But the biggest emergency unfolded in the early morning. A 24-year-old, 300-pound diabetic woman, who was pregnant with her first child, had developed pre-eclampsia. Pre-eclampsia is a complication of pregnancy marked by elevated blood pressure, swelling and mild to severe organ dysfunction. If untreated, it can lead to the mother’s having seizures, stroke and liver rupture, and is a leading cause of maternal death. Although pre-eclampsia can occur in any pregnancy, it is three times more likely in obese patients. New research suggests that babies born to women with pre-eclampsia may have a significantly higher chance of autism or developmental delay. The only treatment for it is to deliver the baby, so this patient had been given drugs to induce her labor.

At 5 a.m. I was urgently called to her bedside. She was having seizures from the swelling and elevated blood pressures. Her baby’s heart rate dropped from 100 beats per minute to 70 to 40, and then the signal was lost — the monitor had come off.

As we worked to treat her seizure, we moved her to the operating room. We needed to sedate her, but struggled to find a vein. We needed to intubate her, but her airway was obstructed from the obesity and the swelling. Just moving her onto the operating table required an additional team: the table was too narrow and the straps too small.

Once she was safely secured to the table and intubated, I checked for the baby’s heartbeat. There was nothing on the monitors. Nor could I see the heart with the ultrasound, as the mother’s abdominal wall was too thick and swollen. There was nothing I could do but deliver the baby surgically and hope that it would survive. Quickly, I cut straight through her swollen abdomen and uterus. I reached through her placenta, wrapped my hand around the baby’s head and pulled it firmly out of the incision. As I gently extracted his body and untangled his legs from his pulsating cord, he clenched his fists and gasped.

Later that morning, when I left to go home, I was deeply grateful that all my patients and their babies were safe. There were many close calls.