After enduring two miscarriages and years of infertility treatments, Emilia Pelton and her husband, Chris, were ecstatic with the news they were expecting. And after trying so hard, they were going to do everything they could to protect their baby girl. And Pelton felt safest not getting a COVID vaccine.
Pelton, 30, works from home, traveling only occasionally for her jobs (she’s part of the gig economy) as bookkeeper for a Louisville, Kentucky, law firm and warranty manager for a manufactured home retailer in Texas, and felt she wasn’t likely to contract COVID.
And yet …
She landed in the ICU with a case so severe, it endangered not only her unborn baby’s life but her own. It took a highly trained medical team to pull her through. Dr. Tom Theruvath (chair of the department of cardiothoracic surgery at Novant Health Presbyterian Medical Center) oversaw Pelton’s cardiac care and called her survival story “one in a million.”
She was due May 12. But on April 28, Cecilia Sloan Pelton entered the world as an early Mother's Day gift.
A scary descent
Pelton got COVID, she believes, on a business trip in December 2021. She tested positive Dec. 20 and felt progressively worse each day. Soon, the marathon runner became weak just walking up the stairs.
By Dec. 27, she was in the emergency room, 21 weeks pregnant, at Novant Health Huntersville Medical Center, just a few miles from their house. Pelton spent one night there and was transferred to the ICU at Novant Health Presbyterian Medical Center the next day.
At Presbyterian, “I thought doctors would maybe put me on some oxygen, give me some medicine and I'd be fine,” Pelton said. But she was much sicker than she realized. Her condition continued to deteriorate.
When she could no longer breathe on her own, her team made the decision to put her on life support. But after just 30 minutes on the ventilator, she continued to decline and they decided her best and last chance was to also be placed on an ECMO (extracorporeal membrane oxygenation) life-support machine.
ECMO is a form of life support that gives the sickest COVID patients a better shot at survival. It can do the work of someone’s heart, lungs or both when they’re no longer able to get the job done because the patient is so sick. It’s the last tool doctors have for a patient in respiratory distress before a lung transplant.
While being on a ventilator involves a breathing tube down a patient’s throat, being on ECMO involves a cannula, a tube inserted into a vein – in this case, in Pelton’s neck, said ECMO specialist Leslie Morton, a nurse and key member of Pelton’s care team. “We take blood out, put oxygen in it and take the CO2 out and then return it back to the heart to be pumped through the body,” Morton said. Pelton is the only pregnant patient at Presbyterian Medical Center to have ever been placed on ECMO.
A doctor told her, before placing her on ECMO, that she had a 1 in 5 chance of surviving. In other words, there was an 80% chance Pelton – and her baby – would die. It was devastating news for her and her family. Her medical team went to work, hoping to beat the odds.
When Pelton was intubated, she was unable to talk. But she still had a lot to communicate to her family and medical team. Chris brought her a whiteboard and markers, and the staff complimented her on her penmanship even though she was heavily sedated. “We found, in all of this, occasional comedic relief,” Pelton said.
Her family came in from Philadelphia; Chris’ from Texas. “Everyone swarmed in to support us,” she said. Eventually, Chris and her sister could visit her bedside. “Anytime I could have someone stay with me, that meant so much. I slept with my hand on top of their hand just so I could know someone was there.”
On Jan. 6, she came off the ventilator. ECMO was working, it seemed. But her ordeal was far from over.
“I started getting a really terrible pain in my side,” Pelton said. “It got to the point that I couldn’t even talk or function.” Doctors discovered she had a life-threatening hematoma – a pool of mostly clotted blood that forms in an organ, tissue or other part of the body – that was displacing her kidney. They immediately took her off ECMO because they realized the clot was coming from the blood thinners she had been on for ECMO. “They had assumed I was doing so well on it that coming off would be no problem. I ended up coding.”
It was terrifying for Chris. “He had been sitting in the waiting room, and he heard ‘Code Blue ICU,’” Pelton said. “And he thought there's a chance it was me but he had no way of knowing. Then, they said, Code Blue OB (meaning obstetrics) ICU, and he was really afraid it was me.”
The medical team immediately re-intubated Pelton to get her oxygen levels back up. The results were mixed. “My numbers were going up and down,” Pelton recalled. “My sister was with me that night. And I kept asking her what country I was in. I was completely delusional. At this point, it had probably been about 36 hours since I slept. I couldn't sleep because I was so afraid I might not wake up.”
“Nothing was working,” she continued. “I couldn't get a full breath.”
At this point, Pelton’s medical team was concerned she may need a lung transplant. On Jan. 13, she was airlifted to Duke University Hospital.
But then another turn: She improved dramatically overnight. There was no need for a lung transplant. She came off the ventilator Jan. 14 and was discharged from the ICU the next day and taken to the labor and delivery wing of the hospital. She was discharged from Duke on Jan. 25.
Scared for the baby
But during a time she should’ve been gaining weight with the baby, she lost 30 pounds.
Throughout the ordeal, of course, “I’m thinking about the baby the entire time,” she continued. “They monitored her so closely every day and they were very communicative about what was going on.”
Dr. Margeaux McGraw, Pelton’s OB-GYN, explained: “If mother doesn’t get oxygen, then baby doesn't get oxygen. The baby was still so young from a gestational age standpoint. And so, the priority was definitely keeping Emilia as stable as possible because that would also keep baby as stable as possible.”
While Pelton’s medical team was concerned with keeping heralive, she was mostly concerned about her baby. Her medical team was, too, even though Morton said, “At just 20 to 21 weeks (when Pelton was admitted), the baby wasn’t viable yet. We knew saving her life was the priority, but we couldn’t ignore the fact that she's pregnant. We knew about her history and her difficulties getting pregnant. The whole thing was pretty scary.”
“Dr. Tom Theruvath oversaw the entire process,” Pelton said of her cardiac specialist at Presbyterian. “He was very good at putting me at ease throughout the whole thing. Dr. (Jeffrey) Walls was the doctor who contacted Duke and oversaw everything pulmonary-related. Dr. (Curtis) Flood oversaw everything obstetrics-related, and he was great.”
Pelton’s regular OB-GYN, McGraw, consulted with the team and kept a close watch over her patient daily and sometimes hourly.
Pelton is grateful for her entire medical team, which included nurses and respiratory techs. “The nurses were so great,” she said. “Leslie (Morton) shaved my legs for me. Bailey (Hunter) braided my hair. They knew I loved dogs and made sure, anytime there was a therapy dog on the hall, that they brought it in my room.”
Back home in Charlotte, “I've been making progress every single day,” Pelton said. “I'm really fortunate. As the patient, you have faith that doctors wouldn't suggest the next thing if that wasn't the right thing to do.”
There’s been a lot of celebrating since the Peltons returned home. “My neighborhood put on a parade the day I got home,” she said. “Everyone has these hearts on their front door with a little prayer underneath it. It gave me chills.”
And the nurses who saw her through this trauma continue to text her and Chris to check in. “God was definitely on her side,” Leslie Morton said. “And she’s such a fighter. I was really impressed with Emilia.”
Theruvath added: “When Emilia was in the hospital, I told her husband that, if she survived, we’d have not a 100% – but a 200% – survival rate because we would’ve saved Emilia and her baby.”
The vaccination question
After surviving her harrowing ordeal, Pelton has embraced the importance of getting vaccinated and has received both doses.
Doctors and public health experts continue to stress: The vaccine is safe for pregnant women and those trying to conceive. The only significant risk around the vaccine is choosing not to get the shots.
“I think it was always in the back of our mind, like maybe later on in pregnancy, I would get it – just not in the first trimester,” Pelton added. “We had had so much trouble getting and staying pregnant. I didn't want another factor to come in and possibly ruin those chances. The doctors I met at Presbyterian were so understanding of why I didn't get it, which meant a lot to me. When they told me I needed to get it, I trusted them. I got my first vaccine and my flu shot on the same day.”
Emilia and Chris are ecstatic to be back home. And she’s maintained her sense of humor through this whole trial. “I joked with the staff that we’re going to have a home birth,” she said. “I'm not ready to go back to the hospital.”
The OB-GYN’s perspective
“That’s not my role,” McGraw said. “It doesn’t benefit the patient/physician relationship. I try to take pressuring out of the equation. But I certainly have a professional obligation to really, thoroughly educate my patients on the benefits of getting the vaccine. It’s something I revisit again and again throughout their pregnancies.”
“What my partners and I – and Novant Health – are recommending is what the CDC and the American College of Obstetricians and Gynecologists recommends,” McGraw said. “And that’s to get a COVID-19 vaccine during pregnancy if they aren’t vaccinated already. We see a higher risk of severe COVID disease, a higher rate of ICU admission and intubation and higher rate of death in pregnant women compared to non-pregnant women.”
McGraw said Pelton’s ordeal is an example of just how arbitrary COVID is. “It’s so troubling because we really can't predict who’s going to get severely ill from it,” she said. “Emilia is an extremely healthy and active woman with really no medical problems. If you looked at her on paper, you would’ve thought she’d have a very mild COVID case. But COVID is unpredictable, and when you factor in pregnancy, that can change our physiology so much.”