Thirty-one weeks pregnant, and in intensive care with sepsis, Lizzy Ryan had almost stopped caring about her own life.
“I decided if one of us was going to make it, I’d rather it would be him,” the 26-year-old says of the baby whom she knew was a boy but was not expecting to deliver for another nine weeks at the National Maternity Hospital, on Holles Street in Dublin. But here she was, lying in the ICU of St Vincent’s University Hospital, nearby, on oxygen and struggling to breathe. Her rapid deterioration was mystifying medical professionals who knew she had an infection but were trying to identify the source while treating the symptoms.
A decision had to be made between the staff of both hospitals on whether or not they needed to advise Lizzy that the baby should be delivered. This would subject him to the complications of being a pre-term baby but would take the burden of pregnancy off her body. Or could they support her through the crisis and avoid her having a premature baby?
Two days earlier, on Tuesday, August 23rd, Lizzy had woken up at home in Portmarnock, Co Dublin, feeling unwell, having been very warm during the night. She had gone to bed with abdominal pain, which she thought was from the baby kicking. But now she couldn’t feel him moving and rang the National Maternity Hospital, where she had been attending the midwives’ clinic during a healthy and welcome pregnancy, after suffering a miscarriage last December. She was told to come in but not before doing a Covid test at home to see if that was the cause of her raised temperature. It was negative.
In the hospital, foetal heart monitoring indicated all was well with the baby but as Lizzy’s pain was worsening, she was sent for antenatal scans and monitoring. The exact sequence of events after that are a bit of blur for her: “I was just getting worse and worse, Tuesday into Wednesday.” National Maternity Hospital staff worked through possible causes, such as gall stones, before asking surgical colleagues in St Vincent’s University Hospital to assess her.
An infected appendix that had been pulled up in the pregnancy was a possibility, or an ulcer. Lizzy needed morphine to ease the pain before her transfer by ambulance to the emergency department of St Vincent’s on the Wednesday evening. A National Maternity Hospital midwife was with her to monitor the baby, while her partner, Alex Murphy (26), drove behind.
A CT scan showed she had an infection in the chest and doctors told her she had developed sepsis – a life-threatening inflammatory response in the body to infection – before she was taken to ICU and put on oxygen.
“At half four [am] I woke up and there was a nurse with me all the time. She could see I was struggling to breathe and trying to sit up. She asked me could I breathe and I couldn’t really talk so I shook my head. She asked me was I scared and I nodded my head. That is when she decided to put me on warmed oxygen, to open up the lungs more.”
The nurse also rang the National Maternity Hospital to inform them she was deteriorating and then contacted Alex at 5.45am to tell him to come in, suggesting he tell Lizzy’s mother to come with him.
“I knew when she told him to tell my mam to come, that something was going wrong,” says Lizzy. The next thing she remembers is Prof Mary Higgins, a consultant obstetrician at National Maternity Hospital, coming to her and saying they needed to deliver the baby by Caesarean section there and then. Lizzy was too ill to be moved back to the maternity hospital.
“I was terrified because I knew I wasn’t far enough long for the baby,” says Lizzy. “My biggest fear wasn’t that something would happen to me, I thought something was going to happen to the baby.” Before giving consent she says she made Higgins promise that he would survive “and she said he would, even though she knew there was a high chance….”, Lizzy trails off. “I put a lot of pressure on her!”
The worst thing was seeing the thing [incubator] ready for the baby because I knew he would be going into that. That’s not where I want my baby to be as soon as he is born
By the time Alex arrived in ICU early that Thursday morning, the decision for the C-section had more or less been made. “He didn’t get much of a choice,” Lizzy says. “I don’t think he would have wanted to make the decision anyway. It felt like making a choice between who was going to make it.”
Wheeled down to theatre at 8.30am for a C-section under general anaesthetic, she recalls a big white room with 15-20 people waiting for her. “The worst thing was seeing the thing [incubator] ready for the baby because I knew he would be going into that. That’s not where I want my baby to be as soon as he is born.”
Accompanied by a midwife and a registrar from the National Maternity Hospital, Higgins did the section and the baby was delivered at 8.49am, weighing 2.01kg (4lb 7oz). A team from the National Neonatal Transport Programme were there to stabilise him and ferry him the 4km to the neonatal intensive care unit in Holles Street.
In a rather unfortunate lapse of communication, nobody told Alex he had become a father. He was sitting with Lizzy’s parents and other family members in the coffee shop area of St Vincent’s waiting for news. He went out to make a phone call and noticed that the neonatal ambulance, which Lizzy’s father had told him was parked right outside the entrance, was no longer there. But he didn’t hear that the baby had been safely delivered until Lizzy herself rang at 10.15am, after coming around from the anaesthetic.
She didn’t want to look at the first photos of their son, which a member of staff had taken with Lizzy’s phone before he was whisked away, without Alex. When the couple settled on Louis as his name, after Alex’s late grandfather, a doctor pointed out to them that their baby had in fact been born on the feast day of St Louis – August 25th.
Seeing their son for the first time on her phone, “it felt like I was looking at stranger”, says Lizzy. She didn’t have the sense of him being her baby until finally, eight days after the birth, she got to see him in person. The delay was due to the discovery, after delivery, that what was thought to be a heat rash was starting to blister and was in fact chickenpox. With her lungs no longer compressed by the pregnancy, they could also see on an X-ray that this infection had caused pneumonia, leading to sepsis.
Chickenpox pneumonia “is an incredibly rare thing”, says Higgins. Due to the infectious nature of chickenpox, Lizzy had to go into isolation – first in St Vincent’s University Hospital and then after her transfer back to the National Maternity Hospital on the Friday evening – as did Louis in the NICU.
For the first three days Louis spent in intensive care, Lizzy was fearing the worst and crying every time somebody referred to him as being “sick”. Although physically separated, she could watch him through the “angel eye” camera fitted to his incubator and linked to an app on her phone. By the Saturday night, “I got a feeling, ‘there’s nothing wrong with him’, and by Sunday afternoon and Monday they were telling me he was getting better”. Alex, who had been able to visit Louis in NICU since the day he was born, could see his vital statistics improving all the time and was reasonably confident about his prospects.
When she was able to hold him for the first time that Friday, at last she could experience that sense of “somebody who looks like you looking back at you”
By the Monday, Lizzy was pleading to be allowed go home. She was afraid of postnatal depression setting in while she was in isolation. “It was getting harder and harder to cope.” She was discharged from the National Maternity Hospital on the Tuesday and told she could visit Louis from the Wednesday. However, as she could still see spots under her wound dressing, she didn’t want to take any chances.
“I put two more days of isolation on myself. I was terrified of going in and setting him back.” When she was able to hold him for the first time that Friday, at last she could experience that sense of “somebody who looks like you looking back at you”.
Lizzy regrets missing the various first connections with her baby – to hold him skin to skin, the first feed, the first nappy change. However, as it was either “I was robbed of my firsts or I was robbed of my baby”, she is very happy it was the former in the circumstances.
Higgins, who works in high-risk maternity care with St Vincent’s University Hospital colleagues, explains how sharing between medical and nursing staff of different disciplines is vital in a case such as this. At the outset they didn’t know what they were dealing with and were trying to work out between them what it wasn’t, what it might be and the best course of action.
“The more senior people involved, the better,” she says. “Before delivery, if you can keep the woman well, you keep the baby well but the fear was that she, and therefore the baby too, were going to be in trouble.”
As Lizzy’s condition worsened, the ICU team in St Vincent’s University Hospital were strongly advising that she needed to be delivered. “If she doesn’t have a baby on board, she just has to look after herself,” explains Higgins.
It’s not unheard of for National Maternity Hospital staff to deliver babies in St Vincent’s University Hospital, she says but it is rare. Often it will be by Caesarean because the mother is too sick to go through labour but, occasionally, a heavily pregnant woman patient in St Vincent’s might go into spontaneous labour, as a natural protective response to illness, and have a vaginal birth.
He is never going to be allowed to forget it
Lizzy says she found out later that, before the C-section, she was probably within about half an hour of needing to be ventilated in ICU. “In which case I wouldn’t be doing this right now,” she remarks, as she and Alex sit in the parents’ room of the National Maternity Hospital’s neonatal unit, recounting the traumatic but ultimately happy story behind the arrival of Louis.
“He is never going to be allowed to forget it,” says Lizzy with a laugh as she and Alex look forward to being able to bring Louis home to meet the grandparents and extended family within a matter of weeks.
