She Survived the Unthinkable — Annie Sterle on Amniotic Fluid Embolism, Birth Trauma & AFE

I hope people leave with my story.

It's a terrible story.

Nobody wants to walk into the hospital and have what happened to me happen.

I don't think that's true if you're the patient.

I don't think it's true or I think it's true if you're the patient or the provider or nurses.

Nobody wants to see this happen.

So it is a terrible, terrible, terrible story.

And I really hope that once people have heard it and seen it, they feel a lot of hope.

Hello and welcome to the Dr. Kristen Lierley show.

You are not gonna want to miss this one.

I am talking with Annie Sturl.

She is an AFE survivor.

She had

an

amniotic fluid embolism when she went to the hospital and was expecting to have an uncomplicated delivery.

That day turned her life around, turned her families.

life around and her story is truly unbelievable.

AFEs are rare.

They're catastrophic and they move faster than almost anything that we as obstetricians face.

We'll get into what they are.

We'll get into how devastating they are.

We're going to get into Annie's story.

Let's just do it right away.

Annie, welcome to our conversation.

Thank you, Dr. Lierly.

It's such a pleasure to be here.

Thanks for the invitation to come share my story.

You know, there are a couple things I love about this.

First of all, I watched your documentary, which is unbelievable and heartbreaking.

And I've learned as a doctor who deals with situations like this, and I personally haven't managed an AFE, but I've had many colleagues who have, including the doctor who...

managed your AFI.

Yeah, Dr.

Elfstrand.

Dr. Beth Elfstrand is one of the most wonderful people in the world and just a dear friend.

So that's kind of a fun little connection that we share.

Well, and how wonderful is it that she was there?

Because she was not my OB.

I had another wonderful OB for all of my prenatal care.

But I don't know.

And I don't know how much we share in the documentary.

But Dr. Elstrand was finishing up, I think, a 24-hour day.

And she was on her way out the door.

And then she got paid to this event.

So it was just a total coincidence that she was still there.

And what a blessing that she was still there because she knew what

so much about an AFE and she's part of the reason that I'm here and part of the reason my son is here too.

Right.

Well,

the

documentary we should mention is called 24 Days Without You and Beth says, Dr. Elstran says, as she's leaving, people are saying, you have to go back to the operating room right now.

She had no idea what was going on.

People were shouting at her.

She was running.

Everybody was running because you were literally dying and we are going to get to that part of the story.

But let's start at the beginning.

because you have always wanted to be a mom.

Tell

us about

you before all of this happened, Annie.

Yeah, of course.

So I am one of four kids.

And I was the baby of the family, so I didn't have any other babies to take care of when I was growing up.

I was the baby, but, you know, went straight into babysitting as soon as I could.

Had nieces and nephews that I would take care of and doted on.

And I had kind of always envisioned, you know, even in my high school college years that

like end game was I wanted to be a mom like that was it for me I knew I wanted to be a mom I wasn't sure what I wanted my career path to look like um but whatever career path I chose I knew that I wanted to have little kids at home

So that was a very important thing for me as I began dating and exploring potential partners.

I wanted to ensure that whomever I was marrying was also interested in having a family.

And before having kids, before this experience, my dad jokes that I would have had five or six kids.

I wanted the busy, bustling household that comes with all those kids.

Again, as a parent, later down the road, you're like, that would be a lot of kids.

No, like going into it, I wanted it more than anything.

And, you know, there was something that just spoke to me or was really magical for me or maybe it was just imagined because I didn't get that experience, but really around what it would be like to become a mother, right?

And have this big transformative moment.

And so it was what I kind of put up on a pedestal as this just life-changing

experience of growth and change and just love and all of those things that happen really within seconds where you meet a brand new person that you're responsible for bringing into the world and I really viewed it as quite magical.

So yeah, I always wanted to be a mom and I met my now husband Tony in

2015, so 11 years ago, and he kind of had the same vision.

You know, he wanted kids too, and we were compatible in other areas as well, and once we kind of got married, we really quickly were like, nope, let's have kids.

Let's do it.

Yeah, so we got married at the end of 2018, and then I got pregnant in summer of 2019, so about six months later.

And the summer of 2019, we had no idea what was on the horizon.

But

you were pregnant.

I was pregnant.

And

you're a healthy person.

You had a healthy pregnancy.

Really, there were no complications.

You felt good.

Yeah, mostly healthy.

I mean, I wouldn't say I felt good.

And I would say I had a...

terrible relationship with pregnancy, didn't like it.

I was, you know, I didn't have HG, but I was sick in the beginning, like appropriately sick.

So first trimester, you know, you're nauseous, threw up a few times.

So didn't feel great until probably even like 17 weeks.

And then I felt good, but

I unfortunately got gestational diabetes unexpectedly week 28.

So entering into my third trimester, which was another just like, I wasn't feeling good.

I'm finally feeling better.

And now I have all these restrictions around what I'm allowed to eat and all these different things, which is supposed to be like the one perk when you're pregnant, right?

It's like, oh, I'm going to have that extra piece of cake or I'm going to be like on my birthday of a donut, you know, whatever.

It's like the one splurge you get.

So yeah, then I got diagnosed with gestational diabetes, which was a huge surprise because I don't have any risk factors.

And yeah, I would say other than those two things, which are largely normal, you know, not that gestational diabetes is normal, but it's common.

And so, yeah, other than that, it was a totally normal, healthy pregnancy.

I didn't have to get on insulin.

So my diabetes was completely diet controlled or diet managed.

Yeah, and so it was downright dull until, I would say until delivery, but that's not even true.

It was downright dull until about February when we started hearing about a pandemic, or a potential pandemic sweeping the world.

So that was probably February when there was, and January, February, that there started to be rumblings about this respiratory illness.

And

And then in March, things got much more serious.

So you lived through it.

I'm sure all your listeners lived through it.

Well, and we don't

know.

I mean, we didn't know.

We knew this was coming.

We knew it was respiratory.

We saw it happening in Europe.

I think for some reason in the US, we felt like we were going to be able to skip it.

But deep down inside, we knew it was going to be a problem.

I don't think we even

could have imagined what kind of a problem it would be for pregnant people and new moms and young

families.

And it really, looking back now, it's it's a devastating disease for pregnant people.

But we didn't know any of that information when you went to the hospital in March to have your beautiful, joyful, wonderful delivery that you were super excited about.

Yeah.

Yeah.

So we like when I think about March, I so I say like, oh, you know, we didn't have any

concerns going into the hospital but probably at that point like that's not even true because we were super stressed out about COVID.

That's why we went into the hospital early because we were concerned about what COVID meant to a pregnant person and their baby.

You know, could it lead to a stillbirth?

Could it lead to mom getting really sick?

We just didn't know.

We didn't have any of those answers.

So we kind of had done our like lockdown, our lockdown thing before going into the hospital.

I was like 38 weeks pregnant when that kind of like 15 day lockdown started where it's like we were all going to stay in our houses for 15 days and then the pandemic would be over you know so that was like right in that window when everyone is just supposed to be sitting inside and it was fun and people were starting to make sourdough I don't know what they were doing.

I was like bulk ordering like everything I could possibly need you know I'm like I need all the diapers I need all the backup formula in case I can't breastfeed or this or that thinking like the groceries.

stores were going to be wiped.

But it's like

nesting to a new

level.

Panicking on a new level.

Nesting, which is probably appropriate, but with this fear that everything's out of stock, the moment you come back from the hospital and you're not going to be able to go anywhere or whatever.

So we were stressed out in that regard, but not concerned about the delivery at all.

Probably my only sadness there was around the restrictions that were starting to be put in place.

So if you kind of transport yourself back to March 22nd is when we went to the hospital, March 22nd, hospitals that were on the East Coast, they had started having women labor alone.

So partners weren't invited into the hospital anymore.

And

that was a great fear of mine, where I wanted my husband to be able to be there.

This was my first baby.

I didn't want to do it alone.

I already had made peace with the fact that my mom couldn't be there.

My sister, who was a labor and delivery nurse at the time, couldn't be there.

Those types of things, I had grieved a little bit and I was kind of angry about, but I knew I wanted Tony there.

We went into the hospital, yes, expecting a joyful birth, a normal birth, right?

But probably it did already have some weight to it where it was, oh, it's already not going to be the experience I wanted.

But

I'll at least get the birth that I wanted.

I'll still have this baby and I'll still have him laid on my chest and I will get this feeling that I've done it.

you know like a climbed Mount Everest and like this is I've arrived this is what I've been looking forward to my entire life and I made it even if it's alone yeah even if it's alone yeah and just thinking like oh I'm gonna have them and while my family can't come into the hospital we'll FaceTime them you know and a day later we'll bring them home and you know I think at that time again people weren't really letting their family members in their house because of COVID but you know we'll show them to our family through the window whatever um

Yeah, and and then I was totally wrong So everything went haywire.

Yeah.

Yeah, it did not go that way

But it was it was going normally as normally as it could have gone at this time in history until What what do you remember from

that

moment as things started to escalate?

Yeah, so about 12 hours into labor.

It was about 7.30 in the morning.

I started having some trouble.

I started moving around.

I got up, maybe use the restroom, get back into bed.

My labor pains had really picked up.

And maybe about 10 minutes later, I told the nurse that I wasn't feeling well and that I felt like I was going to faint.

And at that point in time,

So some of these memories I have and some of them are kind of manufactured based off what I've been told at this point in time because my respiratory failure had already been gone.

And that means that your body

didn't have enough oxygen

for the baby or for you.

Yes, yes.

So my respiratory levels were dropping.

So they tried to put an oxygen mask on me, reposition me.

I think sometimes, you know, if you get into a different position, that can help people who are laboring, you know, better than I do.

But yeah, so, you know, a bunch of nurses came in to assist.

When I got the fetal monitoring back on me, when I got back into the bed, they saw that my baby's heart rate was dropping.

So fetal decelerations on the monitor.

And between my condition and my baby's condition, the decision was made by my labor and delivery nurse to wheel me stat to the OR.

So basically they unplugged everything and hurried me out of the room with the intention to deliver the baby.

uh and maybe I'll pause for a second and this where we can go into how AFE presents and kind of what that looks like um because I had a very kind of long uh presentation of it so um amniotic fluid embolism I hate the name because it's not right no it's not right no it was our first you know 100 years ago it was our first attempt at explaining what was happening to someone um which would be like a clot of the amniotic fluid that caused their lungs to shut down but

From what we understand right now, the pathophysiology is much more like an anaphylactic type reaction.

So amniotic fluid, phenylmaterial gets into a mother's circulatory system, and her immune system has an inflammatory response to that amniotic fluid that is presenting.

Like a severe allergy?

Like a severe allergy, but not exactly.

They won't call it an allergy per se.

But it's an anaphylactic-like reaction.

So, yes.

That's the other name for it that is actually more accurate

is anaphylactic.

I

wish

we would

change

it.

Maybe

they will

after

this

conversation, but we'll

start talking about it more.

Anaphylactoid syndrome of pregnancy.

I like that one better.

But basically it causes respiratory failure.

So that was my first symptom that presented and then it can cause low blood pressure leading to cardiac arrest.

And then it causes a third symptom, kind of secondary to those two events called DIC or disseminated intravascular coagulopathy.

And for the lay person, like the most important thing to know is it just causes massive hemorrhage.

But

breathing and then a heart problem and then bleeding.

Yeah,

breathing blood pressure and bleeding.

Yes.

And it all

happens very quickly.

And as you're in the moment and you're being wheeled down the hall and they're thinking about your baby because they know that you're having a hard time breathing and the baby is not looking good on the monitor.

They're just thinking we need to do a C-section right away.

Yep.

Yeah.

But you're like a human being experiencing this as it's happening.

Yeah, I wasn't.

fully there.

So I learned after the fact that I technically was, like I was, you know, I had my eyes open at certain points.

I think that I may have moved myself onto the operating table.

There's conflicting reports there.

I've been told different things, but I was present enough to have some sense of what was going on, but I don't remember it now.

So I have a flickering of, it's just like classic.

I don't know, classic me during this distressful situation.

I remember thinking like, no, no, no, no, no, no.

Like, I'm good.

I don't need to see section.

Like, just bring me back.

Like, this happens all the time.

Yeah, this happens all the time.

Like, I'll push through it.

Like, bring me back in.

I remember that fleeting thought, like, I can't believe this happening to me.

I did not anticipate this.

I'm kind of a planner.

I get that.

Things didn't work out the way you planned.

But.

Yeah, so that's really the only thing I remember so I don't I don't have like us Concrete memory of being wheeled into the OR or any of those things which is probably a blessing Yeah, so Yeah, things that happen to me, but I don't have a recollection of so I went out to the OR or I was moved into the OR my husband was left in the

delivery room alone, probably a nurse stayed with him.

And then my beautiful doctor, Dr. Beth Elstran came running down the hallway because she got the emergency call.

And I think that they began my C-section probably at 8.03 and my son, baby Henry, was delivered at 8.04.

So she got an extraordinarily quickly, amazing.

Unfortunately with a condition like this one, it can lead to some compromise of the baby.

So because I had been in respiratory distress for about 15 minutes at that point, my son was born with an Apgar score of zero.

So that means basically he was blue, not breathing, no heart rate, kind of no responsiveness.

So for all intents and purposes, you know, dead.

Thankfully, babies are very resilient.

So they were able to get him back really quickly.

And that's another light in this story.

So they got him back really quickly, and they wheeled him off to the NICU for a cooling treatment, which is something that probably changed our lives for the better again.

We were so lucky with where we were.

The fact that we were in a facility that had these types of

of resources available.

All the staff, all the stuff.

Because we got very lucky.

60% of

people who have AFEs do not survive.

So

the fact that all the people were there who you needed and who Henry needed, it really made a huge difference in your situation.

It was incredible.

It was at 8 a.m.

on a Monday morning at that point in what was the best equipped hospital in the city at that point.

Yeah, so incredible care given to him.

He is lovely and beautiful.

He's six years old now, and you would never know how he entered this world.

So we're very, very, very fortunate for his outcome there.

A little bits and pieces.

Maybe like, maybe we should.

tell him less because he can't really get something.

I saw we were just at a friend's house and um he goes yeah Henry was telling people about his birth story at camp and I was like what did he say and he's like well my son or she was like my son came home and said Henry was telling people that that he's been dead for 18 days.

It's like from the mouth of a six-year-old right you take you get like a little bit of information and then yeah he's he was dead for 18 days and came back to life so yeah so yes.

No, we try to give, you know, we never wanted it to be like this big reveal when he's 10 years old.

And so we wanted it to be much more, you know, mom was really sick when you were born and you were sick too, but you got better really fast, you know, and everyone took really good care of you and everyone took good care of mom.

And, and now, you know, we're here and we're healthy and we're fine and we're great.

And

it's important

that this isn't a secret.

It's important

that

you talk about this.

I think it's been really therapeutic that you've been able to talk about it, because otherwise,

if

you bury it, it just grows

and festered.

Yes, 100%.

I think that's part of the trauma thing, too.

I think when people are highly traumatized, some people can have this reaction where they don't want to talk about it because it's too painful.

Right?

And they don't want to put themselves back in that position.

And I think that's where the value of something like therapy and, you know, community support, like I believe personally sharing your story is so therapeutic.

And finding community that can uphold you through all these struggles is so important in your healing.

And it's a large part of why I'm here and able to do this right now because I had people to listen to me and who could validate that what I went through was, was terrible.

And, you know, that I didn't have to be okay during that point in time.

And it was by people telling me that I didn't have to be okay, that I became okay.

You know, like kind of, you can't just skip it.

You got to go through it and it sucks.

It was absolute garbage.

It was the worst year of my life.

I wouldn't wish it on anyone.

And that's how you get to the other side and create something beautiful of it.

And

Annie, the crazy thing is what we're talking about, your actual birth event was terrible and horrific, but it was really what followed that and not just what immediately followed, but what followed in the long term for both you and Tony and Henry and all of the people in your circle.

And I want to get to that, but let's get through so that you have a baby.

I'm

not even like 10% through a birth story.

There's so

much

more.

He's

okay.

He's being cooled.

You are bleeding, but everything seems to be under control, but you're not okay.

It's very touching though.

Yeah, so I so Henry was delivered and at that point in time I hadn't gone into cardiac arrest yet So I was just in severe respiratory failure Henry was delivered at 804 and at 811 I went into cardiac arrest.

So at that point in time my heart stopped And I went into what is called a refractory cardiac arrest meaning they couldn't get my heart to beat on its own even with CPR So I was in that state and kind of wavered between a couple different types of cardiac arrests

To be clear, I'm not a doctor or medical person.

I always tell this story with a little bit like an asterisk.

I'm just talking about what was in my medical notes, but what I read.

So I went to cardiac arrest at 8.11.

I continued to arrest for a while.

They got me back.

I went back into another type of cardiac arrest at 8.31.

That type of cardiac arrest, they could apply paddles or shocks.

So I received a couple of stacked shocks.

And then ultimately they had to put something called the Lucas device on my chest, and that is a device that performs CPR in lieu of having nurses or providers do that work.

So I think it's used when you're having a hard time getting a patient resuscitated.

And at that time, again...

Dr. Elstra, lifesaver, she called for the ECMO team.

So ECMO is an advanced form of life support and it is used to perform the work of the heart and lungs at the same time.

So you can just do lungs or you can do heart and lungs.

ECMO is something that takes your blood outside of your body, oxygenates it in a machine and then puts it back into your body.

So it's, yeah, just a,

Absolutely brilliant invention.

But an

invention that Dr. Elfstrand has never had to use before.

She

never seen it.

I can tell you, I've seen ECMO for cancer patients and training,

but I've

never used ECMO for my own patients.

So this

is

incredibly rare, but it's definitely used for lots of folks who have

cardio respiratory failure like you were experiencing.

So just

to

emphasize like this was a really big deal and it was the quick thinking and the resources that were able

to save you.

Yes, the ability.

Yes, again, my care was top the line.

Such that like I had cardiologists in my delivering OR in a birth center part of the hospital within 10 minutes of my arrest.

And the ECMO team had me up on ECMO by 901.

I was leading the OR on ECMO.

So that's 50 minutes that I was down.

And so it took 50 minutes for them to gather all their supplies, run through the hospital, actually get me hooked up and stable and transport me to the cardiac ICU.

All while also managing a massive hemorrhage that was going on simultaneously.

So while they were getting me hooked up on ECMO, I was also going through that condition called DIC.

They were performing a mass transfusion.

So I received about 25 units of blood and blood products at the same time.

So it was just an incredible orchestration of people and resources and providers, nurses, all the things running at once just seamlessly.

So we are incredibly lucky to have gotten the care that we did and to have been where we were.

So.

I survived.

Yeah.

I wish that was like the end of it.

Unfortunately, my family still had to deal with a lot.

So while my body systems were coming back online, you know, I was in the cardiac ICU, they were able to get me off of ECMO in about two days time, which is a relatively short time to be on ECMO.

And it's a huge milestone to get taken off ECMO because, you know, you just never know how someone's

house of one's body or heart is going to do after that.

But I, at that point in time, did not wake up the way that I should have.

So you would expect after that type of event that a patient would slowly come to.

And I was not showing responsiveness in the way that they were expecting.

So they decided to perform an MRI after a few more days.

And that MRI showed that I had suffered numerous bilateral strokes and bleeds throughout my brain.

And that provided a very uncertain prognosis.

So I might wake up and recover full function.

I might wake up and have limited function, or I might never wake up.

And so my family kind of had to exist in this.

kind of no man's land for a while trying to figure out what to do with me.

And Henry is in the picture as

Tony trying to figure out how to

be a dad on his own with you in a coma

on the

edge.

Yes.

Yeah.

Poor Tony.

Yeah.

So he took Henry home about six days later.

So where Henry was born March 23rd.

Henry came home I think March 29th it was.

But yeah, so he was a single dad for all intents and purposes, brought his newborn baby home, a six-day-old baby who had been in the NICU home, and then also had to go back to the hospital with a wife who may or may not survive, still in a ventilator in a coma during the first three weeks of the COVID pandemic.

So things were not fun at home.

was a wonderful advocate for both of us and kind of through that process.

So he was very clear that he did not want to explore end of life options at that point in time.

He wanted to give me more time.

You know, I think once you get to a certain amount of time in the hospital, it's pretty common to move patients to a care facility, a long-term care facility, and begin conversations with

I'm blanking on the word palliative care.

So while he had the conversations with palliative care kind of in hand in hand with my extended family, both he and my dad who had been a physician at the hospital were very clearly, we don't want to move her, we don't want to move her, keep her here for a little while longer.

So I was moved up to the neuro ICU and I was in the neuro ICU for a few days, maybe a week.

Um, so now we're at like day 16 of my coma.

Um, and on day 17, I started showing signs of responsiveness and awakening.

Um, so 17 days after Henry was born, um, yeah, I, I decided to come back.

So,

um,

what happened with your family?

Yeah, well, I wish it was again, this kind of jubilant like everyone is there and yay, she's back by COVID.

Well, this is not a soap opera.

This is

real

life.

Yeah, everyone was on FaceTime.

So my dad had visiting privileges to come in because he had been a physician.

But the second I woke up because of the COVID, visiting.

protocols, he was asked to leave once I was out of that critical condition.

So my dad didn't return to the hospital while I was awake.

And then Tony, he, again, is such a good advocate, he wasn't going to let me sit in that room alone.

So he kind of fought tooth and nail to come into the hospital and he was granted about an hour or two a day to come in and be with me.

You know, I remember I remember that first day of my dad kind of leaving and then Tony coming in Very spotty at that point in time.

I didn't have full You know, I think I had an episode that day that looked a little bit like a seizure, but I remember experiencing that you know on the inside for the first time and So it was slow.

I also because I had had those strokes was

was partially paralyzed on the right side of my body.

So I couldn't raise my arms.

I couldn't ride or hold a pen.

I also had a trach in, so I couldn't speak.

So I was very handicapped in that regard.

So not just did I have delayed cognitive processing, but I also was incapacitated because I couldn't communicate.

So I was kind of left to my own devices to understand what had transpired.

my brain had unfortunately built a big story for me about why I was where I was.

You know, I believed this is not in the documentary because it would have been too complicated to include the whole thing in a very seamless manner, but I believed I was in Florida actually.

So it's a longer story in terms of why I would be in Florida, but I believed I was in Florida.

I believed that my baby Henry had died.

I believe that Tony amidst that kind of, you know,

time had adopted another baby.

That baby was back in Minnesota, sitting in my family room with my family on FaceTime.

And yeah, and I had been told that I had had a complication of childbirth, but I assumed that was complication when delivering a stillbirth or a stillborn baby.

So that never got fully cleared up in my head, or I should say it took about five days for that to be cleared up in my head.

Because then one of the other problems with

the time is kind of the continuity of care where my family wasn't around to tell me the whole story.

My OB and kind of obstetric team wasn't around to tell me the whole story because no one was allowed to go between units and my neuro team was great but they were neurologists or they were

you know, neuro nurses, right?

They're not used to having a postpartum patient and talking about AFE.

You know, I don't think even postpartum nurses are used to talking about AFE.

So it was just a very unique circumstance where there are a lot of gaps in communication, not because anyone was at fault, but just because of the time and the fact that like families, I think providers at that point in time weren't used to having to bear that load of, you know, the

what the family was probably doing and communicating with the patient before COVID restrictions were in place.

Right.

And to be clear, your mind had built this scenario while

you

were in the coma that you had delivered a stillborn baby in Florida for some reason, and that Tony had then gone out and adopted a baby who was

taking the place of this, this joyful event that you thought you were going to be experiencing.

So you wake up from this coma and you are not able to speak because you have a trache.

You're very weak and you're confused because what you're seeing is not what your reality is, what, what you believe to be true.

Yep.

Well, and or more so, it was exactly what I believed.

Like I woke up in a hospital sick and like that.

that must have happened because I delivered this stillborn baby.

And the hospital, you know, I remember looking out my window, I don't know where the palm trees are, but there must be on the other side of the hospital.

It just like, but my brain was slow and like really bad at cognitive processing.

So I didn't just didn't question things very much, right?

So yeah, I think there was a lot of hand holding that needed to be done.

And yeah, it was just a

It was a wild time.

So about five days in, Tony and I finally, I had had like a speaking valve in place.

I had been working with a speech therapist so I could talk a little more and we were conversing about normal things and I think I asked him.

what city we were in.

Because I was more so like, I think we must be really far north because I don't see the beach, or not that there is a beach in Northern Florida, but like it just doesn't look very warm out there.

It was probably snowing.

It was March.

Yeah, yes.

And he was like, we're in Minneapolis.

But even then I was like, oh, okay, the plane came all the way back to Minneapolis, you know, it didn't, it didn't make a stop landing in Florida.

And you're putting the pieces together and he doesn't

realize that you've got this whole scenario in your head.

Uh huh.

Yeah.

So, um, and yeah, so we have this kind of comedy of errors where I keep asking him these questions and eventually he's like, this doesn't make any sense.

Like she has no idea what's going on.

And so he kind of brings me back to like day zero, right?

Like we came into the hospital, Abbott Northwestern or in Minneapolis and you have

an induction, and you have this baby and your baby's okay, and you have this, you know, complication.

I don't think he gave me all the nitty-gritty details, but yeah, and that's when I was like, okay, yeah, not the experience that I had told myself that was

was much clearer on what had happened.

Right.

Because you were angry because this baby that Tony had adopted in your mind, he named Henry.

And Henry was the name of the baby that you had been

carrying.

Well, I was sad because he had, yeah, I asked what the baby's name was, the baby on FaceTime.

And he told me it was Henry.

And like, I didn't say anything because it was too late at that point, you know, but I was so sad that he was trying to replace.

The baby that I had been carrying, you know That it wasn't just like a one-for-one slot this baby should have his own name and our baby, you know should be Henry Yeah, so it was um again we can laugh about it now.

It wasn't like a happy time I'm sure with time with healing with Community whatever and now it's now it's kind of funny, but um, yeah,

so

So you

were

clear at this point you were getting better you were getting stronger it was clear

you were

going to survive.

But this is where the real battle begins.

Yes, yeah.

Yeah, so I went after the narrow ICU I went to rehab for a time.

Thankfully was only in rehab for for about a week or less than a week, which was much shorter than the initial kind of prognosis.

They thought I would have to be there for a month, but they were taking away my visitors.

And so I was like, nope, I'm leaving.

I gotta get out of here.

And I also, you know, Tony had brought in Henry for the first time, which was great, but it was.

it was brief and trauma-y and Tony at this point had really severe PTSD.

He had watched his wife kind of deteriorate in front of his eyes during what should be a routine childbirth.

And then his son was in the NICU, he wasn't able to hold his son for three days.

He still had this kind of looming, what does this mean for Henry?

Like what types of developmental concerns do we have to worry about?

I was still

I was in a rehab facility, but I wasn't fully healed by any means.

You know, he was concerned that he was going to have to care for what might be a disabled wife for the long term, right?

Like he's got a lot on his plate.

And so I think asking him to bring Henry into the hospital.

Again, amidst this pandemic that had been running for about five weeks at this point was a lot for him.

And so he brought Henry in, but then he left really quickly.

So he left within about five minutes.

So it just wasn't, yeah.

And I couldn't, to be fair, like I couldn't really hold them super well.

And I was uncomfortable because I knew that the

facility didn't want a baby there.

They were very concerned about COVID.

So it just wasn't, it wasn't a warm, happy kind of replacement for what we had lost.

And so, yeah, and so he left.

And then I was in rehab for probably another three days before I left.

And kind of at that point in time, I'll say like, I wasn't sad.

You know, I think I hadn't really

considered the magnitude of what it happened and what it meant for my kind of lifelong dreams and you know what I envisioned for myself right around like I had dreamed of becoming a mom my entire life you know I talked about this in the documentary but like I would watch TLC is a baby story and like all those babies being born and I was like.

I'm going to get that.

I'm going to get that.

I'm going to get that one day.

And you know, that's going to be my experience someday.

And like it was gone and the blink of an eye, like you don't get to become a mother again, even if you have another child, like you're

already a mother.

Um, that moment, those golden moments.

And then when you

finally

get to meet Henry, it's, it's five minutes of discomfort and you can't hold him because you're too weak.

Yes.

And all of the other external factors that you can't.

Yeah.

Yeah.

Yeah, so I, you know, but that didn't hit me at the time, like, because I was just, you know, very cool and like the medical staff was incredible and it was so impactful and so meaningful to see how much they cared about my recovery and just everyone who works in the medical profession just amazes me to this day.

but in a lot of ways their reaction to my recovery was what buoyed me up and like oh no this is awesome you know this is really really great like i'm a miracle and life is going to be wonderful and um you know this isn't that bad and um yeah so i went home just thinking like life is going to be wonderful from here on out like everything sorted out um

And then I went home and kind of that joy and that cheerleading of the hospital team, which was so beautiful and lovely, wasn't there.

And instead, I was in my house, still recovering, like needing 16 hours of sleep.

My baby was a baby, like still a...

a newborn baby who had his own demands you know who I couldn't explain like no baby I'm recovering from a stroke so you you're okay you know like that doesn't happen when you have a newborn so uh you know my husband was again split between caring for both of us um and

It was kind of, and again, Tony had this like severe anxiety, severe PTSD coming out of this event.

So he wasn't who I had married either, you know, like he had changed.

And so it was kind of in the chaos or turmoil of that new home environment without much support because of COVID.

Tony, as a response, didn't want people in our house.

He was concerned that we were going to get COVID, and it was going to kill me and Henry.

And so we had a COVID response, like a high alert COVID response where nobody was allowed in.

Right.

And you were fragile.

I mean, I don't know that that was

inappropriate, because you

were

very fragile still, even if you didn't feel that way.

Yes, yeah.

And so I think it became this constant battle between like what do I need to do for my own mental health and well-being and what needs to happen for my physical well-being.

And so basically getting back into that home environment is when I started to consider kind of the magnitude of what had happened.

And I got really angry that this wound up being our story, right?

That I had lost that moment.

that I was a 29 year old stroke survivor, that I was now in a marriage that I didn't recognize because he was going through his own trauma, that it was, the pandemic was ongoing.

So we couldn't even get the support that we needed, not because people weren't offering, but because it was getting refused because of trauma.

And so that anger kind of also then morphed into sadness and then it turned into this really intense grief.

And really quickly, then that grief kind of caused me to no longer be able to access the gratitude I was feeling in the hospital.

You know, I felt so grateful and so happy and so just like, this is an incredible story and my medical team is amazing and all these things.

And yeah, so I became kind of a shell of myself.

And on top of that, because I was so sick and because I was depressed,

I wasn't showing up as a mother the way I had always envisioned.

You know, that's a

bond with Henry.

Right.

Yeah.

And so I, yeah, for months and months, really, um, you know, I was unwell for, I would say I was pretty unwell for about six months.

And even then at six months, I would say my, I, I, I joke because I never wanted to call it postpartum depression because I'm like, no, no, I had an AFB like.

Anyone who has an AV is gonna wind up like this and it's not depression but like chemically it probably was you know Like I needed the same types of resources that that someone with postpartum depression has so at that point in time like my postpartum depression was raging so once I was physically well and physically able to take care of Henry I I wasn't myself, you know

I was feeling so isolated, so lonely.

I didn't have access to a community and even the community that I had access to, I was feeling really resentful of because I looked at every single other parent I knew and all I could do was picture the moment that they met their baby.

Like that was it.

Like I remember meeting with a therapist.

I shopped around for a lot of therapists and my therapist had a seven-month-old baby and the second I found that out we made it through a session and then I was like I can't do it.

Like I, you know, I had to break up with that therapist because all I could think about was seven months ago, she was holding her baby for the first time.

And, you know, you manufacture a lot of things like one in three women or one in three birthing people has a traumatic birth.

But you don't you don't create that in your mind when you're depressed and lonely, you know, you think about everyone who has this glorious birth experience that they wanted.

And so I then isolated myself further.

And yeah, so it was it was a really tough time.

dealing with kind of the aftermath of trauma and what it looks like for a marriage, what it looks like for a parent who's trying to raise a new baby, what it does to friendships and family members even.

And yeah, and so it was not a good year postpartum, I would say.

Yeah, it's a terrible year, physically, mentally, emotionally, and the pandemic.

Yes.

But you got through that year.

How what was there one thing that was a game changer?

Was it a slow process?

Was it bringing your resources together?

How did you make it?

Yeah, so a lot of therapy So I eventually found a therapist that I clicked with And then couples therapy so

I got Tony to go to couples therapy, which was very helpful.

And my couples therapist suggested that Tony get his own therapist, which he had been resistant to, as most men are, I think.

And, you know, at the couples therapist push, he got his own therapist.

So we had, you know, like the whole house, you know, so my therapist, Tony's therapist, couples therapist going.

And it helped.

It definitely helped.

It definitely helped with our marriage.

It made the.

like a huge difference for Tony like he completely dealt with his PTSD and kind of anxiety coming out of this event so he's kind of back to who he was when I married him which is lovely um and then for me I definitely needed a little bit more help um so probably about a year it was a year because it was Henry's first birthday um

It was then that I, and I had seen it happening during the winter, but Henry was showing such a distinct preference for Tony.

You know, like Tony was his, his person, right?

Tony had done all the nights.

Tony had done most of the feedings.

Tony had done everything.

Like he was, he was the primary parent to a T and babies tend to bond with the people who are taking care of them.

And so,

I started to see that at his first birthday, like he didn't want to be held by me, you know, like he didn't want to be held by his mom.

And your

whole entire young life, all you wanted was to have that relationship, I can't imagine how devastating that must have

been.

Yeah, yeah.

And he just, you know, I was not his person of preference.

And because COVID was still underway, we had this parting on the front lawn.

And I remember one of

Tony's cousins had a baby a week before Henry was born.

And so there was this other one year old with her mom.

And she wouldn't leave her mom's side, you know, she was in her mom's arms the entire time.

And then Henry just wanted to be held by Tony.

And I couldn't like, I'm really holding the presence while he was like

here, here's your present.

You can unwrap this one because Tony wouldn't get out of Tony or Henry wouldn't get out of Tony's arms and just broke my heart, you know, and, and then I realized I was like, okay, this is becoming more than me problem.

Like I'm not taking care of them and why am I not taking care of them?

Because I'm not physically unwell anymore.

And so at that point in time, I explored medication options.

And so I got on an SSRI and it completely changed.

the tide.

So I say this because, well, one, it's not because there's anything wrong with being on SSRI your entire life long.

I think that's a beautiful thing if it gives you the life that you need and deserve.

For me, I was really resistant because

I didn't think I'd ever be able to get off of something once I started and I didn't know what the side effects would look like and I was just fearful that like once you do something you're committed and that's going to be the rest of your life and so I say this with that because that was my own hold up where it's like I got on it and I didn't have to stay on it that long and it gave me the tools that I needed to be able to then go be a good mom and to show up for Henry the way I wanted to be and then a year later

I could get off of it.

Like I had been through this darkness.

You're gotten through this darkness.

And so it's about

getting through that day one day at a time and then

the next

day you make a decision about what the best thing is for you.

I'm so glad you said that, Annie, because I've worked with so many women who just don't want to explore the medication option because they feel like they can just soldier through.

But you realize at some point that your soldiering through is not, it's not functional for you and it's not functional for your family.

100% courageous of you.

Yeah,

yeah, of course.

And again, I just love to say it like it's not a permanent decision.

It doesn't have to be a permanent decision.

Like sometimes you just need it to get through something like to get to the other side of something.

So I always encourage people like it you can try it out get off of it.

try, you know, try a different one, get off of it, you know, and maybe that's not medically sound advice.

You have to find the thing that works for you.

Whether

it's medication or therapy or a different social

media,

whatever it is, you've got to find the special sauce for you.

And part of your special sauce was support.

You found support online.

I did.

Facebook?

Yes, online.

Yes.

So the AFE foundation

Well, okay, so first I found support through the birth trauma mama.

So I sought out another AFE survivor who I found on Instagram.

So she had created a birth trauma space.

You know, I think at that time she had about 400 followers.

So it wasn't too scary to reach out, kind of say, I had an AFE too.

A lot of similarities with a baby boy about nine months beforehand.

So she and I became fast friends.

We messaged all day long.

We've since done a bunch of trips together.

But she also happened to be a therapist, too.

So she was really helpful in kind of helping push me into therapy when I was getting very resistant on, like, I've tried out therapists.

I tried out therapists.

I don't want to keep trying new ones, but helped push me into that.

And then, yes, just like the support of community with someone who has been through what you've been through and kind of understands.

what that looks like, you know, and is also like two steps ahead of you because her baby was born nine months before mine was.

So I think the support of community and like finding people to understand what you're going through is so, so, so important, no matter the complication or no matter the trauma you might be dealing with, because that is like when I say therapy, medication, but then yeah, to your point, community too.

And that can look different for everyone.

But yes, yes.

That was a huge, huge, huge help in my healing.

Yeah, I think it does look different for everyone, which is why you need lots of options and

lots of

support so you can figure out what the best thing is for you.

Yeah, yeah, yeah.

And then the AFE Foundation, which I briefly mentioned.

So the AFE Foundation has been just instrumental as well.

So they have a community of a thousand plus people who have gone through an AFE.

They had support groups monthly during that first year.

So I met probably 10

10 women on a monthly basis just to share about what we were going through and kind of find similarities in our struggles and get that validation that you need.

I

have to say watching the documentary 24 days without you, one of the things as a physician that really struck me

was I looked at it through a physician's eyes and I was watching your dad's response and you mentioned your dad had been a physician at the hospital and he

had lots of

colleagues who were there who responded when you were critically ill.

But then your dad also got to see you not as a patient but as his daughter who was critically ill and then as you recovered in the long term and just the love and passion when he teared up that

that I deposit, that's...

Yeah, everyone lost that part.

People watch this documentary and people are always like,

Tony and your dad

because you think about this is a documentary about birth and how birth is not always joyful and it can be deadly and it's challenging and people need to know that these things are out there but to see how

it affects

the men in your life it affects all

of

you as a community

everyone yeah yeah yes it affects everyone entire community like when yeah when someone

has a baby and, you know, things don't go exactly according to plan.

It impacts the entire family structure.

Um, so it's, uh, yeah, I was glad that we were able to showcase a little bit more of the, like, total picture around what this looks like for extended family, what this looks like for a partner, what this looks like for providers too.

Um, you know, showcasing a little bit like what.

what these experiences look like when you're on the other side of the table or the bedside, you know, and how that impacts you and the work that you do and what you all have to carry as you move through your days, right?

I

remember Beth telling me your story long before

we were

connected and long before I put everything together that this was the story she was talking about.

Yeah.

Yeah.

And that was like a, we were out for drinks, some professional thing.

And she just mentioned it because it's something that she carries with her as well.

And I know that you are really committed to ensuring that people in the medical system, people who care for others understand your story.

and what you've been through and learn from it.

What do you want providers or people who might be listening today to walk away from or to walk away with from your story?

So I would say first and foremost, if you are in the obstetric space, familiarize yourself with AFE, please.

You know, I know it's exceedingly rare, but the first time you experience one, you won't think it's all that rare and you will wish you have.

prepared for it and simulated for it, you know, it's the rare ones that require that practice because you don't see it routinely.

Um, and if my, you know, the reason that

that Beth Austrian was able to respond the way she did.

It was because she was on the Minnesota Mortality Review Committee for 20 years and had read about AFEs.

So even though she hadn't seen one firsthand, she had read a lot about them.

You know, she was an OB who had practiced for 30 years, I think at that point.

So familiarizing yourself with this condition is so, so, so critical because we don't know who AFE is going to happen to.

It was just a run-of-the-mill routine.

I didn't have any risk factors going into my birth.

So you just don't know who shifts, which hospital, when it's going to happen or to whom.

And it's that rapid response that's going to save a life.

Right.

And to be clear, when this happens, it's not like you arrive in the operating room with a sign on you that says she's having an AFE.

You're in respiratory distress.

There are other things that are happening and we're trying

to

diagnose this in real time and provide that supportive care and get the baby out and do all of those things as quickly as possible.

So yes, you are entirely right.

We have to be ready.

Whether we are in an urban center like Minneapolis or a rural center like Northern Minnesota or rural wherever, we're obstetrical.

are closing down like crazy because our healthcare system can't support it, we all have to be ready all the time.

Yes, yeah, especially if your hospital doesn't have the resources that mine did, where it's like, how do you develop a plan for a patient?

You know, what's your transport plan?

What does that look like?

How many units of blood do you have on hand if something like this happens?

And if you don't have enough, what is the plan?

You know, just building out those, those, yeah, I guess just plans to

to prepare for a catastrophic event, I think is hugely important, especially as hospitals lose resources, right?

So where can we send a patient if we need to send them somewhere?

And then the other, I'd say probably two more things in terms of takeaways, but the other one is really around kind of patient language.

And I know how, not from hands on experience, but I know of, you know, the difficulties that exist.

when it comes to providing trauma-informed care in emergency settings.

Right now, in the moment, you are trying to save a life.

That is the most important thing.

After that, I think taking the time to explain what has happened to a patient, offering debriefs at an appropriate level for the patient to understand what has happened, saying things like, I'm so sorry this happened to you.

We're expecting this to happen and this happened instead.

you know, checking in, you know, how can I best support you, you know, providing resources to families, you know, like I wish my husband had been sent home with resources on PTSD, you know, something that said 90% of dads who experience an event like this leave the hospital with PTSD.

Here are symptoms to look out for.

Here are resources for what to do if you experience in them.

So how do you kind of support the whole person and the whole family in a really meaningful way after the emergency?

I think that would be hugely, hugely impactful, so that we're sending families home whole, you know, not left to kind of deal with all of these tragedies after the fact alone behind closed doors where they're suffering, where, honestly, like, most maternal mortalities are happening, right?

It's after the discharge, you know, homicide, suicide, and...

uh, drug overdose, right?

So there's three things that are completely preventable.

Um, and we just need to figure out how to support families in a really meaningful way once they leave the hospital.

Um, not that that's a huge lift for people who are in the hospital to do, but, um, becoming a part of that solution.

Yeah.

And then to your

point, most moms, most new moms die in the postpartum period and most of those deaths are preventable.

So the support is known.

It's a known need that we

can

do better.

Yes, yes,

hugely passionate about that and I'd say lastly like where I hope people leave with my story is Like it's a terrible story.

Nobody wants to walk into the hospital and have what happened to me happen I don't think that's true if you're the patient.

I don't think it's true or I think it's true if you're the patient or the or the provider or You know nurses nobody wants to see this happen.

So it is a terrible terrible terrible story and I really hope

that once people have heard it and seen it, they feel a lot of hope.

And I think that there's a lot of hope no matter who you are.

So whether you are, you know, new and in training and you want to go be a labor and delivery nurse or you want to go be an obstetrician, like hope that you can run that simulation and you can read that extra.

case reporter or study and learn a little bit more and that that's going to make a difference in your practice and how you show up for your patients.

You know hope for people who have a very ill patient that even in the most dire of circumstances they can get to the other side of it and you know no one thought when I was in a coma that I would be here talking to you six years later you know like hope that hope that there's yeah there is

a chance for a good ending.

And then hope too, just for people who have been through a traumatic event, you know, and they're suffering, whether it's suffering in their marriage or, you know, suffering themselves internally that with the right supports, you know, with therapy, with community, with some medication, if you need it, there's so much joy waiting for you on the other side.

And so I hope that that is

is what people are left with when they watch our film.

Yeah, just a lot of hope.

A lot of hope.

It's been

six years, Annie.

It's been six

years.

Yeah.

You somehow had another baby.

I did, yes.

Yeah.

You've got this incredible family.

When you look back on your experience, how

I don't even know how to ask this question because you are so bright and clearly you have a desire to tell this important story that we all need to hear, but it's still not easy.

What do you say when you're talking with Tony and with your family and with Henry and you're trying to figure out where you go from here?

What do you tell them?

Great question.

I frequently turn to Tony because we will just be driving in our car and, you know, we'll hear Henry and we have a daughter.

She's too Helena.

And, you know, they love each other so much.

It is the most beautiful sibling relationship we could have asked for.

But I won't turn to Tony and I'll be like, like, could you have imagined

This is where we would be six years ago.

Like six years ago, I think I said it last night or two nights ago, even.

I'd probably say it once or twice a week.

Can you imagine we got here?

It's not the end, but it feels like we are so lucky.

We had this terrible thing happen and we are so lucky that we're here now.

And I think that, you know, for us, it has been about carrying it forward in a way that honors what we went through, yes, but how do we make it better for the next person, right?

Because a lot of suffering happened, you know, we're here now and we're wonderful and great and happy.

And now that we're here, how can we use, you know, all of the help that we got in order to get here to make it better?

Whether that's around spreading our message around amniotic fluid embolism.

you know, my biggest, like, when people talk about AFE, like, people love to say, yeah, but it's unpreventable.

It's unpreventable.

There's nothing you can do about it.

And I'm like, so was spina bifida.

Like, so was spina bifida until we understood what caused it.

And now it is preventable.

So maybe we just don't dedicate the time and energy and resources into studying this condition because it's unknown.

And, you know, because it's rare, people haven't really cared about it much.

And

We don't have the awareness to get the resources that we need, or the specimens that we need during an event in order to get the right data to study it.

So maybe 50 years from now, it could be preventable and we just don't know it yet.

We're still calling it nembolism.

We think we have work to do.

We are still calling it nembolism.

Yeah.

I was so glad to see that PCOS got renamed.

I don't know.

I don't know what it got renamed to.

I was like, oh, a variant.

What did PCOS get renamed to?

Do you remember?

Metabolic.

Metabolic?

Yes.

Yeah, ovarian syndrome.

But something that's much more representative of what's happening, right?

That's one step forward, right?

But this

also speaks to how women's health research has really been suppressed for pretty

much ever.

There was a spike and now with the current administration, it is again being suppressed.

So there is an opportunity for us as patients who are advocates, as physicians who are advocates, as policymakers to forge ahead with women's health research because not only does it affect that woman, we tend to think maternal mortality, it's a rare event, one in 40,000.

and pregnancies, but it affects communities of people.

Higher communities.

Yes, it is so

much bigger than what our perspective is.

Yes, absolutely.

And I think the moment you've been touched by it to your point, like as rare as it is, once we came forward with our story, Tony knew three people in his inner circle who had an experience with an AFE.

And it just doesn't feel all that rare anymore.

You know, when you think about the number of people you interact with and the

ramifications that it has on a community.

No parent should go into childbirth and be lost, and no baby should be lost, you know?

So I think that during what is, should be a very, very joyous moment around bringing, you know, a new baby home, like, it's a big calling to try to address that.

um, you know, on the preventable front, absolutely.

Like that is low hanging fruit.

We have got to deal with all the preventable deaths that are happening.

And then how do we dedicate the time and resources to better research women's health?

You know, uh, to your point, like we are so under represented in the research that's happening or has happened in the past.

And how do we course correct?

Because, you know, mothers are dying unnecessarily.

Um,

And so, yeah, so that's been my kind of calling coming out of this.

You know, as we move forward, you know, for our family, we just want our kids to grow up with a happy, you know, I never ever want my son to bear the weight of his birth and what that looked like for, for his parents, you know, and I hope that he never feels that because he is

beautiful, beautiful gift.

And we are so glad he's here and we're so glad his sister is here.

And we couldn't feel luckier to have this ending asterisk.

I know life is long.

But for a moment in time, for a snapshot in time, we're very lucky and very happy.

And yeah, and I hope came out of this with much greater perspective to around, you know, what what grief does and what trauma does and how do you show up

differently for other people when they're hurting.

How do you check in on someone six months after a death?

Because they're still hurting, even though you're five months past the celebration of life.

And just how do you show up differently in the world?

Because I think that's what these hard events help you do better with the right support when you're going through it.