Young Mother Receives Lifesaving Care During Son’s Birth

Carolyn Eoff, a labor and delivery nurse, who is among those in the garden, remembers that spring morning in 2008, when Van was born. Miranda had been admitted the night before, and Carolyn took over her care the following morning.

She had been thoroughly briefed by the nurse who worked the previous shift, and Carolyn spent her first hour on-duty getting to know Miranda.

“Miranda was anxious about the delivery, so I wanted her to feel safe and supported,” says Carolyn. “She was such a kind, friendly lady, and this was her first child, so I stayed by her side.”

Miranda had been given an epidural. Carolyn says that when she checked Miranda’s contractions and dilation, she noticed there was some bleeding.

The nurse went to find Miranda’s obstetrician Dane Shipp, M.D., and during an exam, the physician noted that the baby’s heart rate was dropping, and so was Miranda’s blood pressure.

Miranda was given medications through the epidural to help stabilize both her and the baby. Carolyn remembers turning Miranda from side to side and giving her oxygen for her shortness of breath, but says she was not progressing the way she had hoped.

Just that week Carolyn had been recognized as Scripps Encinitas’ Nurse of the Year for her dedication to patient care and nursing excellence. Carolyn says her 23 years of experience helped her remain calm as she explained to Miranda all the steps that were being taken for her and the baby.

“When I called Dr. Shipp, the anesthesiologist and the respiratory therapist back to the room, Miranda looked up at me and asked, ‘Am I going to die?’ I told her to be strong, take control of her thoughts, and stay with me,” recalls Carolyn, with a slight catch in her voice as she remembers the moment — and what happened next.

Because the baby was in distress, Dr. Shipp needed to perform a caesarean section. The operating room in the Leichtag Family Birth Pavilion was already in use, so a team was quickly assembled in the hospital’s main operating rooms (O.R.).

“En route to the O.R. Miranda had lost consciousness and had a seizure,” says Dane Shipp, M.D. “We knew this delivery had to be well orchestrated; there was a room open between cases in the O.R., and there were additional staff available to assist. Everyone had a job for the survival of both the mother and baby.”

When Miranda reached the O.R. she was in cardiac arrest, which caused a temporary lack of blood flow to the baby because of her lack of oxygen.

“While I was at the foot of the table performing the caesarean section, there was staff at the head of the table performing chest compressions on Miranda,” adds Dr. Shipp. “Everything was moving fast. It took only a matter of minutes from when we left labor and delivery to when the baby was delivered in the O.R.”

The baby was immediately taken to the hospital’s neonatal intensive care unit (NICU). Miranda still was not responding well; her blood wasn’t clotting and she continued to rapidly bleed. During her care, she had 45 different medications, including clotting drugs, delivered through IVs to her fragile body, and received 25 pints of blood to keep her alive.

Now, in the intensive care unit (ICU) she was placed in a paralytic coma, through the use of medications, to help her body heal.

Bryce and Miranda’s parents were told the news. What was expected to be the happiest day of their lives was now one of their young family’s toughest.

“I don’t think I slept for days,” says Bryce. “Carolyn took us to a private waiting room where the ICU doctors and nurses provided us with updates. Miranda meant everything to me, and I had to be strong for her and the baby. I prayed — and waited.”

Scott Eisman, M.D., was Miranda’s physician in the ICU.

“We were assessing the situation moment by moment," says Dr. Eisman. "Her body was in shock; she was on a ventilator; she was anemic; and we had to get oxygen to her tissues. It was a coordinated effort between our physicians and nurses, laboratory staff and the respiratory therapy team in the ICU to care for her.”

By her second day in the ICU, Miranda’s medications were gradually lessened to see if she would regain consciousness. Dr. Eisman says no one knew how she would respond, and if, because of the cardiac arrest and lack of oxygen to her body, she would ever function at the same level.

Miranda did wake up. Bryce remembers walking into her room not knowing what to expect, but being hopeful.

“She used sign language to tell me ‘I love you,’ and I knew she was going to be okay.”

Drs. Shipp and Eisman, and the multitude of staff that cared for Miranda, soon had a name for the mysterious condition that affected her. As a healthy, 32-year-old mother with no medical history of disease, and no signs or symptoms during her pregnancy to indicate that she would have such life-threatening complications during her baby’s birth, Dr. Shipp soon diagnosed the cause. Miranda had suffered an amniotic fluid embolism.

An extremely rare obstetric emergency, an amniotic fluid embolism occurs when amniotic fluid enters a mother’s blood stream and triggers an allergic reaction that can cause cardiorespiratory (heart and lung) collapse and excessive bleeding.

There is no known cause of the condition. Most physicians will never encounter a case in their careers; and 80 percent of the women who experience an amniotic fluid embolism do not survive.

“I don’t remember much about the experience,” says Miranda. “I do know that I felt well taken care of while I was at the hospital. Most of my memories are created from my husband’s recollections or accounts from my family, friends and doctors.”

One thing that Miranda will never forget is meeting her son, Van, for the first time. “I was taken in a wheelchair from the ICU to see Van in the NICU. When I got to hold him, I experienced such great love and unbelievable happiness,” she says.

Miranda spent a total of eight days in the hospital — and Van was at Scripps Encinitas a few days longer. Today, she continues to have her progress monitored through neurological and cardiac assessments, and takes medication to shrink the blood clots that later developed in her lungs.

For Miranda, who is a commercial banker, her thoughts have now turned to helping others. Learning more about the mysterious causes of amniotic fluid embolisms, and trying to prevent any other woman from experiencing the same complications during the birth of a child, is providing her with a greater purpose.

“I am so blessed to have had the exceptional care that I received at Scripps Encinitas,” Miranda says passionately, “I have a mission. I don’t want any husband to live without his wife and any child to grow up without a mother.”