Stillbirth

The topic of stillbirth and birth defects is one of those things that freaks out every female medical student, and many males, too, on a personal level. I can only imagine how difficult it must be to go to the maternity ward for labor, knowing that you won’t have a baby at the end of all the pain, or looking at baby clothes that friends and family bought for you that won’t warm a baby anytime soon.

Heather Teysko has written a very practical, honest, and moving blog entry on Open Salonabout how to prepare for a stillborn birth. As this website dedicated to helping parents of Edwards Syndrome (trisomy-18) babies shows, there are so many details that you have to get in order, and it really does change your life forever.

Learning fetal pathology has been difficult in multiple ways. No matter when you think life begins, it’s heart-breaking to look at aborted and miscarried fetuses, or stillborn infants with terrible dysmorphisms splayed out on the pathology table, at any stage of development. Did they experience pain? Did they die mercifully? At the same time, I ate my lunch just fine while looking at slides of amniotic band strangulation, amniotic tissue stained with meconium, gross holoprosencephaly, and aneuploidic fetuses. I wonder if that makes me some kind of monster.

I found Edith Potter’s, the namesake of Potter’s syndrome, words clarifying: “The description of the body of the dead infant is of no value as an isolated piece of information, but if it is integrated with the various aspects of heredity, conception, development, intrauterine and extrauterine environment and behaviour, it becomes part of an important chronicle.” It’s important work. It doesn’t change the disease. It doesn’t change the fact that the parents won’t have a baby at the end of this. But it does offer predictions for future pregnancies, and some degree of closure for parents who may just want to understand, what the hell happened?

Because of the nature of adverse birth outcomes, in obstetrics, like in no other specialty, the medico-legal system is seen in all its sticky emotional entanglements, paranoia, grief and bitterness, and unpleasantness. This New York Times article about stillbirth malpractice cases only scratches the surface of the nightmarish situation. At one of our teaching hospitals, all OB residents are required to sit in on a malpractice case during their training because they fully EXPECT to be sued at least three times over the course of their career. I feel like our lecturers in the Ob/Gyn block end every lecture by saying something to the extent of, “And the reason it’s important to know how to [evaluate physiological changes, know the timeline for development of abnormalities, etc] is for legal protection.”

This attitude distances me from the patient and makes all my education seem like something I have to be able to recite when something goes wrong and the patient wants to take me to court. It’s unfortunate, and it’s unfair to doctor and patient. But in our lawsuit-happy country, it’s necessary, even if it comes at the expense of doctors’ relationships with their patients.

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About the friendly intern

Ask a question: The Friendly Intern My personal blog: Pathos and Pathology
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