On Birth Weights - Dr Mac

– OB RESIDENT, DR HANNA MACINTOSH

Was I too simply too tired to notice? It was easy for us to overlook the larger babies at first. The first cases we studied were a mix of anecdotal information gleaned from overworked urban centers & data gathered from an overall uneducated population with questionable accuracy for dates and medical history. I mean, when you ask a patient, When was your last menstrual cycle? & they reply with, Is that when I bleed?, it is difficult to determine a common baseline from which to base abnormalities.

When I ask myself, was I too tired? Was I too jaded by their overwhelming lack of concern for their own health paired with their overwhelming sense of entitlement that the poor had begun to show? Was I worn down by a system that promoted the poor to procreate with abandon & to proliferate in squalor? The answer is yes.

Fifteen babies were born into my hands, all more than 13 pounds, the last as heavy as 18 pounds, before I considered a trend was occurring. I delivered more than 50 heavy babies in my residency before I felt compelled to investigate. & these were just the children delivered full term.

All the while, the true phenomenon was developing right in front of me. Premature babies had become so commonplace that I had overlooked them for years. But how was I to know? I was thrust into a culture of women with problems ranging through drug abuse, alcoholism, and smoking, not to mention consistent physical abuse, throughout their pregnancy.

The women came to me guessing their date of conception to within several months. Sometimes they came emaciated with dark, dry rivulets of decaying skin on each forearm. Sometimes with both eyes blackened. Or smelling of alcohol, missing every tooth in their head. Or mentally disabled, schizophrenic or developmentally delayed. Or young, they were almost always young, but they became so young! Glossy, dark & prematurely hardened eyes not risking to show the slightest fear or hesitation, peering out from worlds of brightly beaded braids, school uniforms, & soft plastic backpacks glossy and laminated with cartoon images.

Their babies began descending early. The more unprepared the woman’s body was for pregnancy, the more quickly the babies came. 22 weeks. 30 weeks. 26 weeks. It was impossible to predict their due date when our prenatal care for the women only consisted of a series of verbal assessments and possibly one ultrasound.

When the women came in early, we just sent them home, thinking it was yet another symptom of the poor population. Entitlement to have their baby early, or to spend the last weeks in a hospital bed rather than at home, or even that the women were merely too unintelligent to know when they were in labor. Now & again they would persist & deliver early.

We began treating these women when they came to us as if their cervixes were weak, perhaps from HPV or poor circulation or genetics. We would cinch them shut, advise bed rest, & reassure them that their pregnancy wasn’t abnormal, we were just being cautious. The babies came anyway, sometimes even bursting through the stitches.

The birth weights of these early babies was often still lower than normal birth weight. But they babies appeared to be developed beyond their time in the mother’s uterus. I saw a baby born at 23 weeks weight 5 lbs, 5 oz. I remember my surprise at this high weight, but was reassured by the mother that this was normal for her. It was her 5th delivery, she explained, & all of her children had been delivered early. Not one was less than 6 lbs.

This was long before I began to notice the twins.

–