Near the end of Karen's pregnancy we went every Tuesday to see our midwife, who checked Karen's urine and blood pressure as part of routine prenatal check-ups. Protein in the urine and hypertension are signs of a dangerous condition called pre-eclampsia that affects at least 5 percent of all pregnancies. On Feb. 3, four days before our due date, the midwife found protein in Karen's pee and recorded an elevated blood pressure. This was first sign of the condition that would lead to the complications that took Karen's life. I'll never forget that day. Karen picked me up after work on Bozeman's snow-clogged Main Street in the Volvo wagon I had recently bought her for the drive to our midwife's office outside Livingston. On the way, Karen stopped in the historic rail town to pick up a red ceramic utensil holder for the kitchen. I had been storing our spatulas and wooden spoons in a glass pitcher Karen hated. It was a day like so many others with work and errands. The midwife insisted Karen go on bed rest. That night Vicki Davies and Ann Van Den Eden made a cast of Karen's belly. It was the last night Karen and I would sleep together at home.

The next day, Randa Chehab came over to check Karen's blood pressure and this time it was really elevated. The midwife rushed over and drew blood to have a platelet count performed. Low platelets are another symptom of pre-eclampsia, which can manifest as a series of organ failures. Pre-eclampsia can be managed in early-term pregnancies, but the only cure is to deliver the baby. By the time I got home, the midwife had already called off the idea of a home delivery. Karen was sobbing on the couch and Vicki was leaving with our cat Q. When we got word that Karen's platelets, an element of the blood that promotes clotting, were depressed, the midwife instructed me to get packed. We were at the hospital a few minutes later to have our baby delivered, although Karen was not the least bit dilated.

The obstetrician on duty decided a vaginal delivery was the safest option. Karen's elevated blood pressure was becoming erratic and put Karen in danger of seizures. An ulcer medication was applied to Karen's cervix to loosen it up and we spent several hours waiting for her to dilate. We snuggled on the bed in the delivery room, talking about how much we loved each other and excited for the future. When the cervix opened enough to manually break the bag of waters, her labor started. Karen wanted no pain medications, but she had to take meds to control her blood pressure and prevent seizures. These drugs made her a little goofy and impaired her ability to push the baby out. The four-hour labor and delivery went fairly smoothly considering the challenges involved. There were a few frightening moments and we had to use this vacuum suction tool on the baby's head to pull her out. Aryana emerged looking like a cone head and a shade bluer than the color of grape juice.

"I love you, Babula," Karen kept saying as the delivery nurses worked over the 6-pound little human who was lethargic from the influence of the meds. Meanwhile, the placenta failed to make an appearance. Over the next few hours, the finest day of my life turned into the worst.

It was during the post-natal surgery to remove the wayward placenta that Karen suffered a major and ultimately fatal loss of blood. Karen's hemorrhaging practically bankrupted the local supply of AB blood. High Patrol troopers were delivering blood products from United Blood Services on Feb. 5 as surgeons struggled to save Karen's life. More than 20 units of other people's blood were poured into Karen. These days I open my vein for the blood banks every few months. I aim to eventually give all that blood back and then some.

Karen and I started trying to get pregnant in the summer of 2002. She had this anxiety that she had fertility issues because her periods were so erratic and we were advised in January 2003 that it would be a real struggle conceiving. So we were shocked to learn we were pregnant a couple months later. Out of the blue, Karen suffered mysterious abdominal pains. On March 24, 2003, we saw her OBGYN, who discovered the fetus developing in the right falopian tube. That night, the tube and the six-week-old creature were surgically removed. Karen recovered quickly and we got another baby cooking in about six weeks, which may have been some kind of speed record for post-surgical conception.

Karen enjoyed an active summer while pregnant with Aryana, leading tours around Yellowstone and Paradise Valley, without any problems. But about halfway into the pregnancy, in October 2003, Karen again had mysterious abdominal pains, again on her right side. This time, the ovary "torsed," or flipped over, necessitating its surgical removal.

Maternal deaths are so rare for us that when they do occur they seem like tragedies of archetypal proportions. Our society has managed most of the risk out of pregnancy, but before the era modern medical intervention, pregnant women commonly died from complications. Many famous men of American history lost their wives this way. Thomas Jefferson fell out of public life for a time while he nursed his grief over the post-natal death of his wife Martha Wayles Skelton in 1782. Recently, while I watched Cold Mountain, the movie based on the Civil War novel, it struck me that all three of the story's main characters grew up without their mothers. Maybe the author Charles Frazier was making a point about the resilience of 19th century Southerners, but his story highlights the historical fact that women of child-bearing age used to be at serious risk of premature death.

And they still are in the developing world. Pregnancy complications kill about half a million women around the world each year. All but 1 percent of these fatalities occur in the less developed parts of the world. The worst statistics occur in Africa where one in 16 pregnancies end with the death of the mother, according to the World Health Organization. The incalculable social costs of these losses must be staggering. In our country and Europe, only about one in 2,800 pregnancies kill the mom. Why did it happen to Karen, a woman so healthy, strong and conscious about her health? I ask myself that question every day.



To learn more about pre-eclampsia visit the web sites for the Preeeclampsia Foundation and the the HELLP Syndrome Society.

You can also learn more about the World Health Organization's work documenting the disparity in maternal survival between rich and poor nations at http://www.who.int/features/great_expectations/en/.

Sam Whitney and Joanne Payne made this quilt panel in Karen's memory. It will be added to a quilt honoring the women who have lost their lives in pregnancy. For more information see the Safe Motherhood Quilt Project.