July 2, 2012
A Maryland jury made history by awarding Enso Martinez and Rebecca Fielding $55 million dollars but there are no winners in this tragedy. Enso Martinez Jr. has irreversible brain damage and Johns Hopkins Hospital will spend resources that could be used for research for direct patient care, to defend their care of Fielding.
Home birth in the U.S. has increased by 20% in part, because of Ricki Lake’s documentary, The Business of Being Born. Women want to have their babies at home despite the admonishment and warnings from the American College of Obstetricians and Gynecologists. To all pregnant moms who want to have their babies at home, I get it. I truly do. You want a comfortable intimate environment to have what you deem is a “natural event” without “unnecessary intervention.” You want to be like the celebrities who have had successful home deliveries. But here’s the problem: your home is not equipped to deal with emergencies and they DO occur. Just ask celebrity mom Christine Turlington Burns, who experienced a postpartum hemorrhage and had to be rushed to the hospital in order to save her life. Obstetrics is a specialty of the unexpected. You MUST be prepared for emergencies.
Fielding entered Johns Hopkins Hospital because the baby was “stuck.” The midwife couldn’t deliver the baby because it was either too large or she couldn’t manage a shoulder dystocia. According a blogger, Dr. Amy Tuteur, Midwife Evelyn Muhlhan’s license was suspended by the State of Maryland because of five homebirth disasters including Fielding’s delivery.
An ambulance brought Fielding to a hospital where she allegedly waits for over 2 hours for blood test results. A c. section is delayed. A baby has brain damage. Take home message?
- Know your midwife’s professional record. Does she have malpractice suits? Has she been sanctioned by the state medical board for negligence?
- Meet your midwife’s ob-gyn back-up. The Smart Mother’s Guide to a Better Pregnancy discusses this in detail. At the first sign of trouble, Muhlhan should have contacted her ob backup. If she didn’t have one, she was begging for trouble.
- Have a PERSONAL copy of your prenatal chart with you and your back-up hospital or birthing center should have a copy as well. This is standard prenatal procedures. Having a homebirth doesn’t change that. Your prenatal record contains all of the important information including blood type and blood count. No one, I repeat NO ONE, is going to bring you into the operating room without knowing your blood type unless you are hemorrhaging to death. Had Fielding had a copy of her prenatal record, she might not have encountered the delay.
If you’re going to have a homebirth, then please take the necessary precautions. An ounce of prevention is always worth more than a pound of cure.
September 27, 2010
Two years ago, a male partner with two pregnant girlfriends both attended my clinic. They were due within weeks of each other; aware of each others’ pregnancy; didn’t get along and it placed our staff in an awkward position. We scheduled their appointments on different days and prayed neither one would show up unannounced to the other’s appointment.
Last week, I encountered yet another challenging experience. The husband of one of my new patients, looked extremely familiar. His wife appeared very upset but spoke another language. The husband had to interpret because we did not have access to someone who spoke her language and it was never suggested during her initial exam that she needed an interpreter. The husband was somewhat abrupt as I began to ask questions. I turned my attention to his wife and hoped that she could understand me. “Are you unhappy?” I asked. She shook her head yes. And when I asked why, she burst into tears. Her husband was clearly embarrassed and stated that they lived with his brother and pregnant sister-in-law which was a common practice in their culture. It seems the brother was in our office the day before accompanying his wife. I asked the patient’s husband whether he was a twin, and he stated yes. My inquisitive medical assistant swore it was the same man who in fact had accompanied both women (perhaps wives) to our office. My main concern was making certain that the patient was not a victim of Domestic Violence and spent an unexpected additional thirty minutes during her prenatal visit. This week, I will review both patients’ charts to determine if we are dealing with twin husbands, or in fact, a bigamist.
The CDC estimates that 4-8 percent of pregnant women in the U.S. are abused by an intimate partner. In my next blog post, I will address the issue of domestic violence and pregnancy. In the meantime, I will also watch this patient very closely.
May 17, 2010
On February 10, 2010, Katy Hayes, a free lance massage therapist and mother of two, gave birth at home to her 10 pound daughter after 8 hours of labor without medication or intervention. (See AOL’s link http://alturl.com/8bh9). It is not known whether the home birth was attended to by a midwife.
Katy did not have health insurance, nor did her husband, Al. Four days later, Katy was rushed to the hospital because of increased excruciating pain and almost died shortly thereafter. She experienced massive organ failure, and then lapsed into a coma. Katy had Group A streptococcal disease which causes strep throat or mild soft tissue disease. However if this bacteria gains access into the blood stream its effects can be devastating. It causes necrotizing fasciitis or the “flesh eating bacteria.” It is also responsible for Streptococcal Toxic Shock Syndrome, commonly referred to as either “Toxic Shock Syndrome” or TTSS. This infection has been on the rise in the U.S. since the 1980’s with 8 to 10 thousand cases occurring annually and 30% of people affected still die each year.
Katy’s husband faced a major dilemma. The physicians informed him that the only way to save Katy’s life was to remove the source of the infection which was her uterus. In addition, all four of her legs and arms had to be surgically removed as well as her ovaries, stomach and part of her intestines. And there was still the possibility that she might die. Al made the heart-wrenching decision for Katy to have the surgery.
Katy regained consciousness on March 12th and is on a slow but steady road to recovery. She will have to be fitted for prosthesis of her arms and legs and her greatest desire is to hold her baby and return to her family. Her friends and family are conducting fund raisers to pay for her hospital bills.
Some schools of thought will argue that Katy should have never had a home birth. Others will defend her right to do so. I hope Katy did not opt to deliver at home because she lacked healthcare insurance. That would be a moral tragedy. I wish I could turn back the hands of time because here’s what Katy should have known:
- Older women (those over 35) have an increased risk of birth complications. Katy was 41.
- There are federally funded community health centers to take care of the uninsured.
- A fever after childbirth needs PROMPT attention. Katy had a fever for four days before she was taken to the hospital.
Let’s all pray for Katy’s continued recovery and a swift return home to her baby.
Join the FB page created for Katy by clicking here http://www.facebook.com/group.php?gid=343063085090