Thursday, September 04, 2008

First time as Opera, second time as Soap Opera...

Update Below

The McCain campaign has shown a brilliant burst of show biz. (Let us always remember that we are not participating in politics as usual, but entertainment as usual.) Absolutely nothing they could have done, short of raising up Reagan from the tomb, would have brought as much attention as picking this small time politico from the wilds of Alaska. One that actually revels in her ordinariness. One that has so many strings attached she looks like a parachute.

But it was successful. In spite of a mature, serious, and stirring speech a week ago by Barack Obama, he has been driven from the attention of our three-second media (Sorry, Andy, it is no longer 15 minutes) by the little lady with the wandering child.

In spite of all this bluster, there are some real questions of judgement. I think that it is appropriate to question a candidate's judgement. After all, it is the lack of this quality that George Bush and Dick Cheney excel in.

Did Governor Palin, with her last pregnancy, break her waters at the Governor's convention in Texas last April?
"The governor's labor began while she was in Texas, and I do know that she got on a plane and landed in Anchorage late last night," said Palin spokeswoman Sharon Leighow.
This is beyond strange and brings into question exactly went on here from a medical standpoint. Here are some other items:

1. Governor Palin was 44 years old (DOB 02/11/1964)

2. She was pregnant with a fifth child. (apparently no one knew she was pregnant until she announced it at 7 months when she was not showing at all. Not to announce your pregnancy for someone who is clearly into children and not until the seventh month when she should have looked like the women pictured here or here is a bit strange. Much was made of this in a Daily Kos post which stirred much controversy and was ultimately removed. I will say nothing more about the unusual nature of this particular aspect since it has been decided that there is nothing amiss.)

3. She knew that this was a baby with Down's syndrome on the basis of prenatal diagnosis:
Trig arrived about a month early and has Down syndrome, the governor confirmed. Testing during early pregnancy revealed the condition.
Now there are at least three ways of knowing that a baby has Down's syndrome. The most accurate would be to do amniocentisis. However, given Ms. Palin's religious convictions, it is unlikely that she did this since she would not have aborted the fetus under any condition and the procedure itself leads to some potential for spontanteous abortion. The second would be a suspicion on alpha feto protein testing if the value was low (the purpose of the test is to detect neural tube defects where the value would be high.) Finally, prenatal ultrasound can frequently suggest that the fetus is a Down's baby on the basis of extra folds of skin on the back of the neck, and other findings.

4. He was 6 pounds, 2 ounces at birth, average for thirty six weeks.

5. Going into premature labor most likely involved breaking her waters and not labor pains, though we do not know.

5. Governor Palin was at the Republican Governor's Association convention in Dallas when she "went into labor." She did not go to a local hospital but flew back to Anchorage and then went to a hospital in Palmer (a town close to Wasilla where she lives, see map) to give birth. Many airlines do not allow women in labor to fly, particularly the lengthy trip to Anchorage.

Palmer is a town of 4,533 people (in 2,000). The medical center there is the Mat-Su Regional Medical Center which does, indeed, have obstetric services. However, there is no mention of either pediatric or neonatal intensive care (NICU)services. The nearest NICU would be in Anchorage at the Children's Hospital at Providence Medical Center.

Luckily, while premature (36 weeks), the child did not suffer complications at birth and it was not necessary to transport the baby to Anchorage.

Were the decisions of Governor Palin and her husband appropriate in this case?

On the face of it, the answer has to be "no." Governor Palin went into premature labor. It is hard to imagine that she was having contractions in Texas and then flew all the way to Anchorage (where there is a NICU) and then 40+ miles further to Palmer if she was having contractions. Many multips deliver babies very soon after contractions commence. There is almost no way to tell when the baby will come. Certainly there have been a number of babies delivered in taxi cabs by fathers on the way to the hospital. In sum, while contractions had hopefully not started, it was still risky to take that plane ride.

Furthermore, it was risky to go back to a community hospital when the baby was most certainly at risk for respiratory problems after birth which could possibly needed a NICU. In order to get from the regional hospital in Palmer to the Children's Hospital in Anchorage there would have to be a helicopter airlift of the sick baby. Such a procedure in itself has its risks. Even without the risks for respiratory problems there was some increase risk of neonatal sepsis because of the rupture of membranes in addition to risks specific to Down's syndrome, e.g. duodenal atresia.

In summary, it is my opinion that on the face of it, the Palins did not make a wise medical decision in this case. It is unknown why they decided on this journey back to Palmer when very good and well equipped hospitals were available in Texas and Anchorage.

One thing is for sure, I would not want Governor Palin to be making much more complex and weighty decisions as President of the United States.

(P.S. I know the title of the post doesn't really fit, I just thought it was cool.)

Update: I ran across this most interesting post on Mudflats:
A Letter About Sarah Palin from Anne Kilkenny

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