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.
November 7, 2011
A recent article about the shameful infant mortality rate in the U.S. caught my attention. Certainly the statistics quoted are nothing new but still remains alarming. However, the Op Ed by CNN contributor Deborah Klein Walker gave the subject matter a new spin. Walker wrote “This is one of the greatest injustices in our country: that a baby’s chance of having a healthy life is largely dependent on where he or she is born. States and local communities vary widely in what care their leaders choose to provide to women and children.” If Dr. Walker were present, I’d give her a great big hug for her courage to say what no one else dared. A baby can die based on a hospital zip code.
Every pregnant mother needs to take a mini course in hospital politics because they are directly affected. A hospital is no longer a place of healing. It is a business and at times, ruthless. I have witnessed a colleague forced out of business because she said no when a hospital wanted to buy her practice so they withdrew her admitting privileges instead. I recall bitter battles with my former employer because I would not encourage my patients to deliver at a hospital that was notorious for being under staffed, overworked and a haven for medical errors, simply because of a business relationship that my employer had with thatehospital.
I commend our federal government for initiating programs such as Healthy Start and the new home visiting program, but dependence on government assistance alone cannot guarantee a healthy baby. A pregnant mom must do her due diligence. She must investigate the credentials of the provider and hospital where she intends to give birth. What should a pregnant mom do if she lives in a community or state that has a high infant mortality rate? Give birth at a teaching hospital that’s affiliated with a university or medical school. Most of these institutions receive federal and state financial support and are obligated to provide care to patients.
Can a baby die based on the zip code where it’s born? Unfortunately, yes unless the mother is willing to do her homework and take the necessary precautions to avoid that from happening. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
October 5, 2011
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession. Loni Hildebrandt was a 29 year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and her boyfriend saved their money and obtained fertility treatments. Her mother, Jo Novtny, a nurse of 30 years was ecstatic when she saw the ultrasound of her two grandbabies but her happiness was short-lived. One day after the procedure, Hildebrandt began to bleed so they went to Sarasota Memorial Hospital in Florida.
Sarasota Memorial Hospital has an excellent maternal fetal medicine (aka high-risk obstetrics) department but Hildebrandt never made it there. She got as far as the hospital’s emergency room where she was attended to by one of its physicians. Despite repeated requests to have her blood sugar checked, Hidebrandt had to wait six hours before it was done. An ultrasound at the hospital revealed a blood clot that was causing the contractions and the ER doctor told her that he could probably save one by “suctioning the clot so the labor would stop.” According to The Herald Tribune, the physician suctioned the clot and one of the twins as well. Hildebrandt allegedly began bleeding more, passing bright red blood clots. They called for help but no one came. According to the newspaper report, a nurse put the afterbirth in a bedpan and left it near Hildebrandt’s head where she was lying. Her mother moved it and placed it under her daughter’s bed. Novtny ultimately delivered the second twin because no one else was around. The ER doctor returned to the room saw the fetus in Novotny’s hand took it from her and put it in a bucket.
Novtny states her daughter did not receive proper treatment until her personal physician arrived and remained in a pool of blood for over 10 hours. Hildebrandt’s iron count was dangerously low because of the bleeding. Her mother’s request to speak with the hospital administrator was met with no response so she wrote a letter to the governor instead. An investigation was done, gross negligence was found, the ER doctor resigned and Hildenbrandt’s nurse was cited for “lack of critical thinking skills.” The hospital will now have unannounced federal inspections in order to keep their Medicare payments. The hospital administrator issued a public apology.
Perhaps one day hospitals will do the right thing, even when no one is watching. Hopefully, Hildebrandt will become pregnant again and have a better outcome.
June 8, 2011
She was well past age 35 when she showed up in the emergency room inebriated, confused and complaining of a swollen stomach. One might ask shouldn’t she be able to tell whether she was pregnant after giving birth to so many children? Perhaps she was in denial because pregnancy had not served her well. Each child she brought into the world eventually became the ward of social service.
An ultrasound was done and the baby was in plain view. There could be no more denial. It was a third trimester pregnancy. An emergency room physician listened to the fetal heart rate and declared it normal. She requested that social service be contacted as the alcohol began to wear off. Perhaps she was mandated to do so if she ever became pregnant again. When social service was contacted they advised the hospital staff to call the police who in turn, deemed she should go to jail because of an outstanding warrant.
It was not known how long the fetus had been exposed to alcohol but no one bothered to contact an obstetrician. Or place her on a fetal monitor. Instead, the ER doc wrote on her discharge summary to contact an obstetrician in the event that she was incarcerated for more than three days. She refused to allow the ER doc to do a pelvic exam but the nurse did one instead. However, the pelvic exam was not documented on her chart.
It’s not clear what happen when she arrived at the jail. There were no patient records available for review and an obstetrician was not consulted or called. 48 hours after her hospital discharge, while sitting in her cell, she felt like she had to move her bowels, screamed for help and then pushed as hard as she could, and her baby landed into the toilet like a projectile. Its umbilical cord was severed from the traumatic birth and it nearly bled to death. By the time the ambulance arrived, the baby was lifeless but CPR brought it back to life. If only this story had a happy ending. The baby has severe brain damage and required life-saving surgery on its heart because it was born with an anomaly. Had the hospital kept the patient or obtained an OB consult prior to her discharge, the results of her delivery might have been more favorable.
Did she need to wear a neon sign to alert the hospital staff that she was a high-risk patient? No prenatal care. Alcohol abuse. Advanced maternal age. Need I go on?
Life should not begin in a toilet bowl. Its effects can be indelible, far-reaching and devastating.
[i] This is an actual medical malpractice case that I was asked to review and given permission to discuss.
May 11, 2011
At one time, a hospital would be called a 24-hour institution but now it’s a business. Within this business are shift workers that include nurses, technicians, clerical staff and even hospital employed doctors who are now called hospitalists. In a teaching hospital resident physicians also work in shifts so the responsibility of patient care is always being transferred from one group of healthcare providers to another. Do they always communicate effectively? Regrettably, “no.”
Sign-outs, handoffs, shift changes, nurses’ report. These are the multiple names for the process where a departing provider is responsible for letting the arriving provider know what’s going on with the patient. According to statistics, 80% of medical mistakes occur during shift changes and 50 to 60% of them are preventable. Listed below is an excerpt from The Smart Mother’s Guide to a Better Pregnancy that teaches pregnant moms what things should be known during a shift change.
“While in labor, there will most likely be a change of shift and a transfer of information should occur. However, it is not always successful. Information is sometimes lost, incomplete, misunderstood or inaccurate. Your doula or a family member should make a list of all tests that have been ordered since your admission. He or she should also know your most recent vital signs, including your blood pressure and whether your baby’s fetal tracing was reassuring. Other important include:
- The length of time since your membranes ruptured: the longer your membranes have been ruptured, the greater your chances of developing an infection in the amniotic sac around the baby called Chorioamnionitis
- A positive group B strep that must be treated with antibiotics to prevent your baby from contracting the infection
- The length of time you have been receiving Pitocin. The status of your fetal tracing should be noted to make certain that the baby can tolerate the contractions caused by Pitocin.
- Any other significant clinical issue that might have been discussed that could adversely affect your labor
Before the end of a shift, your family member or doula might ask the departing nurse or provider to review his or her notes regarding your care and ask “Is this correct?” When the new shift takes over, your doula or family member would show them the notes and ask whether they received the same information that was verified by the previous shift.
The path to a successful delivery becomes much straighter when everyone marches in the same direction. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
April 11, 2011
Olympic winner and motivational speaker, Jim Stovall once said “Integrity is doing the right thing, even when no one is looking.” In September 2009, I wrote about a blog about Carolyn Savage, a 40 year old woman with a poor obstetrical history. Savage married her college sweetheart and had an uncomplicated first pregnancy. However, her second child was born prematurely. She had 4 subsequent miscarriages and ten years later she became pregnant through in-vitro fertilization (IVF). Because the Savages wanted a large family, they tried IVF again. Unfortunately, Savage was impregnated with the wrong embryo. To their credit, everyone rose to the highest level of integrity. The infertility clinic informed the Savage family as soon as the mistake was discovered and then gave them the option of terminating the pregnancy or continuing it. The Savage family then had to inform the rightful parents of the embryo that were not expecting to have a baby any time soon but was now faced with that dilemma. Savage ultimately delivered the baby and then handed it over to its rightful parent, the Morrell family.
When bad things happen to good people, we are perplexed and often wonder why. I remember feeling despondent as I wrote the blog. A woman had delivered a healthy baby but was leaving the hospital with empty arms. A blatant systems error had reared its ugly again reminding physicians that we are all fallible, despite our years of strenuous training and hard-earned credentials. Yet, the book of wisdom reminds us that everything works for our highest good despite the tragedies that are seen through the lens of our human experience.
Fast-forward 2 years later: the Savages hired a surrogate mother (aka gestational carrier) who was pregnant with their baby but subsequently had a miscarriage. However the Savages didn’t give up and they are now pregnant again, through their gestational carrier with . . . . twins. When Carolyn Savage leaves the labor and delivery suite this time, her arms will be filled with not just one baby, but two. Who says life can’t have a happy ending? We wish the Savage family the very best as they prepare for their joyous occasion.
February 10, 2011
The story of Mareena Silva, a 19 year old pregnant woman who was mistakenly given a medication that could have caused a miscarriage is a precautionary tale of why it’s so important to be vigilant during pregnancy.
Silva was prescribed an antibiotic at six weeks gestation. Although the name of the antibiotic was not given, she ultimately received Methotextrate, an anticancer drug that is sometimes used to treat ectopic or tubal pregnancies and could have caused a spontaneous abortion. Silva unknowingly took one pill before realizing that the pharmacy had made an error. Of course, she is now concerned that her unborn child might be adversely affected as a result of the error. However there’s a deeper story regarding Silva. Her physician prescribed an antibiotic at a critical time of the first trimester called organogenesis which occurs between 6 to 10 weeks gestation. During organogenesis the brain and central nervous system of the baby develop. This is an extremely important time of fetal development and most physicians use a hands off approach regarding prescribing medicine unless the patient is critically ill and compromised. As a patient safety measure, here are some suggestions to avoid incurring a similar or repeat episode of Silva’s near-fiasco:
- If you are given a medication during the first trimester, ask your healthcare provider if you can wait until after your 10th week to take it.
- When receiving a prescription, look up the generic name of the medication as well as the trade name so that you will familiar with both names in order to detect potential errors.
- Make certain that everyone knows you’re pregnant. If you’ve missed your period but haven’t had an official pregnancy test, please request it.
- When picking up medicines from the pharmacy, confirm the name of the medication, including the correct spelling, the strength, the dose of the medicine and number of times it should be taken in a day.
- Ask your healthcare provider about the category of the medicine and potential side effects. A category “A” and “B” are safe during pregnancy but again, it should be deferred if possible until the second trimester.
Never take medication during pregnancy without knowing the risks as well as the benefits. If the risk outweighs the benefit, buyers beware.
Linda Burke-Galloway, MD, MS, FACOG, is the author of The Smart Mother’s Guide to a Better Pregnancy (Red Flags Publishing). Her book is available on Amazon.com and other bookstores. For author requests, please contact Ms. Zanade, L. Mann of Online and Off Marketing and PR Agency, 347-968-8067. All Rights Reserved
May 10, 2010
To look at Beth today, you would never know that she is a breast cancer survivor who had a battle with death and won.
My first encounter with Beth was via the telephone approximately 14 years ago, when I called the labor and delivery suite of our local hospital. In 2006, I was surprised to learn that Beth joined our health department as a supervisory nurse. After 18 years of working in the hospital, she had a calling to provide public service. However shortly after Beth started her new position, she was diagnosed with stage 2 breast cancer. One of her most difficult challenges was breaking the news to her three children and husband, who had been recuperating from recent back surgery.
Two days after Christmas in 2006, Beth underwent a double mastectomy with breast reconstruction. What was supposed to be a four-hour procedure took 12 hours instead. Beth awoke in the ICU on a ventilator and remained in the hospital for the next two weeks. Thirteen days after her procedure she encountered severe low back pain inhibiting her ability to walk. Three physicians diagnosed her with back strain as the result of her breast reconstruction. However, the pain persisted and she insisted on seeing her primary physician. During the car ride to his office, she screamed and writhed in pain. Upon her arrival, her primary care physician immediately called 911 and she was admitted to the hospital. A diagnostic MRI revealed possible metastasis to the bone and she was taken to the OR.
The neurosurgeon found a pocket of pus as he had prepared to operate on her spine. The “bone metastasis” was actually a MRSA (Methicillin Resistant Staph Aureus) infection that would have killed her, had it ruptured. Beth spent the next 12 weeks in and out of the hospital and self-administered IV antibiotics twice a day during that time period. Her breast implants were removed and her chemo therapy was postponed for six months.
Beth had economic setbacks as well. She lost her home and depleted her 401K retirement savings. However, despite insurmountable obstacles, her three children excelled in school and her husband remained by her side.
Fast-forward to the present: Beth’s daughter, Megan, is graduating from Oprah Winfrey’s alma mater, Tennessee State University at the age of 20 on an athletic full-scholarship and there has been a documentary highlighting her accomplishments (http://www.youtube.com/watch?v=UV8thlMSzW0). Her son, Matthew has also received a full-athletic scholarship to play football at West Virginia State and her youngest son is doing well in elementary school. Beth is cancer-free and is enrolled in a graduate program to become an advanced nurse practitioner.
April 28, 2010
The story of Abbie Cohen Dorn (Severely Disabled, Is She Still a Mom?, LA Times, April 11, 2010) brought tears to my eyes and sadness in my heart. Abbie is a 34-year old mother of triplet boys whose former husband will not allow her to see them because she has a severe disability caused by a delivery complication.
Abbie was a chiropractor and the daughter of a physician. She married Dan Dorn, began infertility treatments and ultimately conceived triplets. A triplet pregnancy is extremely high risk and Abbie maintained the necessary precautions. Dan was extremely attentive to her needs during the pregnancy. According to the LA Times, on June 20, 2006 the couple rushed to the Cedar Sinai Medical Center. It appears that Abbie had a C. Section that ended with an emergency cesarean hysterectomy to stop the bleeding. Allegedly, her physician “nicked” her uterus. Oh, do I have several questions for her physician. Why wasn’t she scheduled to have an elective c. section rather than allowing her to have spontaneous labor? Was there an “expert” team to deliver the multiples? Did the labor room practice “emergency” drills or were they ill-equipped to handle this emergency?
Fast-forward to 2010. Abbie has significant neurological damage and receives intensive therapy at the cost of $33,000 per month. Dan divorced Abbie in 2008, is requesting child support and refuses to allow his sons to see their mom because he feels “it would be too traumatic for his sons as such a young age.” Abbie has not seen her sons since 2007 and her father sees his grandsons four times a year. Abbie’s parents are challenging Dan’s decision and a trial is set for May 18th.
I was the daughter of a disabled mother and there was never one day that I did not love her – unconditionally. Dan Dorn is wrong. Dead wrong. Abbie deserves to see her children and a community has emerged to give her support. I urge all of my beloved readers to join the “Stand Up for Abbie” Facebook page (http://www.facebook.com/group.php?gid=116452135047403&ref=ts) and show her some love.
April 7, 2010
Last week the Internet was replete with stories regarding two North Carolina obstetricians who performed a c. section on a non-pregnant woman (see ABC News). Sadly, mistakes of this magnitude occur more often than the public is made aware to the detriment of both unsuspecting patients and unsupervised resident physicians.
Residency training is a pecking order and the neophyte intern is the first responder. He or she must evaluate the patient, and then report their findings to their senior resident or attending physician. More than likely this particular patient was obese and had “no previous prenatal care.” According to the ABC News report, the intern performed an ultrasound and was not able to “see a fetal heart tone.” It’s possible that the intern thought the patient’s baby had died and ordered an induction of labor for its delivery. The “induction” allegedly lasted two days and the patient and her husband requested a c. section. The case was allegedly discussed with a senior resident and attending physician who agreed with the intern’s management. Upon entry of the uterine cavity, a non-pregnant uterus was diagnosed to the chagrin of the physicians and the patient’s abdomen was quickly closed.
Here comes the stampede of lawyers.
Let’s rewind the tape, then hit the play button and describe what SHOULD have happened:
- The intern takes the patient’s history and then examines the patient to determine whether the patient’s cervix is dilated (open) and if the baby’s head is down. If she can’t feel the head, she needs to order an ultrasound in the radiology department. If it’s after hours and a radiologist is unavailable, she can do an “unofficial” scan and see if the scan can be read by either an offsite radiologist via telemedicine or her attending physician.
- She attempts to obtain a fetal heart tone. If none is obtained, she needs an OFFICIAL ultrasound to make certain the baby is alive.
Doing steps 1 and 2 would have documented an empty, non pregnant uterus and eliminated unnecessary surgery. Also, the intern’s senior physician and attending should have BOTH examined the patient to confirm or dispute the intern’s exam.
Our ob-gyn protocols are clearly established. Why on earth can’t we follow them?