/117, Lauren began complaining of a headache. As Larry studied his wife’s face, he realized something had changed. “She suddenly looks really calm and comfortable, like she’s trying to go to sleep.” She gave Larry a little smile, but only the right side of her mouth moved.

In an instant, Larry’s alarm turned to panic. He ordered Lauren, “Lift your hands for me.” Only her right arm fluttered. He peeled off her blankets and scraped the soles of her feet with his fingernail, testing her so-called Babinski reflex; in an adult whose brain is working normally, the big toe automatically jerks downward. Lauren’s right toe curled as it was supposed to. But her left toe stuck straight out, unmoving. As Larry was examining her, Lauren suddenly seemed to realize what was happening to her. “She looked at me and said, ‘I’m afraid,’ and, ‘I love you.’ And I’m pretty sure in that moment she put the pieces together. That she had a conscious awareness of … that she was not going to make it.”

A CT scan soon confirmed the worst: The escalating blood pressure had triggered bleeding in her brain. So-called hemorrhagic strokes tend to be deadlier than those caused by blood clots. Surgery can sometimes save the patient’s life, but only if it is performed quickly.

Larry was a realist; he knew that even the best-case scenario was devastating. Chances were that Lauren would be paralyzed or partially paralyzed. She’d never be the mother she had dreamed of being. She’d never be a nurse again. But at least there was a chance she would live. When the neurologist arrived, Larry asked, “Is there hope here?” As he recalls it, the neurologist responded, “That’s why I’m here. There’s hope.”

Larry began gathering Lauren’s loved ones — his parents, her brother, Frankie Hedges and her husband Billy, Jackie Ennis. On the phone, he tried to play down the gravity of the situation, but everyone understood. When Larry’s mother arrived, the hospital entrance was locked, and Larry and Vaclavik came to meet her. “The obstetrician just said, ‘She’s going to be all right,’” Linda Bloomstein said. “And Larry was standing behind him, and I saw the tears coming down, and he was shaking his head, ‘No.’”

Around 2 a.m., the neurosurgeon finally confirmed what the trauma doctor had said four hours before: Lauren had HELLP syndrome. Then he delivered more bad news: Her blood platelets — essential to stopping the hemorrhage — were dangerously low. But, according to Larry, the hospital didn’t have sufficient platelets on site, so her surgery would have to be delayed. Larry was dumbfounded. How could a regional medical center that delivered babies and performed all types of surgery not have platelets on hand for an emergency? Vaclavik called the Red Cross and other facilities, pleading with them to send any they had. “In my understanding, there was a complete shortage of platelets in the state of New Jersey,” he said in the deposition. Hours passed before the needed platelets arrived.

The neuro team did another CT scan around 6 a.m. Larry couldn’t bring himself to look at it, “but from what they’ve told me, it was horrifically worse.” While Lauren was in surgery, friends began dropping by, hoping to see her and the baby, not realizing what had happened since her cheerful texts the night before. Around 12:30 p.m., the neurosurgeon emerged and confirmed that brain activity had stopped. Lauren was on life support, with no chance of recovery.

All this time, Hailey had been in the newborn nursery, being tended by Lauren’s stunned colleagues. They brought her down to Lauren’s room and Larry placed her gently into her mother’s arms. After a few minutes, the nurses whisked the baby back up to the third floor to protect her from germs. A respiratory therapist carefully removed the breathing tube from Lauren’s mouth. At 3:08 p.m., surrounded by her loved ones, she died.

Larry Bloomstein leaves the hospital with Hailey after Lauren’s death. Too shattered to return home, he slept with the baby in his parents’ living room for the first month. (Courtesy of Larry Bloomstein)

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Research editor Derek Kravitz and engagement reporter Adriana Gallardo at ProPublica and researcher Bo Erickson at NPR contributed to this story.

Production by Jillian Kumagai and Hannah Birch.

Author photoNina Martin covers gender and sexuality for ProPublica. She has been a reporter and editor specializing in women’s, legal and health issues for more than 30 years.


Author photoRenee Montagne is an NPR special correspondent. She’s reported and hosted for NPR since the mid-1980s.


This article (The Last Person You’d Expect to Die in Childbirth) was originally created and published by ProPublica and is republished here under “Fair Use” (see disclaimer below) with attribution to authors Nina Martin and Renee Montagne and ProPublica.


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