Recently, a friend sent me a text, with a link to a news story: “Did you see this?!”
I clicked. The story was about a healthy 33-year-old woman in Nova Scotia who contracted a flesh-eating bacteria after giving birth in March. After going into septic shock, she was placed in a medically induced coma. She had all four of her limbs amputated and a total hysterectomy — and now she's suing the hospital and doctors for negligence.
The story made my stomach drop, and I felt flutters in my chest. That story could have been about me.
Last summer in Albuquerque, I gave birth to my third child. I was induced two days after his due date because he was measuring big and I was 39 years old. He was born quickly and healthy at 9 pounds 5 ounces.
But I felt . . . different. As I sat in the wheelchair holding my squirmy baby before going to the maternity ward, I asked the nurse for a tissue. I’d had a sore throat weeks earlier, but it had gone away. It felt odd to be coming down with a cold so quickly after giving birth.
A few days later at home, I picked up my 2-year-old and a gush of blood rushed out of me. I felt as though my uterus was dropping out of my body. Five days after my son’s delivery, I came down with a fever unlike any I’d experienced before. I was clammy and fuzzy-headed, and as soon as my fever broke, sweat drenched my sheets. My husband called the obstetrics nurse line and they told him not to worry, it was probably related to my cold.
Friends brought us homemade mac ’n’ cheese that evening, and from the bedroom I heard them cooing over the baby. I tried to walk to the family room to visit with them. But for a moment, my vision went dark. I stood in place, my palms against the wall, until I could see again.
I fought the fever for another day and then, in the middle of the night after nursing our newborn, I felt more gushing blood. I woke my husband and, my heart racing, called the hospital. The nurse who answered assured me that it was normal to experience a gush after lying down for a while. But I knew it wasn’t normal: My post-delivery bleeding had already abated. Still, I hoped she was right. Exhausted, I went back to sleep.
The next day, I felt better. We picked up my in-laws from the airport and went to lunch at one of my favorite spots. I ate a salad with pear and blue cheese, and I felt I was on my way to recovery.
But back at the house, I was hit with another wave of chills. I took ibuprofen and wandered to the deck to warm up in the hot July sun. But as I listened to the birds in the pine trees, I shook violently and uncontrollably. It was time to go back to the hospital.
There, my fever spiked to 104. The nurses spread three warm blankets over me and left me alone. The pain roared into my back. It felt as bad as childbirth, and I writhed on the bed. An hour later, they hooked me up to an IV and a nurse came to take my vitals. There was a loud beepingand a flurry, and the nurse hurried to put an oxygen mask on me. My pulse was 210. It was then, lying in that hospital bed with the lights low, that I considered that I might die.
Over the next two days, my fever came and went, and the doctors determined I had sepsis. They pumped me with three kinds of antibiotics as they tried to find out what kind of bacteria was causing the blood infection. As we waited, I started to feel pain in my right lung when I breathed. Two days after checking in and nine days after giving birth, the results came back, and the news was scary: I was infected with group A streptococcus, one of the organisms that can cause flesh-eating disease.
The Centers for Disease Control and Prevention estimates that there were 18,700 cases of invasive group A strep in 2016. Nearly 10 percent of those people died.
Group A strep bacteria can be mild and easily treatable, as when it causes strep throat and lives on skin without causing symptoms. But once it spreads into the body through the skin, the throat and elsewhere, it is a “remarkably aggressive organism,” says Stan Deresinski, an infectious-disease specialist at Stanford Health Care. It releases toxins that can cause streptococcal toxic shock syndrome, destroy tissue and lead to organ failure and death.
If the bacteria gets under the skin, it can move rapidly along connective tissue, destroying skin, fat and tissue covering muscles, and causing necrotizing fasciitis, or flesh-eating infection. To stop the spreading damage, doctors remove dead tissue, in a process called debridement, and sometimes an entire limb must be amputated.
About 600 to 1,100 cases of necrotizing fasciitis from group A strep occur each year in the United States, according to the CDC.
After telling me what the tests had found, my doctor sat on the edge of my bed. She said my liver enzymes were high and rising — early signs of shock. She told me that to stop the infection, I had to get rid of its source. In other words, I would need a hysterectomy. Surgery was also the way to find out whether I had necrotizing fasciitis. I didn’t have any symptoms in my uterus — the doctors were acting on a knowledgeable hunch since I had just given birth.
“We can’t wait 48 hours. We can’t wait 24 hours,” she said. “You need surgery now.”
She told me that they’d seen this before — a case where a woman had group A strep but there were no symptoms in the uterus. I could tell by the way she said it that the other woman died. (She later confirmed that.)
My doctor looked at me intently and said quietly, “You need to be here for your boys.”
This is where I feel lucky: I was at a hospital with experienced and proactive doctors. Less than an hour after that conversation with my doctor, I was rolled into an operating room. I didn’t have time to process the enormity of it all. Afterward, the surgeon told my husband that my uterus had been so infected that when he went to take it out, it shredded. But he got it all out, and there were no signs that necrotizing fasciitis had taken hold.
And then my fever went away, just like that.
After four more days in the hospital, I was sent home with IV antibiotics to take for another week.
In the coming weeks, I asked every doctor I saw how and where I had gotten the infection. Not only am I healthy, but I also was an all-American soccer player in college. I’ve run marathons. I am fit, and I eat a mostly vegetarian diet. What could I have done differently?
They all had the same answer: They didn’t know.
My doctor tells me I’m the only person she’s aware of who may have gotten the infection while in the hospital after giving birth. The doctors had seen a handful of other cases, including the woman who died, and they had all been transported from other hospitals, rural areas and, in one case, a home birth.
Women going through childbirth are particularly vulnerable to infections because it’s “easy for the organism to invade [by using] breaks in epidermal/mucosal barriers in the vagina and vulva,” Deresinski says. Also, a woman’s immunity may be “somewhat depressed” during pregnancy, he added.
In my case, my doctors broke my water by puncturing my amniotic sac to speed up delivery. That can provide a pathway for bacteria, and I had a second-degree tear in my perineum during delivery. In every 100,000 live births, six women will contract invasive group A strep, according to CDC, and most of those cases occur after a vaginal delivery.
Also, contact with young children is an "underappreciated risk factor" for contracting invasive group A strep, according to CDC medical epidemiologist Chris Van Beneden, an expert on these infections, because 25 percent of children carry the bacteria in their throats compared with fewer than 5 percent of adults. "This probably was the result of at least two factors: the widespread contact with other children in day care and other places, and an immune system that is not as mature as in older individuals," said Deresinski. I had a 4-year-old and a 2-year-old at home.
There is one thing I could have done.
During a prenatal visit when I was about 32 weeks pregnant, I had a persistent sore throat. The nurses shined a light into my throat and saw a white spot on the right side. My doctor took a culture and prescribed antibiotics in case I tested positive for strep throat. The next day, the culture came back negative, so the nurse and I agreed I didn’t need to take the antibiotics. It may not have made any difference, but in hindsight, I wish I had taken the meds.
Now, a year later, I’m completely healthy, as is my child.
And when I read stories about women who suffered — or died — after giving birth, as that woman in Nova Scotia did, I’m overcome with emotion. It makes me pinch myself: I’m so thankful I’m here and can hold my little boys.
When my doctor sat on my hospital bed to say I needed surgery right away, she thought I wouldn’t make it another day without the infection consuming my body.
Today, I look back with a wide-eyed wonder that I was that close to death. I learned to have the utmost respect for fever, especially a high one. I Iearned that the bacteria that causes strep throat can be deadly. And I learned that no matter how healthy I am, I am not invincible.
Here’s what I would tell others: Don’t ignore symptoms.
If something feels wrong, it probably is. Trust your instincts; only you know your body. If you have a fever after giving birth, get care immediately. And always err on the side of caution because the line between living and dying is thinner than I ever imagined.
Killian is a freelance writer and ceramist based in Southern California. Before she had her three boys, she was a journalist with NPR in Washington.