03.11.09
The Power of Fetal Movement
The MSNBC article “Autopsies Urged to Unravel Tragedy of Stillbirth” (Associated Press, March 2, 2009) struck a painful chord. The worst experience any obstetrician wants to go through is admitting a pregnant woman into the hospital to deliver a dead baby. Stillborn deliveries are the ultimate dread in obstetrics and they affect twenty-six thousand women in our country each year.
While the article focuses on autopsies of stillborn babies as a means of diagnosis, we also need to seek a means of prevention. Although one-third of stillbirths occur for unknown reasons, a heightened sense of awareness of fetal movement is priceless. Live babies move. The most important question that I ask every patient during each prenatal visit is, do you feel your baby move? After twenty-three weeks, a patient should feel her baby move at least ten times within a four-hour period and once every ninety minutes during the third trimester. If the baby does not move within these periods, than the provider should be contacted immediately. If a provider is not available, the patient should go to the hospital as fast as she can. Fetal movement is extremely critical, yet as obstetricians, we don’t emphasize this point enough.
Watch, watch, watch is the key to a successful pregnancy, and there are tools that can assist along the way. A kick chart is a tool that helps monitor a baby’s movement and can usually be obtained from a healthcare provider’s office. This chart helps patients focus on baby’s movements. Pregnant women also need to be aware of tests such as non-stress tests and biophysical profiles that monitor the baby’s heartbeat, movements and breathing on an ultrasound for approximately thirty minutes.
Fetal movement is always a beautiful thing and reassures you that your baby is alive.
Love at First Sight
On a hot summer night almost thirty years ago, I fell in love at an inner- city hospital. My desire to lead a more fulfilling life led me into the emergency room to work as a volunteer. I had begun taking premed courses with the thought of applying to medical school but was insecure as to whether I could really become a physician. Although I had graduated from Columbia University School of Social Work three years earlier, my beloved alma mater had prepared me for a job that did not exist.
Summer heat and unrelenting humidity brings out the worst in inner- city residents. Tempers flare, patience is short and the slightest human infraction turns into a brawl. It was Saturday night, and the ER was jumping with wheezing asthmatics, women in pain, babies with spiking fevers and inebriated men speaking in tongues — a kaleidoscope of the human experience under duress.
I shadowed the resident physicians but also tried to stay out of their way. “This is not true medicine we’re practicing down here,” said a freckled face, dreadlocked female resident from D.C. “We’re just putting out fires.”
“What’s the chance that I can see an ob delivery?” I asked as the night wore on.
“Speak to the ob chief resident. He might give you a shot.”
About 2:30 a.m., the ob chief finally came down to the ER. He was intimidating but drop-dead gorgeous. After much interrogation and negotiation, I followed him to the fourth floor, changed into scrubs and entered into what would become my future. A young woman was in labor, pushing as hard as she could, and then a few minutes later, the curly hair of a baby’s head began to emerge. It was love at first sight. I had witnessed a miracle — and was never the same again.
