Scene: I’m in the perinatal center at the “premiere” hospital in St. Louis – the center of maternal fetal medicine – the supposed employer of the “best and the brightest” the field has to offer to serve all of us “high-risk patients” in the region, right? I’m hooked up to the non-stress test (NST) machine, and behind my curtain I hear a nurse speaking with another patient.
Nurse – So how’s everything going?!? Baby moving okay? (I’ll pause to point out that this is an extremely leading, nonchalant way of asking a very important question.)
Patient – Well… I’m probably just being paranoid, but… He’s usually a super active baby, but these past couple of days his movements have really slowed down…
Nurse – Are you feeling ten movements in an hour?
Patient – I’m… I’m not sure… He’s just slowed down…
Nurse – Well, you probably don’t usually pay attention… Understandable – haha! As long as you’re getting to ten, I’m sure he’s fine. Babies do slow down at the end, you know? He’s getting bigger, just running out of room!
Patient – Oh… Okay.
(NOTE: I wanted to jump through my curtain, but I also can’t afford to be banned from the perinatal center for interfering with another patient’s care. Although this raises the question of, had I interfered with her care, would it really have been my fault? Or could we both have just sued for all of the HIPAA violations that the cheap, thin ass curtains are creating? Like I’m pretty sure everyone in the perinatal center can overhear me share my name and birthday and situation, which… Fine – maybe I can educate someone… Everyone should be thanking me. Truly.)
Scene: I’m speaking to one of my doctors prior to departing for my exotic vacation to Hilton Head, South Carolina.
Me – So do I need to be concerned about the Zika virus?
Doctor – Well, probably not overly concerned. But you should consider wearing bug spray, and, if you ever notice mosquitoes, maybe consider going inside.
Me – But is it true that, to date, there have been no actual cases of Zika reported in the United States?
Doctor – Yes…
Me – So really, your profession should be much more worried about the risk of umbilical cord accidents, because they’re statistically far more likely, yet everyone is focused on Zika instead?
Scene: I’m being monitored in the Maternity Trauma Center. A midwife is reading our fetal heart rate monitor strips. She’s chatting with us, probably trying to distract me from my hysteria, which, to her credit, is nice of her. We’re speaking about a myriad of subjects.
Mark – I just don’t understand why, if a patient is concerned, or if a baby is showing signs of cord compression on an NST, you don’t just pull out an ultrasound machine to check to see if there’s an obvious cord issue.
Midwife – Because we can’t really see the cord on ultrasound.
Me – But we’re getting weekly pictures of the cord…
Midwife – Oh. But you have to remember that even if we saw something, there’s nothing we could do about it…
Mark – Well, if there were like three neck wraps and a knot, then you could deliver if the pregnancy was far enough along and the baby was showing signs of serious distress.
Midwife – But the vast majority of babies with nuchal wraps are just fine.
Me – But, also, some of them can and will die.
Scene: Same as above – Maternity Trauma Center, talking to midwife.
Midwife – We usually never induce until 42 weeks. Because babies will come when they’re ready – they’re very smart creatures.
Me – Yes, unless they don’t, because they’re in distress.
Scene: I’m being monitored in the perinatal center. The nurse comes in to look at my NST and rips the strip off of the printer.
Nurse – I’m going to have to take this to the doctor.
Me – Why? Is something wrong?
Nurse – Oh, you know… There’s just something she wants to look at a bit more closely. And she’ll want to keep you on the monitor for a while longer. Have you been getting enough fluids?
Me – Yes… So what’s wrong?
Nurse – You’re looking a little… Irritable.
Me – So I’m having contractions?
Nurse – Maybe… Are you sure you’re getting enough fluids? Do you have to go to the bathroom?
Me – Yes, I’m sure. And no, I don’t. Is something wrong with the baby’s heartbeat?
Nurse – No… It’s kind of just the combination of everything we’re seeing…
Me – What do you mean? What are you seeing? Is something wrong with the baby’s heartbeat?
Nurse – No… It’s just the bottom part of the strip. Are you sure you aren’t feeling any pain?
Me – Yes, I’m sure.
Nurse – Well, this is a really good sign.
Me – Aren’t contractions normal?
Nurse – Well yeah, but… I’m just going to go take this to the doctor, okay?
Me (after finally looking at the bottom part of the strip, as I’m usually focused on the top part) – You’re concerned about pre-term labor aren’t you? Because the contractions are at regular intervals?
Nurse – Yes, that’s why we’re going to keep you here for some extra monitoring. And it’s a really good sign that you’re not feeling these. I’ll be right back.
WARNING, ANGRY RANT FOLLOWING
Why in the actual hell are medical professionals in a major metropolitan hospital spewing this shit?!?!? Never mind the relatively poor standard of care in our country, the solution to which is complicated and controversial, but at MINIMUM, at a VERY FUCKING MINIMUM, medical professionals need to do their part to eliminate misinformation and also reconsider some of their approaches.
First, any change in fetal behavior is always a concern to be taken seriously and investigated fully. Babies do not just “slow down at the end.” This is a myth. I cannot (although I guess I, sadly, kind of can) believe that this nurse’s approach with this patient was, “Oh, he’s fine – as long as he gets to ten!” Are you shitting me? This nurse expressed almost no concern, conducted no investigation into what could be causing the perceived decrease in movement, provided no guidance as to what “getting to ten” even means and passed on a golden opportunity to educate this mother that it would be prudent to get to know her baby’s movements, because movements are generally one of the best indicators of fetal health. If this baby dies, his blood is on the hospital’s hands. Seriously.
Second, why obstetricians in the United States are soooooooo worried about Zika, which affects, currently, no one, compared to things like placental health and potentially deadly umbilical cord pathology is beyond me. The level of worry over so many things is completely disproportionate to their actual rate of occurrence. It’s senseless. Though I’m not sure of the solution, acknowledging that sometimes the umbilical cord becomes entangled, and sometimes it can be seen on ultrasound, and sometimes death can be averted, would be a great freaking start.
Third, how on earth is it logically sound to conclude that because the vast majority of babies don’t die from an umbilical cord accident that it isn’t a problem worth monitoring in our first world country with advanced technology? The vast majority of men won’t die prematurely from a slow-growing prostate cancer either, yet everyone is tested for (and aware of) this issue!
Fourth, “Babies come when they’re ready, because they’re so smart?” Ummmmm… What? Unless they don’t! And mine didn’t because he died, as did 26,000 others in our country in 2015, just like in each year prior and probably in each year to come. What an idiotic comment.
Lastly, I don’t know why this nurse couldn’t just come out with her concerns over my possible “pre-term labor.” Instead she danced around the issue, talking to me as though I’m a five-year-old with virgin ears, forcing me to interrogate her like a fucking detective. Because everyone wants to “be positive,” so heaven forbid anyone “scares a mother,” who’s obviously a delicate flower, by, oh, I don’t know, informing her of some very real pregnancy risks such as “pre-term labor” or “stillbirth.” I’m sick of the condescending, paternalistic approach so often taken by those in the medical profession. It’s actually pretty damn insulting. Patients deserve information, scary or not, especially when they ASK for it for crying out loud.
It isn’t doing anyone any favors to sugarcoat things. Because you know what’s scary (and completely devastating and traumatizing)? Being told that your child is dead during your third trimester of pregnancy, and you had not a clue it was even a possibility, which is the position thousands find themselves in each year.
Whether or not standard of care ever changes is one big, complicated issue. But regardless, it is so disturbing that our trusted medical professionals are some of the biggest perpetuators of myths and often pass on opportunities to educate patients, even those patients expressing concerns and seeking information.
This needs to change. I want to help make a change. In exactly what way this will be (besides writing here), I’m not currently sure. But I want to try to do something. For Matthew. And for all of our sweet babies gone too soon.