Brain Dead and Pregnant: A Moral Dilemma

Courtesy of politix.topix.com

Courtesy of politix.topix.com

The contradictions of life can be maddening. On one hand, we have the case of Jahi McMath, a 13-yearold girl who is brain dead on a mechanical ventilator that her family fought to maintain and on the other hand, there is Marlise Munoz, a 33 year-old mother of a 15 month old son, who collapsed on her kitchen floor from what appeared to be a blood clot to the lungs back in November. Munoz, according to her husband and family, never wanted to be on life support but the state of Texas ordered it when they discovered that she was 14-weeks pregnant. Should state law override the wishes of a patient because of her pregnancy?
The family of Munoz is concerned and angry about the state of Texas’s decision for a number of reasons. Munoz was without oxygen for over an hour before her husband found her on the floor which meant that the fetus was without oxygen as well. Medical experts believe this could cause serious problems for the unborn baby. Munoz’s father describes his daughter has having “rubbery arms that feel like a mannequin” which makes it difficult for him to visit her in the hospital. Munoz was very early in her second trimester (14 weeks), remote from delivering a baby, yet forced to be, as her father states, “a host for the fetus.” Who will have the ultimate responsibility of raising the child once the physicians intervene and deliver it via C. Section?
When John Peter Smith Hospital was confronted regarding their decision, they emphatically state that they are merely following the rule of law; however some medical ethics experts disagree and state that the hospital is misinterpreting the law. According to the New York Times, at least 31 states have adopted restrictive laws prohibiting physicians for ending life support for “terminally-ill pregnant women regardless of the patient’s wishes or her family’s.”
Should a brain dead pregnant woman lose her rights under the United States Constitution in order for the benefit of her unborn baby? I’d love to know what you think.

When Swelling Turns to Danger – Guest Blog by Ami Burns

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It is with pleasure that I introduce this very important article written by Ami Burns of SheKnows.

Many moms experience swelling during pregnancy, but sometimes this is a sign of preeclampsia, a potentially dangerous condition for mom and baby.

Dr. Linda Burke-Galloway — and moms who dealt with this situation in pregnancy — share the signs, symptoms and how to have a safe pregnancy and birth.

Many moms-to-be may not be able to wear rings or fit into their favorite pair of pumps, but super swollen hands and feet, along with other symptoms, could mean more than just inconvenience — it could mean preeclampsia. It’s important to understand the warning signs and talk to your doctor or midwife about treatment options to prevent eclampsia, a potentially life-threatening condition of pregnancy.
Signs you could have preeclampsia

Dr. Burke-Galloway, author of The Smart Women’s Guide to Pregnancy says, “Sudden swelling of the hands, legs or face and weight gain of five pounds or greater in one week” is abnormal and you should call your doctor right away. Other symptoms include “blurry vision or spots in front of the eyes, nausea, vomiting and pain in the upper mid-abdomen area, seizures, pain in the upper right side, {and} a severe headache that won’t go away with over-the-counter medication,” she explains.
Treatment for preeclampsia symptoms

Your doctor or midwife will discuss your options. In general, bed rest, extra monitoring during the remainder of pregnancy and possibly labor induction may be advised.

Dr. Burke-Galloway explains, “The definitive treatment for preeclampsia is to deliver the baby because there is something in the placenta that causes high blood pressure associated with strokes and seizure disorder. Magnesium sulfate is only given to prevent seizures while the patient is in labor. If the patient’s blood pressure is extremely high, medication is given to lower the blood pressure while the patient is being induced.”

Molly F. says, “I had been swelling since about Christmas and could barely wear shoes at this point — not even flip-flops — my feet were too fat!” During a regular prenatal appointment, her blood pressure was high and there was protein in her urine. “My doctor, who was usually so calm and never made a big deal out of anything up until this point, became very intense and focused and said to me, ‘I’m very serious — you need to follow my strict orders of complete bed rest. We are going to monitor you very closely now, and you will come to see me every three days until we can get you to at least 37 weeks,'” she explains.

When it had been 37 weeks to the day, Molly’s labor was induced and she delivered a healthy daughter. She had some complications following delivery, and was closely monitored when she started having high blood pressure toward the end of her second pregnancy. “They say that even though you have preecplampsia once, it doesn’t necessarily mean that you will get it with subsequent pregnancies — I was just lucky that this was the case,” Molly says. “But by having an attentive doctor (and practice) who took my history seriously, I felt that I had a healthier second pregnancy by being aware of — and possibly preventing — preecplampsia symptoms.”

Rebecca B. had high blood pressure during both of her pregnancies. She was given magnesium sulfate during her first labor, but her second baby had other plans. “My midwife was planning on starting natural induction methods at my 9:00 a.m. appointment the day before my due date. My water broke the night before at 11:10 p.m. and my son was born 131 minutes later. So we planned to naturally induce because of the preeclampsia, but ended up not needing to — whew!”
Bottom line?

“Trust your instincts,” says Dr. Burke-Galloway. “If something doesn’t seem or feel right, contact your doctor immediately. Early recognition of signs and symptoms of preeclampsia saves lives.”
Read more about pregnancy

Can a Pregnant Woman Eat or Drink During Labor?

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Theoretically, women will no longer have to starve during childbirth. Findings from a study presented at the Anesthesiology 2013 Annual Meeting suggested that it is safe for women in labor to have a protein shake as opposed to the traditional ice chips according to Dr. Manual Vallejo, chairman of the Department of Anesthesiology at West Virginia School of Medicine.

150 pregnant women were divided into two groups. The first group received 325 cc of chocolate or a vanilla shake that contained 30 grams of protein during the course of labor and tolerated it well with the exception of a few patients who experienced nausea and vomiting. The second group received ice chips alone during the course of their labor and some members of that group experienced nausea as well. According to Vallejo, the first group expressed profound satisfaction with their labor experience which is not surprising. What was surprising was the myth that was dispelled about women in labor not being able to tolerate food.

Traditionally, women in labor were only allowed to have ice chips or gelatin for fear that any other type of food could potentially travel to their lungs (aka aspiration) which could prove deadly, especially if they had general anesthesia for an emergency cesarean section. The time food takes to empty the stomach is longer for a pregnant women, thus increasing their risk. However, with new anesthesia procedures and less use of general anesthesia, these risks have been reduced, thus introducing a new practice allowing laboring patients to have protein shakes that would theoretically give them more energy.

All of the laboring patients who had the protein shake had an epidural for anesthesia and their food remained in their stomachs six minutes longer than those who received ice chips which, according to Vallejo is not statistically significant.

Although Dr. Vallejo’s research will now have to be presented in a written journal to be evaluated by his peers before it can be considered a new standard of practice, having a protein shake during labor is certainly food for thought.