In this news story, a full-term baby was born so severely brain-damaged that the doctors say he has no hope of recovery. His parents want to keep him alive longer, after the doctors have recommended turning off life support and letting him die (he is on a ventilator and is being fed through a tube, but is moving his legs and arms on his own). They have won a stay for three weeks so they can get another consultation with another doctor.
There are some things I don’t understand about this story, though. It says the mother was in labour for 40 hours, during which the baby had the umbilical cord wrapped around his neck and breathed amniotic fluid and fecal matter. Is this normal, for a woman to be in labour this long and not get a C-section? Also, can doctors tell from birth that a baby has no hope of recovery? The story says that the baby was healthy up until birth, as far as anyone knows. Can the consulting doctor tell from his consultation what the prognosis for the baby is? Is there any chance of a good prognosis for a baby born in these conditions?
Paging Cyn
.
Till she gets here, IANA OB Nurse, but I was married to one and worked in a medical feild. Meconium aspiration is not a good thing, nor is being strangled with an umbilical cord, or an extremely long labor. The combination could very well result in a poor prognosis. Without alot more detailed information on babys labs, and exam findings it would be tough to say deciseively “pull the plug” but if they have several docs saying to, baby is probably in bad shape.
I’m of two minds on this.
As a disabilty rights person I can attest that most docs are operating under a very basic understanding of how the human body and brain works.
Many folks with disabilites were told that they would never do this or that.
Heck, I’m supposed to be at best " severely mentally retarded"
However, at the same time I do think that some parents are tries to think of a good word
Well, I do think many new parents including many pro life parents do not understand how hard it is to care for a child with PROFOUND disabilites. Matter of fact most kids with profound (NOT severe. Severe is toddler level functioning) disabilites live/end up in nursing homes, and are profoundly multihandicapped. Yes, very few of them are in persistant vegeitative states. Which is awesome. But still, that doesn’t negate the fact that profoundly affected kids are pretty much eternal babies. Some of them will never be able to walk or talk (some profoundly affected kids can walk and talk) or even know who their parents are!
I do think there are many parents of profoundly mentally affected kids who are …almost clueless or so devoted to “keeping their child alive” that they don’t see that their kid doesn’t have much of a life.
Does anyone know the details of the profoundity of the brain damage? Like is it pretty much 100% that the baby will not have much of a life?
Just another couple of data points. My daughter was born after 40 hours of labour (34 or so in early labour, 6 in active labour and 20 min of pushing). There was no talk of a c section for her, although had she shown any distress (like irregular heart rate, muconium in the amniotic fluid etc), I would have been in the OR in 4 min, and she would have been out in 15 (based on previous discussions with my Ob).
My mother had 3 kids, with labours up to 36 hours. My sister was born with her cord around her neck, and I was born with a knot in my cord. Both of us were very lucky - I have heard of babies being stilborn at full term due to the same conditions. Devestating for the family involved.
Oh…anyone notice the Biblical names? I wonder if the parents are VERY naive prolifers.
Not that there’s anything wrong with that, but honestly I don’t think they understand what they are up for. Yes, their baby can open his eyes and move a bit. So what if that’s the only thing he’s ever able to do?
I wonder. The parents are quoted in the news article as claiming that the kid opens his eyes, moves his limbs, and so on. If so, it doesn’t make much sense that the doctors would advise pulling the plug. Looks like you Canucks get your own Terri Schiavo fiasco.
My third son was perfectly healthy until a few hours before his birth. Then the cord prolapsed and, due to the incompetence of the attending staff, he was denied a sufficient supply of oxygen until he was born by C-section.
His Apgar Scores indicated that he was in a very bad situation even before he was moved by helicopter to a better hospital. A pediatrician spent some time telling us about the range of deficit he could experience and the likelihood of him managing to live. He died within minutes of being removed from life support.
So yes, the pediatrician knew what he was talking about even with a baby only a few hours old.
I don’t think you can read much into the length of labour. As alluded to by the Girl From Mars 40 hours of labour doesn’t mean the woman is lying on her back pushing for 40 hours.
Don’t Ask, that must have been horrible. My first daughter had the umbilical cord wrapped around her neck and the “relaxing” midwife only birth moved quickly to a more tense affair with several nurses and a doctor in attendance with the birthing eventually requiring a plunger (I can’t remember the medical term.) Fortunately for us the outcome was good, your story reminds me that it might not have been.
yeah that was a fiasco, but the time is nigh to make a decision about continuing life support, not next year or 10, 15, 20 …or 51 years down the road. I think once you go down that road there is no turning back.
Poor bean, how do you turn your back on your baby esp if he is moving around on his own and such…
Generally I’m for unplugging in cases like this. However, in the case of a baby or child I think it’s reasonable to give it more time. The brain has an amazing capacity to recover especially at a young age.
I mean, I personally know two people who were severely brain-damaged and in comas on life support with no detectable brain function in childhood (one drowned as a toddler, one was hit by a car at 7 years old), and both, with a lot of time, recovered fully.
Even in the case of my dad, who was 43 when he lost almost half his brain from bleeding and swelling- he has had a truly miraculous recovery, a lot of which is probably due to his age. From the area and extent of his brain damage we were told he would probably die, and if not be permanently paralyzed on his left size, most likely with no short-term memory and limited ability to speak, as well as personality changes. And here he is 10 years later walking without even a cane, talking perfectly, with his personality intact and almost unchanged. He has a little left-side physical disability, and his memory, attention span and grasp of reality are pretty shot, but like I said - miraculous.
Still recoveries like the above are pretty rare, which is why docs make the recommendations they do - it’s based on reality. If I was in the same position, even knowing there was a chance of my child becoming non-vegetative, I would probably unplug - I would feel pretty comfortable choosing death for my child over probable severe disability. This is also why I plan to abort if I know my fetus has a disability that would decrease their quality of life (this doesn’t include Down’s, for me).
I always assume it does–what does “early labor” consist of then? Minor contractions or something? Sorry if this is a dumb question–I’ve never really been there. How does it feel? Can you walk around and do stuff?
“Labor” just means that you’re having contractions and your cervix is dilating. You can be up and around for *most *of your labor. You’re imagining “hard” labor, with the wheezing and the pushing and the contractions coming fast and furious, which (while it varies wildly) is not how most people spend the majority of their labor.
To offer some perspective, I was in labor for sixish hours, but only in hard labor for about an hour, and only in the delivery room for 20 minutes and four pushes.
The first stage of labor ends when your cervix is completely effaced and dialated to 10cm. Contractions become closer together and more intense over time. This can last for days for some women - although they like to hurry things along in modern times (by administering Pitocin once you’re admitted to the hospital). Years ago they used to send you home to wait if you went to the hospital with contractions and you weren’t dialated to a certain point.
In very early labor, except for having regular contractions, life is usually pretty normal. Things get worse over time and you never know how fast it will go. First births tend to be the slowest, but every pregnancy is different - some women always have short labors or long labors, but not everyone is consistant through multiple labors. Since it’s so individual you never know what a woman is going to feel like… some women though continue walking around almost up until the birth. Some immediately need to be lying down. Some vomit throughout labor. Some are exhilarated. Etc. The one constant seems to be that contractions hurt like hell. In comparison, pushing an 8-lb baby through a 10-cm-wide orifice is often referred to as ‘a relief’. LOL
When you’re fully dialated, you progress into the second stage of labor after going through ‘transition’- where hormones really kick in and the pain, side-effects (digestive disturbances, shaking, chills) and emotion become very intense and overwhelming. Usually it’s time to push shortly after transition. Pushing lasts for 2 hours or less for the vast majority.
This is a tough one. First of all, I can’t even begin to imagine what it’s like for a parent to go through something like this, so it’s not really fair for me to judge them.
I would have to believe that the desire to keep their child alive, and to hope against hope that the doctors are wrong and he will recover, are absolutely natural reactions to the situation.
The cynical side of me, though, can’t help but focus on the final paragraph of the linked article:
If this case is truly about whether or not the baby remains on life-support – which it seemed to be up until that point – then why the implicit placing of blame for his condition?
Let’s see We’re both unemployed. If we take the kid off life support, we’ll get X amount from the hospital. But if we keep it alive, we can get 21X or more for expenses relating to keeping the kid alive for years.
I can’t answer any of the other questions, but with our first child, my wife was in labor for 38 hours before her doctor went for a C-section. I think they would have waited even longer, but the labor hadn’t really progressed for hours.
My SIL was in labour for 56 hours before my niece arrived. No C-section in sight, even though all the blood vessels in my SIL’s eyes were burst from pushing so hard.
I think, if the labour is progressing, even if it’s progressing slowly, most Drs will shy away from C-section. I believe there are some benefits for the mom and baby with vaginal delivery so I think they like to encourage that whenever possible.
Everyone is different, but during the early stages of labor the contractions are usually not at all uncomfortable. Imagine somebody squeezing your arm for 5 seconds every half hour or so. Normally the duration of the squeeze lengthens and the time between them shortens. There would be no point in medicating that sort of thing.
FWIW and regardless of what you see on TV, many of us deal with the contractions with relaxation and breathing techniques. Myself I had not a drop of any kind of pain killer at all.
Obviously this is not true for everyone. At the extreme of hard labor, especially if it goes on for a long time and you are tired and stressed, maybe even panicky, it can get a whole lot worse. Add to that, sometimes anatomical differences and the size and position of the fetus make things a whole lot different. Some women’s bone structure tends to the long and flexible, others not so much.
