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.
October 27, 2010
Incarcerated pregnant women are back in the media again because of the National Women’s Law Center (NWLC) October 2010 Mothers Behind Bars Report. The report looked at how each state treated incarcerated pregnant women and then graded them according to certain standards.
According to the report, there are more women in the U.S. behind bars than at any other time of history, most of them non-violent first-offenders convicted of drug charges and an increasing number of them are pregnant. As an obstetrician, this is important because the quality of care or lack thereof will have a profound effect the health of their unborn babies. Sick babies place a significant burden on our healthcare system and the economy.
Shackling of pregnant inmates was discussed in a previous blog, and also addressed in the NWLC Report. Thirty-six states received failing grades of D or F for failing to limit the use of restraints on pregnant women during transportation, labor and delivery and post partum care. Ten states adopted laws that address shacking procedures but 22 other states didn’t. A disappointing 38 states received failing grades for not implementing policies that would ensure prenatal care for pregnant women. Although these women are incarcerated for committing crimes, their unborn babies should not be punished through benign neglect. Women in prison have high-risk pregnancies and inadequate prenatal care only compounds the problem. What was even more disturbing was the absence of advance transportation plans or arrangements for deliveries from the prisons to hospitals by forty-four states. An advanced delivery arrangement is always preferred in the event of unforeseen emergencies that require special equipment or staff. The last thing one wants is to transport a patient to a hospital in an emergency only to discover that there’s no one on duty that can perform a C. Section or administer anesthesia.
Prison nurseries were not offered in 38 states to new mothers who are incarcerated. This which means there is no opportunity to for bonding or attachments between infants and mothers.
Pennsylvania was the lone state to receive an “A” grade for prenatal care, shackling and family-based treatment as an alternative to incarceration. Hopefully, the other 49 states will take notice.