Writing Sample

Baby, Or Mother? Mikayl Nikola

INTRODUCTION Sarah has been trying to conceive for ten years. It's been very rough on her marriage, and she has been depressed during this time. One spring day, Sarah finds out she's pregnant and has never been so happy. Her and her husband enjoy the pregnancy, and excitedly plan for the future. Around 32 weeks into the pregnancy, Sarah finds out she has congenital heart failure. Her OBGYN talks with her about options and possibilities. Sarah makes it very clear that if during labor there is a choice between saving her or the baby (Iris) that the doctors are to save Iris. Sarah's husband doesn't say much; he doesn't even want to think that a problem will arise. He's worked hard to conceive Iris, but he hasn't met her, and he loves his wife. Fast-forward nine weeks, Iris decided to come late to the party and is about a week past her due date. Sarah has been laboring for 20 hours, and her blood pressure is sky high, she's experiencing maternal fever, and her pulse is dropping; she's losing a lot of blood. Iris is also struggling, her heart tones keep dropping and she needs to get out of her mother’s womb soon or she may die. If surgery is performed on Sarah, there's a VERY high chance she won't make it with her unstable vital signs, but if she keeps laboring, baby Iris will die. The doctors want to give Sarah medications to stop the bleeding, but doing so will also be too hard on Iris, she might not be able to handle stronger contractions that are needed to clamp down the uterus and stop the bleeding. The OBGYN remembers Sarah's instructions to save Iris over her. Sarah's husband, Paul, begins begging and pleading with the doctors to save Sarah.

THESIS In this situation, is Sarah's autonomy more important than the pleading of her husband? Sarah had made it clear to her entire birth team, including her husband Paul, that if things went south, she wants Iris to be saved instead of herself. Her husband is now begging that Sarah be saved, and that Iris be allowed to die in the process. Since Sarah is of sound mind, and has voiced her opinion before her vital signs became unstable, Sarah's autonomy, and the autonomy of baby Iris should be honored. Saving Iris doesn't guarantee a death sentence for Sarah she still might make it. Saving Sarah first however, will definitely kill baby Iris. As a mother, Sarah is the sole decision maker for not only herself, but for her baby. The decision she has already made is the first she will make as a mother, so her wishes should be followed through with no matter what. Paul is panicking and changing the plan, and ethically, this decision is not his to make. MEDICAL INDICATIONS Sarah has congenital heart failure. During pregnancy her condition has greatly deteriorated. Sarah is in labor and her blood pressure is sky high, while her pulse is very low. Sarah is experiencing a maternal hemorrhage, and she also has a fever. Iris, Sarah’s baby, is not handling labor well, and Sarah’s high blood pressure seems to be affecting her quite negatively. Her heart tones are much lower than average, and with each contraction she is beginning to flat line. It is not predicted that Sarah will have a good outcome medically no matter what happens. The only way that baby Iris will make it, is if she is delivered via cesarean section, in which case the probability of Sarah dying is VERY high.

PATIENT PREFERENCES Sarah has made it abundantly clear that if the choice rises between saving her life and saving baby Iris’s life, Sarah would like to die. Sarah does not want to live a single day knowing that baby Iris didn’t make it. Sarah’s husband would like Sarah to be saved, he’s never met baby Iris after all. He thought he would be able to respect his wife’s wishes, but once the choice is presented he has clearly abandoned his position. Sarah stands strong and wants the life of her baby spared, even if that means she dies. Sarah’s husband feels as though Sarah is incapable of making this decision with all the labor pain and “hormones.” Sarah is fully competent, and she not only made this decision before all of the labor pain, but she stands firm throughout it, she means what she said. She wants Iris to live, no matter what happens to her. QUALITY OF LIFE Sarah has congenital heart failure, but she could lead a fairly normal life. If Iris is left to die, mentally Sarah will never be okay again. With the amount of blood Sarah is losing, after Iris died it’s likely that a full hysterectomy would take place, and Sarah has no other children. She’s always wanted to be a mother. Sarah will likely never forgive Paul for taking this decision away from her and essentially killing their daughter. Her life will be anything but normal physically and emotionally. CONTEXTUAL FEATURES In this case there are a few conflicts. Which life matters more, Iris or Sarah? Who decides who lives, and how do we even know who will live depending on which action is taken? If Sarah opts for a cesarean in an effort to save Iris, she might still live. If Sarah

keeps laboring, both could die, and Iris will only have about a 2% chance of survival even if Sarah lives. Giving Sarah medication to slow down her hemorrhaging will most likely kill Iris very quickly if her heart tones continue the way they’ve been for the past ten hours or so. Doing nothing will likely kill Iris, giving Pitocin will kill Iris even faster, and performing a cesarean will likely kill Sarah, and nobody really knows if Iris would survive or not but this would be the best option for her. ALTERNATIVE OPTIONS The options are to have a cesarean section, which is what the patient wants. With this option, it is predicted that Sarah wouldn’t survive based off of her current vital signs, and how quickly she’s already hemorrhaging. Another option is to keep laboring and do nothing. With the hemorrhaging, Sarah might die within the hour, and baby Iris has about the same life expectancy. There is also the option to administer Pitocin to try and speed along the labor, as well as help clamp down the uterus and help prevent the hemorrhage from worsening. With this option, baby Iris will likely die rather quickly. Her heart rate is already flat lining with contractions, and Pitocin is known to make contractions harder and last longer. CONCLUSION The dilemma is extreme, no matter what is decided, someone will likely die. In this instance, the patient Sarah has voiced her opinion of sound mind before going into labor. Her opinion has been the same for nine weeks. Now in labor, she hasn’t wavered in her position. The patient’s autonomy should remain intact and a cesarean should be performed in an effort to save her baby’s life, even though it is predicted that she won’t

survive. A mother should never be forced to live without their child if it can be avoided. If the cesarean is performed, there is no guarantee Sarah will most definitely die. A blood transfusion can be performed, and generally the odds would be in Sarah’s favor. Her unstable vitals are concerning, but there is still a chance. If Pitocin is administered, or Sarah keeps laboring, it is an almost guarantee that baby Iris will die. A mother should be able to decide what steps to take during labor, especially if the decision could kill her or her baby. This is, as previously mentioned, one of the first big decisions Sarah will make as a mother in an effort to protect her child.

BIBLIOGRAPHY Mikayl Nikola (writer) – Birth Assistant with 2 years of experience aiding a midwife during childbirth Rebecca Mcinnis – Nurse Midwife with 32 years of experience delivering babies Eve German- Professional Midwife with 7 years of experience delivering babies