When Marisa Christie arrived at the hospital for a planned C-section to deliver her triplets everything seemed to be going smoothly. But soon after giving birth, something unusual happened.
“The doctors had pulled all three (babies) out. Actually, they were resting them on my stomach to do a delayed cord clamping,” Christie, 30, of Tomball, Texas, tells TODAY.com. “My arms flew up and that was when my heart stopped.”
Christie experienced an amniotic fluid embolism (AFE), a rare, but often deadly birth complication. Luckily, doctors immediately realized what was happening and they started stabilizing Christie. Still, she spent a week unconscious. When she woke, she learned some shocking news.
“My husband was like, ‘Hey, so we had the babies. They’re healthy and great,’” Christie recalls. “I was absolutely terrified … How could I not remember having my babies?”
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Unexpected triplets and pregnancy complication
Marisa and Dillon Christie have a 4-year-old son and had been trying to have another baby for about two years. Eventually, Christie spoke with her doctors and started an ovulation trigger shot, which encourages egg maturation to assist pregnancy. She was thrilled when she became pregnant, but she received some unexpected news after her first ultrasound.
“They were like, ‘We’re pretty sure it’s twins. There might be a third one hiding,’” she says. “I was in complete shock.”
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She “cried most of that month” as the couple considered life with four children.
“I was like, ‘There’s no way we could physically do this,’” she says.
Soon, their worry turned to excitement, even though being pregnant with multiples was tough at times. Christie felt exhausted all the time and she felt “very sick” for the first five months. By the end of her pregnancy, it was tiring to stand for too long. Then, they learned that one of the three babies had its own separate twin that never developed, and needed to undergo a procedure while in the womb.
“Our baby C was sharing a sack with a twin but that twin never got a heartbeat,” Christie explains. “That (twin) was still getting blood flow.”
Doctors had to remove the remains because the lessened blood flow “was putting too much stress on baby C’s heart.”
“That was a little scary,” Christie says.
On Aug. 21, at 33 weeks pregnant, Marisa and Dillion Christie arrived at Memorial Hermann Medical Center in Houston for a planned C-section. Her OB-GYN, Dr. Amber Samuel, delivered the three babies successfully. As they rested on Christie, though, Dr. Ricardo Mora, the anesthesiologist, noticed she was seizing.
“She (was) essentially gray,” Mora, an anesthesiologist affiliated with Memorial Hermann the Woodlands Medical Center, tells TODAY.com. “I knew something terrible just occurred.”
About 15 years ago, Mora was the anesthesiologist during a delivery where a mom experienced an amniotic fluid embolism, basically an intense allergic reaction to amniotic fluid after delivery. Immediately, he knew Christie was experiencing that same emergency.
“It’s pretty catastrophic. When it occurs it’s about 80%, 85% fatal,” Mora says. “I asked Dr. Samuel what she had done. She related to me that she had just started pulling the placenta out and that’s usually the time when this occurs — the separation of the placenta and uterus.”
Mora called a code blue because he knew they needed help and medical staff flooded into the room. The situation was dire.
“She wasn’t breathing,” Mora says. “We started CPR because she had no pulse.”
Mora and his colleagues performed CPR while she hemorrhaged. Doctors kept replacing her blood, while Samuel tried to stop the bleeding by closing the uterus. Meanwhile Dr. Stephen Maniscalco, a cardiothoracic and vascular surgeon, prepared to place Christie on ECMO, a machine that works for the heart and lungs to help the body recover. Almost an hour after her heart stopped, ECMO was pumping blood for Christie.
“She essentially lost what we consider her whole blood volume,” Mora says. “We replaced her blood volume. So, for 45 minutes she was clinically dead.”
While Christie was in the intensive care unit after she stabilized on ECMO, she began bleeding again and Samuel brought Christie back to the operating room.
“Anything that can bleed will because you don’t have the normal clotting factors,” Samuel, who's also a maternal fetal medicine physician at Memorial Hermann the Woodlands Medical Center, tells TODAY.com.
Samuel tried medications and devices to encourage the uterus to “clamp down” and stop bleeding. But nothing worked and Christie experienced uncontrolled hemorrhaging from her uterus.
“We tried to resuscitate her and prevent her from having a hysterectomy,” Samuel says. “Cutting into (her) was very very dangerous.”
Still, they eventually needed to remove the uterus. To help her heal, doctors left the incision open so they wouldn’t have to perform subsequent surgeries.
“There are lots of little, tiny blood vessels that in normal circumstances will just clot up and stop bleeding on their own,” Samuel says. But in patients with an amniotic fluid embolism, “if you close that up, what happens inevitably is that (blood vessels) dump a bunch of blood in that space, and it causes it to re-open.”
Amniotic fluid embolisms
Amniotic fluid embolisms are “very rare occurrences.”
“The likelihood of it happening to any individual mom who might be reading this is incredibly low,” Samuel says.
Still, doctors remain uncertain what causes it, though being pregnant with multiples is a risk factor.
“It’s a little bit like getting struck by lightning,” Samuel. “Unfortunately, it happens sometimes to some people. Almost never again to the same people if they survive.”
Despite how uncommon they are, doctors know they’re a potentially fatal medical emergency and many hospitals prepare to address them if they should occur, she adds.
An amniotic fluid embolism occurs when some fetal substance crosses from the baby’s circulation to the mom’s circulation, Samuel says. In the past, doctors once thought that tissue moved into the mother’s lungs causing an embolism or a blockage that impacts normal heart and lung function by blocking circulation.
“More recent studies show that actually what’s happening is some sort of anaphylactoid — which means like an allergic reaction but not — to some protein that moms are exposed to which basically causes a bunch of different problems,” Samuel says.
The body reacts by shutting down blood flow which leaves the lungs and the heart starts failing. Then people begin clotting and bleeding at the same time.
“It’s something called DIC or disseminated intravascular coagulation,” Samuel says. “You immediately make a bunch of blood clots, but you also start bleeding from everywhere.”
This makes treating it challenging for doctors. Clots can cause more blockages making it hard for the organs to work properly and blood loss means patients constantly need to undergo transfusions.
“Every organ system is failing immediately so you need people to take care of every organ system,” Samuel says. “Having access to blood products, having access to ECMO, which is what Marisa went on, those things are vital to surviving.”
‘Stronger and stronger’
For a week, Christie remained unconscious while she was sedated and on ECMO. Mora visited her often, hoping to see signs of improvement.
“You can do the best CPR in the world, but if you don’t get enough blood to the brain, essentially they are alive but with brain damage,” he says. “I needed her to live to raise her kids. So, it was a personal thing for me.”
After a few days, Mora noticed Christie fluttered her eyes and seemed as if she heard people talking around her. These signs gave him hope. After she was weaned off the breathing machine and ECMO, he talked to her, relieved by how she was doing.
“Essentially, she got stronger and stronger,” he says.
Christie felt confused and thought she was experiencing the vivid dreams she had throughout pregnancy when she first woke. After realizing she delivered her triplets, she felt the pain from the open wound, which made her realize that being in the hospital was reality.
“The pain that I felt, I’m like there’s no way this is not real,” she says. “That’s the first very coherent thought I remember having.”
The triplet girls were “completely healthy” but stayed in the neonatal intensive care unit to gain weight and learn how to eat. When Christine first met the babies Charlotte, Kendall and Collins, it felt “very surreal.”
“I remember thinking, ‘I don’t know these babies. This is very strange. They feel like they’re not real. They feel like they’re not mine,’” she says. “They were already over a week old by the time I had met them … It took a little bit to get that connection with them.”
They knew her. Staff placed baby blankets on Christie while she was in the ICU, and they swaddled the babies in them so they knew how their mom smelled. Christie also did skin-to-skin with them while she was unconscious.
“They could tell that I was their mom,” she says. “They respond to me when I talk to them as opposed to other people.”
When Christie returned home, she still had an open wound. Fortunately, she was able to rest at home for a week before the oldest baby, Charlotte, came home — the first of the three.
“I basically lived in a recliner in our living room because I couldn’t really get up and move. I was attached to a wound vac,” she says. “My core is completely obliterated. So, it was really really hard for me to move.”
Kendall and Collins followed Charlotte, who already exhibits big eldest daughter energy and is the “ringleader,” home. Having the babies leave the hospital in staggered order helped Christie adjust to life with a toddler and multiple infants.
“That was a blessing in disguise,” she says.
Nine weeks after her delivery, her wound finally healed. Grappling with a health crisis has been tough.
“I feel very disconnected to whoever (I) was before,” Christie says. “I’ve gotten stronger, but I’ve also changed so much because going through a traumatic experience like that changes the way you view things.”
Christie shared her story to raise awareness of amniotic fluid embolism and offer others hope.
“It’s rare but it does happen,” she says. “There were so many miracles that led up to me living instead of dying and we’re grateful."
This story first appeared on TODAY.com. More from TODAY:
