Friday, December 29, 2006


On Christmas Day I attended a cesarean section. The baby was full term and came out crying and vigorous. As usual, his birth and initial cries were met with expressions of happiness and contentment, and I couldn't help but smile at him. It was the mother's third delivery, her second C-section. She was eighteen years old.

The delivery perhaps epitomized the sum of our emotions working with these patients. On the one hand, any new life is special and can be celebrated, especially one born on Christmas Day, a holiday that means so much to so many people, both religious and non-religious. On the other hand, though, an 18 year old with three babies is just downright discouraging.

I was chatting with the obstetrician and OB resident at the nurse's station after the delivery and mentioned my disappointment that this was mom's third pregnancy. The conversation turned to young mothers with multiple pregnancies, and the obstetrician told us of a 19 year old she had seen with her 13th pregnancy, which was mind boggling even for a jaded guy like me. The OB resident - a young black woman, a contemporary of the mothers we were discussing- shook her head and said "Those women just need to be beaten."

A commenter on my previous post asked what I meant when I said "Some women degrade themselves," and other commenters noted the courage of single women for having babies instead of aborting them. As I've said before, I don't mind it so much when a young single woman comes in with her first pregnancy, because anyone can make a mistake. But when that woman gets pregnant repeatedly, time after time, she degrades herself and her children, by condemning herself to a lifetime of dependency and irresponsibility, and by starting her children in life with two strikes against them, poor and with no strong male role models around. She degrades herself because she just doesn't care about herself or her kids. As for choosing life by deciding to bear the children rather than abort them, I suspect that as often as not the reason they are not aborted is because they sought prenatal care too late to have an abortion.

On New Years Day I'll gather with extended family for the day. I'll see a variety of siblings, nieces, nephews, and great nieces and nephews, from ages 6 to about 66. We'll watch football and play foosball, and there will be lots of fun stuff to eat. It's always good to see the kids, who for the most part are well raised and respectful, except for the trash talking during foosball. It will be a surprise if most do not finish college and a shock if any are young, single parents. I can't help but wonder: Are these kids better than the 18 year old who had her third baby - or just luckier?


Anonymous Ariella said...

It's probably neither luck nor intelligence. The children in your family sound like they've had the benefit of good role models and they probably come from a well-educated background. This is not to say that people who are well-educated don't get pregnant (my husband's 22 year-old cousin did, and she graduated with honors from college), but the more support a child gets from the family, the more likely they are to make good choices in life.

For me, the statement about women "degrad[ing] themsel[ves]" is one that is sort of offensive. Are these women truly educated on birth control? I don't want to get into some kind of socio-economic debate about birth control in this forum, but the fact that it's not covered by MediCaid means that many of these women probably do not have access to it. I'm not talking about whether they have the money for cigarettes versus BC, either.

Moreover, it's not degrading to have 10 kids at age 25 (or whatever). It's just sad. Those children are probably a burden on society in one way or another. Every time I hear someone say that we need to illegalize abortion and teach abstinence in the same breath that they talk about how "our taxes" go to support "those people," I get very upset indeed.

Degrading yourself is having sex with people for money. It's not being naked and in labor. I think the choice of the word "degrading" probably speaks more about your internal discomfort than it does about these girls having children.

12:09 PM  
Blogger karrvakarela said...

I see what you're saying though, like Ariella, I too found your use of the word degrading to be offensive, simple because it implies moral inferiority. What you write about is a tragic situation and, while we may have our frustrations about working in such fatalistic circumstances, I'm not sure if we're permitted to assign any moral value to individuals. Not unless the standards, in terms of both advocacy and amenities, you associate with a good upbringing are equally distributed among all. As you so sensibly concluded, given the same set of circumstances, who is to say one of our own loved ones wouldn't be caught in a similar situation?

Which is not to forego all hope for our patients but to try and redress the balance in whatever way we can, through public and private initiative.

12:41 PM  
Blogger Stacey said...

These women are certainly selling themselves short. And sadly enough their children and society will pay the consequences. These children probably will not go to college, because they will not be expected to go to college. Children mostly do what is expected of them and respond to the level of their support systems.

There really is no excuse. Sure, one time is a mistake. But you certainly know what causes pregnancy after the first time. (Although I’m sure they knew that before.) And I’m sure that even people in the lowest socioeconomic level know how to prevent pregnancy. I know where I live pretty much anyone can go to the health department and get cheap if not free birth control. And then again, sex isn’t a requirement to live.

I’m tired of everyone giving you such a hard time. You are a well-educated man with a well-respected job who is sharing your thoughts and opinions with us. I enjoy reading your blog. But I can’t figure out why those that don’t continue to keep reading.

3:13 PM  
Anonymous Anonymous said...

All I can say is OMG!!! I agree with the resident. I appreciate the provocative topics you post and their responses. Keep it up.


3:53 PM  
Blogger Thea said...

"These women need to be beaten." Many of them are, but it doesn't seem to be changing anything for the better. What shall we try next?

As for getting pregnant repeatedly, unless like the single mother we feted a few days ago the Good Lord is the alleged father, they're really not the only ones to blame for that problem, are they? Just the ones stuck bearing the consequences, and consequently bearing the brunt of our judgement.

5:39 PM  
Blogger Felix Kasza said...

Ariella --

I regret that you do not wish to discuss "whether they have the money for cigarettes versus BC, either," as you wrote; I believe looking at that aspect would be instructive.

Sex for money, by the way, is a job. If you regard this as degrading, your opinion is not shared by both of the whores [and yes, they prefer the term] I count as personal acquaintances. As an aside, would you regard hauling trash or cleaning sewers as degrading?


7:57 PM  
Anonymous Anonymous said...

They are luckier

8:04 PM  
Blogger Surgeon in my dreams said...

Are your young neices and nephews luckier?

I believe, like another of your commentors, that the way you bring a child up has a lot to do with the decisions they make.

I personally (as an only child)was left alone, from the age of 11, from the time I got off the school bus in the afternoons at 4pm, until the time my parents got home from work at midnight (when I was in bed asleep).

Neither of them were uneducated, and they chose the shifts they worked. They were just not "into" being parents.

I wound up with a baby and a husband by my 16th birthday. I made the choice - yes - but had I had support and someone leading me, or at least showing me I was important enough to spend time with, I might not have fallen for the first guy to come along and act like he loved me.

At some point we have to understand our decisions are our own, no matter what rough road was laid down in front of us, but for some of these kids, that time doesn't come quickly as for others.

Think about it...where do we learn about life? Where do we learn to be parents? There are 3 and 4 generations out here now who grew up seeing this behavior (having one baby after another without benefit of a husband and/or a way to support them financially) as normal.

For example, I grew up thinking all homes were violent like mine, because that was my "normal", so when my first husband hit me the first time 8 days after we married, I was not shocked, I was not surprised. It never once occured to me to tell someone or to even think about leaving. That took 24 years in my case.

Finally, I would be willing to bet that after the 2nd or 3rd baby, some of them just feel like they've caused so much trouble now, that they just give up...on themselves, on life, on their children.

I can see why it bothers you. To care about them and work your butt off to save some of them and then to have to send them home where you just know in your heart they won't have someone caring for them they way they deserve. And if it didn't bother you, just a little at least, you wouldn't be the caring medical professional that you are.

9:09 PM  
Blogger Dani said...

I absolutely love this blog. I find it refreshing that you are able and willingly admit your feelings and concerns without "outing" anyone. This is your place to vent, to write, to do whatever the hell you please.

Do you know what bothers me? My husband and I went through 5 rounds of IVF with ICSI along 2 frozen embryo transfers without a successful pregnancy. Our story did have a happy ending, we have two beautiful sons by the miracle of adoption.

While we were undergoing IVF treatments, the idea of multiples scared us to death. We made an adoption plan with our sons birthmother when she was 20 weeks along; she delivered at 27 weeks. We still ended up in the NICU. :)

But, years later, it still bothers me to some degree. I think it's unfair that we couldn't have children while others have many and cannot provide for them. Maybe one day I'll resolve these issues. I just think it's unfair.

Enjoy your family time.

9:38 PM  
Blogger the granola said...

They're both.

Lucky in the background they got, but when they make correct choices those successes are their responsibility.

I have a dear friend who grew up while her mother had multiple boyfriends, drank, and partied. My friend chose to not live that life when she was a teenager. She was abstinent before marriage, and has been married now for 14 years. Her sister, OTOH, has had multiple boyfriends, drinks and does drugs, parties and only stopped having children when she had to have an hysterectomy.

At some point, if it isn't going to come from home, maybe we need to find a way to educate these kids that they don't have to live that life.

Interesting, ACOG wants young girls to come in around 13-15 to talk about growing up, BC, STDs, etc. The only girls this is going happen for are those the least at risk.

11:39 PM  
Anonymous nikeroo said...

I often wonder about this question myself. Having lived in China I found that there was an incredible pressure for young girls to be married out. time and time again my young girl-friends bemoaned that they were encroaching their marriage used by dates.

As soon as they're married their mother-in-law would start putting pressure on them to have a baby. The idea being that the mother-in-law wants to be young enough to be able to take care of the child.

Meanwhile the girl is recovering or returning to work. It's also thought that the girl can recover her body more successfully if she is young and that every child prefers to have a mother who is young and pretty.

Some of my friends in Japan and Korea had simmillar notions. The whole purpose of getting high scores and going to a good college was to be in a good position to find a good husband (The 3 highs: High pay, Height and High Grades). These very educated girls would revert to being housewives and mothers upon graduation... in these cultures this is traditionally considered a woman's ultimate contribution to mankind.

Different culture, different perspective...things are changing now...for better or worse.

5:07 AM  
Blogger SuperStenoGirl said...

Stop looking for scapegoats. Put the blame on those responsible. Yes, in some cases it is a lack of support and proper upbringing, but in many cases it is simply a lack of good judgement. Many of these women become single parents of multiple babies because they have poor judgement and a lack of common sense. One, two babies? I can understand - but three, four and more? I think it'd be time then to start looking of better ways to stave your reproduction qualities; tubal ligation etc.

Stop trying to put the blame on families, in the end, to put it delicately, if she didn't want kids she should have kept the nickel between her knees.

Degrading? Yes. They reduce their honor, and by becoming yet another burden on society they decrease their worth as conductive member of the community. Yes, they are degrading themselves.

11:45 AM  
Blogger What The Hell Is This? said...

I find your comments NOT offensive at all and I agree that these women are degrading themselves.
People.. you have choices in life.. learn to make the smart choices and your life won't seem as 'complicated'. What education do you need on absitnence (sp?). It is all about taking responsibility for your actions!!!

5:50 PM  
Anonymous Anonymous said...

I've met kids from all different backgrounds - from a kid from a welfare family who is now a professor in Harvard, to rich kids from the homes of celebrities who are truly dysfunctional individuals.

We have no way of proving that one kid is "better" than another, but we DO know that financial and parental resources are instrumental in the upbringing of good kids - even in "good" homes.

Growing up, I knew many upper middle class kids who would never make it through school without a string of tutors and financial/punitive incentives. If kids growing up in my wholesome neighborhood needed sooo much guidance, especially during the teenage years, to stay on the right track and not get into trouble, is it any surprise that kids who have no mature responsible adult watching over them get into such messes?

Rather than speculating on what I think the kids born into your family ARE (lucky versus "better"), I'll say what they SHOULD be: thankful. Having more than enough money to cover necessities as well as extras, and growing up in strong families based on values where the kids are guided and encouraged, and where adults are role models of responsibility - that's a gift to be appreciated.

Your mother was a real role model for your family. She had expectations of you that you were required to fulfill. Would you be the person you are today otherwise?

7:20 PM  
Blogger Ariella said...

Felix, I realized after I posted that that someone was going to take me to task for using whoring as an example of degredation. And, in fact, it is the world's "oldest" job and I think if it's what keeps the mouths of your family filled with food, then there are worse jobs.

No, I don't think trash haulers or sewer cleaners (if there is such a professions) are degraded by their jobs, nor are the jobs themselves degrading.

I think degredation is something that occurs because you let it occur. There are as many lawyers who degrade themselves for money (and I'm thinking primarily of those who bring meritless suits in order to force a settlement from a "deep pocket") as there are people in menial jobs who degrade themselves (and here, I am thinking of an acquaintance of mine who worked at a home improvement store and used to pee in the corners of the store to get back at his superiors).

And, finally, I would be happy to discuss the topic. But I don't think it's appropriate to discuss in the comments of Neonataldoc's blog. So feel free to e-mail me if you'd like to know what I think of the subject.

12:39 AM  
Anonymous Anonymous said...

One more thing, Neonatal Doc, I think you are doing an incredible amount of good for these unfortunate kids simply by the way you treat them and talk to them. To you it may seem standard or routine to speak respectfully to all parents and include them in planning the care of their baby (encouraging them to pump, offering them choices, etc.), but for these kids it could very well be the first time an authority figure spoke to them as an equal, with respect. It really could boost their self esteem.

Unfortunately you're powerless to do more. I think powerlessness is what you often describe in yuor posts - that even if it's not these kids' fault how they were brought up, the cycle will continue as they go on to bring up the next generation as they themselves were brought up. You are standing at the intersection point of these generations of failure, wondering if your role is simply to ensure the next unfortunate survives, and where the cycle will end.

I think you're doing the most that anyone CAN do in your position. As you said in the post about the young mom who was afraid to be home alone, even if you took one into your own home, there are so many more out there it would be a drop in the bucket. I think in this sense your job is very frustrating.

Everyone wants to feel they're making a difference through the work that they do. You definitely make a difference in terms of saving the lives of these babies, but you wonder what kind of life you're saving them for. I don't envy you that kind of frustration!

As for me, I mentioned I'm a professional tutor in a college (paid by the college). My work is very rewarding. I get the kids from your world who finally decide to go back to school and do something with their lives. Our college is full of single moms from poor backgrounds, and they work hard! So my work is rewarding because I really make a difference and I know it means like will be better for them AND their children - a feeling which is lacking in your profession at times. In my case, I have been the one who actually made sure some kids graduated! Seriously, I've tutored kids where this was the last class they need to graduate, they've failed the course before and they're failing it njow, and if they don't pass now they're dropping out because they can't afford to pay for classes they don't pass. Do you know I've taken these kids and helped them achieve a B? To you, as a med school high achiever, a B might not sound great. I myself was a straight A student. But to these kids a B is not only a huge achievement - it's also the ticket to graduate and go on to nursing school (the most popular choice here) or whatever esle they plan to do.

So from my end there's tremendous satisfaction thiking of this single mom's three kids looking forward to a brighter future where mom is a nurse, rather than a minimum wage worker. For you... I truly sympathize. Of course every human life is precious, but you would feel better knowing that your patyients went home to warm, loving, secure homes. My hat's off to you for continuing to work with so much dedication and compasison despite the sometimes depressing conditions.

8:45 AM  
Blogger jennifer said...

Hi Doc,

I began reading your blog for its discussions of issues surrounding Down syndrome, and since then, I've come to appreciate your perspective on life in the NICU, where so many of our babies begin life. I made my own blog for parents of children with Down syndrome called Pinwheels, and I'd like to link to yours, if that's ok?

It's at

Either way, thanks for the terrific dialog and have a Happy New Year!

12:06 PM  
Anonymous Anonymous said...

1)"Degradation" is an appropriate word. The only problem is this: These women have nothing to lose. The children in your family know that everyone expects them to get good grades, go to college, have a career, get married, and then have children. In that order.

For these women that keep having multiple children, their kids become their way of proving themselves. ( "I can't do much of anything right and I probably won't do much with my life but I can have this baby to look forward to and I can succeed at being a good mother.")

2) These women know all about birth control-they just take a fatalistic view that "if have unprotected sex and I get pregnant, that must mean that this baby is meant to be" or they think "I'm being unselfish by having this baby, not like those middle and upper-class women who would have an abortion and don't value life."

3)If you can afford an abortion-or multiple abortions-you can afford birth control. First of all, birth control is FREE for poor women. Second of all, it is completely illogical to believe that a woman can scrape together several hundred dollars for an abortion and find transportion to an abortion providing facility that only exists in 13% of the counties in the US, but the same woman didn't have $10 to go buy condoms from the corner store or can't afford FREE birth control from public aid? I don't think so.

4) As someone who had an unplanned pregnancy and decided to give birth, I can testify to the fact that at just about everyone one of my last prenatal appointments my nurse/midwife asked me what form of birth control I would be using after I gave birth and I was also queried on my birth control choice when I was in the hospital after the birth. And yes, I was on public aid.

5) I chose the Copper T IUD-which was paid for by public aid-and it lasts for up to 10 years. In my state, public aid does not pay for the 5 year IUD. Poof!!! I have absolutely no reason to get pregnant unless the IUD fails.

6) I think that doctors/nurses etc should be encouraging this women with multiple pregnancies/abortions to user longer term methods of birth control such as IUDs and implants. They need to be steered away from bc pills and condoms because they are obviously too irresponsible to use them as effectively as they could be used.




6:27 PM  
Blogger OHN said...

Some things in life I will never understand. When hubby and I were struggling through 8 years of infertility, stories like this post would make me want to scream.We wanted to nurture and cherish a child when others were popping them out like gumballs.

9:11 AM  
Blogger Liz said...

Somewhat off topic, but I did want to say:

Happy New Year to you and yours. I wish you all the best for 2007.

9:56 AM  
Anonymous Anonymous said...

I have worked as a psychologist with recovering drug addicts/ prostitues and in a juvenile hall as well as in Beverly Hills. With the lower class, my oberservation has been that such decisions have an almost mathematical correlation to the level of abuse experienced as a child.

The really high achieving/gifted people as well as those with some family support have an almost impossible task. Work to overcome memories, scrape by rent, eat and take so many buses they can't fit in or navigate school (which is like a foreign city if you think about it). Even when there is a fit, with a kid childcare is almost financially impossible without the help of family (and when someone is from an abusive family and trying to change, they're not going to have these people babysit so school is a non option).

Untill I witnessed it firsthand, I had no idea how difficult is was to make it. Even with programs in place, these people aren't psychic. They have no idea how to access them and where to begin. There is also a sense of being not worthy enough for such reward or that somehow the money/opportunity is earmarked for someone else.

The others (majority) drown in despair and a sense of powerlessness. Being sexually abused multiple times or physically abused by an addicted parent, etc. overwhelms their daily functioning. To keep a baby is to make a statement of responsibility in their eyes. They're choosing love towards a child unlike their parents/relatives chose for them. It feels like God's will. Problem is, underlying issues are still unresolved so the resolve to do differently, using the baby as a new chance/foundation, fails. Then the cycle begins again. Finally at around 3+ kids there is despair when denail stops working that a kid will solve their heartaches. Maybe abuse starts. Always self-hatred. Then maybe more kids. At that point, a lot of people relapse or get into abusive relationships and the whole 12+ kids types who seem proud about it emerge.

The extremely affluent clientele that I had also created lasted emotional damage in their kids, but by neglect, unrealistic expectations, lack of support and verbal abuse. However, money is a parachute. Even if you're a mess, you are afloat. That was the difference. That and cultural expecatations of what success is as well as a well defined cultural structure taught to them which works within the rules of the...elite? Corporate world? They fit in. AA can be a calling card for them and a way to break the ice with others.

Overall, I prefered working with lower class people because the denial was less and unless court ordered, the desire for change was palpable. This was unlike the rich kids who knew change would be advisable but ultimately not neccessary.

6:04 PM  
Anonymous Brandy said...

I love your blog Doc. I can see all sides to this, and I at first reading your post on degrading was taken aback....but then re-read it and understood what I believe you were trying to convey. It is so sad and unfortuanate that children are having children. BUT with education,guidnce, and caring will help them to maybe better their children. (even when at times it seems like we are hitting our head on a brick wall)

I think with your family they have good rolemodels, and your nieces and nephews are lucky to have you. A kind man, with an open mind and heart. Happy New Year!

9:49 PM  
Anonymous Anonymous said...

spIt depresses me to see you so judgemental of poor people. Did not Jesus Christ say "Judge not that ye be not judged?" These kids are our future, no matter what their circumstances of their birth.
As a society we abandon them because of this kind of attitude

10:48 PM  
Blogger SuperStenoGirl said...

anonymous, actually the whole phrase is "Judge not, that ye be not judged. For with what judgment ye judge, ye shall be judged: and with what measure ye mete, it shall be measured to you again." Matthew 7:1-2. As I interpret it it means: If you do not wish to be judged then you should not judge. But if you judge, know that how you judge others will be how God judges you.

6:52 PM  
Blogger neonataldoc said...

Fascinating comments, thanks to all, and thanks for the kind words. Smartblkwoman and anonymous 6:04, very interesting stuff, although anonymous, it's a bit depressing!

8:20 PM  
Anonymous Anonymous said...

great post, doc.
in the state where i live, one can go to the public health office and get free contraception (pills, injectibles) so i really don't understand why it keeps happening over and over again.
the first time, it's a mistake, i agree. but the second, third, fourth time? i don't know...
somehow, i really think one needs a license to breed.


2:04 AM  
Anonymous Anonymous said...

I've got 2 words to say for these gals: Depo Provera. Feds need to make it mandatory if you're on welfare. Problem is our politicians are too out of touch and too eager to please the religious right to ever make this happen.

9:26 PM  

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