October 12, 2011
The fact that Amber Miller did not fall or faint or develop complications while running in the Chicago Marathon is nothing short of a miracle. An ounce of prevention is worth a pound of cure. What on earth was her physician thinking when she was given the green light to half-run half-walk a 26.2 mile marathon? Miller was not your usual runner; she was approximately 39 weeks pregnant.
Although pregnant women are encouraged to maintain an active, healthy lifestyle that includes aerobic exercise, moderation is the order of the day. A woman’s body changes when she becomes pregnant. She has more fluid circulating in her body; hormones from the pregnancy make her ligaments more relaxed, thus she waddles. As the baby enlarges, the diaphragm (aka muscle of respiration) gets pushed up making it difficult for pregnant women to breathe. The heart rate increases and the center of gravity changes as the uterus becomes larger thus, increasing her risk of falling.
Miller participated in 8 previous marathons including one when she was pregnant with her first child. At that time she was 18 weeks. She says that she’s “crazy about running.” As the mother of two sons who were Junior Olympic Track and Field participants, I can relate. However, where is the voice of reason? Prolonged exercise means an increase in heat production which may or may not affect the fetus. Years ago, pregnant women were discouraged from running or performing any exercise that would increase their core temperature for fear it would adversely affect the fetus. Unborn babies cannot regulate temperature because their brains are not fully developed and it is a special part of the brain that controls temperature. In recent years, this rule has been relaxed because the medical studies are inconclusive. However, it is not recommended that pregnant women perform more than 45 minutes of continuous exercise and it should be in a temperature controlled environment. This was not the case with Miller. Although she ate frequently and drank water, she ran and walked for over 6 hours, developed contractions and subsequently went into labor. If her physician gave her permission to run at 39 weeks, then perhaps he or she should have accompanied MIller to monitor the process.
26.2 miles at 39 weeks is not a benign act and I certainly hope this will not become a trend among pregnant women. Can you imagine delivering a baby in the middle of a marathon? It would not be a pretty sight.
August 22, 2011
Charinez Jefferson’s infant son was born the day before my birthday but it was also the day that she died. The doctors kept her on life support while they frantically tried to deliver and save her baby, a scenario I know quite well.
Jefferson was gunned down on a Southside Chicago street at the tender age of 17 while walking to the store with friends. She allegedly stopped to speak to a guy that she knew and someone drove up and began shooting a gun. She didn’t know the gunman and reportedly begged him to spare her life as he fired several shots that ultimately pierced her head and body. It’s not clear why she was shot but quite often it never is.
On a hot summer day many years ago in New York City, a pregnant woman living in a housing project was shot by a bullet that pierced her kitchen window as she was cooking a pot of collard greens. Her husband, who was watching TV in the next room thought the loud bang that he heard was a fire cracker and quickly got up to check on his wife. He discovered her lying on the kitchen floor with a spoon clenched in her hand. I was a junior resident on call when the EMS rushed into the Emergency Room announcing that they had a pregnant woman with a gunshot wound who was barely alive. A stampede of running feet quickly converted the largest examination room into a make-shift operating room. There was simply no time to transport her up to the labor and delivery suite. She was dying and if we didn’t move quickly the baby would die too. Her vocal cords kept closing in spasms as the anesthesiologist attempted to place a breathing tube down her windpipe (aka trachea). The “code” team was doing CPR on her chest and my chief resident and our OB team were frantically attempting to deliver the baby by performing the fastest c. section on earth while the pediatricians were standing by holding a blanket. In the end we lost the mother, just like the doctors in Chicago lost Charinez Jefferson but saved her baby as they did in Chicago. Our patient’s baby remained in the hospital for almost 2 months before it was discharged home.
So far, Jefferson’s son appears to be stable but he will eventually be discharged home to his grandmother who has advanced breast cancer that has spread to her bones. Her pregnant daughter took an evening walk and never returns home. Sometimes life just doesn’t make any sense.