Crack pipe mommy.

I just totaled up my hours for the week and all I can say is; wow. It has been a long week but I have learned a ton and loved the things I have been able to see and do. I am on labor and delivery and I have assisted, done / participated in many new lives making their debut into this world. I have become very comfortable with how to deliver a baby in normal conditions and how to precede in emergency / difficult situations. 

The patient population I am dealing with are poor and living in some difficult situations. Many of these mother do not have any prenatal care and they show up to the hospital for the first time when the contractions start or their water breaks.  I have had several mothers who drink, smoke and use drugs regularly during their pregnancy making it difficult for the fetus to grow and develop properly. It is hard to see these situations and not become frustrated or angry. I try to remind myself that I am not there to judge and I have no idea what their lives are like or the kind of problems they have had. I am there to provide treatment and care for the mother and the fetus.

Last night I had the emergency department (ED) ob/gyn pager and at about 6:00 pm I was paged to the ED for a trauma that involved a pregnant women. I grabbed the ultrasound machine and a senior resident and we went down to the ED to assess the mother's condition and see how the fetus was doing. All we knew about the case was that she was 6 months along in her pregnancy and had been involved in a fire where she had 3rd degree burns over her head, neck, chest and abdomen. As we approached the trauma room we could hear the high pitched screams of a female ringing out. It sounded painful. I could not imagine what I was in for as I entered the trauma bay. There was a 27 y/o African American girl lying on an exam table screaming as several other doctors and healthcare personnel scurried around trying to do their specific tasks to care for her. Someone was putting in an IV and administering her pain medication and IV fluids while others were cleaning the burns and deriding the melted flesh. My senior resident announced our presence and who we were and we started in on our job. I began firing up the ultrasound and asking her questions about her pregnancy.

"How far along are you?" "I do not know" was her response. "Have you had any prenatal care up to this point?" "No" she muttered. I continued to ask her questions while y senior resident started a vaginal ultrasound to assess the fetus. We were able to determine that this was her 7th pregnancy and all the other babies had been with different fathers and were now in the custody of the state. She did not know who the father of this baby was and did not want the baby. She had been using marijuana, cocaine, heroine, tobacco, alcohol and some other drugs throughout this entire pregnancy. The fire was caused when here crack pipe exploded setting her chest on fire. It did not sound like a suicide attempt but rather an accident while smoking crack.

We were able to determine that she was 26 weeks into her pregnancy and that the fetus was alive. We hooked her up to a fetal monitor that we could monitor from the L&D floor while they finished taking care of her burns. It did not look like she was in risk of going into early labor. We monitored her the rest of the shift and the doctors on the next shift were introduced and continued to monitor her and the fetus. 

I have had several drug abusing mothers who are pregnant and continue to use their drugs. It is always a sad situation. I have to remain focused on patient care and education while trying to not judge the patient. This patient will most likely live for now and will go onto to deliver an infant who has brain damage and other abnormalities due to the exposure to drugs while developing. The most common drug and often the most dangerous and damaging of these substances is alcohol. 

There is not a lot of time to worry about the controversies of hysterectomies while working like this and trying to care for these patients.