“Uhm, hunh, what?” That’s exactly what I think whenever I read
Andy’s blog. I don’t have the foggiest notion of what he’s doing
with his life except that there’s a lot of technical jargon. I’ve
tried reading those entries but I find my eyes glazing over with my
head wobbling dangerously. So maybe I should start writing about
Since I was on the Newborn/Well Baby Service this past week, I might as
well discuss one particular interesting case. My patient was a
female 2725 g product of a 39 wk GA to a 34y/o G4 P1 to 2 woman. It
was a vaginal delivery complicated by thin meconium with APGAR scores of 9 and
9. MOB was Rubella immune, GBS + for
which she was treated times one, Hep B negative, RPR immune and VDRL nonreactive. Finnegan scores of 0 and 1 were taken every
four hours after the delivery (but why?). After the
delivery, the patient was taken to the unit where she was allowed to nurse at
her mother’s breast.
It wasn’t until I came across a notation on the chart stating that the
MOB imbibed illegal substances during the pregnancy, that we advised
her stop breastfeeding until both she and the baby were found to be
clean of all harmful substances. The
mother was vehemently opposed to the idea of cessation of breastfeeding. Both the patient and the MOB were tested for
illegal substances with the patient found to be positive for both cocaine and
opiates while the mother was negative for all drugs.
During this entire process, the MOB adamantly denied any illegal
substances beside marijuana for “nausea/vomiting” even though her chart
stated prior abuse. Of course I asked her about this during the
initial interview and when she denied it I took the track that anything
else she had to say would be suspect. In any case all this was
complicated by the FOB who was bent on blaming somebody for the fact
that the mother was even ALLOWED to breastfeed in the first place if
there was some reason to suspect foul play. He was blaming the
pediatrician present during the delivery, the OB/Gyn and even the
nurses! Apparently his mother overheard some nurses discussing the
impropriety of the MOB nursing when she had tested positive.
Anyhoo, as protocall stands we had to c/s SW and they in turn consulted
CYS which didn’t make the FOB especially happy. At some point the
MOB was upset b/c she felt that the Finnegan scores were calculated
incorrectly based on the fact that the nurse learned of the positive
tox screen and decided to be more “aggressive” in her scoring.
I informed the nurse that if she could, she should get another person
to attend to that particular room. Well, I come back the next day
(after much discussion with MOB/FOB/attending/resident/other people on
the team), to find that custody of my baby has been taken away from the
MOB by CYF and given to the paternal grandparents! Whoa.
Okay, so now the MOB is d/c’d but the baby has been tx’d for monitoring
(apparently Finns were high). The FOB didn’t even look at us
anymore and the MOB kept on trying to BF again (s/p the 60hr mark for
proper clearance) and mentioned to me that she had made a huge mistake
and she was sorely disappointed in herself. All I could say is,
yeah, well, that’s true; but it’s a good lesson learned.
It was a socially dynamic and charged situation with the possibility of
litigation but as per Friday, my baby was still downstairs and the
custody hearings were pending. I hope she does well.
Parents do such stupid things sometimes…