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View Full Version : In real life, whose life would be saved?



TheCuriousOne
12-17-2014, 07:33 PM
Sorry if I posted in the wrong thread, but this one seems to be the most relevant.

Basically, I'm reading this horror fiction, and I've just come across a scene where the wife of the main character is delivering their baby. Things go bad in the delivery room, and she suffers from an haemorrhage, while the baby is still inside. When she flatlines, the physician decides to shock her despite voiced concerns that it would kill the baby. His reason: there was no time for a C-section. The feel is that it happened very quick (well I think it probably would anyway).

I know this is fiction and horror as well, so I'm thinking that this is all part of the plot. I'm not querying the scene in itself.

It's just made me think of my mother, who went through a similar ordeal. She haemorrhaged while still in her room, was rushed to the delivery room, and they delivered the baby by C-section to give him a chance he wouldn't have had had they left him in the womb. She didn't flatline though, so it's not entirely similar. But the physicians tried to save both. The baby had been starved of oxygen for too long, and, not being able to save both at the same time, they opted to save my mum in the end. But there was that reasoning of "who has the best chances to survive if we can't save both". That was in France.

I watched local ER programs and dabbed in the medical world when living in the UK, and it seems to me that doctors will always try to save a viable life. Obviously, this can't be generalised, and situations can be very different from one another.

I'm just wondering if doctors in the US (where the writer is from and the story is set) would automatically go for the mother even though there is a chance that the child might be saved. It's purely for personal knowledge :) Thanks!

kuwisdelu
12-17-2014, 07:34 PM
You want story research and interviews (http://www.absolutewrite.com/forums/forumdisplay.php?f=66). A friendly mod should be able to move this for you.

TheCuriousOne
12-17-2014, 07:35 PM
Thanks kuwisdelu! Will bear this in mind for next time :)

Vince524
12-17-2014, 10:00 PM
Before it gets moved, my guess would be the wishes of the mother if they were known would be honored. If she said, "save my baby" then they'd work with that as the priority. If she didn't , then they wouldn't. If the mother was unable to voice her desire, it would go to the next of kin.

When my wife was pregnant with our girls she was always worried about something happening. We'd had 2 lost pregnancies before. She actually wrote a letter and had it notarized and handed it to her OBGYB advising her that if anything happened and there was a choice to be made, the babies came first.

Man that doctor gave me the stink eye for "Letting her worry about that." As if I could control where my wife's mind went.

cmhbob
12-17-2014, 10:10 PM
Not sure if this is the news you want, but Googling "defibrillation of pregnant patients" led me to this link, among others:

http://circ.ahajournals.org/content/112/24_suppl/IV-150.full



Defibrillation
–Defibrillate using standard ACLS defibrillation doses (Class IIa).5 (http://circ.ahajournals.org/content/112/24_suppl/IV-150.full#ref-5) Review the ACLS Pulseless Arrest Algorithm (see Part 7.2: “Management of Cardiac Arrest”). There is no evidence that shocks from a direct current defibrillator have adverse effects on the heart of the fetus.
–If fetal or uterine monitors are in place, remove them before delivering shocks.


And from an AED manufacturer (http://www.zoll.com/medical-products/automated-external-defibrillators/faq/):

Should I use the AED if the victim has a pacemaker or is pregnant?
Yes, never withhold AED use in a person with SCA.


And this article (http://www.modernmedicine.com/modern-medicine/content/cpr-when-patients-pregnant?page=full) may be the most helpful. I'd have to paste the whole thing to show you.

The short answer is, there's not necessarily a need to choose right away. Defib shocks aren't thought to hurt the baby, as long as any fetal monitors are removed prior to shock.

TheCuriousOne
12-17-2014, 10:11 PM
Thanks Vince524! You can't control the mind of a pregnant woman, especially when the hormones kick in. Would you believe me if I said that when I got the post-partum blues, I was absolutely terrified at the idea of my son getting nappy rash? Women gets lots of worries with a newborn. For me as a first timer, it could have been "How am I going to cope?" "How am I going to stay awake for the night feeds?" "What do I do if baby keeps crying and I don't know what's wrong?" etc. But no. Nappy rash was my main worry. I'm laughing about it now, but I didn't back then!

Thanks for your take on this :)

TheCuriousOne
12-17-2014, 10:18 PM
Thanks cmhbob! I should have googled, it would have saved you the time, sorry! I didn't realise that pregnant women could be shocked without there being an impact on the baby. That's good to know :)

I just assumed by what the author wrote that it would kill the child :( Lesson learnt :)

cmhbob
12-17-2014, 10:22 PM
Happy to help. My instinct (and I should have known this by now; I have 8 kids) was that it was safe with modern technology to do so, but I wasn't sure.

NinjaFingers
12-17-2014, 10:25 PM
Not everyone does their research. (And we've all failed on occasion).

Marian Perera
12-17-2014, 10:33 PM
You can't control the mind of a pregnant woman, especially when the hormones kick in.

When a friend was pregnant, she once told me she wondered what would happen if the umbilical cord got twisted around the fetus's neck somehow. And my friend would never know until it was too late. Even if she did know, she would hardly be able to reach in and untangle it somehow.

TheCuriousOne
12-17-2014, 10:39 PM
Happy to help. My instinct (and I should have known this by now; I have 8 kids) was that it was safe with modern technology to do so, but I wasn't sure.

Now you know (and I know too, thanks again :) )

TheCuriousOne
12-17-2014, 10:40 PM
Not everyone does their research. (And we've all failed on occasion).

It happens. And sometimes we think we know something but we don't. And some things are difficult to understand if we don't have some knowledge in the field already. Like medicine :)

TheCuriousOne
12-17-2014, 10:42 PM
When a friend was pregnant, she once told me she wondered what would happen if the umbilical cord got twisted around the fetus's neck somehow. And my friend would never know until it was too late. Even if she did know, she would hardly be able to reach in and untangle it somehow.

Yes, that's unfortunately the thing about pregnancy. You get past the first 3 month and you're still not out of the woods. Thankfully progress in medicine means pregnancies are safer now than they used to be. I'm not sure I understand the bit about your friend not knowing until it was too late [Edit: I'm native French so there are still some "bits" I don't grasp - not your fault :) ]. Sorry if this happened to her, and I hope it ended well.

Marian Perera
12-17-2014, 11:07 PM
I'm not sure I understand the bit about your friend not knowing until it was too late [Edit: I'm native French so there are still some "bits" I don't grasp - not your fault :) ]. Sorry if this happened to her, and I hope it ended well.

Native French! I had to learn French for an interview so I could get provincial migration to Canada through Quebec. I asked my uncle, who worked in the Alliance Francaise, if he could get me some French videos to watch, and he gave me a copy of La Reine Margot. After Margot moaned, "J'ai besoin d'un homme cette nuit" I told my uncle, "If I ever have to say that, the interview will not be going too well."

Ahem. Anyway, my friend meant she wouldn't know if the baby had been choked by the cord until she'd given birth or the doctors had noticed a problem during regular checkups, by which time it would be too late to do anything. But as it turned out, that fear was unfounded. Healthy baby girl, going on twelve now. :)

Williebee
12-17-2014, 11:10 PM
Mod Note:

A move has occurred. Thanks for the heads up.

asroc
12-17-2014, 11:17 PM
When she flatlines, the physician decides to shock her despite voiced concerns that it would kill the baby.

You never shock a flatline.

nikkidj
12-18-2014, 01:58 AM
Agree with asroc. You only shock ventricular fibrillation or pulseless ventricular tachycardia. And once the mother codes, there's only about 4 minutes before hypoxia-related neurological injury starts in the fetus. In emergency departments, we're trained that doing an emergency c-section should be done before those 4 minutes are up. Ideally, an OB will be present to do the procedure, but every emergency doc has a story of either doing an emergency section or knowing someone who did one.

Not only does emergency delivery give the fetus a chance at life, but it can actually help resuscitate the mother by improving vascular return and decreasing vascular resistance.

TheCuriousOne
12-18-2014, 02:50 AM
But as it turned out, that fear was unfounded. Healthy baby girl, going on twelve now. :)

Glad to hear it :) Have you moved to Canada now, Marian?

TheCuriousOne
12-18-2014, 02:51 AM
Mod Note:

A move has occurred. Thanks for the heads up.

Thanks, and my apologies for posting in the wrong thread in the first place. As you can see, I'm still working my way around the forum :)

TheCuriousOne
12-18-2014, 02:55 AM
Thanks nikkidj and asroc, for the information :) The bit about improving the cardiovascular return by delivering the baby makes sense. So you shock the mother if there is fibrillation/tachycardia to restore the heart rhythm, but if she's dead, you deliver the baby and then deal with the mother's heart, if I get it right?

Vince524
12-18-2014, 03:21 AM
Thanks nikkidj and asroc, for the information :) The bit about improving the cardiovascular return by delivering the baby makes sense. So you shock the mother if there is fibrillation/tachycardia to restore the heart rhythm, but if she's dead, you deliver the baby and then deal with the mother's heart, if I get it right?

Of course, since we're talking about fiction, you could take another approach.

Have vampire bite the mother, turning her into the undead at the last moment. The baby would be born with many of the same vampire abilities, but without the curse of being a vampire. Able to be in sunlight, not burnt by holy water, not stuck in the same state, so will grow, become a teen, get acne, grow hair in all those private places and have dreams that require the sheets to be washed.

Cath
12-18-2014, 04:07 AM
Since we're in the research forum, let's keep it focused on facts please.

MDSchafer
12-18-2014, 05:17 AM
The midwives who taught me in college always said that if it's a question between a baby and a mother you always save the mother without hesitation.

TheCuriousOne
12-18-2014, 01:45 PM
The midwives who taught me in college always said that if it's a question between a baby and a mother you always save the mother without hesitation.

Thanks. I see the point :)



Vince, I'm not sure I have the ability to carry on with your theory, vampires are simply not my thing. But thanks anyway!

BenPanced
12-18-2014, 05:05 PM
You never shock a flatline.
You mean...TV HAS LIED TO ME? AGAIN?! :cry:

slhuang
12-18-2014, 05:57 PM
You mean...TV HAS LIED TO ME? AGAIN?! :cry:

Yes, this is one of those things that TV always, always, always gets wrong. I'm not a doctor but once I learned that it started annoying me every time, because they ALWAYS do it, and it's ALWAYS wrong!

MDSchafer
12-20-2014, 06:01 AM
Yes, this is one of those things that TV always, always, always gets wrong. I'm not a doctor but once I learned that it started annoying me every time, because they ALWAYS do it, and it's ALWAYS wrong!

It's not entirely wrong.

It doesn't happen that much, but there is a grey line between what is a shockable rhythm and asystole. Asystole isn't a completely flat line, and a there have been some very borderline situations that have been shocked back into rhythm.

slhuang
12-20-2014, 09:14 AM
It's not entirely wrong.

It doesn't happen that much, but there is a grey line between what is a shockable rhythm and asystole. Asystole isn't a completely flat line, and a there have been some very borderline situations that have been shocked back into rhythm.

Oh! Thanks for the correction, good to know. :) I won't be quite so hard on them then. ;) (I've just heard doctors / other medical people complain about this so much that it started annoying me vicariously, heh.)

TheCuriousOne
12-20-2014, 02:39 PM
Yeah it lied to us all, BenPanced!

Once!
12-20-2014, 03:17 PM
When a friend was pregnant, she once told me she wondered what would happen if the umbilical cord got twisted around the fetus's neck somehow. And my friend would never know until it was too late. Even if she did know, she would hardly be able to reach in and untangle it somehow.

That happened to my son. He had somehow managed to get the cord around his neck and to tie a "true knot" in it. This meant that every contraction tightened the cord around his neck. At first the hospital didn't spot this. They left us on our own as the contractions increased.

When they did check on my wife they found that our son's heartbeat or pulse (can't remember which) was fading alarmingly with every contraction.

Then suddenly we had doctors and nurses appearing out of nowhere. Before we really knew what was happening were in the theatre for an emergency C-section. The doctors were shouting orders at each other. We didn't know what was happening - whether our son was going to be okay or not. They pulled a screen over my wife's stomach so we couldn't see what was happening at the business end.

Then the doctors started asking each other about their holidays. It seemed such an odd thing. It was if we weren't there. The pace and urgency just fell away.

I heard a baby crying. I didn't dare say anything at first in case it was someone else's baby in a nearby room. That would be a cruel irony.

I peaked over the screen and saw the nurses washing a very pink and bloody little boy. They checked him over and then wrapped him in a blanket. He was fine.

He's now a strapping 14 year old. Taller than both of us, and already knows everything. Except how to get dressed before midday.

To answer the OP - I'm not an expert but I would have thought that the doctors would always prioritise the mother unless the mother had medical complications which meant that her chances of survival were small.

MDSchafer
12-21-2014, 02:06 AM
Then suddenly we had doctors and nurses appearing out of nowhere. Before we really knew what was happening were in the theatre for an emergency C-section. The doctors were shouting orders at each other. We didn't know what was happening - whether our son was going to be okay or not. They pulled a screen over my wife's stomach so we couldn't see what was happening at the business end.

Then the doctors started asking each other about their holidays. It seemed such an odd thing. It was if we weren't there. The pace and urgency just fell away.

Yeah, if there's one thing we're bad at, and the MDs in particularly is not scaring the crap out of patients. There's what "Emergency" means to normal people, and what it means to medical people.

kuwisdelu
12-28-2014, 10:42 AM
Yes, this is one of those things that TV always, always, always gets wrong. I'm not a doctor but once I learned that it started annoying me every time, because they ALWAYS do it, and it's ALWAYS wrong!

I was just watching a movie and was reminded of this thread.

Of all things, my favorite anime (Evangelion) actually gets this right, when Shinji is shocked with a faint rhythm.