The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, October 15, 2006

Life Isn't Fair

Still in pediatrics, I am now part of the team that attends deliveries if there is any reason to think that there might be a problem with baby. I was half-hoping that this experience would help calm my fears regarding pregnancy and childbirth as the centre I'm at now handles much more low-risk and uncomplicated stuff than the centre where I actually did my baby-catching rotation.

Just before midnight last night we were called to a delivery because there was some meconium in the amniotic fluid. This means that the baby passed its first bowel movement in utero, which can be a sign of fetal distress. On top of that, if the baby manages to inhale meconium with its first breath, it can cause a very serious pneumonia and breathing complications. So that's why we were there.

Baby came out pink and wailing. These are good things. The nurse put the baby under the warmer, and I went to work. Rubbing the baby dry, suctioning his mouth and nose... soon the gurgles quieted and he seemed to be the perfect newborn boy. But as I was doing the quick head-to-toe exam required in all newborn assessments, it quickly became obvious that the baby lacked tone. Instead of holding his elbows and knees bent, arms and legs curled against him, his limbs were splayed out limply to his sides. I pointed this out to the attending after the rest of the exam proved normal. The attending spun the baby around an looked carefully into it's face.

"Did you have prenatal testing?" He called out to the new mom having her fun parts stitched up behind us.

"Yes, the integrated prenatal screen" she replied.

"And it was all negative?"

"It was. Why?" asked the new mom, understandably growing concerned.

"We need to look at your chart for a minute. We'll be back to talk to you soon."

And with that, we left the room.

Once we were safely out of the family's earshot, the staff pediatrician swore under his breath.

"That kid has Down's Syndrome."

"What? Why? But she had a negative IPS!" I didn't understand how such a thing could have been missed by such a sensitive test.

"Micrognathia, macroglossia, slanted eyes, low-set ears, nuchal fold, transverse palmar crease and hypotonia. I couldn't be any more certain without having the chromosomes laid out in front of me."

I was stunned. I always thought that the IPS protected people against surprises like that. The biggest risk of IPS is that it is sometimes TOO sensitive, identifying risk where there is none and exposing women to unnecessary tests as a result. And now this perfectly healthy 28-year-old woman has to be told that the similarly perfect child she was expecting will suffer from one of the exact syndromes that she thought she was safe from.

The reason that this scares me so much is that I, personally, don't think I would be able to handle the challenges of raising a child with severe developmental delay. I don't want my children to be physically dependent on me for the rest of my life. And as shallow as it might sound to many, my husband and I have agreed that we would likely terminate a pregnancy if something serious were found to be wrong. We will get IPS, and if a positive result occurs we will have an amniocentesis. How am I supposed to work up the nerve to get pregnant if even IPS can't predict outcomes?

Before you all comment that I'm deluded and juvenile and that nothing in life comes with a foolproof guarantee, I know. But I guess I just figured that when it comes to pregnancy and childbirth, there is SO MUCH that is still out of our control that it's nice to have some control when you can.

Now, back to worrying. This may have pushed back the babymaking schedule another 6 months, easy. Sorry, mother-in-law.

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Blogger mm said...

Scary isn't it.
First child I did all the tests and got a false positive. Secondary testing showed normal. Our five year old is now in Kindergarten and reading at a grade two level...
I didn't do anything, no ultrasound, no extra tests, no amnio... I adored my midwives for respecting that.
Three healthy kids.
No matter what, it's a gamble. And you are admirable for admitting to what a lot of us think...can I raise a child? let alone wone who needs more than usual?

10:37 PM

Anonymous Anonymous said...

I'm getting a little freaked out over here! And I'm older than the 28 yr old in your story. But, I guess it's the chance you take. How many normal births are there compared with abnormal ones? Small percentage, isn't it? At least, that's what I keep telling myself.


10:41 AM

Blogger Sarah said...

A million things can happen after birth that would make the child physically dependant on you for the rest of its life. Parents don't expect that either.

You're right, life isn't fair.

8:32 PM

Blogger WriterGrrl said...

I never thought I would be able to handle anything like that. They say that god only gives you what you can handle, and I always assumed he just knew that I couldn't handle anything that awful. And then D. was born. And lo, my heart has kept beating, and the world has kept turning on its axis, and I do somehow handle it. The thought that D. might be dependent on us forever terrifies me still, but I keep breathing. It astounds me daily, but I keep living.

12:53 PM

Blogger Gabrielle said...

I agree and when I thought I wanted kids (no way in ice cold hell now) this was my greatest fear. I would terminate if I found anything wrong. I admit to selfishly not wanting the burden. I know I could not handle it. There's alot to be said aobut self honesty.

12:20 PM


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