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Aborted Abortion

Aborted Abortion.

 

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Aborted Abortion

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(Photo courtesy of http://www.ehow.com/how_2335892_manage-preeclampsia.html)

Few months ago, one baby was referred to my service because the mother was having a life-threatening, severe pre-eclampsia (if I’m not mistaken, her BP was >180/100 and can’t be controlled), on the verge of having seizure. Baby had to be delivered prematurely because she was already not faring well. Baby then was born at 28 weeks, 815 grams. She was able to survive and was discharged after nearly 2 months in the hospital.

When baby was 3 months old, she was supposed to have her injectable hormonal contraceptive but she missed it because the obstetrician was out of town at that time she had her post-natal visit. Then when baby was 5 months old, mother found out that she is 1-month pregnant again. She was very confused and alarmed because she cannot forget her traumatic experience with her first baby, when she almost had seizure due to the very high blood pressure.

On her 2nd month of gestation on the 2nd baby, she came and talked to me in a soft whisper. She was asking my opinion on her plan to have abortion. I was shocked. But at one point, I got her point, her fear of possibly dying while being pregnant again, especially that her first-born is just 5 months old. I really could sense her confusion. Do I blame her to be afraid? No. The thing she fears is a reality and not just a make-believe. I told her, personally, I would not advice abortion as it is a crime. I tried to talk to her, told her the chances of severe hypertension related with pregnancy decreases on the next pregnancies.

Gladly, she took my and her obstetrician’s advice not to go on with her plan. Now, she jokingly blames her obstetrician for being absent during that prenatal check-up that’s why she got pregnant too soon. She gave birth via a repeat cesarean section. This time, she was able to do the Unang Yakap and she was so grateful that she was able to do this at least to one of her kids. Immediately, she had ligation – she and her husband decided on this before the delivery.

Can you blame them for deciding to have ligation? My take? It was their choice. They were well aware of what the consequences of pregnancy to her health, their kids, their family. It was a well-informed, intelligent choice!

 

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How Pro-Life Are You?

How Pro-Life Are You?.

 
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Posted by on July 12, 2012 in Abortion, RHBill

 

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How Pro-Life Are You?

Your stance as a PRO-LIFE is definitely distinguishably palpable and admirable. You fight with all your might for the welfare of the UNBORNS, and would prevent any factors that will harm them, right from the very point that LIFE begins. You ardently believe that life begins the moment the sperm fertilizes the ovum. Yes, so does the many (including us) agree with you on that, even if the definition indeed of when life exactly begins remain still to be controversial, even among those regarded as experts in that particular field of discipline.

But just how admirable your being a prolife is, that’s the same magnitude how disgusting you are spreading lies. You label contraceptives abortifacients. All experts, those who think rationally than you do, agree that contraceptives prevent fertilization to take place. If no fertilization happens, then there’s no life that forms. (You must agree with this as you emphatically annunciate it to be so). When there is no life formed, there is nothing to abort. Thus, how can a contraceptive act as abortifacient? You’re no experts in that field let alone have sufficient medical background, yet you act and talk superior than them. You are challenged to file a class suit against the manufacturers of these contraceptives. Yes, you can do that, with the billions you amass every mass. But why don’t you? Those that you are saying are of course LIES; you, who are so righteous, judgmental perverts and experts of morality, know that lying is an act of sin. Or doesn’t it matter anymore if you are committing an act of sin as long as you convince your clout to believe your lies?

BUT… until what extent of their lives will you fight for? Just until they’re born? What about afterwards?

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(Photo courtesy of http://lover-caring.blogspot.com/2010_08_01_archive.html)

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(Photo courtesy of http://sforiginal.blogspot.com/2010/02/baby-thrown-into-garbage-bin-and-burnt.html)

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(Photo courtesy of http://cura-personalis.blogspot.com/2010/12/why-help-street-children.html)

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(Photo courtesy of https://abandonedchildren.wordpress.com/)

(Photo courtesy of http://yvettetan.com/2012/07/07/child-labor-the-cbcps-latest-argument-against-the-rh-bill/)

Unplanned pregnancies are so rampant they comprise >50% of the total pregnancies. What do they end up with? Abortion, dumping of live borns at garbage bins or sewers and then left to die, street children, and then children being forced to join the labor force. Is this what you envisioned their life would become, after all your valiant efforts to fight for their welfare whilst in pregnancy? Shouldn’t being a pro-life also entails ensuring that their offsprings will have a good quality of life after birth?

EMPOWERMENT vs. CONTROL

During the time of Jesus, he said “give them fish, and they will live for a day. Teach them how to fish, and they can live a lifetime.” Since then, Jesus has encouraged EMPOWERMENT for his followers to survive. But how does empowerment apply?

Empowerment is:

  • When a family has free will and varied options on how to plan their family. Consequently because they were able to plan, without restriction,
  1. parents are able to provide for the family; parents don’t have to work overseas in order to augment family income, thus parents also performs their supervisory role over their children; parents are able to save for their retirement, and do not end up as nannies of their grandchildren
  2. children are able to receive all vaccines and thus fare better against these vaccine-preventable diseases; they do not contribute to under-five mortality burden; grow up as healthy individuals and thus a healthy society in return
  3. children are able to go to school instead of being forced into child labor; receive good education that will prepare them as they enter the labor force during adulthood.

Control is…

  • when you blind your followers and limit their options. Consequently, the options you have provided fail more than succeed.
  • impose your belief, whether rational or not, to others who do not necessarily share your views
  • when your followers keep on feeling indebted to you; when they always seek and rely on your approval;
  • when you use your position and blackmail your followers with abomination, excommunication and eternal damnation
  • when you label those who adapts a modern evidence-based, legal, ethically sound practices as terrorists, insurgents, filibusters, demons, just so you can get what you want
  • when you extend your duties and powers beyond pastoral and shepherding to governing.
  • when you suppress truth from surfacing and impose what was “traditionally” accepted truth as infallible.

My religion classes way back then taught me that one of the gifts of the holy spirit to us humans is FREEDOM and FREE WILL. Clearly, this is being contradicted, oppressed by some who thinks their power is limitless.

 

 
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Posted by on July 12, 2012 in Abortion, RHBill

 

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The Filipino Adolescents 2012

The Filipino Adolescents 2012.

 

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The Filipino Adolescents 2012

(Photo courtesy of http://reynthology.blogspot.com/2012/06/pinoy-teen-smokers-on-rise.html)

A woman recently gained attention after she performed cesarean section on her OWN SELF, delivering her own baby. As of this time we don’t know what drove her to do this. Did she use anesthesia, what kind and how, to avoid pain; or did she do it without any anesthetics at all? What drove her to do this when the baby is term and she could just have waited to labour? She sew herself with a regular needle and thread.

I remember another case of abortion that I came across with, though not as violent as that top story. She was in her early 20s, student. She was impregnated by her boyfriend; they’re unmarried. She looked frail, like someone who’s so meek enough to who raise her point when they’d argue. She seemed like she’ll say yes to everything.

At about 28 weeks, her boyfriend told her to take they need to do something about the pregnancy. They bought some abortifacient from the witches selling “pamparegla” (menstruation regulating substance/concoctions) outside Quiapo Church. (Yes, that iconic church that seems not to do anything about those witches around her, and allowing them to bastardize her with their merchandize, even on a Sunday). She took in 5 tablets of the drug, and inserted another 10 tablets into her vagina. Presto, preterm labor instantly.

She delivered to a 28 weeks preterm baby boy, who eventually needed mechanical ventilator to breath. They cannot afford surfactant so it was not given to the baby.

I talked to the mother of the baby as well as her mother about the incident.

First, I asked her why she committed that act. She blankly said, her boyfriend told her to do it.

Second, I asked her if she knew that taking the drug and inserting them as well to her vagina will cause labor pains, she just said “no.”

Then I told her, “are you aware that what you did is a form of killing?” She just said “no.”

My next question was “do you know that what you did is a crime?” Again, blankly, she said “no.”

Lastly, I told her, “did you know that I can call a police right now and have you arrested for what you did to your baby?” That was the only time she seemed to have realized the gravity of her crime, and so was her mother, and they broke down.

It is overwhelming and alarming that young people nowadays are not abreast with the different things they are doing. Only after the crime as been consummated will they come to realize that such an act was criminal.  What have you there… bullying classmates until the victim falls in a manhole and die, joking about holding/pointing a gun to a playmate and then accidentally shoot and kill him, daredevil stunts with a bike or skateboard just because they saw it was cool on youtube videos and then they get the worse fracture an orthopedics would almost object attending to, and many more.

Adolescence is a time of big confusion during a person’s life; they’re no longer kids, but they’re not yet adults. Hormones are raging making them ambivalent or confused, seeking identity or roles to portray, explore their sexuality, among other else. Peer influence is strong enough thus the high probability to form gangs during this age.

Parents have the biggest responsibility to guide their children until they can become totally independent and live on their own. It’s not the teachers at school, nor the religious at church. But how could the parents attend to all of their children’s needs when there are too many of them? Guidance and proper education can also fill in the void these adolescents quest.

A very matter of fact education that these teens need these days is age-appropriate sex education. This does not teach students to foreplay and have orgasm. Rather, sexuality education that will teach them about their body parts, how it functions, how pregnancy occurs, what are the sequela of being pregnant, responsible parenthood, contraceptives, sexually transmitted infections (STIs), etc. With the advent of information technology, a person can easily access these information, but without guidance, they will not understand it clearly. Still guidance is what these young people need so as to avoid unwanted “excursions.”

A study done has already shown that sexuality education has significantly delayed the first sexual intercourse among teenagers, lesser incidence of STIs, lesser incidence of early pregnancy and increased use of contraceptives.

Another sad facts that have plagued the young people recently are: (1) Philippines has been ranked no. 1 having the most number of teenage pregnancies in Asia, (2) increasing incidence since 1984 of HIV/AIDS among the 15-24 age bracket (2282/9669 or 23.6% cummulative incidence as of May 2012, http://www.doh.gov.ph/sites/default/files/NEC_HIV_May-AIDSreg2012.pdf), and (3) the very high incidence of smoking among the Filipino teenagers. These must have caught the attention of those in the palace.

Will you just be startled there?

 

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Beinte-Cinco: Quatro

Beinte-Cinco: Quatro.

 

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Beinte-Cinco: Quatro

For the past few days, I have been plagued by extremely premature babies for the first time, all 25 weeks gestational age, with different stories embracing each…

UNO…

Parents are well-to-do. They have a business, requiring husband to be out of town. Allegedly, the current pregnancy is not of the husband’s… Mother came in to the labor room, in active phase of labor, meaning, baby is already about to come out. Based on limited data gathered by my resident, mother is about 25 weeks pregnant, had been having diarrhea few hours prior to abdominal pain.

Baby was born, I immediately provided his needs – intubation, mechanical ventilator support, umbilical vascular catheterization. Despite full support, baby’s oxygenation status was never better. Chest x-ray showed collapsed lungs due to sequelae of prematurity. Husband is out of town, the mother’s companions are her employees, who cannot help me with legalities and decision-making.

Then the obstetrician revealed, (as she has the rapport with the mother), that the mother attempted to abort the baby by ingesting some abortifacient. About six hours from birth, the father arrived, but even if he wanted to be aggressive, the baby couldn’t respond anymore to treatment. They then signed a DO NOT RESUSCITATION order. Baby expired after about 12 hours from birth.

DOS…

Both parents are young and unemployed. Mother is 18 years old, father is 22. She came in too to the hospital because of abdominal pain. When at the emergency room, baby’s head was already presenting so she was rushed to the delivery room. I was called in after the baby was delivered so I rushed like an ambulance driver to the hospital. Baby’s urgent needs were provided and then I talked to the father about baby’s condition, what he needs. Unfortunately, even after he has called all possible resources, he wasn’t able to provide the medication baby badly needed.

Baby was only relying on the mechanical ventilatory support. However on the 30th hour of life, he started showing signs of deterioration. His mechanical ventilatory settings were unusually high that eventually led to rupture of both lungs (just as when I left the hospital). I had to rush back to possibly rescue baby. His x-ray revealed rupture of both lungs, with air escaping out but still within chest cavity, thus compressing both the lungs, and the heart. If this were not addressed, baby will die in a few minutes..

I called in a pediatric surgeon to insert tube to drain the air, while I only deed a rescue needle thoracentesis. Alas, after our attempts to rescue baby, he didn’t make it. He expired at about 38 hours from birth.

TRES…

I was informed that there is a pregnant mother, on her 28th week gestational age, for control of labor, but if she will deliver, I will attend to the baby. At least, the baby was older this time (and so I thought)… I instructed then the NICU staff to prepare equipment that baby will need upon delivery. Only two hours after the referral, the phone rang again, calling me now to the delivery room as the baby’s head was already almost out. At least this time, I was already able to have dinner.

I rushed to the hospital and in less than 10 minutes, baby came out. But baby wasn’t looking normal, he was deformed. His head and face were deformed, the abdomen was as large as the head (normally, for a preterm, the head is larger, abdomen and chest are almost the same in diameter), the feet are compressed, looking like club foot. When I was asked what the gender of baby was, I couldn’t commit whether baby is a boy or girl. It seemed like there are scrotal sacs, but empty (which is expected at this gestational age), there was a protrusion that is hard to discern if its penis or clitoris. (In cases where genitalia is ambiguous, we are not obliged to assign a gender until we were able to document it by chromosome (DNA) analysis, so as to avoid mistake in gender assignment). Baby’s skin were also showing red spots highly suggestive that baby has congenital infection, probably german measles or cytomegalovirus. The large abdomen suggests that liver or kidney is enlarged. Whether it is a tumor or a reaction to maternal infection during the course of pregnancy, I could not be certain. Physical assessment also revealed that baby is only 25 weeks, and not 28 weeks as thought of by the mother.

Upon birth also, heart beat was already less than normal, and he was already gasping (an ominous sign of arrest). I already knew that resuscitative efforts in this kind of situation will be otiose. So, I immediately called in the grandmother (as the husband is abroad) and explained how futile resuscitating baby is. We provided comfort care, had baby baptized, and waited for baby to expire.

In retrospect, I learned that at 5 months gestational age, baby’s ultrasound revealed that there was polyhydramnios (excessive amount of amniotic fluid). The placenta was large too, heavier than the baby, also substantiating my suspicion that mother had a lethal form of asymptomatic infection that grossly affected the baby.

After 58 minutes from birth, baby expired.

QUATRO…

It was a Sunday, it was supposed to be lazy day, rest day for me, but for some crazy reason, the world does not want me to fully enjoy my rest days, this day included. I was called in for emergency cesarean delivery at a hospital for the birth of yet again 25 weeks old baby. Baby had to be delivered as the hand is already coming out of the vagina.

Upon arrival at the hospital, the obstetrician and her assistant was already operating on the mother so I barely had time to prepare. Baby came out in few minutes and needed resuscitation as he was not spontaneously crying and breathing. We had to provide bag-mask ventilation but the equipment was dysfunctional. Also, many equipment that baby needs is not available in that hospital so I had to immediately transfer baby to a higher center. The baby is the 2nd child, the 1st child being 13 years old already and parents want the baby to live. What am I to do but to stress myself thus? (evil-grin) 

The ambulance and I rushed to the other hospital in convoy. Again, his needs were provided. This time, I or perhaps the baby was lucky because the father was able to provide that much needed surfactant. Also, the baby’s lungs are not that collapsed compared to the other ones I previously mentioned.

It seemed that the mother has uterine infection as the bag of waters broke one day before she had labor pains. Usually infections at this week of gestation is lethal/deadly to the premature baby.

The baby is currently stable at present, although still requiring mechanical ventilatory support.

 

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Dilemma…

Dilemma….

 
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Posted by on June 10, 2012 in Abortion, neonates, Pregnancy

 

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Aside

Scenario:

A pregnant woman comes to the emergency room. On interview and examination, she complains of having loose bowel movement and abdominal pain. You also find out that she is in active labor, in fact, her labia is already gaping wide, and the head of the baby is already visible. The spice to that is, she is only 25 weeks pregnant. (As she is already in labor, it is impossible already to get a very DETAILED history from her before the baby comes out.)

Pediatrician is called. With the available data, pediatrician/neonatologist resuscitates the baby accordingly — full resuscitation provided aggressively. Baby being severely premature, no surfactant available, unable to breath spontaneously, gets intubated and bag-ventilation provided. Baby is brought to the NICU for further care. Mechanical ventilator is provided to assist baby’s respiration; saran wrap helps to improve and regulate his temperature; umbilical venous catheter inserted for central access; x-ray done to assess baby’s lung status and document the placement of endotracheal tube and umbilical catheter.

Obstetrician, who has established rapport with the mother also wondering why she went suddenly into labor when she has good and unremarkable prenatal status. She elicits that… (brace yourselves)… this is a case of INDUCED preterm labor after intake of some drugs. BOOM!

Question… 

Now suddenly, as the pediatrician, you try to go back from the start of everything and ask yourself: should you have been aggressive in providing care for the baby? And then you suddenly tell yourself, but the baby is not at fault, didn’t want to be expelled prematurely, and still deserve the best and optimum care as any other babies would… then the dilemma sets in… How far should you, as a physician, go and asserting the baby’s needs, over the lackluster of maternal affection.

To resolve matters, you call for the husband… Unfortunately, the mother was only accompanied by her live-in female employees. The husband is out of town, working. Not a single nearest of kin, who can stand as guardian, give consent, is available.

What would you do now as the pediatrician? The mother is sedated after the delivery procedure; you cannot get a consent from that kind of mind frame; the baby’s watchers are not legally suited to sign consent for him.

Resolution…

My resolve: I told the mother’s employees– I need you to inform the nearest of kin. I cannot make you sign for the baby’s welfare as it is not legally binding. Meanwhile, since the mother is still sedated and not at the best mind set to give any decisions yet, I will assume the responsibility for the baby, I will act as his parent until she has fully recovered from sedation. (I am not sure but I think these employees were not aware that the mother intentionally wanted to get rid of the baby). I gave them a prescription for surfactant as it is not available at the institution where she gave birth. (Some of you might disagree with me, but I had to think fast and consider the best option for the baby. And at that instant, that was the best I could come up to.)

Meanwhile, I waited from them. Baby’s condition was not good; he badly needed that surfactant. Do I expect the surfactant to be bought by the employees under the command of the mother (who wanted to get rid of the baby)? The father was apparently on the way home now. I waited still, and tried to give the baby a chance, but despite all I could do, he wasn’t faring well.

In my subspecialty, there are a lot of situations in which we are fazed with ethical quandary. The major template from which decisions will be based on is the current condition of the baby and its prognosis– what potential/s will be preserved to have a good quality of life. The other major factor is parents’ resources. It is a common knowledge that behind the intensive care of a sick baby, preterm at that, is a staggering hospital bill; cost of care of a baby requiring intensive care is NOT CHEAP. Other determinants include, among other else, the number of children in the family, age of parents, support of the community around them. The conflict sets in when: there is mismatch between either factors. This time, my dilemma is, should I go aggressive after knowing that the mother wanted to get rid of the baby? It would have been easier if the husband were here, at this very moment. I will pass on the decision to him, after full disclosure of course.

 

Dilemma…

 
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Posted by on June 10, 2012 in Abortion, neonates, Pregnancy

 

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