Monday, November 13, 2006


With her history of no prenatal care and 10 previous children, plus her cachectic build and the pock marks on her skin, she might as well have had "drug user" stamped on her forehead. I was called to the delivery because there was no prenatal care, and after the baby delivered and things calmed down a bit I went to talk to her.

"Hello, I'm Dr. Neonatal; I take care of babies after they are born."
"Hi," she said, "How are you?" I liked her already; the "how are you" was a nice touch from her, something I don't usually hear, understandably, from mothers who delivered a baby about 10 minutes before. After the pleasantries, I got down to business.

"How many kids do you have?"

"Are they in good health?"

"Do they live with you?"
"The older ones do, but the younger ones are with their father." If kids don't live with their mom, there's a high likelihood Protective Services has removed them.

"Have you ever had Protective Services involvement?"
" Yes." She was being remarkably nice and cooperative, but that soon stopped.

"Did you take any drugs during your pregnancy, like marijuana or cocaine?"
"Ohh, ooh." She started moving as if in pain. The OB resident rephrased the question, "Did you use any crack during your pregnancy?" Again the question went unanswered.

It was no surprise when her urine drug screen came back positive for cocaine and opiates, and when I called the case into Protective Services the worker said "Oh, my goodness gracious" when her previous history of protective services involvement came up on the computer screen. I couldn't help but like the woman, though, even though her lifestyle was pretty much the very antithesis of mine. She was so nice, and her baby was so cute, and she was so thankful to me, even when I explained that the baby would have to stay in the Special Care nursery instead of with her until P.S. checked out the home. She understood, having been through the drill before. It's one thing I like about this job: Sometimes you meet the nicest people at the most unexpected times and places.

On my way out of the special care nursery, I saw a spider on the wall. I smushed it with my foot.


Anonymous Anonymous said...

What harm had the spider done that you killed it?
Its a cute story,but it sickens me to think that people like this shamelessly procreate. The poor child likely go through a million foster homes ultimately get sc*ewed like his/her mother!

4:46 PM  
Anonymous A. said...

thEhhh...It's social/enviromental. I bet this mother was raised in the same circumstance. Not that it makes it better. Funny how it seems some people are from another planet. Really, some of them kinda' are.
That's why...I am grateful to be educated. I am sorry if that's not very "PC."
But...Somewhere in her there is bound to be hope, or else she might not have been as grateful acting to you.
Oh well...A pleasant vibe in the NICU has to put a little wiggle in your step.
You should whistle when you walk through the halls...
Good job on the spider. A lot easier than looking for a sterile jar to stick it in, and then
waiting to release it out into the common grounds.
It's nice to not be PC, sometimes.

5:12 PM  
Anonymous Anonymous said...

I'm glad you killed the spider, especially after reading all this stuff in the news lately about those lovely Camel Spiders in Iraq.

5:50 PM  
Blogger Dream Mom said...

I would be o.k. with the cute baby, it's just the mother with a total disregard for a fetus that I'd have an issue with.

Probably would have been better to smush the mother and let the spider live. After all, the spider didn't do anything:)

5:52 PM  
Anonymous Tiffany said...

As a Mother that delivered my daughter at 32 weeks, I cannot get over why pregnant women would or could use drugs during their pregnancy. I guess the biggest question is why? Why would they want to do that to their unborn/innocent fetus?

Good ending with killing the spider! :0)

9:16 AM  
Blogger Shinga said...

In 2003 Avshalom Caspi and his colleagues published a fascinating paper in Science that discussed the relationship between the gene, 5-HTT, and childhood maltreatment in causing depression. Current theories say that 5-HTT is crucial for the regulation of serotonin to the brain; and that the proper regulation of serotonin protects us against depression in response to trauma or stress.

"In humans, each 5-HTT gene has two alleles, and each allele occurs in either a short or a long version. Scientists are still figuring out how the short allele affects serotonin delivery, but it seems that people with at least one short 5-HTT allele are more prone to depression. And since depression is associated with unemployment, struggling relationships, poor health and substance abuse, the short allele could contribute to a life going awry." Quoted from A Question of Resilience New York Times.
The researchers emphasise that they believe that there are tandem effects of genetics, environment and life experiences that influence addiction, social interaction and a life that may go off the rails.

Was it a choice between smushing the spider or kicking the next dog/cat that you saw?

Regards - Shinga
P.S. If NYT asks for a log-in, use Bug Me Not.

7:37 PM  
Anonymous Anonymous said...

Why is it that a woman can use drugs during her pregnancy, have no prenatal care and have 10 (mostly) health babies while another woman can go to every prenatal visit, take the vitamins, have no caffine, cigarettes, alcohol, eat only healthy food and have a baby with severe disabilities?

12:05 AM  
Blogger Kelley said...

That's the way it works. I'm glad her babies are healthy. Very glad. I don't wish a disabled baby on her because she's a pathetic excuse for a mother. I'm glad I got my son, with his extra chromosome, as it scares me to imagine him belonging to someone like her. He's too precious. Doc, you're so darn interesting. It's interesting that you even gave the spider a second thought after smushing it. What kind of irony went through your mind then?

12:25 PM  
Anonymous misha said...

people...people.... Can't you see that ND likes to instigate his readers? He's just waiting for the chaos when someone starts to judge him for killing a stinking spider. He's taken a few hits lately. I bet he's keeping track of how many negative and positive comments he gets for the spider in comparison to his thoughts about "mustache mom" or "why can't I have my baby mom" or "crack mom" .

2:22 PM  
Anonymous Anonymous said...

I imagine that most pregnant women who use drugs use them because they were addicted before their pregnancy. Every conceivable statistic shows that it is nearly impossible for addicts to quit, even those that have the state of the art in treatment programs. The recitivism rate even for those programs is in the 90%+.

2:28 PM  
Blogger neon88 said...

I'm a neonatolgist too. I've been away from your blog for awhile. Although I have enjoyed it, it was begining to seem too much like my life. But that spider thing! You got me back.

2:40 PM  
Blogger The Imperfect Christian said...

Ten? Wow, I guess she's going for a dozen. With our middle daughter, we were told mom was a drug addict but "only used her inhaler" during her pregnancy. Yet she unexpectly went into seizures on the delivery table when my daughter was born.

Who's to say?

4:17 PM  
Blogger Christa said...

This doesn't quite relate to your post here, but I'd like to see what you think of this report on regarding new guidance in England on how very early pre-term babies should be treated. They want to prohibit treatment of babies born at 22 weeks or earlier. I can't necessarily argue with that, but it would seem to me that unless you try with some babies you'll never know what is possible. If not for the attempts at saving their lives and research in to what could be done for them you wouldn't have seen the age of viability get pushed back to 24 weeks.

One other thing, the article includes this quote, "Although the number of premature babies surviving has been increasing since the 1980s, only about 1 percent of infants born between 22 and 23 weeks gestation survive to leave hospital, according to the report." If they only referred to 22 weekers, I'd buy it, but I thought I've read where you've said that 23 week babies do have some chance at survival in the double digits.

And one more thing, I first saw this topic in an article in the Daily Mail (I commented about it to Julie at alittlepregnant dot com and she pointed me your way). In that article, it says that Holland prohibits treatment of babies born before 25 weeks. Have you heard that?

You have some facinating posts. Keep up the excelent writing.


7:31 PM  
Blogger neonataldoc said...

Thanks, guys. Shinga, very interesting stuff about the genetics of depression. I didn't smush the spider because I was frustrated. He just didn't belong in the nursery.

Misha, I don't know if I would say I like to "instigate" readers, but I do like to probe sometimes controversial topics. On the other hand, I never dreamed the moustache thing would draw that much reaction.

Neon88, welcome back. It can get kind of depressing, can't it?

Dream Mom, I understand your frustration with these moms, but hey, shouldn't we have a little compassion for those less fortunate than us?

Christa, you bring up issues way too complex to be discussed in a comment here. I'm sure we'll touch on them in the future. Babies born at 23 weeks gestation have about a 30% chance of survival.

8:33 PM  
Blogger stockingup99 said...

Imagine the spider dropping into a surgical site, a baby's bottle, walking across the floor, and then across a neonate.

Way to go Doc, the spider could have killed.

10:59 AM  

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