Friday, February 5, 2010

Baby for adoption

By noon on a recent call day I was ready not to be so entertained by this job. After a morning full of teenagers having their second or even third baby, a 23 year old woman with limited prenatal care arrived in obvious labor. By limited care, I mean two brief visits to a free clinic. The patient’s fundal height (measurement of the pregnant uterus) was so small, at first I believed the due date she gave of 3 and 1/2 months from now. Her cervix was 4 centimeters dilated on arrival to labor and delivery. I did not have much hope of stopping her labor but I ordered the tocolytic, magnesium sulfate before I doing a sonogram. There is now some literature to suggest that premature infants whose mother receive magnesium sulfate to stall or stop preterm labor also have a better neurological prognosis, so I figured it could not hurt.

On doing my sonogram, I discovered this woman was very close to a term due date. In fact, her other two babies, which were 28 and 14 months old, weighed 6 and 6 1/2 pounds. This one fell right in that range on sonogram. The patient got her epidural and we began to have a less frantic conversation. Her other two children were with her mother in law in a small town an hour east. The patient and her husband could barely support themselves and these two children. They were placing this baby for adoption. Or at least that was the plan they made at the free clinic. And no, they had not made any arrangements with an adoption agency or and attorney nor had they even called one of the phone numbers given them.

So the baby arrived weighing just over six pounds. A girl with a very good set of lungs. She was screaming and pink within a minute of arrival. She left for the nursery after the 5 minute apgar with the pediatrician's approval for the newborn nursery. Mom never held her. Dad didn't even look at her. He was gathering up his jacket to go to work when I left the room.

Of all the babies I delivered this morning, these parents seemed the best equipped to raise a child. In fact they were raising two. The same situation, no health insurance, which landed this woman in my care, has contributed to her getting pregnant three times in as many years. And yes, she would qualify for Medicaid at least for the pregnancy. It is complicated, these issues of access to medical care.

Now I wonder if this free clinic provided birth control, would she have gone after her first child? I wonder if she kept this baby girl, would her chances be any better than her mother's? This last is the question I have about almost every baby I deliver. What I do know is this problem of unintended pregnancy is not getting any better. Cheap, easily obtainable contraception, and the motivation to use it needs to be a societal priority. No matter what you believe about the rest of health care, on this we cannot afford to wait.
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