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Special Delivery in the Intensive Care Unit

Maternal fetal medicine team helps guide Bethan Nowak through difficult pregnancy

Success story-Bethan Nowak

Bethan Nowak, 27, of Tobyhanna was an active mother of two who stayed fit by eating healthy and running in 5K races and half marathons. Her life took an unexpected turn in summer 2015 when she developed kidney stones for the first time.

Over the next 18 months, Nowak developed five kidney infections and sepsis – a serious medical condition that can result in organ damage or death. A computed tomography (CT) scan revealed a congenital condition called medullary sponge kidney, which increases the risk for kidney stones and urinary tract infections. A whirlwind of appointments followed as Nowak and her physicians tried to get ahead of her painful symptoms using preventive antibiotics and pain management. Then in May 2016, she learned the unexpected news she was pregnant with her third child.

A pathway for high-risk mothers 

Nowak’s previous pregnancies were healthy. Her sons, Fillip, 4, and Leif, 2, were born close to home at Pocono Medical Center (now Lehigh Valley Hospital–Pocono). But this pregnancy was different. She was suffering from severe morning sickness and dehydration and in pain due to daily kidney stones.

Nowak saw obstetrician-gynecologist Karina Reed, MD, with LVPG Obstetrics and Gynecology, for routine visits and treatments for her frequent urinary tract infections (UTIs). Early in her second trimester
her condition worsened, and she was referred to physicians at LVPG Maternal Fetal Medicine (MFM) for specialty care.

“Bethan had pain and kidney problems throughout her second and third trimesters,” says Reed. “When a UTI flared or she was dehydrated, she was admitted quickly into the labor and delivery triage for pain management and fluids.”

At first, trips to Lehigh Valley Hospital (LVH)–Cedar Crest were monthly, then twice a month. During the third trimester they occurred twice a week.

“I knew this pregnancy was going to be long and difficult,” says Nowak. “My husband, Michal, took intermittent family leave to care for me when my mother couldn’t.”

Nowak’s family rallied around her throughout the fall and winter. Her mom, Joe Cassidy – an emergency room nurse at LVH–Muhlenberg – and Michal, took turns driving her to doctors while her father, Phillip, took care of the older children. On Jan. 2, Nowak was in excruciating pain. Joe drove her to LVH–Cedar Crest, where doctors discovered an obstructed kidney stone 1 centimeter in size (larger than 1/3-inch).

The next morning she woke with a raging fever, low blood pressure, a rapid heartbeat and trouble breathing – all signs of sepsis. She was 36 weeks pregnant.

Intensive care unit physicians sedated her and began to treat the kidney infection with antibiotics. Later, a fetal monitor started picking up contractions, and at 3 a.m. a team of doctors and nurses began to prepare for delivery.

A memorable delivery

Kidney infections develop into sepsis quickly during pregnancy, putting mothers at risk for preterm labor.

“Bethan’s blood pressure was dangerously low, and she was having trouble breathing,” says maternal fetal medicine specialist Daniel Kraus, MD. “Using an epidural for pain control was out of the question because it could drop blood pressure further.”

Nowak needed a breathing tube and ventilator to keep her airway open. A traditional delivery could cause the tube to dislodge, so a team of doctors and nurses came up with a plan to sedate Nowak and perform a forceps-assisted delivery with the help of obstetrics, MFM, infectious disease, intensive care, pulmonary critical care, labor and delivery, pediatrics and the neonatal intensive care unit (NICU).

Over six hours, more than two dozen team members rotated in and out of her room in the intensive care unit. Finally, baby Coraline emerged healthy to a chorus of cheers. 

Over the next several days, Nowak’s condition stabilized. She and Coraline roomed in together with the assistance of NICU nursing staff. “I never imagined I would have a high-risk pregnancy,” Nowak says. “I chose LVH–Cedar Crest so Coraline would have access to the region’s highest-level neonatal intensive care unit if she needed one. I couldn’t be happier with the team that took care of us. I’m so grateful that everything turned out OK.”

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