Sam's brain injury and his mother's near death

Sam's story is told by his parents and his aunt.

From a letter Sam's Dad, Frank Comstive, sent to friends shortly after his birth:

My wife Tina lost her mom to cancer last August, well after she came home we became pregnant with our 3rd child – turned out to be a boy, Samuel. We decided after prayer to have a home birth using a midwife, also being turned away from Tina’s OBG because we didn’t have maternity insurance was also we though a little push from GOD to seek out an alternative to a conventional hospital birth.

Ok, now the real story starts – hold on tight. I went to bed at approximately 11:00pm on Monday May 17th (Sam's due date), and fell asleep about 11:30. Tina called to me about midnight that there was blood in the potty. We called our midwife and she was there in 30mins.

After conferring with her "backup" doctor it was decided to continue the birthing process at home but there was talk of a "placenta abruption". This is when the placenta pulls/breaks away from the uterine wall which then in turn causes bleeding. So Tina is in hard labor at 3:00am in the hot tub.

Sam's heart rate started to drop and the decision was made to transport Tina to the hospital. We hopped in the car turned on the emergency flashers and flew down 359 toward Memorial Herman in Sugar Land. So what do I see as I approach 359 and Highway 90 intersection? My worst fear, a train! They don’t have short trains at 3:00 AM, this sucker was a mile long (or so it seemed) so there we are waiting for a train to pass – lots of intense praying, finally the train passed and we were on our way to the hospital.

We arrived approximately 3:15-3:30 AM up to labor and delivery. Lots of people scurrying about even at 3:30 AM trying to decide what to do next, a vaginal delivery or c-section. The doctors decided to prep for the emergency c-section, as this was being done Tina had the opportunity to push and push she did just before they were going to begin moving her to the O.R. Samuel was born vaginally @ 4:00 AM. Blue and not breathing the nurses began working on him, massaging "bagging" him for his breathing. I never did hear him cry.



Back to Tina.

After the birth Tina's blood would not clot, another term I heard was "DIC", which has to do with the inability of the blood to clot. 4:30 AM the decision was made to take Tina to the OR- losing a lot of blood- possible hysterectomy. Called to lab for blood, none available. Tina lay bleeding on the operating table for the next 1 ½ to 2 hours, basically bleeding to death. The chaplain was called in for comfort and prayer.

The doctors came out around 6:15 AM and told me that they were "not optimistic" about Tina’s recovery. I asked the doctor if Tina had stopped bleeding, he kind of shrugged his shoulders and said yes, but that was probably due to the fact that there just was not a lot of blood left in Tina's body. He also informed me that her hemoglobin had dropped to 3. (don't know what the means except it was really bad) Frustration with the lab's inability to provide blood started to show on the doctors and nurses faces as they knew Tina was slipping away.

Finally, some type O (universal type) was brought up and put into Tina. Her body temperature was also very low. One of the ways I knew she was still alive was I could peek into the O.R and see her legs in the air and instruments still inside her and I knew that if she indeed had passed her legs would come down- they stayed up. My sister Candice was with me at all times. Prepared for the worst, we got our knees dirty and prayed hard.

Candice prayed for Tina not to go, I prayed for HOPE. I knew we needed a miracle so I just prayed for HOPE. In a twist of irony: as this was happening the sun was rising. It was truly spectacular. I thought that such a beautiful beginning to a day would be the worst day of my life.

OK, so about 7:00am the doctors come out and tell me that Tina’s hemoglobin has risen to 6 - still dangerously low but rising- legs still in the air – Tina still alive. There is hope, doctors decided against hysterectomy after a lot of consult with other doctors at other hospitals. If in fact they had opened her up she would have bled out on the table. GOD granted the doctors and nurses the wisdom to not operate.

Her hemoglobin rose to 9 about 7:30 AM and one of the doctors actually cracked a smile. He was surprised – we all were – now we really had hope. The day also brought something else, blood products that begin feeding into Tina to basically rebuild her blood. Her recovery had begun. In total they pumped 13 units of red blood cells, 8 units of plasma, 26 units of platelets and 10 units of a clotting agent into her body for a grand total of 51 units of assorted blood products. She is on a ventilator, but it should be removed today – long term effect of blood loss – only time will tell. Long term effects on Samuel due to trauma during birth again only time will tell. Well, that about wraps it up.

Sam's aunt Candice San Pietro, an RN explains what happened to Sam:

Smae began to seize early morning, May 19th. The NICU doctors told me that the baby was being transported to Memorial Hermann, downtown Houston Medical Center for an EEG and further evaluation.

To summarize my nephew’s status, the EEG, (electroencephalogram) taken within 24 hours revealed that his entire brain had been affected by the lack of oxygen due to the loss of blood that he had sustained. A MRI was completed and read one week after admission and clearly delineated that there was global brain damage which confirmed the results from the EEG.



We celebrated when his pupils constricted (even though they were sluggish), when exposed to light via an ophthalmoscope because that meant he was not brain dead. There was a response. We were happy to hear that the sedation medication, Phenobarbital and Ativan, were maintained at adequate levels in order to keep the brain from seizing. It was critical to have the brain rest so it could recover and heal to whatever extent he was capable of. We were so glad to have him taken off the respiratory equipment (CPAP) days after the incident because given time, he was able to take deep enough breaths to satisfy his blood oxygen levels. He could breathe on his own!

In conclusion, my nephew has been diagnosed with sever encephalopathy due to a hypoxic ischemic event or HIE.

Sam's parents brought charges against the midwife in the Texas Board of Midwifery. The Board acknowledged that she had failed to immediately transfer Sam's mother despite evidence of abruption. The punishment? Six months probated suspension. The Comstives have filed an appeal:

We are asking that our case be reviewed again due to the fact that Cathy lied at the Board meeting in September 2010. We hope for a stricter disciplinary action.

Cathy originally lied to the Board at the September meeting when she stated that she was unaware of how much blood was in the toilet due to the paper. I was completely coherent at this time and recall Cathy stating to the physician on the phone that the blood was a substantial amount.

Cathy later placed the blame on the physician for her negligent care/decisions. Her statement to me personally and apparently to the Board as well was that the doctor instructed us to stay home and proceed.

It was only when I was in the hot tub and Sam's FHR started to drop that Cathy demanded I get out of the hot tub and we proceeded to the local hospital for emergency care. At this time 3-4 hours had passed since my initial phone call to Cathy at midnight reporting the blood in the toilet. Had we sought emergency care immediately after my phone call to Cathy, Sam could have been delivered via C-section and would have been fine. At the very least, he would have been less severelyinjured than he is today.

I almost died. My husband was told there was not much hope for my survival. I required 51 units of assorted blood products. Unfortunately, Sam was diagnosed with a global brain injury which means that many areas of his brain were injured due to the negligent care of the midwife Cathy Rude. Sam's official medical diagnosis is severe hypoxic ischemic encephalopathy.

At the date of this letter, Sam is almost 10 months old. Sam can not sit, creep, crawl, pull up, purposefully use arms/hands. He is orally fed but is not able to take in the typical amount of calories as a child his age should nor does he show any indication yet of being able to manage chewing food. He battles with constipation due to the affected muscle tone in his body and he has yet to consistently sleep through the night. I am still up most nights (multiple times during the night) feeding him or trying to calm him so that he can sleep. He has multiple sensory issues which prohibit him from tolerating a car seat, stroller, baby swing, certain positions, touch, noises, etc. His ability to entertain himself due to these challenges are very limited therefore he requires much interaction from his family. Caring for Sam each day is exhausting work.

Cathy Rude has remained in utter denial or unwilling to accept the extent of damage done to Sam due to her negligent care. Upon our last communication, she was giving advice to me as if Sam was a typical baby. Cathy has been able to return to her life as usual....even opening a birthing center....while remaining in denial. My family’s life has forever changed.

We don't know what Sam's future holds. We know that each day is very hard work and we continue with therapy (PT and OT) each week in the hopes that this will indeed help Sam to live a somewhat normal life and that he will have a chance at an independent life as an adult. At this time Sam has not been given any further diagnosis besides the initial HIE diagnosis but we expect that he will at some point be diagnosed with cerebral palsy as this is the indications that we get from his physical limitations and this has been brought up by medical professionals involved in Sam's care.



Sam's parents have begun lobbying for a law mandating malpractice insurance for certified professional midwives. Their efforts were reported on local Fox News:

While Frank and Tina still support the use of midwives and home births, they want to see a change in state law that would require midwives to have liability insurance.
"When the wrong decision is made then there should be a financial obligation to the injured," Tina said.
"It's not about me, or Tina or Sam," Frank said, "It's about the next Sam or the next Samantha."


 


Addendum: Same passed away in April 2013 as a result of aspiration in his sleep. I received the following from his mother.

We lost Sam during his sleep 4/26/2013 due to aspiration.

The autopsy ruled that it was directly related to his labor/birth injuries.

We had a celebration of Sam's life on 5/18/2013........what would have been his 3rd birthday. Our family is heartbroken yet due to our Christian faith, we do rejoice for Sam. He is now free of all limitations........fully restored as God had originally intended.

Sam never talked, sat up, crawled, stood, walked, used arms/hands purposefully. He was completely dependent on us for his care. He was orally fed but it was always a challenge and he never had enough caloric intake so most of his nutrition was by PediaSure/Boost.......Sam was still on a bottle.

He was our sweet, precious little boy. He seemed very aware and interested in his surroundings...........had a twinkle in his eyes and a huge smile............wonderful laugh/giggle. He knew all of his family and those involved in his daily care/weekly therapy.

From Sam's obituary:

 

Samuel Frank Comstive 2, of Richmond, TX ran through the gates of Heaven into the awaiting arms of Jesus Christ during the wee morning hours of Friday, 4/26/2013.

 Sam was born to Frank and Tina Comstive on May 18, 2010. He was welcomed into the family by his big sisters, Rose and Lily. Caring for a child with special needs was the hardest challenge our family had ever endured yet there was much joy and reward. Sam impacted so many lives in such a short period of time although due to his disabilities, never spoke a word. Sam brought together a group of ladies that have formed a support group for families of children with special needs....The Special Mom’s Group.

Sam loved people and they were all drawn to him. Sam had a smile that could brighten the darkest room and a light in his eyes that reflected the love of Jesus. Sam’s last day on this earth was spent with people that loved him the most. He was greeted in the morning by his Daddy and played with...”daddy-style”. Sam was smiling from ear to ear and giggling as they played. He then spent a few hours at the Fort Bend Shriners circus where he was the only person in the crowd to receive a clown nose from one of the clowns. Sam continued to enjoy the rest of the day surrounded by loved ones.

The autopsy report concluded that Sam’s passing was directly related to the injuries he sustained during labor/birth. Sam aspirated during his sleep. Aspiration was one of the many threats to Sam’s health due to his injuries. It appears that Sam never awoke. What a blessing!!! To spend the day with the ones you love, close your eyes and walk into the arms of your Heavenly Father...the one that loves us most.

Sam had a purpose. (Romans 8:28) Sam fulfilled his purpose and God took him home in order to spare him any further hardships due to his disabilities. Our family is positive that Sam was greeted with the words, “Well done, good and faithful servant”. Our family is heartbroken yet we find comfort in knowing that Sam’s body has been fully restored as God had originally intended. Sam can now walk, run, dance, talk, sing, etc. Glory to God!

Left behind to treasure our time with Sam are his parents-Frank and Tina Comstive and sisters-Rose and Lily ... paternal grandmother,.. paternal grandfather,.. maternal grandfather,.. and caregiver Adriana .. and her son Angel... Sam was also loved by his extended family members. One of many to greet Sam at Heaven’s gates was his maternal grandmother...

We will have a celebration of Sam’s life on what would have been his 3rd birthday, May 18. We will have birthday cake!... One of the best blessings in our life is Adriana ... “Ms. A” has helped us love Sam for the past 2.5 years. She loved Sam as her own and he loved her. She is forever part of our family...