Editor’s note: This story was originally published in the Hartford Courant. It has been edited slightly for timing purposes.

HARTFORD — Northampton couple Sara Farber and Esther Smigel have a beautiful, healthy baby girl with a full head of hair.

But she almost lost one of her mothers just after she was born. Only an emergency hysterectomy kept Farber from bleeding out.

Eden Reed Smigel, born Nov. 29, was given her English and Hebrew names on the first day of Hanukkah in a Simchat Bat ceremony — Hebrew for “celebration for a daughter” — followed by a Hanukkah-themed party, with jelly doughnuts, chocolate gelt and dreidels.

“There were families and children, so it was nice,” Farber, 37, said. “The whole community got to welcome her.”

The party was possible because Farber’s life was saved by the doctors and medical staff at UConn’s John Dempsey Hospital when she suffered a hemorrhage after giving birth. She was given 13 units of blood, as well as 13 units of fresh frozen plasma and three packs of platelets.

The couple credit Farber’s survival to their choice of Dempsey, though they live in Northampton.

They have been married for seven years and have another daughter, Libby, 4½, who had her own sister ceremony last Sunday. “She wants to hold the baby. She wants to care for the baby,” Smigel, 36, said. “She would like to walk across the room with the baby, which we don’t let her do. So she’s going to be great.”

Challenging pregnancy

Both girls were born by cesarean section, and scarring from Farber’s first birth made the second pregnancy more risky, she said.

“The pregnancy I would say from the get-go was challenging,” she said. She had “really severe morning sickness for the first 16 weeks. And then I had COVID for three weeks.”

Two weeks later, a fetal echocardiogram showed she might have a condition known as placenta accreta, in which the placenta attaches too deeply to the wall of the uterus. But it wasn’t clear she had the condition until the C-section. The placenta was removed easily, despite the attachment.

They had planned to have the baby near Northampton. “And then when this diagnosis was made at that echocardiogram, there’s not a specialist, per se, for accreta up in Northampton or Springfield,” Farber said.

“So we started looking for doctors, and we looked at New York hospitals … We have an apartment in the city, so we thought maybe we would relocate to New York for a few weeks and deliver there,” she said. They also looked at Boston.

Then Farber’s aunt, Lina Godfrey, an OB/GYN and labor and delivery nursing manager at Dempsey, told the couple the hospital had recently hired a maternal fetal medicine specialist from Johns Hopkins, Dr. Nicole Gavin.

“So we met with Dr. Gavin at 25 weeks and really connected with her,” Farber said. “She’s a really excellent doctor. She has amazing bedside manner and is super, super smart. And I felt really comfortable in her hands.”

“When she came to see me, that’s when I agreed with the other providers that it was concerning that she could have a placenta accreta,” Gavin said. “She has had one C-section before. And this pregnancy was IVF, which are both risk factors.”

Gavin said Farber’s risk was less than 1%, “so we just followed her, looked at her placenta and it sort of looked stable throughout the rest of the pregnancy. And so we made a plan for an earlier delivery to avoid bleeding, with a goal to save her uterus if possible, which ultimately was not possible.”

They planned to deliver at 36 weeks because Farber had hemorrhaged during her first pregnancy as well. Usually, an accreta requires a hysterectomy, but the doctors thought they could avoid it in her case.

To remove the placenta, “they kind of did a little bit of a pull and it came right out and they’re like, OK, great. It wasn’t particularly adhered,” Smigel said. Farber did bleed some so she was given blood and brought to the recovery room. She even began breast-feeding the baby, born at 6 pounds, 7 ounces, who was doing exceptionally well.

“And then I started having really extreme pain in my abdomen,” Farber said. “And I started bleeding. And my blood pressure started rapidly going down and we rushed to the OR.”

Gavin called in Dr. Molly Brewer, a gynecological oncologist who has specialized training for difficult surgeries. Godfrey also was present.

For Smigel, it all started out fine. “I was holding the baby, watching them weigh the baby … things partners do in the C-section room, but it happened to be an actual OR and I witnessed a lot of blood loss,” she said. “It’s pretty gross. Yeah, just a lot of blood on the ground.”

In the recovery room, though, when Farber started to bleed heavily, “The speed at which the nurses moved, and they were yelling to each other to get her back to the OR, was one of the things that you can hear in someone’s voice, how serious it is,” Smigel said.

‘Got bad very quickly’

Farber had run out of clotting factor. “We still think about all the different hospitals that we could have been delivering at where she wouldn’t have survived. Any hospital without the blood and also without the expertise,” Smigel said.

But Brewer, along with nurses and anesthesiologists, took over and started making decisions.

Brewer said placenta accreta happens most often with a prior C-section or other disturbance to the uterus, and Farber had had a C-section with her first baby. The procedure has increased 40% to 50% over the years, Brewer said.

She said it can be so serious that the placenta can break through the uterus and can “invade the bladder and invade the bowel.”

“Sometimes, as in this case, there was only a very small area that looked abnormal. They weren’t 100% sure, so they asked me to be on standby in case we needed to do a hysterectomy.”

In Farber’s case, the removal of the placenta did not require Brewer’s services, but she returned when Farber began hemorrhaging.

A hysterectomy on a postpartum uterus is difficult, Brewer said, “because your uterus is so big and the blood supply is so big.”

“Think about the size of the uterus. It’s about 6 centimeters. And a pregnant uterus is about 40 centimeters. … And it’s got at least 20 times the blood supply. And so instead of having vessels that are 2 or 3 millimeters, you have vessels that are 2 or 3 centimeters. And they really bleed.”

Farber bled so much and so quickly, “that we had to basically get her stabilized. … She had started to use up all of her clotting factors,” Brewer said. Someone can bleed out in as little as 30 minutes if they aren’t given more red blood cells and platelets with clotting factors, she said.

“She was essentially a patient that just got bad very quickly,” Brewer said.

Each surgery took about an hour, Gavin said.

After Farber was placed in intensive care and intubated, Smigel arrived and told Farber how much blood she had lost and that she had had a full hysterectomy.

“It was a lot more serious than I think anyone was anticipating” because her blood had stopped coagulating, Farber said. It was the rapid transfusions of platelets and red blood cells that kept her alive.

“I saw her later that afternoon and she was still on the ventilator,” Brewer said. “By the next morning she was off and I saw her late the next afternoon and she looked like a million dollars. She had completely reversed.”

‘Immeasurable’ gratitude

While the couple and the doctors all believe Farber could have died, she recovered quickly after the surgery.

“I improved really rapidly,” Farber said. “I think in the first 24 hours my blood levels stabilized. … I started walking, I think the second day, short distances.”

Meanwhile, “the baby is wonderful,” Gavin said. “The baby came out beautiful and crying and happy, and the fact that this little 36-weeker could breastfeed right away was pretty amazing. The baby was amazing the whole time.”

“It’s a really intense recovery,” Farber said. “I’ve had surgeries before. This one definitely takes the cake in terms of physical toll. I think that was a very close call and the transfusions are life saving and my energy is very depleted.”

“It was definitely a massive surgery,” Farber said. “But I think every day I’m doing better and getting more energy and having a new baby … she’s wonderful.”

Gavin emphasized that the entire team, including two sets of anesthesiologists, was essential to the success of the case.

“A number of people and nurses just came into the hospital room during the subsequent days just to see Sara,” Smigel said. “They knew that she was OK, but I think they wanted to see her. … I think it was a challenging day for everybody. I think that it was a real group effort, and I think that everyone’s recovering in a way.”

“I think that it’s really hard to quantify gratitude, the gratitude I have for each person in that room,” Farber said. “It’s sort of immeasurable that I got to come home and be with my family. It’s really a measure of all the gratitude I have for every doctor and every nurse and the people who gave blood.”

In the spring, the couple plans to collaborate with the Lander-Grinspoon Academy and Congregation B’nai Israel to hold a blood drive in Northampton. They are also encouraging people to make a donation to the UConn Maternal-Fetal Medicine group.

“How do you give back after something like this happens?” Farber said. They ask that anyone who wants to give a gift donate to that high-risk pregnancy practice to do so at https://www.foundation.uconn.edu/fund/maternal-fetal-medicine-support-fund/

]]>