Saturday, 16 April 2011

Sarah Palin Could Change the Face of Obstetrics

As Sarah Palin and other teabaggers risk being pelted with Wisconsin's fine dairy products at the Tea Party rally, we continue to have a look at Sarah Palin's obstetric adventures, this time focusing on amniotic fluid.

In May 2009 I wrote a post about it: "Sarah Palin, Baby, fluids, risks and the doctor"

This is what I had found about amniotic fluid leaks:

There are times when the amniotic sac may develop a tear or may rupture causing the amniotic fluid to leak before term. When this occurs before 37 weeks, it is referred to as ‘Premature Rupture Of Membrane’ or PROM.

When the premature rupture of amniotic sac occurs, it is necessary to determine the cause of the leaking amniotic fluid. Normally, the leaking is caused by a bacterial infection or by a defect in the structure of the amniotic sac or the uterus or the cervix.

This leakage may lead to further complications for the growth of the fetus, as it may hamper the growth of the fetus and may cause bacterial infection to spread from the vagina to the uterus and consequently to the fetus.

Premature rupture of the membranes can present serious risks to mother and baby

* To the mother - the risk of infections and early delivery
* To the baby – the risk of infection, blindness, cerebral palsy, deafness, cognitive impairment and death

Other complications that could occur include compression of the umbilical cord, postpartum infection, early detachment of the placenta from the uterus.

In addition, a reader left an interesting comment on the thread about Cathy Baldwin-Johnson's letter, using slightly different terminology.

No practicing physician would EVER endorse/suggest or support a decision for a pregnant woman to delay seeking medical help with a ruptured bag of waters (BOW) with/or without being in labor.

Ruptured BOW is a red flag for refraining from sitting for long periods and emphasizing the importance of keeping the genital area clean and free from possible bacterial contamination. So, don't use public facilities and be aware the vaginal canal may be the route for a prolapsed umbilical cord to descend through, thus causing the still tight cervix to diminish the blood flow and oxygen delivery to the infant still in the womb. Almost all of us know oxygen deprivation causes terrible maladies, most of which are not known until time has passed and development can be evaluated.

The time line for absolute need for medical intervention for a near term pregnancy with ruptured BOW is 24 hours. It has been that for decades, because the amniotic fluid is a great place to grow bacteria. Recognize that the pathway for the amniotic fluid is from the vaginal outlet up through the vaginal vault through the cervix and into the uterus and whatever is still on the baby's skin, mouth etc. and all of those sites can harbor unfriendly bacteria that have motility to spread.

No health care medical practitioners can possibly believe or support the idea that Cathy Baldwin-Johnson sanctioned $P's "wild ride". As well we know Mat Su Hospital's license would not permit Trig Palin to be born there given the diagnosis publicly spouted.

I found a good article about premature rupture on the amniotic membranes. I gives advice to expectant women who suspect a leak:

If you think your waters have broken contact your caregiver for advice. Keep any pads or underwear and take them with you for your caregiver to look at.

If there is doubt as to whether your waters have broken, your caregiver may use one of the following methods to try and determine if they definitely have.

They can:

Place a speculum into the vagina to see if the water pools or collects on the speculum. Sometimes the caregiver takes a sterile cotton bud swab test to send to the pathologist to check for infection.

Use an amnicator test. This may be an orange coloured cotton bud that changes to navy blue if it comes in contact with amniotic fluid (like a pH indicator) or another form of test based on similar principles.

Sometimes neither of these methods are conclusive and even the most experienced caregivers can find it difficult to know if the waters have definitely broken. In this case, it is often just a wait and see approach, observing if any more fluid comes away over the next few hours or days. Most women can go home unless the baby is premature.
The site is Australian, which may explain the wait and see approach, which doesn't apply to premature babies. In the US, where malpractice lawsuits are very common, doctors would be a lot more cautious.

We know that Sarah Palin didn't have any tests carried out on whatever leak she had. All the "examinations" were conducted by telephone.

There is a very big difference between "wait and see" after the woman has been examined, tests carried out and the woman returning home (which we assume wouldn't be thousands of miles from the hospital) and a 44-year-old woman exhibiting symptoms of premature labour with a baby who had been diagnosed with Down Sydrome. That this woman was not only not tested, reassured and told to wait and see, but was also two long flights plus a one-hour's drive away from the only hospital this woman would consider for the birth of her gift from God, that this woman waited around eight hours after the onset of symptoms before she started her long journey to the hospital because she had to stand before an audience to make a speech while having contractions, makes this woman's story absolutely unique.
The people who believe Sarah Palin's version of the events should urge her to become the object of a serious and pioneering study about pregnancy and labour in the older woman. Sarah Palin's circumstances are so unique, from the absence of a baby bump very late in the pregnancy to the very unusual development and management of her labour with this truly miraculous baby, that it could revolutionize obstetricians' approach to all older women's high risk pregnancies. Why stop there? It would apply to all pregnancies! If the doctors unlock the secrets of how this remarkable woman achieved such a discreet pregnancy and such an easy and risk-free labour against all odds, they could save millions of dollars in tests and examinations, which could then be carried out over the telephone, saving their precious time as well.

Pregnant women would be able to come and go as they please, their careers wouldn't be impacted by trivialities, such as a big belly and concerns about air travel to far away locations. For example, they could go to a convention in Hong Kong in the last month of their pregnancies, go into labour the night before the convention and still be able to take part in it before comfortably returning to their country and the hospital of their choice. No hassle, no worries!

Sarah Palin would have a truly honourable claim to fame, she would be the woman who changed the face of traditional medicine and heralded a new era in the field of obstetrics! She would free women from the constraints of large bellies and traveling by air while in labour, they could work until the last possible minute, advancing their careers and Sarah would be celebrated as the ultimate feminist!

Please read another woman's account of her difficult pregnancy in this interview. It's a shame that she couldn't benefit from the new revolutionary approach, sparing her much anxiety and her doctors' time and resources. Sarah Palin should hurry up and offer herself for that study... or perhaps some doctors in the field should approach her. Imagine the possibilities!

Some nice photos of women who don't have tight abs, compared to amazing Sarah.