ERDoc Posted October 17, 2012 Posted October 17, 2012 (edited) OK, this one has piqued my interests. Here is another article from NYT. http://www.nydailyne...ticle-1.1181731 First, they were being see by maternal fetal medicine (MFM), meaning it was a high risk pregnancy. They don't disclose the reason this was a high risk pregnancy to start with. Second, the baby's trunk was too large for delivery at 26 or so weeks so it would be considered large for gestational age (LGA). This may be related to gestational diabetes, which may be the cause of the MFM care. Third, the NYT article says that the pulling resulted in the head being seperated from cervical spine, implying an internal decapitation. There would be no reason for the arteries and veins to bleed at this point. The blood also shouldn't spurt towards the parents, it would spurt towards the providers. EDIT: OK, here is another one with a little more detail. http://www.courthousenews.com/2012/10/02/50841.htm So it says that the baby was decapitated in the delivery room but then it also say that the baby was surgically decapitated in the OR. Well, which is it? Something smells fishy here. Edited October 17, 2012 by ERDoc 1
DwayneEMTP Posted October 17, 2012 Posted October 17, 2012 Doc, why do some doctors seem to choose, what can appear to the uninitiated, like in this case, a higher (relative to other vaginal deliveries) risk vaginal delivery instead of the C-Section? Shouldn't they have had a pretty good idea that this was going to be a difficult delivery? I'm guessing that there is a really complex differential involved in the decision, but what would that be do you think? Maybe in this case, if you're correct about the gestational diabetes, that the risk factor for mom might have been raised unacceptably high for such a surgical proceedure? Looking for guesses and speculation only in general. Not asking anyone to judge those involved in the story. I know with Babs/Dylan that she was induced (I don't know why..I just assumed that there were good reasons, though they weren't explained that I can remember.) During labor she had to stay in a very specific posture or Dylan's heart rate, according to external and then internal monitoring, would drop down into the 40s-50s. After this went on for a few hours we were notified that he was going to be removed C-section. She was prepped, and then suddenly the doc came in an said, "We're going to go ahead with a vaginal delivery.." There were stretches of time, during the hours that followed the no C-section decision, minutes long, while they tried to adjust her position again and again (I'm assuming it was because his head was being compressed) when he would brady back down into the 40s and this seemed to cause everyone a lot of concern.. Dylan is going to be 16 this year, so this isn't about blame or lawsuits, hopefully that would go without saying to most that know me, but I've always been curious why we went through so much drama to deliver vaginally...? Also, I hope that it goes without saying that I don't see a c-section as a benign proceedure.. Just curious...
Curiosity Posted October 17, 2012 Posted October 17, 2012 Sounds like what Dwayne said. Internal decapitation during delivery and as you mentioned, coming out is hard enough, it probably doesn't go back in so in order to get the baby out, the head had to be detached completely and delivered vaginally while the body was delivered through the c section. No one commenting on the fact she was not anesthetized prior to the start of the surgery? Baby is dead, why make mom suffer more? An extra minute or two isn't going to harm the baby. Right?
cscboulder11 Posted October 17, 2012 Author Posted October 17, 2012 I way I read it is as that the baby had started to come out, then enough force was applied to cause spine separation, but not total decapitation (maybe some skin and muscle holding on in the front?). Then the doctor put the baby back in along with the head, ordered a C-section, and completed the decapitation with the C-section procedure. Regardless, I don't think the full details will be known as this will be settled long before it ever gets to a jury.
triemal04 Posted October 17, 2012 Posted October 17, 2012 Let's see...newspaper articles being written by people with no medical education...basing their info only off what the people who filed the lawsuit are saying (just guessing here, but I highly doubt either doctor mentioned, anyone in their practise, or the named hospital would be dumb enough to be talking to a reporter about this)...does anyone else want to consider that all the facts are so far from known that it's pure speculation at this point? Telling someone that they need to trial a vaginal delivery before a c-section is different than flat out refusing to do one. (and since nobody here is an OB or was involved in this case...do you really want to guess what the reasoning behind that decision was?) An epesiotomy was performed...perhaps that's where the extra "spurting" blood came from... An "internal decapitation" would be something along the lines of an AOD as best I can figure...little different than tearing the head off the body. But which will sell more papers and earn certain people more money? "oh the horror...the horror...that evil monster doctor!" The doc tried to "cover up" the injuries before handing the kid to the parent's...um...why is that bad? You can argue all day about what the motives may have been, but cleaning up a dead body before the family views it is par the course...at least around here. And if the head was off the body...hard to do. There is so much about this that isn't known and so many different ways this could really have played out that it's impossible to say completely what happened right now. I'm very curious to see if this full story on this comes out and what actually happened. But I've been in L&D during a...let's just say freaky event that, if someone with only one partial side of the story heard would have sounded just as bad, if not worse. And in that case nothing had really been done wrong...it was just what happened. 1
Curiosity Posted October 17, 2012 Posted October 17, 2012 Doc, I would imagine at 28 weeks a baby would be more susceptible to internal decapitation right? These doctors may have done nothing wrong. Even with the diagnosis of an enlarged abdo, I wouldn't have guessed that at 28 weeks, this would have been a difficult vaginal birth. As far as pushing the head back in, what else was he suppose to do? If you know the baby's not coming out that way, it's gotta come out an other way right? And as far as the blood part, the patient and her husband probably didn't know what to expect. 1
DwayneEMTP Posted October 17, 2012 Posted October 17, 2012 ...Telling someone that they need to trial a vaginal delivery before a c-section is different than flat out refusing to do one. (and since nobody here is an OB or was involved in this case...do you really want to guess what the reasoning behind that decision was?)... Well, yeah! That's where all of the good learning is in this situation, right? Trying to guess, exploring the possibilities, comparing the relative value of different theories? I'm not really sure where the motivation to say, "No point in guessing, we weren't there and it's just a newspaper article" comes from...but it's mentioned often in these discussions. What is the down side to exploring these issues even if 100% of the reported information is bullshit? No offense to you Brother, as I love your posts, but I truly don't get this....
triemal04 Posted October 17, 2012 Posted October 17, 2012 It's not so much that I'm against discussing what happened, or trying to figure it out; I'm all for that and if I came across otherwise that wasn't my intent. It just seemed that, in this thread and in a few other recent ones about medical events that honestly had some questionable reporting, some posters seem to be taking what is written as gospel. That's just one of those things that will drive me nuts when I see it, especially when you consider that most posters here are supposed to have critical thinking skills, some degree or another of medical education, and the ability to question what they read when it doesn't make complete sense. Anyway, editorial off. Please continue. 1
DwayneEMTP Posted October 17, 2012 Posted October 17, 2012 I'm with you Brother. In fact, I'm probably one of those. Not because I believe the article necessarily, but because holding it as gospel also holds it as a baseline for the argument. Know what I mean? But your point is well take, and more than anything gave me the opportunity to make a point that's been bothering me for a while. That wasn't really fair to you, but, I'm sure you know the kinds of posts that I'm talking about... Sorry about that...
ERDoc Posted October 17, 2012 Posted October 17, 2012 I can't say why the OB went for the vaginal delivery first. A lot of times it is a judgement call, the reason why medicine is an art and not a science. The fact that the week before the mom was told she would need a c-section makes me question the decision, but without all of the facts, I can't really say. It's possible that the OB who told her she would need a c-section saw that the baby was big and would need a c-section if she went to term. Dwayne, the only reason I can think for your situation was the his head was compressing the cord during contractions and when she changed positions the position of the head or cord moved. Despite what the media and general public think, OBs don't like to rush people in for c-sections. It is higher risk to all involved. Having delivered several 14 weekers, both breathing and not, it is not an easy situation to deal with.
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