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.
May 28, 2012
As a young girl growing up in a small Long Island town called Amityville, Memorial Day was a huge holiday filled with parades and barbeques. I would inevitably end up at my friend Diane’s backyard eating a hotdog along with the rest of the kids on our block. It was also a day when we made our annual trip to the cemetery to place American flags on the graves of veterans and flowers on the graves of the deceased. Well, today, in honor of both Memorial Day and Preeclampsia Awareness Week, I’d like to take time to remember all mothers and their babies who died during childbirth, especially from preeclampsia.
What is preeclampsia and why is it so deadly? Preeclampsia is a condition of pregnancy in which there is high blood pressure; swelling of the ankles, feet, or face; protein in the urine; and abnormal kidney function. This condition requires the delivery of the baby in order to preserve the mother’s life and prevent seizures and strokes. The old fashioned term for preeclampsia was toxemia and it affects 1 out of 12 pregnancies each year. Approximately 76,000 women die annually from this disease and most people know of at least someone that it has affected during pregnancy.
When I think about preeclampsia, a woman name Dawn Fleming comes to mind. Dawn was 31 years old, a member of my sorority, Delta Sigma Theta and a popular radio personality in Orlando. Although I did not know her personally, she was from my former hometown of Queens. She was gregarious, a community activist who died unexpectedly from a preeclampsia related stroke. She had recently married and delivered a baby girl 6 days before her untimely birth. Her daughter is now approximately 8 years old and will never know her mother. When I attended Dawn’s wake, I was both angry and sad. I suspected someone had inevitably missed the diagnosis and by the time she was given treatment, it was too late. Such is the case of the vast majority of preeclampsia victims. By the time a diagnosis is made, the damage is already done. In her book, You Have No Idea, celebrity Vanessa Williams and her mother, Helen, discusses preeclampsia as the reason for her paternal grandmother’s death.
In my next blog, I will describe the signs, symptoms and treatment for preeclampsia that is also described in The Smart Mother’s Guide to a Better Pregnancy. But in the meantime, I urge all of us to take a few moments to remember all the moms and babies who are no longer with us and pray that a cure for preeclampsia will one day be found.
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.
September 5, 2011
It seems that Matthew Scheidt, had a summer job working part-time for a surgical supply company. He allegedly went to the Human Resources Department of the Osceola Regional Medical Center (ORMC) and convinced them that he was a Physician Assistant student at Nova Southeastern University and lost his identification badge. This is the hospital where many of my former patients were forced to go for medical care because they were either uninsured or received Medicaid. My former employer had a fiscal relationship with them. The use of the word “forced” is quite appropriate because my uninsured patients had no options. When those who had Medicaid requested to deliver at a women’s hospital in another county they were discouraged to do so by the powers that be. I recall with great pain the memos, reprimands and threats I received from my former employer because I wanted to give my patients the freedom of choice. Oh, the stories I could tell about the numerous altercations I had with certain staff members regarding patient management issues. So the fact that this hospital is now on local and national radar screen does not surprise me at all. The hospital was formerly owned by the organization that Florida’s incumbent governor once worked for and eventually paid fines because of fiscal improprieties. The hospital’s long-standing former administrator resigned once the governor ran for office. Yes, politics indeed can affect patient management. But let us return to the story of Scheidt.
Scheidt allegedly performed CPR, changed IVs, cleaned wounds, performed interviews and physical exams on male patients who were disrobed. He was also in the operating room. He only got caught when he asked permission to go to “restrictive areas” of the hospital and I pray it wasn’t the labor and delivery suite. How did this happen? Because our healthcare system is presently on automatic pilot. There are no checks and balances. No accountability. A 17 year old can show up in the human resources department of the hospital and no one does a background check to verify his credentials. Pity the poor patients. This is one of many reasons why The Smart Mother’s Guide to a Better Pregnancy (TSMG) was written. Patients need to be protected.
Could this happen to you? In a heartbeat if you’re not astute and aware. There is a chapter in TSMG, called Investigating the Places Where You Will Receive Care. I strongly encourage everyone to read it.
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 9, 2011
There are two types of physicians who practice medicine: those who choose medicine as a career and those who medicine chooses to serve. When you are called to serve, your relationship with patients extends beyond a 15 minute boundary. Such was the case of my relationship with my patient, Adriana Echeverri Tucker.
Adriana was 38 years old when she first entered my office both happy and anxious about her first pregnancy. If Adriana had medical insurance, I might not have met her. She was married to a U.S. citizen but had to wait the prescriptive time period for her green card so she was not eligible for state-funded insurance and her husband was self-employed.
Adriana was a dog trainer by trade and originally from Colombia, South America. Her ambition and entrepreneurial spirit was contagious and admirable. She was also a perfectionist and because we shared the same birth month, I intuitively understood her fears and concerns about this first pregnancy. I would see Adriana even without an appointment on days when her anxiety got the best of her. She was an older woman who had conceived without the benefit of In Vitro Fertilization and I, who was childless at that time, knew her pregnancy was a precious gift. She ultimately delivered a beautiful baby boy, who she named Martin. When she brought Martin to Colombia to see her family, she brought me back a gift that remained on my desk for years.
I eventually lost contact with Adriana until this past Friday night when I flipped through my local newspaper and saw her name in the obituary section. At first I wasn’t sure if it was the same person until I read the part about her being a dog trainer. A was a memorial service scheduled for the next day.
The parking lot was completely filled and there must have been over 100 people in attendance. When the pastor asked if anyone else wanted to make a comment, I was given a microphone and tearfully stated how fitting that her memorial service was held on the day before Mother’s Day because she was such a proud mother. Through the testimonies I learned that Adriana was a volunteer COP in her community. She organized a movie night once a month in her church. She became a U.S. in 2009 and her 7-year-old son, Martin, was thriving. I also learned that Adriana had late-stage cancer that was only recently diagnosed 2 months prior to her untimely death that occurred in Colombia, one day after she returned to the country of her birth.
Her service ended by the release of purple balloons in the parking lot symbolically returning her spirit back to God. Her life was abbreviated but purposeful. I am proud to have been her physician and equally proud to call her my friend.
May 2, 2011
If a pregnant woman finds herself scratching and itching during the third trimester, these symptoms should not be ignored. Each year, approximately 0.1 to 15% of pregnant women are affected by a liver disorder called Intrahepatic Cholestasis of Pregnancy or (ICP). ICP patients tend to develop symptoms of itchiness of their hands and feet that becomes progressively worse and then spreads all over their body. The itchiness usually worsens at night and if untreated can cause jaundice and several life-threatening complications to the unborn fetus. When a pregnant woman complaints of itchiness (pruritus) all over her body, the first order of business is to determine whether a rash is present. If a rash is absent, ICP should be suspected.
The liver is the largest gland in the body and in addition to filtering harmful substances such as alcohol it is also responsible for processing fats, carbohydrates and proteins. To process fat, the liver makes bile salts. In ICP, bile salts are increased which contributes to the symptoms of itchiness. Affected women will not only be plagued by pruritus but their unborn babies are at risk for stillbirth, preterm labor, fetal distress and abnormal heart rates. South American women and especially those from Chile have a greater risk of developing ICD as do women from South Asia and Sweden.However, North American born women in the U.S. have also been affected as well as women with Hepatitis C. Female hormones such as estrogen and progesterone contribute to the development of ICP as does genetics. The diagnosis of ICP is made by specific laboratory tests. Once the diagnosis is confirmed, the patient should be referred to a maternal fetal medicine specialist for further management. ICP is a high risk condition and the baby usually has to be delivered early because the mother cannot tolerate the intense itching. There is a special medicine that can be prescribed to reduce the elevated bile acids but it should be given under the supervision of a high risk physician.
A complaint of severe itching that develops during the third trimester should not be ignored or given Benadryl if the symptoms have lasted for more than 3 business days. At minimum, lab work should be ordered. Remember, a healthy baby doesn’t just happen. It takes a smart mother who knows what to do.
April 13, 2011
Twin pregnancies have always kept me in wonder and awe, especially at the time of a delivery. At present, they represent 33% of all live births and their numbers are rising thanks to the increase in older women who are successfully conceiving through In Vitro Fertilization (IVF). Fertility drugs account for a 70% increase in multiple births. Are you at risk for having a twin pregnancy? You are if you have:
- Advanced maternal age
- Are African or African American
- 3 or more children
- A tall height or are obese
Unfortunately twin pregnancies can be complicated and everyone must be appropriately prepared.
Twins can be divided into 3 categories: monozygotic (identical); dizygotic (fraternal) and conjoined. In a monozygotic (MZ) pregnancy, only one egg was fertilized but “split” and then divided. MZ pregnancies represent the greatest risk for complications because the babies share the same placenta and circulatory system. One baby can have too much fluid and the other baby not enough. This is called a twin-twin transfusion or TTS. Dizygotic twins involve the fertilization of two eggs and have two separate placentas. It is more common, representing 69% of all pregnancies. Conjoined twins result when a single, fertilized egg only partially splits and the babies share a delay or a partial split from when there is a delay in the division of the fertilized egg and the babies share are physically connected. This is sometimes referred to as Siamese twins and represents a very poor prognosis in terms of survival. ALL twin pregnancies are at risk for preterm contractions and delivery and therefore are high risk. I am therefore perplexed when patients with twin pregnancies are not referred to a high risk specialist for a consultation.
At minimum, patients with twin pregnancies should have
- Monthly ultrasounds to document appropriate fetal growth. The number of ultrasounds might increase as you get closer to the due date
- Nonstress tests beginning at 32 weeks to document fetal well being
- A well thought out delivery plan in a level 3 hospital with a pediatrician waiting in the delivery room
Twins are a joy but remember their pregnancies are high risk. If you are pregnant with twins and no one has recommended you to see a high-risk specialist, make some noise . . . loudly. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
Check out my informational pregnancy video!
April 6, 2011
In the wee hours of the morning, Patricia Garcia took her last breath and made her transition. Her death was not a total surprise, she had almost died before. Garcia was 39 years old and the mother of an 11-month old son name Josiah who had made his entrance three months earlier than expected because he had stopped growing in his mother’s womb. During her pregnancy, Garcia was concerned that she might die before Josiah was born because of her complications of having a stroke, obesity and failing kidneys. At barely 5 feet, Garcia weighed 261 pounds and was decidedly obese with a basal metabolic index (BMI) of over 40.
Obese pregnant women are plagued with almost every type of complication imaginable from miscarriages, higher rates of cesarean deliveries, birth defects, pre-eclampsia and sometimes death. Garcia received general anesthesia during the cesarean birth of Josiah. It would have been technically challenging to attempt to give her an epidural or spinal anesthesia. Because she was put to sleep, the surgical team had to move quickly to remove the baby so that it would not receive excessive amounts of the anesthetic. Garcia’s procedure was unfortunately prolonged by several minutes, again due to technical difficulties.
Obesity is a national epidemic with 26.7% of our population affected. Garcia was considered the smallest person in her family because her brother weighed 700 pounds prior to receiving a gastric bypass. Obese patients often face discrimination and humiliation from within the medical community. Diagnostic procedures have been cancelled when it is determined that the patient is over a certain BMI for fear that their equipment would not sustain the additional weight. Patient safety experts propose that “obesity centers” for pregnant women be established to provide nutritional counseling, emergency cesareans as necessary and neonatal intensive care units.
Garcia promised her physician that she’d lose weight after she was discharged home. She didn’t. Although Josiah is now more than a diminutive 1-pound-11 ounce baby, he is still very small and was recently diagnosed as having dwarfism. He will be raised by his sixty-something year old grandmother who is also taking care of Garcia’s mentally disabled brother. Obesity is not a benign disorder. Until Americans make better lifestyle choices, tragedies like Patricia Garcia’s will continue.
March 14, 2011
So, here we go again. Yet another slap in the face by big Pharma. Something is fundamentally wrong when a company charges $1,500.00 for a $10.00 drug that will not only save the lives of human beings but also reduce the annual $26 billion dollar cost of premature births.
Hydroxy progesterone caproate, marketed as Makena, has been around since 1956 and has been used for the past 15 to 20 years to help reduce premature births. It was originally manufactured by Squibb Pharmaceuticals but was removed from the market for reasons unknown. However, physicians were able to continue prescribing the drug by having it made in compound pharmacies for $10 to $15 per injection. The FDA subsequently gave KY Pharmaceuticals the exclusive right to produce the drug. Well, that was a glaring mistake. Why would the FDA want to give a company EXCLUSIVE rights to produce the drug? In a free market, competition is critical in keeping prices down. Twelve percent of births in the U.S. occur prematurely and a disproportionate number are African American women and teens. The drug has to be given between the 16 to 20th week of pregnancy and continued up until 36 weeks. Let’s do the math. The medicine has to be injected weekly. A patient taking the drug beginning at 16 weeks will have to continue taking it for approximately 20 weeks and 20 x $1500 =’s $30,000. So what originally costs $200 to $300 to prevent preterm pregnancy has now spiked to $30,000. How many different ways can we spell the word, GREED?
The prevention of premature births is paramount to the well-being of a newborn. Makena is not an optional drug. It will benefit many unborn babies and especially those whose mothers have a short cervix. Because Makena is now an FDA approved drug, the off-label brand previously made by compound pharmacists is not an option because of liability issues. Do you really think the insurance companies are going to pay $1500 for this drug?
I leave you with a profound quote from one of my readers, Dorice Arden:
“. . . a shocking reminder of just how low the value for humanity has sunk. The notion that patients are considered a commodity has far-reaching consequences. The very thread that ties us to our humanity is the value we place on life and life-sustaining measures. The attention and care we share with each other sets the tempo for the future.
Well said, Dorice. Well said.