Hospitalisation. Marina's story from Immaculate Deception 2. By Suzanne Arms.

Marina.
Exerpt from “Immaculate Deception 2” Myth, Magic & Birth.
By Suzanne Arms.
The following true story is representative of a disturbing trend in the United States. Every year thousands of helthy newborn babies are placed in intensive care unit (ICU) nurseries simply for “observation” but they almost always end up undergoing aggressive testing and treatment in the name of “active management”. These healthy babies, who could easily be observed while in their mother’s care, are subjected to the full range of current perinatal testing and technology. Parents are, for the most part, kept ignorant of what is being done, uninformed about the necessity of it, and made unnecessarily anxious. In this case, the parents are aquaintances of mine and the nurse-midwife and obstetrician are people I know to be highly competent. They did their best but were unable to buck the hospital system, in this case a major medical center connected to an internationally renowned medical school.

Marina was born after thirty hours of labour, twenty four of which was “active”. Although long, this was a normal labour, there was continuous confirmation that mom and baby were doing well, consistant progress in dilation of the cervix and considerable progress in the baby’s descent prior to the mother’s pushing. The waters broke spontaneously and copiously near the end and were clear, another sign that all was well.

During the pushing, fetal heart tones remained excellent and Marina came out head first, in a slow controlled delivery. Her mother had no tears. There was no cord around the baby’s neck.

Still, although she was pink and had a normal heart rate, Marina was limp and made only slight attempts to breathe after being laid on her mother’s belly. (This practice has been ducumented to be the best way to keep a baby warm). The attending obstetrician and the nurse-midwife, who’d been with the mother throughout labour both felt there was no reason to worry or panic. The baby was likely to be tired after such a long labour. They would observe her carefully for a minute.

The cord continued to pulse and the obstetrician specifically delayed cutting it to allow Marina more time to get breathing going on her own. (Since the placenta was still attached to her mother’s uterine wall, oxygen continued to flow into Marina’s body from her mother.)

Because of hospital policy, the nurse felt she had to call the neonatal staff. When they arrived, Marina was starting to respond. Nevertheless, the nurse had already taken her away from her mother’s warm skin and put her under an electric warmer, which unfortunately, was not working properly and was cold.
Marina was given several whiffs of oxygen. Her Apgar scores were only 4 and 5 at one and five minutes (on a scale of 10), but at six minutes her muscle tone had greatly improved.

Unfortunately, the decision had already been made, so she was on her way to the ICU when she was just six minutes old. By seven minutes, according to the records, she was crying and had good muscle tone. Her mom and dad were told, “She’s just going to be observed for a few hours, because of her slow start.”

In the ICU a nurse thought she saw Marina’s chest retracting (hollowing) with inhales. Although this was not confimed by another neonatal nurse, because Marina’s birth had been labeled “traumatic” by the neonatal staff (none of whom had been present for any part of it), the wheels were put in motion and she was given standard ICU protocal. Blood was drawn from her veins to be cultured in a lab, an Xray was taken and a spinal tap (a needle inserted into the space alonside the baby’s spinal cord, withdrawing a sample of spinal fluid) was performed. A temperature sesnor and a heart monitor were taped onto her skin. A metal clip was attached to her finger to record blood gas, electrolytes, and blood sugar.

Marina’s parents were not asked permission to perform any of these procedures. Although her father had gone to the nursery with her to comfort her, he felt helpless to stop the flow of events. She lay on her back in a brightly lit room, naked, under a lamp. So the father returned to his wife’s side, and she was wheeled to her room.

The Xray came back showing “streaking”, which was interpreted as possibly meaning fluid in the lungs, a symptom of pneumonia. Pneumonia was the diagnosis. Because the mother had no elevated temperature and no other signs of infection, there should have been no reason to suspect any infection in the baby. Since healthy babies normally don’t get Xrayed, it is impossible to know how many of their lungs might also show some “streaking.”

Rather than wait for more test results, the neonatologist decided to administer two antibiotics immediately. It is standard procedure to begin treatment before any test results are in, “just in case.”

Marina was not held by her mother until the next morning, ten hours after birth. She was not even allowed to nurse because the staff was concerned it might be too tiring for her. when her mother was finally able to put Marina to breast, she nursed well, one more indication of a healthy newborn.

Twenty four hours after the antibiotics had first been givin, the mother was told that Marina’s kidneys had become poisoned and were unable to function properly. (This is a well known side effect of the drug gentamicin that Marina was getting.) The staff then started an IV to run fluids through her kidneys to flush the antibiotics out. They promised the mother that the IV would be taken out as soon as the medication had been flushed. She was only permitted to nurse every four hours, even though most newborn babies would naturally breastfeed about every two hours.

During the night, nurses informed her that, because the baby had urinated only once in the first twenty four hours, they were going to increase the fluid in the IV. (Peeing only once in the twenty four hours after birth is within the range of normal, however. The resident who made this decision either did not know this or ignored it.) The mother was appropriately concerned that if Marina got too much fluid by IV, her desire to breastfeed would diminish. Sure enough, at 6:00 the next morning Marina did not nurse so well; her mother wanted to try again at 8:00 but she was not allowed to come until 10:00 because the medical rounds were beginning.

Meanwhile, preliminary reports came back from blood tests and cultures all came back normal. Marina had been taken off the gentamicin, but was still on another antibiotic. Despite the favourable reports, the IV remained in, apparently due to concern that the drug had not been fully flushed from her system. It takes longer for drugs to clear from newborn’s bodies because their systems are not yet able to handle drugs very well.

At this point, the mother just wanted to take her baby home. The hospital neonatal staff wanted to keep Marina there so that they could keep her on the antibiotics just in case it turned out that she did have an infection. Her private pediatrician felt uncomfortable going against hospital protocol - it is never politically wise for a physician in one speciality to question another - but did tell the parents that their baby was fine and did not need to be in the hospital. The mother thought having Marina come home and be in a normal environement, in her arms, might help them both. She asked if she could take Marina home and bring her to a private pediatricain for shots of the antibiotic, but was told it would be too difficult and that shots were too painful for a baby. She felt guilty for suggesting it.

Test results continued to come back negative throughout the week. A sympathetic nurse lobbied successfully on behalf of Marina’s mother to cut back on the IV fluids so the nursing could go better. Marina’s mother spent all of her time trying to get information about what was being done to her baby, trying to learn the rationale for each procedure, trying to be an advocate for her baby, in addition to trying to hold and nurse Marina as much as possible. The ICU was located nearly a quarter mile from the mother’s room. Because Marina was doing so well she was sent to the “stepdown” nursery, which was located even farther from her mother’s bed.

Five days after the birth the mother began to hemorrage. Her OB wanted to take her into surgery to explore her uterus under anesthesia for possible retained parts of placenta. Heavy bleeding, however is not uncommon right after birth, when a woman is on her feet too much, is under a great deal of stress and is getting too little rest. (One of the best ways to control bleeding is to have the baby nurse frequently.) This mother was told she could not nurse because the doctor had not left orders that she could.

The obstetrician and midwife finally intervened, against the pediatric staff’s orders, and insisted that Marina be brought to the mother to nurse. By the time she came, her mother was not there. She had neen wheeled to the operating room, where she was made to wait outside for the next hour until the anesthesiologist showed up. Just as the mother was taken into the OR, she was told that her baby had been taken back to the ICU for observation due to possible seizures. (It would later turn out that a nurse had seen some movement of an arm and leg she feared might be a seizure.)

There proved to be no seizures, but by the time the midwife arrived at the ICU they were doing a second spinal tap and all the standard procedures for possible meningitis, and Marina had been started on phenobarbital. The father, who was there, asked a resident if the muscle movement could be a side effect of the medication his baby had been on. He was told “definitely not.” The midwife later read in the Physician’s Desk Reference that muscle twitches, even convulsions, are common side effects of the antibiotic gentamicin, especially when the kidneys have shown toxicity.

A CAT scan was strongly recommended, because of “possible cerebral hemorrhage”. It was done. The results were unclear. The neonatal physicians wondered if Marina might have bruising on the brain. They elected to continue the phenobarbital. It made Marina sleepy so she couldn’t nurse.

On Sunday, a week after the birth, the parents finally got up the courage to insist on taking their daughter home, but not before being made to watch a video on infant CPR, which made them doubt their decision. Marina was supposed to be given phenobarbital three times a day by injection. Her parents were told nothing about follow-up-neurological checks. After a week of struggling with nursing and with the growing conviction that Marina was in fact healthy, they sought the support of a second private pediatrician who, after examining the records and Marina, advised them to stop the drug treatment altogether.

Once a baby is in a hospital intensive care nursery, it is condidered the legal property of the nursery. Parent’s wishes do not have to be considered. Because of the aggressive approach to these babies when they are in ICUs, well informed parents and midwives -and some obstetricians- do their best to keep babies out of them altogether. Some parents choose to take their babies and sign out of the hospital AMA (against medical advice). However, you should know that doing this can result in a future investigation by child protective services.