Someone just asked me the following question on Facebook.
If you had an interview where you stated you don’t even care about your own births, they have “no bearing on your life”… then why do you have to be up someones vagina the minute a fucking baby pops out of THEIR crotch?
What prompted that expostulation?
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The issue is medical neglect.[/pullquote]
Yesterday I was sent this photo:
The caption reads:
Baby born unassisted tonight. Slow recovery but I’m curious about the cord. My others didn’t look like this, they just turned white. This was candy cane striped for more than an hour after her birth. We cut it and she seemed fine.
It was an apt description. A “candy cane” cord can be associated with severe infection.
As I wrote on my Facebook page:
This baby needs to be seen in the emergency room immediately. A baby can have a life threatening infection without showing any symptoms until it collapses and dies.
If anyone is a member of this group, could they please pass along this information. The mother is planning to take her baby to the pediatrician tomorrow. The baby could be dead long before that.
Obviously, it’s impossible for me (or anyone) to make a diagnosis from a picture, but the picture is sufficiently unusual and the consequences so dire that someone needs to tell the mother.
As I had hoped, the mother learned what I had written. What did she do?
She took herself to the hospital because she had fainted repeatedly, apparently due to excessive blood loss, but, by her own admission:
I did not tell them we had concerns about the baby.
In an effort to justify hiding the truth about the baby, she noted:
Her temperature, color and breathing have remained good (although she is quite grunty and seems to have a lot of birth gook in her nose and throat, congestion sounds)… [W]e’re going to watch her closely for signs of infection and take her to see a doctor on Monday…
But signs of infection in a newborn can be extremely subtle. Newborns with serious infections do not have the same symptoms as toddlers and older children. They may have no fever or even a lower than normal body temperature. Grunting can be a subtle sign of infection. A baby grunts because she is having trouble keeping her airway open. Grunting may be the only sign of a life threatening infection. Everything else might seem fine until the baby has a cardio-respiratory arrest and dies.
The mother appeared on my Facebook page in order to defend herself (she has since deleted her comments), and, of course, her friends swooped in to tell me to mind my own business. As usual, I was accused of being mean to the mother. The issue, according to the mothers defenders, is that I had publicly shamed her. Curiously no one seemed to be the least bit concerned about the health of the baby.
Why did I make a public plea? For two reasons: 1. It was the only I way I could be sure that she would see it; 2. The mother publicly solicited advice about the umbilical cord and I wanted to inform as many people as possible about what it could mean.
The mother is embarrassed? I should hope so. She’s committing medical neglect. Sure, the baby might be perfectly fine, but this is like the case of the Canadian couple who let their toddler die of meningitis. They were told the baby might have meningitis, but instead of getting it checked out by a medical professional, they waited until he was in extremis and then it was too late.
The issue here is medical neglect. The mother has no fear of hospitals; she took herself to the hospital because she doesn’t feel well. She was warned that the baby could be very sick DESPITE the fact that she looks fine. I can imagine many reasons why the mother does not want to have any contact with the hospital (all having to do with protecting herself), but I’m struggling to imagine any reason why getting the baby checked by a pediatrician could have any downside for the baby.
So what, if any, are the ethical obligations of bystanders? If we see a child who may be seriously ill or even dying, and a parent who doesn’t seem to understand the seriousness of the situation, do we have an ethical obligation to let her know? And what if we let her know about the risks and she chooses to ignore them? Do we have an ethical obligation to attempt to change her mind? Do we have an ethical obligation to inform child protection authorities?
I think I do, not because I’m a doctor, but because I’m a human being. It is entirely possible that the baby is fine; I recognize that. In fact, as time goes by and the baby does well, it becomes more likely that she is fine. But then it is entirely possible that any child subject to medical neglect will end up fine, but that doesn’t mean it isn’t medical neglect.
The mother understood that something was wrong. That’s why she sought reassurance on Facebook; but when she couldn’t be reassured she decided to ignore the issue. Should the rest of us ignore it along with her? I don’t think so.
To do so seems to me to be fundamentally unethical.
