Nicole Hall was looking forward to meeting her third child after a blissful, straightforward pregnancy.

As a healthy 29-year-old who had previously carried and delivered two healthy babies, there was no reason to suspect her life was in danger as she was induced at UCH Memorial North hospital in Colorado Springs on the February 13, 2018.

A registered nurse herself, Nicole was unaware of the downward turn events were about to take as she and her husband, Anthony, waited to meet their new baby. And given she was seven centimetres dilated, that moment was getting close.

However, Nicole suffered a life-threatening reaction, called an Amniotic Fluid Embolism (AFE) which occurs when amniotic fluid enters the mother’s bloodstream, triggering a serious reaction which can lead to massive bleeding and heart and lung collapse.

While Nicole doesn’t remember a lot after this moment, she recalls that she started to feel very hot and nauseated.

Anthony, on the other hand, remembers the following minutes all too clearly.

“I went to get Nicole a wet washcloth, and the nurse came in to see how she was progressing,” he tells Mamamia.

“Nicole kept saying she couldn’t breathe, and her whole body started getting red, her back arched, and the nurse asked me to grab her (oxygen) mask.”

Anthony was forced to hold the mask to his wife’s face as she tried in a panic to pull it off. Then her body turned blue, and the nurse jumped on top of her to start chest compressions and yelled for a code blue in Nicole’s room.

The room turned into a flurry of activity, and one nurse held Anthony back as medical personnel tried desperately to save Nicole, performing chest compressions for almost six minutes.

“People instantly came running into the room and equipment started flying. Nicole’s IV had popped out when the nurse jumped up to start compressions,” he says.

Anthony’s mother and brother were in the waiting room just outside the delivery room when the doors burst open and Nicole was rushed out to the operating room with the nurse still straddling Nicole, mid-compression.

Anthony dropped to his knees and started praying, but part of the nursing team and a chaplain stopped him to tell him what was happening: they need to do a post-mortem c-section.

Nicole was gone.

Now it was a race against time to try to save Nicole and Anthony’s baby.

Dr Leslie Moats was rostered on as an Emergency Medical physician at UHC Memorial that night, and the “code blue” for Nicole’s life is a call he will never forget.

At the time the call came through, Dr Moats had his hands full in the ER with several challenging patients, and said that a code blue to the Labour and Delivery ward was not typically an event he’d give a second thought to as his responsibility was to his patients in the ER.

“My responsibility in the ER technically precludes me from responding to a distress call on the hospital floors, but I found myself standing up and looking over at our charge nurse who was leaving to respond to Labour and Delivery,” Dr Moats tells Mamamia.

“I thought to myself that there are multiple doctors on that ward: why would they call a code blue? Something inexplicably caused me to drop what I was doing to at least investigate the issue so I called out to our charge nurse, ‘Wait up, I’m coming too.’”

The scene in the OR - nurses in a flurry and no OB/GYN on site - put Dr Moats’ heart into his stomach. Nicole was in cardiac arrest, with no pulse, no IV line, and no oxygen.

One of the high-risk nurses pushed a scalpel into his hand: “She’s been down five minutes. You have to get this baby out now!”

Dr Moats felt for a pulse, confirming there was nothing. He felt the side of the uterus - a faint kick. He didn’t know Nicole personally, but they had a few co-workers in common. Whoever she was, he knew she would want him to save her baby.

With no anaesthesia and no antiseptic, Dr Moats cut Nicole from hip to hip. A rush of amniotic fluid with no blood was good sign, but what he saw next caught his breath.

The baby was so engaged in Nicole’s pelvis that the scalpel missed the baby’s head but left a slice from shoulder to armpit. He lost his bearings for a moment, but continued the rescue. First a foot out, then a hand, almost a shoulder, but the baby wouldn’t budge. The nurse pushed up into Nicole’s womb to finally free the beautiful, but lifeless baby boy.

Dr Moats quickly handed the baby off to NICU staff while he continued to work on Nicole, who was bleeding profusely. Above the chaos of the room split a beautiful cry from a newborn followed by: “This baby looks perfect, Doctor!”

Nicole’s obstetrician arrived and took in the reality - a beautiful mum of three lying covered in blood, the result of what appeared to be an amniotic fluid embolism. However, within a matter of seconds, Nicole miraculously regained a pulse and blood pressure.

As theatre staff worked to stabilise Nicole, Anthony made his way down to the OR. As far as he knew, he was going in to say goodbye to his beloved wife.

“I told them I wanted to see Nicole, say goodbye, hold her, and be with her. I got gowned up and went down there when one of the nurses outside the room told me they got the baby out and that they also got Nicole’s pulse and blood pressure back.

“I asked her if I could go in, but I wasn’t able to yet because they were still stabilising her. She’d lost four to five litres of blood.”

Instead, Anthony made his way to the NICU, where he found a group of nurses huddled over one of the baby tables.

“I broke down crying when I realised we had a healthy baby, a boy. I lost it crying because Nicole wasn’t there to be with me.”

The surgical team working on Nicole was forced to perform an emergency hysterectomy to stop her bleeding, but the next 24 hours was a life and death tug of war for her. When Anthony was finally able to see her, the sight was confronting.

“She looked exactly like a corpse that you would see at a funeral home. They had intubated her to move her, and they stopped wheeling her to the ICU so I could kiss [her] and tell her I love her.”

Despite the odds, Nicole responded well to the blood transfusions she received, and eventually regained enough strength to be extubated; a moment she remembers well.

“I don’t remember anything after asking Anthony to get me a washcloth. The next thing I knew I was waking up being extubated off the ventilator. I was shaken. I kept asking what happened.

"I didn’t even know the sex of the baby till I was able to ask with the tube finally being taken out of my throat. But, I have to say that was THE most horrific gender reveal party if you asked me.”

Over the next four days, Nicole made a tremendous recovery and her baby boy, Haxton, healed. Their story of both mother and baby surviving an amniotic fluid embolism is rare: in most cases, at least one of the two, if not both, die.

Today, Nicole is doing well and Haxton is a delightful one year old (with an amazing story of survival to go with the scar he got during the post-mortem c-section). She shares her story and her beautiful family through her Instagram page, Before You Push, spreading awareness of amniotic fluid embolism.

While rare, AFE is a leading cause of maternal mortality in the developed world. Nicole and Anthony hope that by sharing their incredible story, they can help to raise awareness of this potentially deadly condition that few expectant women have heard of, and better equip hospitals with the necessary resources and procedures so that more lives might be saved.

You can visit the Amniotic Fluid Embolism Foundation to learn more about AFE or donate.

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