We have covered this topic before, but it won't hurt to take a fresh look at Sarah Palin's wild ride...
It's very difficult to find straightforward medical advice regarding long haul flights in late pregnancy, but there are bits and pieces to be found on the forums. Funnily enough, when searching for medical advice about flying while leaking amniotic fluid and having contractions, the results are overwhelmingly about Sarah Palin and the wild ride!
I found an actual medical opinion and emphasized the relevant passages:
Women who fly during pregnancy, whether as passengers or crew, continue to fuel the debate over the potential impact on pregnancy outcome and fetal development, the two risk factors most commonly invoked being relative hypoxaemia due to the decreased cabin pressure and, more recently, cosmic radiation. On both theoretical and experimental grounds (altitude physiology and studies in pregnant women during flight), commercial flight poses no threat to the fetal oxygen supply in a normal pregnancy. As for cosmic radiation, only theoretical estimates are available of flight crew exposure: if annual doses approximate to background at ground level (3-5 mSv), the dose received during an individual pregnancy can be estimated from the fraction of annual flight time spent while pregnant. It is doubtful whether any epidemiological study could ever confirm or refute this theoretical estimate of a low increase in risk. Many airlines have opted to allow pregnant crew to continue flying. There is thus little if any ground for advising against passenger flight in pregnancy. Flying is probably the safest and most comfortable way to travel long-distance in pregnancy. The few relative contraindications include flying close to term, a history of miscarriage and premature delivery, heavy smoking, severe anemia, cardiopulmonary disease, and a serious fear of flying.
We all know that Sarah Palin's pregnancy with Trig was not normal and her own book revealed that she had two miscarriages.
From a forum:
After reading the postings regarding flying when pregnant, and having had a trip planed for my 30 week of pregnancy, I realized that perhaps I also should contact my doctor to get their advice. I belong to Kaiser and can tell you that the advice nurse all but laughed at me when I told her my situation. She said that she would forward the message to my doctor but could tell me immediately that the doctor was NOT going to approve it. Granted, my situation is slightly different as I was planning on flying to a wedding one day, and returning the next. Wanting to get a second opinion, and make sure that Kaiser was not overreacting to prevent a potential lawsuit I sent email to my father-in-law who is a retired general practitioner. Below is his reply. Hence, my trip has been cancelled.
"The third trimester is a time when complications occur, which can be abrupt. As an example, if membranes rupture in the seventh or eighth month, labor can be very rapid, all within the period of an airplane flight. Although the odds are fairly low, such complications, unfortunately are common, and you would have much better chances for a favorable outcome if you are near your physician and hospital. My answer was always no. My usual response was that, although you'll miss the wedding, it is far better to visit later, and show off your new baby."
I don't think doctors anticipate having to advise their patients about flying in the late stages of pregnancy after they start leaking amniotic fluid. Their advice is normally about one or the other, not both! The same goes for contractions.
Article on the ADN:
Palin said she felt fine but had leaked amniotic fluid and also felt some contractions that seemed different from the false labor she had been having for months.
Sarah Palin reinforced the story about the contractions in Going Rogue, but left the fluid leakage out:
The next month, Todd and I checked into a hotel in Dallas. The following day I was scheduled to keynote another oil and gas conference. My pregnancy was going fine, and with five weeks to go, I felt great. But at 4 a.m., a strange sensation low in my belly woke me and I sat up straight in my bed.
Later that afternoon we entered a packed house at the energy conference, where I’d speak on the urgent need to tap conventional supplies and innovate on stabilizing renewable sources.
Then I took the podium and opened by teasing the audience about how great it was to be in our "little sister state of Texas."
Big laughs. More contractions.
Dr Cathy Baldwin-Johnston found herself in a very unique position, having to advise her patient on three different aspects of pregnancy, all at the same time.
On the same ADN article, we find this quote:
"I don't think it was unreasonable for her to continue to travel back," Baldwin-Johnson said.
Advice about leaking amniotic fluid: (Preterm Premature Rupture of Membranes -- PPROM)
How is it diagnosed? If you are leaking amniotic fluid, the diagnosis is easy. The doctor will do a pelvic exam to look for amniotic fluid leaking from the cervix. A speculum will be inserted much like when a Pap smear is done. A fluid sample will be taken. The fluid will be tested by putting a drop on special paper. Amniotic fluid will cause this paper to change color. The fluid can also be tested by looking at a drop under the microscope. When amniotic fluid dries, it looks like a fern pattern. An ultrasound will tell if there is less amniotic fluid around your baby.
Based on the information we have, Dr Baldwin-Johnston performed this test and an ultrasound over the phone.
How will the affect my pregnancy? PPROM can lead to other problems such as premature labor, infections of the mother or baby, kinking of the umbilical cord, delivery of the umbilical cord before the baby (prolapsed cord), and poor growth of the baby’s lungs.
The sac around your baby helps to protect the baby from germs that normally live in the vagina. When this sac breaks, these germs can cause an infection in the mother and/or baby. This is called chorioamnionitis.
The umbilical cord could get pinched with less fluid to protect it during uterine contractions or when the baby moves. In rare cases, the umbilical cord can come out of the vagina before the baby is born (prolapsed cord). An emergency delivery would be needed because the baby would not be able to get oxygen. Without enough amniotic fluid, the baby’s lungs may not grow well. If the lungs are too small, (this is called pulmonary hypoplasia), it may be hard or impossible for the baby to breathe after birth. There is no way to predict this problem.
Apparently, Dr Baldwin-Johnston was able to make many predictions based solely on telephone examinations.
There are two ways of looking at the good doctor's behaviour:
1. She gave very, very bad advice over the phone. I can't imagine any other doctor thinking that it would not be unreasonable for a 44 year old multipara leaking amniotic fluid and having contrations to continue to travel back from Dallas to Anchorage, then travel a further hour to reach a hospital without appropriate facilities. Did I mention that the baby in question was already known to have Down syndrome?
2. It was not unreasonable for Sarah Palin to continue to travel because she was not pregnant at all.
Whichever of these options is true, it leaves Dr Baldwin-Johnston facing a conundrum. Either she gave appalling advice or she's covering up a major fraud.
The third option is that she was caught in one of Sarah Palin's many instances of using people as she pleases, then discarding them. Dr Cathy Baldwin-Johnston has been awfully silent and virtually unseen since the April 2008.
I wonder why!
(Previous post about the wild ride)