Tuesday, August 5, 2008

Too Little, Too Late

She was in for vaginal bleeding and cramping. She was 8 or 9 weeks pregnant. She had been to the doctor at her Tribal Clinic the day before and been told that there was a "threatening miscarriage".

When I asked if she took any medications, she said, "yes, I started taking prenatal vitamins yesterday."

I truly am very sorry about your loss, young lady, and maybe there was nothing you could have done anyway, but seeking care and starting prenatal vitamins 8 weeks in is far too little, far too late.


Bianca Castafiore? said...

Mon cher, let us imagine that she only knew of her pregnancy at 5 or 6 weeks. What is it that she should have done by this time that you *know* she did not do? Harrumph, young père, faites attention, hein? La Belle Bianca Castafiore, moi, j'ai eu plusieurs fausses couches... Is it your sensitivity as a father that (at least partially) informs your response to her loss, or your greater wisdom as a nurse? I frown in your general direction. (Mais grosses bises, quand meme!)

Gina said...

I have to agree with the above comment--I am one woman who does not go to the doctor before the 12 week mark. In fact, with Baby #3, my first appointment was at 15 weeks. Am I a negligent mother? No. I know my body, and I also know that with bleeding and cramping before the 12 week mark, there's not much anybody can do to save the fetus.
In addition, much to my husband's dismay, I do not take prenatal vitamins on a regular basis. But he will also tell you that I consume more fresh fruits and vegetables on a daily basis than most people, and my diet is quite varied and healthy, for the most part. I drink only skim milk. I eat very little meat, and what I do eat is very lean. I bake my own bread, sweetened with honey, and it contains whole wheat flour (which I grind myself). Goody for me. My point is, I do eat quite well for a fat girl.
I have a couple of very skinny family members who take their prenatals faithfully, but live on cheeseburgers and diet cola for 9 months. No joke. Are their babies born healthier than mine simply because they take their vitmains? No.
The OB I saw with my second child told me that the baby will take what it needs, nutritionally. Prenatal vitamins are actually for the mother to replenish what she loses to the baby. Prenatals are probably beneficial to those who have an aversion to fruits and vegetables, or those who just plain don't care what they consume because they feel the vitamin will make up for what they lack in their diet.
I'm very sorry for her loss. Despite what anyone may think, if there was a "threatening miscarriage", there wasn't much she (or you) could do to prevent it. Prenatal vitamins will not prevent a miscarriage. Even bed rest has been shown not to have any real positive effect, in some cases, the only advice a doctor can give is to stay in bed. Talk to a few more mothers about their pregnancies. I think you'll find there's no one right way to have a baby.


M.E. Again said...

Nothing she coulda done. Most miscarried babies are either implanted improperly or devoloping improperly and no medical intervention can save them.

Don't blame the girl.

Braden said...

Just a few words of response:

1. I don't want to say too much for HIPAA's sake.

2. This was a very nice girl and I don't mean blame this all on her - the truth is that very often a miscarriage just happens (as properly mentioned in the comments above).

3. I do mean to put blame on her to some degree, though - not for the miscarriage (as properly mentioned in the comments above), but for the general attitude about caring for herself and her baby. She knew for some time that she was pregnant, and she had not seen a doctor for a long time even though she was trying to get pregnant. She had not researched information about pregnancy. She had not made any effort to even schedule an appointment or to seek information about what doctors were in the area.

4. Miscarriages happen much more frequently than most people realize. My mother miscarried, my sister-in-law miscarried, and some might argue that I was somewhat of a miscarriage (I mean just look at me).

5. In my state, lack of money and lack of insurance is no excuse when it comes to OB care. When we were pregnant with our first baby I was making 16 dollars per hour at a per diem job (averaging probably between 20 and 30 hours per week) - certainly enough to qualify as not hopelesly poor, and yet not enough to afford insurance easily. The state paid for everything around my wife's labor and delivery and even provided a supply of healthy foods to be sure she was getting enough good vitamins and minerals.

6. There is back and forth debate in the medical community about the benefits of prenatal vitamins during the course of pregnancy. The benefit - almost universally accepted in my experience - of Folic Acid is in the time immediately before and after conception, where folate best does it's thing: helping with the overwhelmingly rapid cell division and growth of both Mom and baby.

Anyway, my couple comments turned into something much more. To summarize: I'm not trying to say that this girl is a terrible person. I sympathize greatly with her for her loss. I don't know that her pregnancy could have been saved by seeing a doctor sooner or even by taking Folic Acid. I guess ultimately what bothered me about the whole thing is that she was trying to have her first baby, which is a huge responsibility, and yet did not prepare herself mentally or physically for it.

In that respect, I think that a lot of the fault goes to the system. We make having babies look so routine and so easy these days, that a lot of people forget what a complicated, intricate, and dangerous thing it is.

Perhaps Prisca or AtYourCervix can correct me if I am wrong on the medical facts (after all, I was busy flirting with my wife-to-be during the OB-GYN quarter in nursing school).

Anonymous said...

insensitive post if you ask me

this from someone who has suffered quite a few miscarriages that were threatened and for which nothing could be done but to watch and suffer them.

but then, this I expect from someone who would not understand.

most doctors won't even SEE you til you are practically 12 weeks' gestation!!!!

very bad post.

AtYourCervix said...

Most midwives and docs won't even see you during your pregnancy until at least 8-10 weeks gestation - and at that time, it's just a general physical with pap smear, and the initial prenatal labs. Yes, taking folic acid BEFORE pregnancy, and during the early weeks of pregnancy is benefitial in reducing the risk of neural tube defects (which occur in the very beginning of embryonic development), but it's no guarantee that things will turn out ok.

I don't think that seeking care and starting prenatal vits at 8 weeks is "too little, too late".

As a side note - I couldn't tolerate prenatal vits, and didn't take them until my 3rd trimester, with my last pregnancy. Does that make me a bad mother? Because I certainly am educated enough, as an L&D nurse, to know that prenatal vits are important during pregnancy. I did, however, start my prenatal care at 7-8 weeks, only because of severe morning/all day sickness, and needing to be on anti-emetics to function at work.