The three children (ages 3, 9 and 10) and the unborn baby of Ebony Wilkerson are lucky to be alive, despite the fact that she drove her van into the frigid Atlantic Ocean. Two hours prior to this horrific event, the Daytona Police interviewed her, deemed that she was sane and left. The day before, a local hospital kept her overnight for mental health observation for 24 hours and then sent her home. If I were the sister of Ebony Wilkerson, I’d speed-dial liability attorneys and then immediately request Wilkerson’s medical records because obviously someone dropped the proverbial ball.
Wilkerson’s sister knew something wasn’t right because Wilkerson exhibited paranoia and kept discussing Jesus and demons that she felt were controlling her. She had fled South Carolina because she believed that her ex-husband was attempting to kill her. Eerily, Wilkerson is from the same state where Susan Smith drove her children into the ocean 20 years ago and blamed the crime on an unknown man. Unlike Smith, whose children died; Wilkerson and her three children were gratefully rescued by a heroic group of men who selflessly plunged into the water to save them.
Kudos goes to Wilkerson’s sister who had the wisdom to call law enforcement and report her sister’s bizarre behavior and hide her car keys. Unfortunately Wilkerson had another set of keys. What’s troubling about this case is how Wilkerson was able to sign herself out of the hospital and how she fooled the police to thinking that she was sane which meant that didn’t have to “Baker Act” her or commit her to the hospital . I find it hard to believe that Wilkerson could walk out of a hospital after seeing a psychiatrist which leads me to speculate that perhaps the hospital didn’t have a psychiatrist on duty at the time.
Law enforcement officers are not trained mental health specialists. In the future, when they are called for a suspected mental health issue, a better approach might be to take the individual to the hospital, despite the appearance of a person’s “calm demeanor” and let the experts make or rule out the diagnosis of mental illness.
Mental illness is not a joke, America. It claims innocent lives every day.
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It’s your first pregnancy and very exciting. While doing your first ultrasound, the technician frowns as she scans your cervix with a vaginal probe. You ask what’s wrong and she mutters something about the cervix being too short but that your provider will explain more. What’s going on? You could possibly have a short cervix which means you’re at risk for having the baby too soon.
One out of eight babies born in the United States is premature which accounts for over one-half million babies each year. Premature birth is the leading cause of infant death, brain damage, blindness and other complications that costs $26 billion dollars a year in health care.
Women who have had a previous premature baby are at significant risk for having another one and should be seen immediately by a maternal fetal medicine specialist (a high risk pregnancy specialist). Does this also apply to women who are pregnant for the first time? The answer is yes. All pregnant women should receive an ultrasound for dating and documenting normal fetal anatomy no later than the middle of the second trimester and if the cervical length is less than 2.5 centimeters, the mother is at risk for a premature birth even if she is not complaining of cramping or bleeding. If the cervix is less than 25 mm or 2.5 cm,
· A repeat ultrasound should be done ASAP to document the short cervix
· Vaginal progesterone tablets should be prescribed as soon as possible and before 24 weeks. Why? Because they reduce premature births by 44%
This information is especially important for first-time pregnant women who have no documented history of previous preterm births. Several years ago, first-time pregnant moms with a short cervix were not treated but recent medical studies have proven that these women should be treated. Therefore, a short cervix should not be ignored.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother or knows what to do.
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Tiona Rodriguez, a 17 year old teen mom was arrested in a New York City Victoria Secrets store on suspicion of shoplifting and accompanied by 17 year-old Francis Estevez, who was also arrested. The security guard looked in the shopping bag and found a foul-smelling dead fetus wrapped in a black plastic bag along with underwear and clothes. Rodriguez informed him that she was 6 months pregnant, had a miscarriage and didn’t know what to do with the baby. She was then taken to Bellevue Hospital, most likely for a psychiatric evaluation. The dead baby was taken to the morgue where it was reported that he weighed 8 ½ pounds and died from suffocation. It is alleged that Rodriguez gave birth at Estevez’s house and from a recent picture on Facebook® where she is wearing camouflage pants and a tee-shirt; it is quite possible that she was concealing the pregnancy. She was allegedly excited about an upcoming interview at a popular restaurant.
There will be those who despise Rodriguez and others who will sympathize with her. Could this tragedy have been prevented? Absolutely and here’s how:
• Rodriguez should have received a long-acting birth control method before leaving the hospital after having her first baby 2 years ago
• All pregnant teens should have at least one home visit during their pregnancy by The Healthy Start Program or the Pregnant Home Visit Program
• Messages about the Safe Haven Infant Protection Law should be plastered in doctors’ offices, prenatal clinics, billboards, text-messages, buses, subways and even on MTV to let families know that they can anonymously leave their baby at a hospital, fire and police departments for three days without getting in trouble
• Adoption IS an option. There are loving parents desperately waiting to adopt newborns and give them a decent home.
A newborn baby took his first breath and then ended up dead in a shopping bag. Who ever thought we’d see this in the 21st century?
In today’s tough U.S. economy, healthcare is in the forefront because of the three trillion dollars spent each year. Patients are not seeing their money’s worth and neither is the U.S. government who writes the check for a large percentage of it. The cost of women having babies too early or prematurely costs our society $26 billion dollars each year. Something has to give.
Women’s health is the topic of great political debate as you may well be aware if you listen to the news or watched both political parties’ national conventions during the past two weeks. Do women control their destinies? Do we and will we continue to have control over our bodies? These are the questions at hand. While there’s great chatter about this topic as the U.S. election nears, there’s also a quiet revolution occurring in our healthcare system that will directly affect pregnant women.
Prenatal care as we know it will begin to change, especially if you receive Medicaid or government sponsored insurance. The current trend is to visit your healthcare provider’s office individually and wait to be seen. In the future, you will be seen by your healthcare provider as a member of a group, not as an individual. This is called enhanced prenatal care with group appointments and will be the wave of the future.
Groups of 10 pregnant women will be seen at the same time for approximately 10 prenatal visits that will last approximately 90 minutes. It is anticipated that 2 healthcare providers will not only take your vital signs, listen to your baby’s heartbeat, but will also allow you to interact with the other patients in this group setting to discuss prenatal issues, receive health education information and any concerns that you may have. Believe it or not, this model of care is not new. The concept was called Centering Pregnancy and was developed by nurse midwife Sharon Shindler-Rising in 1989.
In the future, doulas and social workers along with midwives will become more prominent in terms of prenatal care as things continue to evolve. Are you ready for group prenatal visits?
Journalist Nicholas Bakalar of the New York Times wrote an article that addressed a profound issue regarding pregnancy: Does Fear Make Labor Longer?
Over 2,000 pregnant women in Norway were given a questionnaire at 32 weeks to determine if they had a fear of labor. These women were then followed to determine how long they were in labor and according to the study, there was a 47 minute difference in the length of labor of 165 women who feared childbirth compared to those who don’t. Why is this important? It’s important because fear is something that we can control.
Three of the most empowering things a pregnant woman can do are request a tour of the labor room before she has a baby, take childbirth classes and request pain meds or an epidural if she experiences pain while in labor. When a pregnant woman is calm, the unborn baby is calm but if she’s writhing in pain, the adrenaline that she’s producing affects the baby and inevitably causes fetal distress. Prolonged fetal distress means emergency c. section.
One of my most memorable deliveries was as an intern during the late ‘80’s. Recording artist Anita Baker was very popular back then. I was astounded when a very “Yuppy” expectant father, pulled out a tape cassette and played Baker’s tape while his wife was in labor. He requested dim lights and held his wife’s hand as they listened to my favorite song, Sweet Love. Although I respected their privacy, I was never far from their room. His wife ultimately had a beautiful, uncomplicated delivery that left an indelible impression.
No, everyone doesn’t have to listen to Anita Baker while they’re in labor but they should do what makes them comfortable including receiving an epidural or pain meds if necessary. You don’t have to be stoic. Here’s a quote from The Smart Mother’s Guide to a Better Pregnancy that I’d like to leave you with: “The Force that moves the air within our lungs, the blood within our veins, is the same force that has created the life within your womb. The most important key to a healthy pregnancy is the consciousness that lies within. Your child will be shaped by your thoughts, your dreams, your values, your energy. You are the ship that will carry the baby to the shores of its preordained human experience. Please let the journey be smooth.”
You are smarter, stronger and more brilliant than you could ever imagine. Childbirth should not be feared. It should be celebrated.
Photo credit: Public Health Image Library (PHIL)
A few years ago, a 20-something year old pregnant woman presented to her physician with complaints of a skin bump that was red and painful. She was told it was a spider bit and given antibiotics. The patient ultimately went in labor but required an emergency cesarean which went well without any complications. Four days later she developed skin lesions and 3 months later she expired after a very stormy hospital course. What did she die of? MRSA, which stands for Methicillin Resistant Staph Aureus.
Staph Aureus (Staph) is a bacteria that can be found on the skin and doesn’t usually cause problems as long as there are no breaks or cuts in the skin. However, if there are cuts and Staph gains entry into the skin, an infection can develop that if often not serious. However, Staph has a very dangerous form that is resistant to the medications that will normally treat it. The resistant form of Staph can cause havoc if unrecognized which can lead to several complications including death. In fact, 20% of people who have (MRSA) dies from this infection because the diagnosis is made too late. One of the most common complaints patients have when there is a MRSA infection is a bump or red lesion on the skin that is misdiagnosed as a spider bite. How do you avoid the misdiagnosis? By knowing who is at risk and what to look for.
MRSA tends to be found in places where there are many people living close to each other such as nursing homes, but of late, several cases are also associated with
- People who are either in a prison or an athletic facility.
- Athletes who share towels or razors
People who either work in prisons or visit relatives or friends incarcerated should always wash their hands after a visit.
If you are given a diagnosis of a “spider bite,” request that it be cultured, meaning a Q-tip is used to take a sample from the bump. Sometimes people can have the infection without having any symptoms. This is known as being a “carrier.” Again, if you are given the diagnosis of having a spider bite, ask that a culture be obtained from inside of your nose to make certain you don’t have MRSA.
MRSA can be treated appropriately with the right antibiotics. Medicines that are associated with Penicillin such as Amoxicillin and cephaplosporins will not work.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
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.