October 17, 2011
Miracle in Plain View: Twin Sisters Give Birth Less than One Hour Apart
It is said that when one wants to learn the mysteries of life, observe Nature. To everything there is a season, but what are the chances that twin sisters would give birth on the same day? Alicia Teepler and Ari Ostler are identical twins . Their own births were miraculous when you consider that there was one fertilized egg that split into two during their conception. They shared one amniotic sac, one placental connection with their mother and one common birth date. Now, their children do as well. Ostler gave birth to a baby boy on October 7th and 43 minutes later Teepler gave birth to a baby girl. Both sisters had exceeded their due dates and were induced. Ostler requested an epidural for pain management while Teepler opted for natural childbirth. Both moms’ deliveries had an abnormal amount of amniotic fluid and their babies had nuchal cords, meaning the umbilical cord was wrapped around their necks but they were easily removed at birth. Surprisingly, both labors progressed at the same pace.
Sometimes miracles are in plain view and we discount them as mere coincidences. I recall the time when I had a patient who was in labor and ultimately delivered a baby girl on her daughter’s birthday. She now had two daughters born on the same day. Or the patient who had a miscarriage with a twin pregnancy after she had relocated to another state. She returned pregnant again and an ultrasound was ordered to confirm her dates. When I initially reviewed the ultrasound report, I thought there had been a mistake. The ultrasound report’s findings indicated twins. However, I quickly discovered there had not been a mistake. The patient was pregnant with twins – again. She went on to have a successful delivery. Then there was the patient who had lost her daughter to undiagnosed heart failure at the age of four and was understandably anxious when she became pregnant again. She ultimately delivered a baby girl on her deceased daughter’s birthday. As an obstetrician, these experiences have made me both happy humbled.
“Life is not measured by the number of breaths we take, but by the moments that take our breath away.” The births of these twin sisters, Teepler and Ostler’s babies can certainly be counted as one of them.
October 5, 2011
Patient’s Miscarriage Gets Hospital in Trouble
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 21, 2011
Woman With Double Uterus Gives Birth to Twins
Imagine being pregnant and discovering that you have not one but two wombs (or uteri) and each of those wombs contains a baby. Such was the case of Andrea Barbosa of Clearwater, Florida. On September 15th, she delivered a baby boy and girl who had developed in two separate wombs. Thankfully, mother and both children are doing well.
Although twins are fairly common and represent 1 in 32 births, the type of twin pregnancy that Barbosa had occurs only 1 in 5 million chances in a condition called uterine didelphys or a double uterus.
Uterine didelphys falls under the category of Mullerian disorders and occurs in approximately 1 in 2,000 women. It is the result of a failure of the early female reproductive system (aka Mullerian ducts) to fuse between 9 to 11 weeks after fertilization. Mullerian disorders are usually undetected until a woman becomes pregnant, has pelvic pain when they begin to menstruate or has difficulty becoming pregnant. Although Barbosa had 2 separate wombs, some women have one but it is divided by a membrane called a septum. This condition is known as a Septate uterus and is associated with an increased risk of miscarriages. Other forms of Mullerian disorders include a heart-shaped uterus (aka bicornuate) or the absence of a vagina. The cause of these disorders is unknown because affected women have normal female genes. Sometimes problems such as pelvic pain, menstrual problems including delayed period and painful intercourse are the first clues of this disorder. Other women may experience difficulty becoming pregnant, repeated miscarriages or have an ectopic pregnancy.
Mullerian disorders can also affect the outcome of a pregnancy because it is associated with frequent miscarriages in the first and second trimesters, poor growth of the fetus (aka fetal growth restriction), prematurity, or a ruptured uterus. Pregnant women with Mullerian disorders should have at least one consult with a maternal fetal medicine specialist to minimize adverse complications. Barbosa’s successful twin pregnancy and delivery with a double uterus is nothing short of a miracle and keeps the medical community humble. We wish the Barbosa family well.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
