A Traumatic Birth to Healthy Beginnings

Level II trauma care isn’t something you think about - until you need it. That CHI St. Alexius Health is equipped, staffed and prepared 24/7 to provide lifesaving care is appreciated more than ever by Alexis Wangler and her family.

Like most people, Alexis wasn’t thinking about trauma care when she woke up on a snowy March day. It was a Friday and her 27th birthday. But by late afternoon, Alexis would share her birthday with new daughter, Rayah Ruth Wangler, who was delivered nearly six weeks early following a devastating car accident.

Both would be okay, thanks to the heroic efforts of first responders and a CHI St. Alexius Health team. “We were just given a lot of different blessings that day,” said Alexis.

Jerry Obritsch,MD, the obstetrician-gynecologist who delivered baby Rayah, agreed. “This was a case where it could have been a dual fatality. So this is a miracle story,” he said.

It happened on March 1st of last year, a typical North Dakota winter day with blizzard-like weather. As a post office carrier, “I’m used to driving in those conditions,” Alexis said. She got her one-year-old daughter, Reese, ready for the day along with husband Wendelin. Getting into her car, Alexis remembers the hint of a weird feeling in her stomach. But she put on yellow sunglasses for better visibility and headed out with her husband and daughter not far behind.

Driving on US Highway 83 for the 10-mile commute into Linton, Alexis noticed a vehicle facing northwest off the southbound lane. Then, suddenly, yellow blinking lights 10 feet ahead. She slammed on the brakes as her LeSabre crashed into the back of a school bus. The air bag deployed and glass shattered into Alexis’ face and arms. The steering column was up to her chest, she struggled to move her legs, and terrifyingly, couldn’t feel her baby moving in her belly.

“I was probably screaming ‘I think my baby’s dead,’” Alexis remembered. “My husband was second on the scene. At first, he thought I was dead. He was pulling on the doors, trying to get me out.”

Alexis saw first responders arrive, and her stepfather, who is a volunteer firefighter, and the Jaws of Life. They painstakingly extricated Alexis and got her into an ambulance. At the Linton Hospital emergency department, the decision was quickly made to transport Alexis 63 miles to the nearest level II trauma center, CHI St. Alexius Health, where a multidisciplinary team gathered.

“Everybody was here right away. We were all waiting for her, knowing she was coming,” said Derek Kane, MD, the trauma surgeon on duty. The emergency department was a flurry of activity as Alexis’ condition was assessed. The fetal heart rate was 178, a bit higher than during Alexis’ prenatal appointments, but not yet concerning, and an ultrasound was normal. X-rays showed no broken bones and a large contusion below her left knee. Alexis was hooked up to a defibrillator, an important piece of equipment as it monitors vital signs while patients are transferred from one hospital area to another - and it stayed with Alexis as she was moved to Labor and Delivery for fetal monitoring. There, Dr. Obritsch watched for signs of placental abruption, when the placenta sheers away from the uterus. There had been no vaginal bleeding, the most obvious sign. “Baby’s heart rate was reassuring,” he said. But that changed. “The baby started having a higher heart rate and it flattened out.” Alexis remembered Dr. Obritsch explaining it as “hills and valleys, not peaks and valleys.”

A KB stain, or Kleihauer-Betke blood test, was ordered to check for baby’s red blood cells in the maternal blood stream. “It came back positive and it was quantifying at 50 ml of blood. Baby only has 250 ml of blood so that’s very significant,” said Dr. Obritsch. Another test, the biophysical profile, came back at an alarming two out of eight. “When the baby went into distress, it happened very quickly,” Dr. Obritsch said. He rushed to break the news to the Wanglers. “Things had settled down in Labor and Delivery. Now they’re being told they need an emergency Cesarian section. It was an abrupt change of course,” Dr. Obritsch said.

“I knew it was a life or death situation for her,” Alexis said. “That was one of the hardest things, wondering how she would adjust to being out here five weeks and four days early.” The entire team rallied behind the urgent situation. “You push your stat button,” Dr. Obritsch said. “Teamwork is essential.”

At 3:21 pm, Rayah Ruth, named after her great-great-grandmother’s nickname and middle name of Ruth, came into the world at 5 pounds, 12 ounces and with a full head of dark hair. “She went right to the NICU. I didn’t even get to see her. They wanted to make sure they could get her breathing,” said Alexis. The NICU team sprang to action. “After the delivery, the baby didn’t cry. We started resuscitation,” said Neonatologist Himadri Nath, MD. “Rayah required extra oxygen than what is available in room air to maintain blood oxygen level in normal range. We intubated and put her on a ventilator, and put medication into the lungs to help with breathing.”

Meanwhile Dr. Obritsch and Dr. Kane checked Alexis for any internal complications. “It turned out to be a 50 percent separation of the placenta. That’s disastrous. Every minute counted,” said Dr. Obritsch. The terrifying, touch-and-go day turned into several wait-and-see weeks. The Wanglers were told to expect a two- to six-week NICU stay. The priorities were getting Rayah on room air, weaning her off of total parenteral nutrition and onto oral feedings, and clearing a possible infection.

Long days were highlighted by moments of progress, such as moving Rayah from an isolette to a regular bassinette. “With even the little steps you were in happy tears,” Alexis said. Baby Rayah was discharged after 13 days in the NICU. “Generally it can take two to three weeks to establish full feeding,” said Dr. Nath. “She learned faster compared to many babies her age, and that’s why she went home early.” Nearly a year later, Rayah is a rambunctious little girl and the Wanglers are deeply appreciative of the care they received that fateful day. “Everyone was just very amazing and encouraging of us,” she said. “From the get-go, I felt like everything was going to work out.”