From Crisis to Celebration: How Quick Thinking Saved a Woman From a Rare Complication of Childbirth

UCAN flight nurses Susan Marston and Jannie White with Jason and Stacy Martinez, and flight doctor Alexei Wagner

UCAN flight nurses Susan Marston and Jannie White with Jason and Stacy Martinez, and flight doctor Alexei Wagner

The call, a scary one, came on a Saturday in November 2012. What transpired over the next few hours to a 25-year-old wife and mother was a harrowing tale that could’ve ended poorly had it not been for the quick action and teamwork of some medical and emergency professionals.

A little after noon on Nov. 17, Stacy Martinez had given birth by Caesarean section at Franciscan St. Anthony Health in Crown Point, Ind. She had two healthy girls, identical twins. But immediately after the delivery, something went terribly wrong. Her blood pressure plummeted, she passed out, and then her heart stopped.

As the team at St. Anthony administered CPR, inserted a breathing tube and prepared to shock Martinez’s heart back to life, a colleague called the University of Chicago Medicine to arrange an emergency transfer. In Chicago, a Call Center nurse on the line recognized the urgency and immediately conferenced in the helicopter transfer team. In less than 20 minutes, two flight nurses and a doctor from the University of Chicago Aeromedical Network (UCAN) were on their way. They coordinated with the care team at St Anthony to make certain multiple blood products — packed red cells and fresh frozen plasma — were present at the bedside.

Later, flight doctor Alexei Wagner, MD, would acknowledge that these blood products were “absolutely critical for her survival.”

The UCAN flight crew landed at St. Anthony about 15 minutes after takeoff. Doctors there were able to restart Stacy’s heart, but she was losing blood. The two teams, from UCAN and St Anthony, gave her massive amounts of blood products. Around 2 p.m., even though she was still bleeding, Martinez was stable enough to ride on a helicopter. By 2:20, she was in an intensive care unit at the University of Chicago Medicine.

What doctors found was that Martinez had suffered an amniotic fluid embolism, a rare and often deadly complication during or after childbirth, first described in 1941 by researchers at the University of Chicago. The authors of that article argued that the cause was “amniotic fluid which gained entrance to the maternal circulation.”

Ordinarily, amniotic fluid protects and cushions the fetus before birth, but it can be deadly when there is a breach in the barrier between this fluid and the maternal circulation. In the bloodstream, amniotic fluid has two devastating effects. At first it triggers massive coagulation, sending clots to the lungs and heart. Then, with the clotting mechanism exhausted, it leads to bleeding.

The combination is lethal. “In some cases,” notes one review article, “death is inevitable despite early and appropriate management.” Estimated mortality rates from amniotic fluid embolism range from 25 to 80 percent. Up to 85 percent of those lucky enough to survive have significant brain damage.

“This was a case where seconds, not minutes, counted,” flight nurse Jannie White said.

Martinez’s prospects looked dim. Indeed, her heart did not beat for a little more than three minutes. Before lifting off for the flight back to the University, White gave Stacy’s close friend, who had brought her to St. Anthony, “the talk.” She carefully explained that despite all that they could do, Martinez “might not survive the flight.”

Stacy’s husband, Jason Martinez, heard the same message. He was on his own urgent flight to Chicago from San Antonio, Texas.

“I’m an Army medic,” he told a reporter from the Chicago Tribune, “so when I heard the word embolism, I was a complete wreck.” Having completed tours of duty in Iraq and Afghanistan, he had “seen some ugly stuff in combat,” he said, but this was the “worst thing I’ve ever had to go through.”

Stacy and Jason were both medics when they met in the Army. She didn’t take to him at first. But as they got to know each other, their relationship blossomed and they soon married. This fall they were both stationed in Germany, one of their few opportunities to live in the same country, but she was struggling with the difficult pregnancy and flew back to the United States early to deliver her twins. In mid-November, the Army flew Jason to his home base in Texas. He was preparing to join Stacy in Indiana for the births, but the babies came sooner than anticipated — 37 weeks into the pregnancy.

Once his nerve-wracking flight landed in Chicago, Jason went directly to the University of Chicago Medicine to be with his wife in the intensive care unit. He spent much of the next 24 hours going back and forth between Chicago and Crown Point to check on the twins, who were still at St. Anthony.

The next day, Stacy woke up and was told what had happened.

The following day, Monday, Stacy was out of the ICU, sitting up in bed and chatting with visitors. That afternoon, her twins were discharged from St. Anthony.

18-month-old Lilliana (striped shirt) and 3-year-old Jacob with their new baby sisters Mila and Scarlett

18-month-old Lilliana (striped shirt) and 3-year-old Jacob with their new baby sisters Mila and Scarlett

On Wednesday evening, four days after giving birth to two babies totaling almost 15 pounds and surviving cardiac arrest, Stacy left the hospital. That night she saw her two new children for the first time, reconnected with her two other children, a 3-year-old son and 18-month-old daughter, and had a chance to think about how to spend the next day, which happened to be Thanksgiving.

That decision came naturally in light of the holiday.

Stacy Martinez was pleased to wake up that morning with two beautiful twins, Mila Marie and Scarlett Rose, and was happy to have easy access to pumpkin pie.

Jason Martinez was not only glad to have the worst day of his life behind him, but also excited at the prospect of spending extended time with his wife and four young children. His new familial responsibilities earned him what the military calls a “compassionate reassignment,” a desk job at Fort Sam Houston in San Antonio rather than hazardous duty in a war zone.

And the caregivers at St. Anthony and the University of Chicago Medicine also gave thanks that they made all the right decisions under intense pressure and, thanks to a little good luck, beat such daunting odds.

Watch a video from the Chicago Tribune of Stacy and Jason talking about their experience