Monday, March 20, 2006


I don't get it.

A mother delivered a 34 week gestation baby this morning. The baby is doing fine. Mother's history is remarkable for chronic high blood pressure and 4 strokes, although it has been hard to find evidence of those strokes on imaging. Also, in a tragic note, the mother lost two children eight years ago in a house fire (an all too common occurence in the poor urban area in which I work.)

Wouldn't you think that a pregnant woman with chronic hypertension would seek prenatal care? Wouldn't you think that a pregnant woman with 4 strokes would get prenatal care? Wouldn't you think that maybe a mother who had two children die in a house fire would consider each child precious and get prenatal care? Wouldn't you think that such a mother might be able to forego her marijuana smoking during pregnancy?

This mother did none of those things. She said she had no health insurance, but in our state any woman who is poor can get Medicaid, and since she was hospitalized for 6 days at about 27 weeks gestation - the extent of her prenatal care - I know a social worker discussed getting Medicaid with her. This mother simply did not follow through, did not do the responsible thing for herself and her baby.

I've always considered myself sort of a bleeding heart liberal, one who tries to see the problems and difficult life of a woman like this and feel pity for her, and try not to blame her for her lack of prenatal care. But I get a little tired of it when I see case after case similar to this. Maybe it isn't as easy for her to get prenatal care as it is for a suburban woman with good health insurance. Maybe it would require her to take a trip to the Medicaid office, or to fill out some forms and mail them in. But that's not a valid excuse; doing the right thing in life takes a little effort sometimes, and this woman simply didn't put out the effort. I'm sick of it.

The Institute for Healthcare Improvement recently surveyed patients and families about what they want and expect from healthcare providers. The first item they wanted was to be listened to, taken seriously, and respected as a care partner. I would love to do all those things for my patients and families. But first they have to respect themselves.


Blogger Fat Doctor said...

Well done. A+. Excellent post. Thanks!

8:06 PM  
Blogger neonataldoc said...


9:40 PM  
Blogger morris the safety tortoise said...

Do you ever wonder if you're too much of a bleeding heart to be in the practice that you're in?
I am in the process of trying to go to medical school (I'm a non-trad student having spent a year doing investment banking in Europe) and I volunteer as a "cuddler" in my University's hospital.

Inevitably the question arises (from the docs I shadow and from the nurses in the NICU) "Do you want to be a neonatologist?" The first thing I say is that, "I don't know b/c I haven't seen many other practices of medicine" but my first real thought is: "Yes! Yes! Yes! But I think it would break my bleeding-liberal heart".

8:47 AM  
Blogger Dream Mom said...

Good post!

Yes, the parents have to meet you half way-they have to care. Sometimes I wonder, if they don't respect themselves, how is that little baby ever going to grow up with some self esteem and self respect.

Morris the safety tortoise-Go with what you love. You can't control the actions of other people (parents) so you can't worry about that. Your passion and compassion will always make you a better doctor. Sometimes, as a parent of a severly disabled child, life is very hard. Although I never say much to the doc, you can always feel their kindness; every once in a great while there are days when it's especially needed and when it is, their kindness just wraps around you like a great big hug and you can feel the love. On those days, when life has been especially hard, I say a little prayer at night thanking the Lord for such a good doc.

9:08 AM  
Blogger That Girl said...

I would like to point out that it's kind of ironic that we can talk about the child and see a bad life ahead for them - born into a house where no one cares enough or is educated, does drugs, doesnt receive basic care available and yet as soon as sperm hits an egg we expect these very same people to become someone different (good parents).
If we want to see real change lets advocate for free birth control (instead of denying it to women who CAN afford it), education - teach everyone that being a parent is a priveldge - and put our money where our mouth is in giving our very best care to children who are born instead of punishing children by punishing "welfare moms".
Id also like to add that the bad outcome for my first and second pregnancies was in no way helped by prenatal care (both cases resulted in emergency c-sections due to unexplained, sudden pre-encalmpsia/enclampsia).
And even in my case (obvious high-risk history) my doctor could barely contain his eye rolls at my hyper-vigilence. When the worst happened he said with disbelief "I really didnt expect that this time." And I had top-drawer insurance, pre-natal care, self-education and a previous case history.
And my doctor's attitude is the rule, not the exception. Just look to the home-birth movement if you want to study backlash.

10:26 AM  
Blogger Tara's World said...

I just think that your seeing a person who didnt give a darn about her or her childs life. You cant save people who dont want to be saved Doc.

1:20 PM  
Blogger Flea said...

I'm no bleeding heart, neonatal, but there's a perfectly understandable reason for this mom not seeking prenatal care. It's chaos. That's not an excuse, it's an explanation.

This mom is dealing with too much chaos. It's all she can do to get through the day. It doesn't have to make sense, that's just what it is.



2:31 PM  
Blogger Janae said...

I was reminded of Ken Auletta's book The Underclass as I was reading your post. This woman sounds as if she belongs to the underclass. She has lost hope, and unfortunately, she's the only one who can do anything about it.

5:33 PM  
Blogger neonataldoc said...

Thanks, everyone. Morris, I love being a neonatologist.

I know these people live lives of chaos. I know they were probably raised without teaching or example of how to live properly. I know they might have lost hope, sometimes for good reason. But I still get frustrated sometimes.

And I'm definitely in favor of good access to birth control, education and help for mothers who need it.

6:48 PM  
Blogger That Girl said...

Im sorry if it seemed like I was attacking you (I wasnt). I just get frustrated that the "haves" do not recognize the burdens the "have-nots" labor under and assume that it is a matter of personal choice rather than glaringly obvious societal ills.
In a way, it reminded me of your previous post. Im sure to some doctors it appeared I was not paying attention when they were discussing treatments, procedures, etc. I WAS paying attention with some of my mind but the majority of my mind was focused on other things - the information doctors were giving me effected in no way my ability to effect an outcome.
When my infant son needed an emergency (at the bedside) operation to relieve a numo-thorax (sp?) that was compressing his lung the surgeon explained the operation, the need for it, the risks involved.
I know for sure that what I was doing was staring at the shiny, shiny instruments being laid out on blue paper. Sure, I was listening but, really, he could've saved his breath.
Cause listening/not listening would have no effect unless I decided that I knew more about medicine that he did and chose to deny the operation.
These are both the same frustrations - dealing with people who believe that they have no ability to effect the outcome of their lives/their children's lives in any way.

10:41 AM  
Blogger neonataldoc said...

That girl: Don't worry, I didn't think you were attacking me. I think I do recognize the burdens of the "have nots", at least as well as any "have" can. I know that life is harder when there is not enough money, family support, etc. But the point I was trying to make was that even though I recognize their burdens - I still get frustrated with them!

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