Heather Robbins and baby Caden
Teamwork Leads to Special Delivery for Heather and Baby Caden
Every birth is special, but the moment Heather Robbins first held her son Caden was truly amazing.
Six years ago, Heather suffered a spinal cord injury during a car crash, which left her paralyzed from her upper chest down. When she first learned she was pregnant, she was concerned that her condition might cause complications for herself and her baby. Her sister encouraged Heather to see Sean Kenney, MD, a maternal-fetal medicine specialist at the Center for Maternal & Fetal Care.
“Dr. Kenney was familiar with spinal cord injuries and had worked with people in wheelchairs before. That really helped calm my fears,” Heather says.
While most patients with spinal cord injuries do well with pregnancy, Dr. Kenney says they may face potential challenges.
“They have an increased risk of complications because they can’t feel their contractions, so we have to watch for pre-term labor,” he says. “They also have an increased risk of blood clots, since they aren’t able to be up moving as much, as well as other complications.”
Relying on her team
Heather relied on a team of doctors, nurses and staff to help her through her pregnancy. Early on, she was hospitalized for hyperemesis, a severe form of morning sickness. While she was in the hospital, she developed a blood clot that traveled to her lung, so she was put on blood thinners. Heather also suffered from severe itching caused by cholestasis, a condition where pregnancy hormones cause bile to build up in the liver. Cholestasis can be dangerous for the baby, and it can lead to pre-term birth and even stillbirth.
“The combination of everything together was nerve-wracking and scary for me, especially as a first-time mom, but Dr. Kenney told me something that really stuck with me,” Heather recalls. “He said, ‘You’ve been through a lot more difficult things in your life, like the accident, and you’re going to make it through this, too.’ That helped get me through the rest of my pregnancy.”
Heather also was concerned about the challenges her wheelchair might present in caring for her baby. Dr. Kenney connected her with a former patient who was also in a wheelchair, and she gave Heather practical tips and advice.
Research behind the scenes
Dr. Kenney coordinated with Patient Care Services Vice President Lisa Vail, RN, DNP, NEA-BC, and the Intensive Care Unit so that equipment and staff would be available in case Heather needed an arterial line to monitor her blood pressure while she was in labor. Although Heather didn’t end up needing it, their planning proved useful.
“I had another patient a few weeks later that we used it on, so that pre-work was a real lifesaver,” says Dr. Kenney.
To prepare for her delivery, Heather worked with anesthesiologist Sean Leach, MD, of Associated Anesthesiologists. Although Heather wouldn’t feel the pain of labor, her team was concerned that it might trigger autonomic hyperreflexia, a condition where the nervous system can’t properly regulate pain signals because the spinal cord injury prevents those signals from reaching the brain.
“This lack of regulation can lead to a hypertensive crisis, where blood pressure can go very high,” explains Dr. Leach. “It puts mothers at risk for intracerebral hemorrhages, strokes, hypertensive encephalopathies, retinal hemorrhaging and even death.”
Dr. Leach had to find an anesthetic technique that would prevent these signals from being sent, but a traditional epidural wasn’t a reliable option. Previous surgeries to stabilize Heather’s spinal column left her with scarring in her epidural space. This scarring would make placing a traditional epidural extremely difficult, and it might prevent the anesthesia from spreading adequately.
Dr. Leach decided to use a continuous spinal catheter, a method he had learned during his residency at Banner-University Medical Center Tucson (formerly the University of Arizona Medical Center). During this procedure, a spinal catheter is placed in a similar manner as for an epidural, with a few significant differences. It is placed in the cerebral spinal fluid, rather than the epidural space, and ideally, it requires a smaller diameter needle and catheter to continuously deliver a local anesthetic.
“I felt very fortunate to be able to use this technique for Heather, because it was perfectly suited for her specific needs,” he says.
More challenges ahead
The next challenge facing the team was obtaining equipment for the spinal catheter. Julie Smith, director of perioperative services and anesthesia, and perfusionist Vic Grdina (now retired) worked with the purchasing department. Generally, Bryan orders items in bulk, but buying a single catheter — which also was a rare model — was going to be difficult and potentially costly.
“I’ve worked at Bryan for 30 years, and I’ve never had to order this catheter. That’s how rare it is,” Julie says. “Our purchasing department did a great job negotiating pricing and working through the challenges to get this for Heather.”
Dr. Leach notes that the special catheter and others in a range of sizes were ordered.
“We reviewed our options and chose to use a traditional but smaller than usual size catheter in a nontraditional fashion to deliver a continuous spinal anesthetic,” he says.
Julie applauds Dr. Kenney, Dr. Leach and every member involved with Heather’s care. Without their careful planning and collaboration, Julie says Heather likely would have had to go out of state for her delivery.
At 37 weeks, Dr. Kenney induced Heather. On March 4, she welcomed Caden into the world.
“I cried,” Heather recalls. “I was amazed that I had been able to push him out. My mom was like, ‘How did you do that?’ I didn’t know that I could. It was an amazing feeling, and after being sick my whole pregnancy, it made everything finally worth it. I felt so much love for him and being a mom. You can’t even describe it unless you’ve been through it.”
Caden was 4 pounds, 13 ounces at birth, and he spent a week in the neonatal intensive care unit. He was treated for jaundice and sleep apnea. Despite those early minor setbacks, Heather says Caden is healthy and growing.
“Now you’d never know that he was born at four pounds,” she jokes. “He’s chunked up a little bit.”
After coming home from the hospital, Heather and Caden have enjoyed settling into a routine. Heather says he sleeps well, and he’s hitting fun milestones, like rolling over and babbling.
“He is such a blessing to me,” she says. “Even though I had a rough pregnancy, I’m glad my baby is OK. Dr. Kenney got him here safely, and my whole medical team was great. I’m so thankful for them.”