I agree that in most situations it would be fine to deliver
a trisomy 18 baby at home. But there are occasions, just as
with other births, when it would not be appropriate. One of
my moms who had a trisomy 18 baby also had a placental
abruption. I sent her in for an ultrasound because of
symptoms of partial abruption. The abruption, SGA, trisomy
18 pattern of defects were all missed on the ultrasound and
they sent her home until she went into more serious
abruption. Then they sent her to a larger hospital for a
c-section. The problems for mother were more because of the
placental abruption than the trisomy 18 birth. The baby
lived about 35 hours.
-Judy Jones, CPM
====
I looked up trisomy 18 in Taber's: "causes severe deformity
and mental retardation. These children usually do not
survive beyond the first year of life. Characterized by
prominent occiput, overlapping of index finger over third
finger, frequent facial abnormalities, straight nose coming
off sharply from the forehead, low-set ears, and cleft
palate and lip."
As a midwife I don't see anything here contraindicating a
natural vaginal delivery. With cleft palates there are often
special feeding needs, but that can be worked out with a
lactation counselor who has training in that area.
Anecdotal evidence suggests that babies with severe
anomalies often present other than vertex, so discussion
about a breech birth might be in order.
The provider handbook for the AFP/Triple Screen says that
these babies often spend what little time they have in a
neonatal intensive care unit--all the
more reason to have a homebirth.
Our practice has had a baby with (undiagnosed prenatally)
severe anomalies inconsistent with life. We ended up in
hospital because of maternal infection in labour (broken
waters), where a sono told us what was coming. The mom went
on to have a completely natural, uncomplicated 10 hour
labour and birth, catching her baby in the bath with only
her partner and one of us with her. It was all she had left
of her original dream and she cherishes that memory.
If your family wants a homebirth, they should have the same
opportunity as any other family, because they will have only
a short amount of time with their child; because that time
will be spent walking a path far and away from the one they
envisioned when creating this child; because this child will
be taken from the family soon enough, it should not be
"taken" from its mother's body. You and your family are in
our prayers.
-Anon.
Reprinted from Midwifery Today E-News (Vol 2 Issue 26 June 28, 2000)
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