May 2, 2012
In Part 1 of Monday’s blog, we learned about Angela Burgin Login, a first-time pregnant mom who was developing pre-eclampsia but the signs were ignored by her physician. Angela almost lost her life because the recognition of her diagnosis was delayed. While most pregnancies are uneventful, a “normal” pregnancy will not always mean a “normal” birth. Things can change quickly, especially in the labor room. In order to have a favorable outcome at the end of a pregnancy, the healthcare provider and the patient must be in total agreement regarding expectations and treatment. Sometimes that may not happen. The most important task of a pregnant mother is to select the right provider and Chapter 1 of The Smart Mother’s Guide to a Better Pregnancy addresses this issue in detail. What then should a patient do if her physician is not responsive to her concerns? Here are a few strategies:
- Ask that your concerns be documented in your chart and then ask to receive a copy of the chart. If your concerns are still present and not addressed to your satisfaction, call your insurance company, explain the situation and request approval to change providers.
- If for some reason, you are not able to change physicians or providers, contact your insurance company, explain yours concerns and dissatisfaction, then ask for approval to obtain a consultation with a high-risk specialist (aka maternal fetal medicine) so that he or she can evaluate your condition to make certain that it’s not high-risk
- If you are in labor and are not satisfied with your progress, have a family member or your support person request to speak to the nursing supervisor. When he or she arrives, inform them of your concerns and that you want it documented in your chart. Ask her who is the on-call or consulting maternal fetal medicine specialist and then request an in-house consultation. Simultaneously contact your insurance company, explain your concerns and ask for approval for the consultation advising them that if anything happens to you or your baby, they have been duly notified in advance. Also ask to speak to the hospital’s risk management office as well.
By implementing these strategies, you improve your chances of having a favorable outcome because you are formally documenting your concerns and holding people accountable for your patient care. Your proactive role will protect both you and your child.
Most physicians are compassionate, competent and caring. On rare occasion, you might unfortunately encounter one who needs to be “brought back down to Earth.” If that happens, you now know what to do.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
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.