This much is clear: Annie (Cragg) Sterle is a medical miracle. There’s no other way to explain what happened five and a half years ago, after she nearly died on what should have been the happiest day of her life.
Sterle ’13 was in labor with her first child when she was struck by amniotic fluid embolism (AFE), a rare and often fatal complication. Her son, Henry, was delivered via emergency cesarean section. She went into cardiac arrest and bled uncontrollably. Nearly 50 people crowded into the operating room in the frantic rush to save her — at a Minneapolis hospital grappling with the first wave of COVID-19 in March 2020.
For the next 17 days, Sterle lay in a coma, given only a slim chance of waking up and even slimmer odds of regaining full physical and cognitive function. She made a complete recovery, leaving her and her husband, Tony Sterle, overcome with gratitude.
They got their miracle. Then came the aftershock, when the Sterles faced a mountain of emotional wreckage they were not prepared to handle.
“You wake up from a prolonged coma that no one thought you would recover from, and you’re on top of the world,” Annie says. “I had made it. Then life goes on for everyone else, and you’re the one who has to live with this trauma forever. You’re the one who has to make meaning of it and heal. That can be a very lonely process.”
The marvel of her survival gave way to profound grief as Annie recognized what AFE stole from her: She was separated from her baby for the first 24 days of his life because of the hospital’s COVID restrictions. Once she came home, she was too weak and exhausted to care for Henry, watching from the sidelines as others bonded with her child. Annie began to believe she might never experience joy again. Over time, she realized she couldn’t erase her pain, but she could still fight her way back to the life she wanted.
She and Tony are living it now in their comfortable Minneapolis neighborhood. Henry is a healthy 5-year-old kindergartner, long removed from his days in the neonatal intensive care unit. Last year, Annie, 34, gave birth to a daughter, Helena, on a day blessed with all the beauty and tenderness she and Tony had missed the first time around.
Annie’s healing started after she connected with other AFE survivors. Inspired to pass on that support, she is promoting a documentary film, 24 Days Without You, which tells the story of her medical crisis and its aftermath.
When Annie started the project with filmmaker Rebecca Rizzio, she hoped it would help her process her emotions. It evolved into a way to assist women who experience AFE and other birth traumas, as well as the doctors and nurses who treat them. Since the documentary premiered last October at the Twin Cities Film Fest, Annie has offered screenings to medical conferences, hospitals, clinics and educators, seeking to raise awareness of AFE and the mental-health needs of survivors.
“I cried through the whole movie,” says Dr. Elizabeth Elfstrand, who delivered Henry in that chaotic operating room. “What happened to Annie was a tragic, horrific event. She didn’t have to be vulnerable and tell her story. But she chose to take this path, and I give her a lot of credit for that.”
To Annie, it felt more like a calling than a choice.
“An experience like this can turn you into someone who’s really hurt and angry,” she says. “Or, if you get the right help, it can make you more empathetic; make you want to get back and do a little good.
“That was my call to action with the film. After something like this happens, how do you make things better for the next generation? I want to do my part.”
The AFE Foundation estimates that amniotic fluid embolism occurs in one of every 40,000 deliveries in the United States. While maternal death is itself highly uncommon, AFE is a leading cause, with a mortality rate ranging from 20 percent to 60 percent. Because AFE is so rare and so deadly, little data exists for researchers to study. That — and a lack of research funding — has kept its mysteries intact, preventing doctors from fully understanding what causes AFE,
who could be at risk and how it might be prevented or treated.
It’s normal for amniotic fluid to enter the mother’s bloodstream during childbirth. Research suggests AFE is triggered when the body reacts abnormally to that fluid, with a massive immune response similar to anaphylactic shock. The catastrophic consequences often include cardiac arrest, respiratory failure and disseminated intravascular coagulation, which causes uncontrollable hemorrhaging.
Annie had never heard of AFE until it came for her. On March 22, 2020, she and Tony drove to The Mother Baby Center at Minneapolis’ Abbott Northwestern Hospital. With COVID spreading rapidly, the center was inducing labor in all low-risk pregnancies — including Annie’s — to reduce time spent in the hospital.
The next morning, as Annie’s contractions intensified, a nurse came to check on her and discovered the baby’s heart rate was dropping. Annie said she felt like she was going to faint. Within seconds, she lost consciousness and went into respiratory failure.
“I saw her go lifeless right in front of my eyes,” Tony says. “The nurse called for help, and 10 more nurses rushed in. They immediately took her to the operating room.”
Elfstrand hustled to the OR to find Annie unresponsive. With Annie’s vital signs in free fall, the doctor knew she had to get the baby out as soon as possible. Henry was not breathing and had to be resuscitated when he was born via C-section at 8:04 a.m.
He was sent to the NICU, where he was placed on an ice blanket to protect him from brain damage. Tony, left alone in the room where Annie was supposed to deliver their child, desperately waited to learn what was happening to his wife and baby.
At 8:11, he heard the code-blue call go out over the hospital intercom. Annie had gone into cardiac arrest.
“My labor and delivery nurses start doing CPR,” Elfstrand says. “Teams were coming in from all over the hospital: a perinatologist, the blood bank, ECMO. It was loud and chaotic and crowded. But every team did exactly what it needed to do.”
Though Elfstrand had never encountered an AFE, she had studied it and recognized the signs. She knew what was coming next. As she finished the C-section, which took just 15 minutes, Annie’s abdominal tissue began turning white. Elfstrand covered the surgical wound, and blood surged through the bandages.
AFE patients can die from massive hemorrhaging. Nurse Randi Clark squeezed donor blood into Annie as fast as she could, while the blood Annie was losing pooled under Clark’s feet.
Over the next several minutes, doctors used a mechanical CPR device to deliver chest compressions. Annie continued receiving transfusions. With her heart and lungs failing, she needed to be connected to extracorporeal membrane oxygenation (ECMO), a machine that would do the work of those organs.
Dr. Michael Mooney, an interventional cardiologist, marshaled the ECMO team. From their base across the street at Abbott Northwestern, they grabbed the equipment cart and ran the half-mile distance to The Mother Baby Center.
Annie had no pulse and low blood volume, making it a delicate task to connect her. Mooney got it done at 9:01. While the medical team worked to keep her alive, Tony was taken to the NICU to meet their son.
Henry lay in an incubator, with a breathing tube in his trachea and electrodes monitoring his brain activity. His father could not hold or touch him. Henry’s initial Apgar score, which measures newborns’ health, was zero.
Still, within two hours of Henry’s birth, doctors told Tony his son would survive. They were not so sure about Annie.
“You walk into the hospital thinking it’s going to be the best day of your life,” Tony says. “Then, 12 hours later, you go home by yourself. Your son is in a box on an ice blanket. Your wife is on ECMO. You don’t know if you’re going to get a call in the middle of the night saying she passed away. It’s just a hollow feeling.”
While Annie clung to life, Henry’s condition rapidly improved. An MRI showed no damage of any kind. After six days in the NICU, he went home with his father without ever meeting his mother.
Once Henry was out of danger, Tony asked about taking him to Annie’s room. The hospital staff resisted. They were trying to contain a virus they knew little about, except that it was highly contagious and potentially deadly. Tony worried about COVID, too, so he didn’t push back — a choice he and Annie would second-guess in the months to come.
The NICU nurses taught Tony how to bottle-feed and change diapers. For nearly two weeks, he toggled between two worlds. At home, he nurtured a newborn son. At the hospital, he faced the reality that Annie might die.
Tony managed to talk his way around the COVID restrictions and into Annie’s room for a few hours a day, wearing an N95 mask and slipping swiftly through the empty hallways. He read that hearing voices can help coma patients, so he asked the nurses to play recordings of family and friends telling stories from Annie’s life. They also played the couple’s wedding video.
An MRI showed Annie had suffered multiple strokes and brain bleeds. Day after day, Tony searched for evidence that his wife could hear or understand. He found none. And the longer she stayed in the coma, the lower her chances were of coming out of it.
Neurologists gave Annie less than a 5 percent chance of resuming her life as she knew it. It was suggested that Tony consider end-of-life care for the woman he had married only 15 months earlier.
“The neurology team said, ‘The person you know is gone,’” Tony recalls. “They thought she would be in a vegetative state or have significantly diminished physical and cognitive function.
“But knowing Annie, if she was still in there, she was going to do everything she could to come back. If there was any chance she could make a recovery, I wanted to give her that chance. I wasn’t going to give up until hope was truly gone.”
Mooney felt the same way. A longtime friend and medical partner of Annie’s father, Dr. Andrew Cragg, he couldn’t dispute the grim facts. But in the operating room, when Annie teetered at the edge of death, Mooney sensed “a little aura around her.” He felt an undercurrent of grace aiding the doctors’ work, which he took as a sign. “I told them, ‘I don’t think we’re done with Annie,’” Mooney says. “‘I think she’s got a real chance, and we’ve got to wait this out.’”
As the coma stretched into a third week, Elfstrand talked to another physician involved in Annie’s care. Both of them wept. Annie wasn’t doing well, and doctors planned to move her to a rehab facility for people with brain injuries.
Elfstrand arose on Easter Sunday with little hope. Then her phone rang. It was Dr. Allison West, Annie’s primary care physician.
“You won’t believe who I’m talking to,” West said. “It’s Annie. She woke up. And she wants to know everything.”
When Annie Sterle opened her eyes on April 9, she expected to see the ocean. In a vivid, disturbing dream during her coma, she and Tony had gone to the Caribbean for a vacation; she had given birth to a stillborn baby and been evacuated to a hospital in Florida. The dream ended with Tony adopting another infant.
Once she awoke, Annie couldn’t speak because of the breathing tube in her windpipe. The strokes had impaired her right arm, so she couldn’t write. She looked out the window to see the colorless landscape of a Minnesota spring, but that didn’t make sense to her.
Everything else seemed exactly as it was in her dream. She wasn’t pregnant. She had no baby with her, and she was in a hospital. Annie’s mind insisted she must be in Florida, mourning a child who had died.
“I was sitting on the side of the bed,” she recalls. “I started crying. My dad was there, and I mouthed to him, ‘I had a miscarriage.’ He couldn’t read lips, so he had no idea what I was saying. But he said, ‘I know. I know.’ I was getting that affirmation, so I believed everything in the dream was real.”
Tony showed her pictures of Henry and told her all about him. Still, it was hard for Annie to comprehend she had given birth to a son, a child she had never held or kissed or even seen.
It took five days for her to fully understand what had happened. Two more would pass before Henry was brought to her, after she was transferred to a rehab center.
Medical staff again told Tony that COVID protocols prohibited babies from visiting. This time, he insisted. He was told Henry could come in for one hour.
The family reunion ended after five minutes. Tony worried about COVID infection, inflaming his already jangled nerves. A disapproving nurse hovered in the corner, while Annie struggled to hold her baby.
“Everyone thought it was going to be wonderful,” Annie says. “But because of the situation, it wasn’t as beautiful or magical as I wished. You hope maybe you can replace what you lost on the day he was born. But you can’t.”
Annie came home on April 21, 29 days after Henry’s birth. She tried to share parenting duties with Tony, but neither her brain nor her body was fully healed. She suffered vertigo and slept 16 hours a day.
Her doctors urged Annie to take care of herself. She knew they were right, but stepping away from caregiving created more distance between her and her son.
In hindsight, Annie feels things might have been different if Henry had been brought to her while she was in the coma. She believes she would have sensed his presence, giving them a chance to start bonding. Instead, Henry was taken away as soon as he was born, and they were kept apart for 24 days. It felt like a fracture, Annie says, one she didn’t know how to mend.
Her mental state grew worse and worse. COVID lockdowns kept Annie sequestered at home, and no one understood her emotional scars. She constantly heard how lucky she was to be alive and how grateful she should be. She was, but that gratitude lived alongside sorrow and loss and resentment.
“So many things went wrong,” Annie says. “It was all adding up. I know everyone was doing their best, but I had a lot of anger at the circumstances.
“I let myself get to a very bad place. And Tony had his own demons. So there were two traumatized people in our house trying to take care of a baby. It was the worst year of our lives.”
For a while, Tony didn’t recognize the toll things were taking on him, even as his easygoing nature turned anxious and edgy. His wakeup call came on the day he punched a wall and blacked out in anger.
“I was prepared to do my duty for my family, taking care of my son and helping my wife,” Tony says. “I wasn’t prepared for the impact the event would have on my own psychological state. We both had a lot of healing to do to get our lives back.”
While doing some online research into AFE, Annie discovered a lifeline. She stumbled across an Instagram post by Kayleigh Summers — known on social media as “The Birth Trauma Mama” — detailing Summers’ own experience with amniotic fluid embolism.
Struck by the similarities, Annie sent Summers a message. That led to long, frequent chats that gave Annie something she desperately needed: validation. Finally, she met someone who knew the same pain, the same loneliness, the same challenges that come with surviving an often-fatal condition in childbirth.
“Most people have never heard of AFE,” says Summers, a licensed therapist who leads support groups for birth-trauma survivors. “Isolation is one of the most prominent features of birth trauma, and bridging that is a key to healing.”
Little by little, Annie fought her way back. She and Tony each went into therapy. As she grew physically stronger, she could take on more parenting duties and looked for the quiet delights in her daily routine. Her doctors prescribed a short course of medication. During the winter months, when things seemed especially bleak, Summers checked in with her every day.
Annie’s healing accelerated once COVID lockdowns eased in 2021. She could return to things she treasured, like family gatherings and meetups with friends, and grow closer to her son through all the fun kids’ activities that had been shuttered by the pandemic.
Summers once promised Annie a time would come when Henry saw his mother as the center of his world. Annie sometimes doubted it would happen, until it did.
“I remember going downstairs to play with him, and it was the first time he showed a preference for me, not my husband,” she says. “It was a very affirming moment. He wanted to spend time with his Mom.
“It was amazing how quickly we were able to form a really beautiful relationship. Because I put in the work to heal, I could really be there for Henry.”
Making the documentary film became an unexpected pathway towards that end. Rizzio, the filmmaker, who is Tony’s cousin, had been looking for a subject. In the spring of 2021, she approached Annie about telling her story.
Annie jumped on board. By doing research and interviews, she could reconstruct the experience, gaining new insight into what happened and how she survived. At the same time, she could pull back the curtain on her pain, offering a window into the destruction caused by AFE.
She and Rizzio worked on the film intermittently for three and a half years. At home, Annie pursued another emotionally charged project: convincing Tony they should have a second baby.
She raised the subject only a month after her near-death experience. Despite the lack of evidence that AFE survivors face a greater risk of recurrence, Tony wasn’t willing to take the chance. “You touch a hot stove once, and you’re not going to do it again,” he says. “We always wanted to have more children, but I was very opposed to it.”
For Annie, the fear of regret outweighed her fear of AFE. If they didn’t try to have another child, she would spend the rest of her life wondering if they made the right choice. Eventually, she persuaded Tony to take a leap of faith.
Several people who helped save Annie returned to her side for her daughter’s birth at The Mother Baby Center on April 2, 2024. Elfstrand and Annie constructed a detailed plan for the day. The baby would be delivered via C-section before Annie went into labor, lowering the chance of complications. Specialists at the hospital remained on standby.
“I tried not to be too nervous,” Elfstrand says. “But that day, I was. We were in the same place with the same people, and a lot of them needed closure. They wanted to be part of something good.”
Helena was born without the slightest bit of drama. While Annie could never change what happened with Henry, her second child’s arrival brought a measure of joy to counter the sorrow.
“Once she was born, my fears went away,” Annie says. “I thought, ‘She’s here. I did it.’ It was a very beautiful experience, and I was just grateful to have it in my memory bank.”
Her second project came into the world last October. Annie’s medical team gathered again, minus the scrubs and masks, at a suburban Minneapolis theater for the premiere of 24 Days Without You.
The film emphasizes that Annie’s survival hinged on top-notch medical care. The Mother Baby Center and Abbott Northwestern had the specialized equipment she needed, wielded by experts trained for emergencies. They acted swiftly and trusted each other to make the right decisions.
The documentary also reminds doctors and nurses that for patients like Annie, the healing doesn’t end when they’re discharged. “On the surface, their brains seem to be working pretty well,” Mooney says. “But they’re a mess, trying to put their lives back together. We need to develop tools to help them find support and let them know they’re going to be OK.”
Annie believes she emerged from her trauma as a better version of herself. She learned how to be present for people in need, to offer the kind of understanding and empathy that can help others find the same peace she did. It’s a blessing she’s trying to share through the film.
She’ll never be able to explain her miracle. All she can do is make the most of it. “For a long time, I was really, really angry,” Annie says. “You can make the choice to stay in that space, or you can put in the work to get out of it.
“Now, things are incredible. We’ve made something really beautiful out of tragedy. And I think that’s the grief journey. The healing has to happen to see the light.”
Rachel Blount is an award-winning journalist based in Minneapolis. Her career as a sportswriter has included coverage of the Olympics, the NHL and college sports, most recently at The Minnesota Star Tribune.
Editor's note: The documentary, 24 Days Without You, is available to rent for $9.99 for a limited time.