Sunday, February 12, 2006

Mistrust

There is a news article today about a baby born in a toilet at home. It may seem weird to a lay person, but actually toilet deliveries are not that uncommon. Apparently the urge to push to deliver a baby is not unlike the urge to push to have a bowel movement. You can figure out the rest yourself.

I'm just a little mistrustful, though, of women who don't make it to the hospital in time to deliver there. The same goes for women who do not get prenatal care. I hate to be judgmental, but the sad fact is that some of these women use illicit drugs or have had run-ins with the law or child protective service agencies. They may avoid prenatal care to avoid prosecution or to avoid having their baby removed from them by the protective services folks.

So I've developed a simple screening question of all moms with unintended home deliveries or no prenatal care. I ask them if their other children live with them. If they don't, there is something wrong, because in our society you usually have to mess up pretty bad to get your kids taken away.

Remarkably, the mothers are pretty truthful about the answer. Maybe it's because they've just given birth, and that induces truthfulness, or maybe they know that we'll figure it out some other way, but they usually admit it if their kids are not with them. And then we have to do the unpleasant duty of beginning the process to separate a mother from her child.

5 Comments:

Anonymous Chris and Vic (CAK) said...

The scenario where a woman who gives birth in the toilet is entirely different from the scenario of the woman who doesn't get prenatal care for the reasons that you gave.

Giving birth in the toilet (my adopted son was born in the toilet, by the way) can be an accident--as I think you are acknowleging when you say that it is not that uncommon.

My question is: what happened next? Did the mom and/or whoever was with her, take immediate steps to rescue the baby from the toilet bowl? Or did she leave him there? My son was left in the toilet bowl . . . and I still allow that his birth-mom was in a state of cocaine-induced stupidity, maybe even walking unconsciousness.

Neonatal Doc, we see the women who have lost custody of their kids pretty far down the road. We only understand the first causes of irresponsibility. The first causes and symptoms of irresponsibility can easily be reversed, if addressed immediately; but when a mom is way down the road, the behaviors with consequences which lead to further irresponsible behaviors (and further consequences) are hard to reverse.

The impaired person may not be able to figure out the long line of cause and effect, and how she got to the place she is presently.

She may not get prenatal care because she expects blame and because she knows the medical people are holier-than-thou. AND they may turn her in. (This happened in my state 2 or 3 years ago---a drug-using mom who was discovered during a prenatal visit, was incarcerated for the remainder of her pregnancy, so that she would not abuse the in-utero child with drug exposure. It was a case of "child abuse," and she went to jail. And, yes, we are pretty sure that a lot of women didn't come for prenatal care for a while after that incident.)

Some of my older kids dabbled in drug-use. Their original problems, whatever they were---anger, poverty, divorce between their mom and dad---were forgotten and unresolved. The more pressing problems became the drug use itself, and all the school skipping and bad friends, and what you have to do to support a drug habit. It takes a good therapist, and perhaps a rehab setting for 30 days, involvement of the other family members, and the school to reverse the problem. And it takes a very long time. Do the mothers you see have those luxuries? My son's birth-mom had maybe one of those opportunities to reverse her longstanding drug use . . .

There, but for the grace of God, go I.
Chris and Vic (CAK)

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