November 30, 2011
On a recent Sunday in the bathroom of the Baltimore-Washington International Thurgood Marshall Airport, a baby boy made his entrance to life. His mother was approximately 28 weeks and delivered prematurely, however both baby and mother were healthy according to the media. Although the details of the delivery are sketchy, anyone involved in obstetrics can predict what occurred.
The mother might have had a previous history of a urinary tract infection, or complained of back pain. Did her ultrasound reveal a short cervix? Or perhaps she had a history of a previous early delivery. If it was her first pregnancy, did she complain of mild abdominal pressure? Premature labor is one of the most common reasons for birth defects and has a price tag of approximately 26 billion dollars per year. The signs and symptoms of preterm labor often go unnoticed or diagnosed because healthcare providers aren’t paying attention. A urine analysis report showing bacteria in the urine will not be addressed. No inquiry will be made as to whether the patient made frequent trips to the bathroom or whether she drank soda. Soda predisposes patients to urinary tract infections because of the carbonation or bubbly component of the drink irritates the bladder. Untreated urinary tract infections can cause premature labor. A complaint of lower abdominal pressure will be attributed it to “round ligament pain” even though the patient is well beyond 20 weeks when it is most likely to occur. A complaint of back pain will be blamed on the changing shape of the uterus rather than sending the patient to the hospital for further evaluation. In essence, some healthcare professionals keep missing the diagnosis or intervening too late.
According to the American College of Obstetrician/Gynecologists (ACOG) pregnant women can travel up to 32 weeks by air provided they don’t have any complications or high risk conditions. The change in altitude can sometimes cause the “water to break” or the placenta to separate too soon. All pregnant women who plan to travel (especially by air) should consult with the OB provider for advice and instructions. For pregnant women who plan to travel, here are some suggestions:
- Obtain a copy of your prenatal record prior to traveling in the event of an emergency
- Find out the name of the nearest Level 3 hospital where you will be staying
- Do not sit for more than 2 hours without standing for a few minutes to stretch your legs to prevent blood clots.
- If you are complaining of back or abdominal pain before traveling, contact your provider immediately
Fortunately the baby born in the airport bathroom appears to be fine. However not all unexpected births have a happy ending. Pregnant moms, if you have to travel, please don’t push the envelope.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
September 7, 2011
Although Kathryn Stockett’s novel, The Help, had been a New York Times bestseller for months, somehow it had escaped me. However after hearing all the buzz about the movie, I was determined to see it even if I had to go by myself which ultimately happened.
Set in rural Mississippi during the turbulent sixties, on the surface, the movie appears to be about race relations between African American housekeepers and their Caucasian female employers, but as the lens sharpens, it becomes evident that the deeper meaning of The Help addresses issues regarding motherhood, fear, courage and trust. The characters are memorable such as Aibileen, an African American maid who has raised seventeen Caucasian children during the course of her domestic career. She becomes disturbed when the 2 year old that she cares for is emotionally neglected by her mother who is buckling under peer pressure from Hilly, the alpha woman who organizes the annual charity ball and spreads her unique brand of ignorance in the form of fear and intimidation. Hilly convinces her female counterparts that they all need to build outside toilets specifically for “the help” in order to avoid contracting mythical diseases. The discussion of Jim Crow segregation laws is nothing new in America. But what was unique about The Help is that we meet Skeeter, a young Caucasian college graduate who was raised by an African American maid whom she credits for giving her confidence. Skeeter looks beyond the occupation of the maids and seeks to discover their humanity. She asked Aibileen the very poignant question: “How does it feel to raise someone else’s children when yours are often left alone?” Aibileen diplomatically asks Skeeter to ask another question perhaps because it conjured up too much pain.
There are thousands of children left in the care of extended relatives or friends each year while their mothers work as domestic housekeepers taking care of someone else’s children. Some even leave their own country. I have met these women. I have been their physician. Their hopes and dreams for the future of their children are just as strong and vivid as mine. And if the truth be told, many housekeepers become an integral part of the family. What The Help demonstrates is that it is not easy to identify “them” versus “us.” The lines of those relationships are often blurred.
What we learn from the movie is that when women come together as a collective force, expect nothing short of triumph. The bond that unites us is far greater than the distractions that keep us apart.
February 7, 2011
In less than six months after writing Seven Reasons Why Pregnancy Becomes a Deadly Affair , the public outrage is faint and inaudible regarding domestic violence committed against pregnant women. The subject therefore has to be revisited again.
On a college campus, less than 90 minutes away from my home, a 17 year old woman was kicked and punched in her abdomen for no apparent reason other than she carried life within her womb. The alleged father of her baby, Devin Nickels, a college student at Florida State University was apparently not happy about his new prospective role. He purportedly contacted a high school buddy, Andres Luis Marrero, who now attended the University of Tampa and asked him to beat his girlfriend until she had a miscarriage for $200.00. Marrero, instead, offered to assault the girl for free.
According to the University of Tampa’s newspaper, The Minaret, Nickels drove his girlfriend to a secluded wooded area near an apartment complex and Marrero allegedly assaulted her despite her pleas that she was pregnant. The woman was treated at a local hospital and her pregnancy was still viable. Hours later, Marrero allegedly wrote about the attack on his Facebook® wall describing it as “fun”. He was subsequently arrested for armed kidnapping and aggravated assault on a pregnant woman. His father made a statement that his son was an “outstanding kid all his life” and he had no idea “where this was coming from.”Nickels was also arrested on the FSU campus.
Unfortunately these travesties continued. A Comcast.com online newsletter reported the story of a 17- year- old Ypsilanti high school that allegedly stabbed a classmate 12 times in the back of the head, with whom he had sex because she told him she “might be pregnant.” She ultimately had surgery that resulted in an intensive care unit admission. The classmate lived because she “played dead.”
A few facts are in order for those misguided individuals who look at violence as a means of ending a pregnancy. According to a medical study, violence does not influence pregnancy loss. A 45 year old pregnant woman has an 80% chance of having a miscarriage. A 17 year old girl, despite being kicked in the stomach does not. One of the consequences of having sex is procreation. According to CDC, 49 % of all pregnancies in this country are unplanned. Teens need to be aware of the awkward fact that if they have sex, there is a near 50% chance that they will become pregnant and if their partner is not happy, they are at a greater risk of experiencing domestic violence even to the point of death.
Violence against pregnant women is becoming unparalleled in its viciousness. How many dead bodies will it take before we start doing something about it?
August 23, 2010
Pretty is as pretty does. It’s an old adage my mom used to say but still holds true. An article in the Orlando Sentinel discussed how hospitals have deep pockets regarding providing amenities for maternity patients as a means of soliciting “business.” One hospital spent $112 million dollars on its new all women’s facilities. Its competitor than felt compelled to spend $16 million to refurbish its maternity floors. While flat TV screens, wood floors, granite paneled bathrooms and a masseuse are nice, do these perks add to the quality of obstetrical care?
Make no mistake, ladies, the cost of these amenities will somehow show up on your hospital bill. Elizabeth Cohen, of CNN’s show, The Empowered Patient discussed toothbrushes that cost over $100. And ironically, I ended up on her show discussing my dissatisfaction of having to pay over $800 for a $167 disposable pair of forceps during my own surgical procedure.
While it is nice to give birth in a comfortable atmosphere, the quality of care is equally important. One of my patients was pregnant with her first baby and wanted to deliver at an upscale hospital. I supported her decision because the hospital provides excellent obstetrical care and it also happens to be aesthetically beautiful. My patient worked as a manager, had a picture-perfect prenatal course and had third-party insurance. What could possibly go wrong? The lack of compassion from the admitting physician.
Although she was in the early stages of labor at 3 centimeters and extremely uncomfortable, the physician refused to admit her. His attitude was both condescending and demeaning. My patient was close to tears and her nurse was livid. When she presented to my office, it was obvious that she was uncomfortable. I offered to call the hospital and advocate on her behalf but she wanted no part of them. She requested to be delivered at a less upscale hospital where she was subsequently admitted and treated like a queen. So much for the “resort” environment.
Hospital perks might be great for marketing but they need to be accompanied with quality care and good old-fashioned courtesy.
A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
December 2, 2009
However, what Woods and I DO have in common is our public visibility. As a public health employee, my life is an open book.
A few years ago I had to report a former boss for inappropriate behavior based on several patients’ complaints. The case “blew up” because of his notoriety as both an elected official and a physician and I ended up with the media on my doorstep. The reporter, camera crew and satellite truck remained parked in front of my home for almost three hours, reported the 11:00 o’clock news and then finally left. Although I didn’t speak with them that night, I knew that I would have to do so the next day. “Never say ‘no comment’” was the advice that I had been given from a law enforcement agent who was investigating the case.
When I reported to work, a public information officer suggested that I participate in an elaborate scheme to avoid the media. And when I flatly refused, she told me that “I was on my own.”
The maintenance man and a secretary accompanied me as I walked out the door and faced the paparazzi. It was one of the most difficult days of my life. However, I was polite, non-judgmental and advised them that I was leaving the matter in the hands of the courts. My former boss lost his medical license and was removed from political office by the Governor. He faced criminal charges and the case dragged on for years.
In the court of public opinion Tiger, a lie unchallenged becomes the truth. The media is NOT going to go away.