Trauma in Pregnancy, Eating for Two, Living for Two, Dodging Bullets for Two

December 14, 2007

What the prospective mother smells, the developing baby smells (to some extent). What she eats, the baby absorbs (again, to some extent).   If you are what you eat, then you've been what your mother has consumed.

But there are dangers to the unborn child other than the possibility that the mother may drink or smoke or use drugs.  The developing baby is a passive passenger in the prospective mother for about 39-40 weeks.  Where she goes, the baby goes.  Wherever the mother succumbs to the laws of physics, so too will her baby inside.

Besides abortion, one of the most common causes of fetal death is maternal death, because the baby is only as safe as the mother is.  I saw a patient recently who had sustained injuries from a terrible car accident.  She wasn't wearing her seat belt (which is in contrast to her new policy of doing so), and she flew out of the car, pin-ball style on the way out, and landed dozens of feet away.  Her limbs took the blows, sparing her injury to her head, face, and abdomen where her unborn baby sat safely cradled.

The most unusual thing about this accident is that she didn't die--and her baby along with her.

The Forces of Gravity-Pregnancy Weight

We live on a planet with gravity where Force = Mass x Velocity.

We live our lives interacting with moving bodies, machines, wildlife, and natural phenomena.  We all need to be just a little careful to survive it all, but pregnancy can affect the care with which we try to remain safe.

There is a shift in the center of gravity for one thing.  With weight shifting due to the increasing bulk of the baby, uterus, and placenta, and with the figure shifting due to the hormones, pregnant women temporarily waddle their serpentine way to avoid the obstacles of the world around them.  Unusual muscular aches tell the tale of different postures used during this shift in the axis.  Besides the minor (or major) physical discomforts of pregnancy, the hormonal roller coaster adds additional distractions that make navigational decisions hazardous while walking, running, or driving.  Something as simple as buckling up can be challenging.

Trauma In Pregnancy

During my training I did research on trauma in pregnancy.  Back then, the use of seatbelts were seen to be controversial by the patient.  My research into the studies that had been done overwhelmingly pointed to keeping the mother safe as the best way to keep the baby safe.  The leading cause of fetal death, as stated above, was the mother's death.  It's intuitively obvious that seatbelts are in fact a pretty good idea.

Again, during my training, I was on call one night when a pregnant woman came to the ER with a gunshot wound.  Her history was that she had been in an argument with her boyfriend over rent when she decided to get even by shooting herself.  She pointed the gun to her belly and fired.  It was taught that any gunshot wound to the abdomen mandated an abdominal operation to look for damage.  General surgeons worked side by side with us to first inspect her uterus (womb), then her other organs.  To our disappointment, her uterus showed both an entrance and exit wound.

This baby had been undoubtedly in harm's way.The bullet ultimately had lodged in this mother's Vena Cava, the main large vein accompanying the Aorta and which runs blood from the lower half of the body back up toward the heart.  So "harm's way" involved two people, mother and child.

We quickly performed a C-section delivering a 2 pound 10 ounce baby boy to the pediatricians waiting.  The baby, 12 weeks premature, looked fine to me during that brief time I handled the baby for the delivery before handing him off.  The uterus was repaired, the bullet holes were cleaned up and patched, and then we figuratively tipped our hats to the general surgeons who had a date with her Vena Cava for the rest of the night.

The infant had ultimately needed surgery himself at Children's Hospital, for he had sustained six in-and-out injuries to his bowel and colon, and the bullet had also knocked off a lobe of his liver.  And then like so many Charity Hospital patients and their stories, all further information fell victim to the transience of the Charity doctor-patient relationship.

As a mere coincidence I happened to fill in for a fellow resident one day at one of the birth control pill clinics.  I saw a patient who looked familiar and stood wondering just who she was. 
She answered my expression when she said, "You don't remember me?  I'm the one you operated on when I got shot."
"Oh."  I did the routine well-woman exam, then I finally asked.  "How did your baby do?"  I was afraid of the answer, because there had been a lot of trouble that night for not a lot of baby.
"Oh my baby's doing fine," she answered.  "And I did good, too."
"So where's the baby now?" I asked. 
"Where you think the baby is," she fired back, "I'm the baby's mother.  He's with me.  What did you expect?"
"Oh."

My patient who was in the car accident became even more pregnant than ever.  She may have the orthopedic pins in her wrist, but she also has the intact baby in her uterus.  Another patient of mine got mugged.  She had a gun put to her head in Hammond, so she handed over a little more than a hundred dollars to her shaky, inexperienced, adolescent gunman.

As John Lennon sang, "Life is what happens to you while you're busy making other plans." 

As Salmon Rushdie wrote, "Being alive makes up for what life does to you."

then of course there are those pesky laws of physics.

Whether there are hormonal distractions, physical distractions, or just plain lightning bolts out of the blue, just because pregnant women are grown-ups doesn't mean they don't have to be just as careful looking both ways when crossing as they tell their other children to be.

Because for nine months, women their children.  If you are what you eat, then you are what you bear. To some extent.

The next chapter?  "You are what you raise."

 

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