Saturday, May 15, 2010


"I'm pregnant? I can't be pregnant! I mean I have had a period every month." Ducking her head to avoid my gaze, she thinks. "Yes, every, agh.." The next contraction takes hold and she has to breathe and then she is overwhelmed and tries to push.

"We have to get to labor and delivery'" I declare as the ER nurse calls report on her mobile phone. Unlocking the bed, I make sure the patient is completely covered before we start the journey that is about a city block of corridors and a short elevator ride. I have never understood why anyone, even a hospital architect would allow so much distance between the two departments.

We do make it to labor and delivery. The patient is thirty-two weeks pregnant. Labor stopping drugs, tocolytics, are used to get steroids, which aide in fetal lung maturity, on board along with antibiotics to protect the baby against infection. Her urine drug screen is positive for cocaine and marijuana and the baby delivers a day later despite our best efforts. She has a rough start in life, weighing just over three and a half pounds.

Even more challenging is the fact that this mother will leave the hospital with a three month contraceptive shot. She will not get any follow up care even though it is free and she willcontinue on the same behavior which got her here in the first place, unless and probably even instead of the fact that she may be put in jail for a short period of time. This mother has a parole officer and a 20 month old son. The 20 month old son is in foster care, taken away because of her drug habit. I suspect this baby will end up in foster care also.

I have already thought about this scenario too much. How does one change this pattern? Where will it all end, for this young woman and for her children?
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