This story of the birth of Trig Palin has intrigued me for the reasons I have stated in earlier posts. I had a high-risk pregnancy and a complicated delivery by a very careful and skilled surgeon (OB) in an urban hospital a mile from the children’s hospital where my son lived for the first few months of his life. I’ve written extensively about our experiences.
On the other hand, there is no clear, consistent account of Sarah Palin’s putative pregnancy and Trig Palin’s birth, while there is a lot of speculation about what was right, wrong, risky and/or foolish. Or true.
I spoke at length with a pediatric specialist who has worked in the field for 30 years, including Level 3 Neonatal Intensive Care Units. I was curious about his take on the stories and rumors. He spoke honestly, gently and without regard for what I or anyone else might want to hear.
Read his comments carefully. There is one section that some people might find difficult to read. It is blunt, but illustrative of how he knows all that he knows about cardiac anomalies in Down syndrome children.
I am presenting this informally. Take away from this conversation what you will. And if you have follow up questions that are reasonable for me to ask him, I’d be glad to.
On delivering babies early:
There’s a lot going on in the OB and medical safety literature right now about pushing back from this culture of “I’m gonna have my kid when I’m gonna have my kid”, rather than “I’m gonna have my kid when he’s ready”.
Your OB was ahead of the game, or it was far enough back in years. No more “let’s time our delivery because this is good for me, or because I want my kid born on 1/1/11”. Clearly kids who are born prematurely have significant issues globally, even though that doesn’t mean every single one does. On average kids who are born early have more problems - even if that’s at 37 or 38 weeks. So there’s been increasing pushback on this culture of “I want it done my way.”
Inducing a 44-year-old multipara woman carrying a 35-week Down syndrome fetus:
What could explain her being induced? Unless there was a problem with the fetus itself there would be no reason to do this. And I don’t know of anything related to Downs that would push you to go in that direction
Sarah Palin states she began leaking amniotic fluid in Dallas 24 hours before she delivered:
Leaking fluid is a relative indication that labor needs to be induced because of risk of infection. You don’t want that to go on for long period of time. The situation is more difficult than just putting the mother on bed rest. You can put her on antibiotics but that won’t prevent infection. And the fetus can be more severely impacted by that kind of infection. They might push to deliver because of that.
Flying 10 hours while leaking amniotic fluid:
That’s an issue. Why fly? If you’re leaking fluid you ought to go to the most reasonably near facility that can deal appropriately with your condition. Getting on an airplane when you might go into precipitous labor at any period of time seems unwise. If she’s leaking fluid she can go (into labor) anytime. Doesn’t have to leak for hours. And in an airplane you don’t have access to anything. Best of circumstances you have half an hour before the plane can be on the ground and that’s if you’re flying over an airport.
So why would she take that risk if she didn’t have to? In some sense it’s judgment call. If she wasn’t who she was would anyone say anything about it? Anybody would want to deliver close to home. For her, privacy invasion would be more likely at an out of town hospital. Is there risk? Yes, but relative to a delivery in rural Alaska?
If not leaking fluid, why induce at 35 weeks:
If Palin wasn’t leaking fluid? Unless there was something going on with fetus you’re not aware of, it’s probably not a good idea to induce labor.
Delivering in small hospital without NICU:
But by itself, this is not a problem, no. Downs babies may have things wrong with them, but as I recall there’s not really anything that you would expect to cause an immediate risk to health. So they may have heart defects and that sort of thing. But they tend to be relatively stable during first month of life.
Emergencies certainly happen and a diagnosis might not be made in advance. . But if someone just walked into hospital to deliver, it might be safer for them to deliver there than transport the mom - especially in a place like Alaska where transport can be hit-or-miss anywhere. You may say that you’re going to move them because of some health issue. But you may find that risk of transportation is more than risk of delivering.
But in terms of planning ahead to deliver this way, does it reach the level of being egregious? That would be hard to say without having a lot more information. The circumstances all seem kind of strange. If you’re concerned about the kid why do you deliver where the kid won’t have access to the appropriate level of care? And if kid is not having problems why are you delivering at all?
Now if you have all the resources of a possible candidate for the Vice Presidential nominee of the Republican party, you might want to go farther. People are funny. They don’t always make rational choices. Quite possible she simply wanted to be closer to home rather than in some place where she would be covered by media all the time.
Clearly the kid didn’t have problems. So did she put the kid at more risk by doing what she did? Possibly. But the difference would have been at the margin at best. Any normal hospital with routine OB work would be fine. You wouldn’t want to go to a place that doesn’t have an OB service or delivered one baby a week. But a place that was set up to do things was probably fine.
Delivery of a Ds baby by a Family Practitioner:
When you live in an urban area, you’re not used to this. But there are a lot a places where family practitioners do most of the deliveries. And having a Board Cert OB available is not necessarily easy. I was delivered by my family practitioner.
Down syndrome heart defects at birth:
They can have heart defects but they are the type of defects that don’t usually require emergency intervention. They need to be assessed and potentially followed but that doesn’t mean they have to have a pediatric cardiologist waiting for them.
The way things work now, there are ultrasounds that are the size of your iPhone, so if you have a technician who knows what they are doing or can work with a cardiologist over the phone, they wouldn’t even necessarily have to be in the same state. That’s not 4 or 5 years ago, but now. If they had a responsibly competent, well-trained technician it might very well be able to do the echo on site and just transmit it to whomever to evaluate. If the quality was bad or something was question, they might call the kid in and repeat it on site.
Ds heart defects in general:
Thirty-five years ago it was the pioneering days of pediatric cardiac surgery. They did a lot of heart surgery on Downs kids for 2 reasons: At the time they didn’t consider it a loss if they lost the kids. And because it was hard to kill them. They survived. In some sense they were hardy. The surgeons were experimenting at the time. That’s one of the favorite aphorisms of a pediatric cardiac surgeon at the time: He’d lose a kid on the table, and look at the cardiac surgery Fellow and say, “it was all experimental anyway” and walk away. That’s a long time ago. But that’s the way it was. The survival rates seemed to be higher for the Downs kids than the other kids with heart problems. So having a Downs kid in a regional hospital with a sort of normal ability for OB and routine nursery care is probably not that out of the question.
Taking a 3-day-old newborn to work:
I would say if the kid was born at 40 weeks and was otherwise normal, I still wouldn’t take him to work. I find it crazy when I walk into Safeway and see a kid who’s a couple of weeks old at best out with in public exposed to who-knows-who with who-knows-what potentially infectious respiratory problems. Why would you do that if you had a choice? It seems showy.
I’m constantly telling people the most dangerous place for your kid is the back seat of your car. If there is no one available to take the kid at home and you had to go to work, that’s one thing. But how many moms with newborns have to make that choice in the first place? You going to go Walmart to work with the kid and have them under the cash register? No, people find someone to leave the baby home with.
It’s a different society up there in Alaska. It’s a frontier mentality. And people do things that we would consider out of place down here but might not be up there.
Downs kids tend to be pudgy. If they’re preemies, if they’re developmentally at 35 weeks, they may have some problems feeding. But feeding is variable. It’s not related to the Downs but to the gestational age. The kids born at that age in the nursery are there mostly because they don’t feed well and they want to make sure they are feeding enough and gaining weight. Some quite conceivably go home that day.
Photo of Trig seemingly with a nasal canula for oxygen:
He may have had an RSV infection or bronchiolitis and needed extra oxygen. It makes you wonder what the source of the picture is. If they are on oxygen they are not at home. The other part of that is that some of the cardiac conditions, and I’m no expert, are in some sense oxygen sensitive. So that if you maintain your level of oxygenation, you prevent their circulation from screwing itself up. There are oxygen sensors in your circulatory system and blood vessels will expand or contract based on what they are seeing and maybe a little extra oxygen was to prevent an adverse reaction from happening. That’s before a heart defect is fixed.
Downs kids can have ventricular septal defects, and a lot of those are what are called muscular, and over time they functionally close if not anatomically close. And the atrial septal defects as well. There are two types of ASD’s and one closes spontaneously because it’s a physiologic opening, meaning it’s there to function during gestation so its supposed to be there. They don’t always close the way they are supposed to and they take time to seal. And if they seal you don’t have to do anything with them. So he may never have needed surgery.
If I were writing for the New York Times and I was the editor, I would say, it’s a waste of time, in that you can probably make something of this if you want to, but there’s really nothing of any great import here. If you’re working for People Magazine, then let’s throw this one out here and sell a few more copies.
There’s not much substance here. The kids doing okay now as far as we know, I think. So while the decisions may not have been 100% in line with conventional thinking, they weren’t so far off line that the kid has suffered any significant problems.
There’s really not a whole lot to it. It’s a mom in the public eye trying to make decisions that seem appropriate to her. It’s easy to second guess. But I’m not sure a lot of other people would have done it differently, or she might have had she not been in public eye. Having other kids certainly would help in the sense that she would be more comfortable taking a kid home. She’s been there before. If she’s saying, “he’s my kid and I’m going to treat him as normal kid,” then why not?
This is within the bounds of normal. We have parents and patients all the time that do things different from what we recommend. But as long as they are not putting their kid at risk, there’s a limit to how much steering you can do. If I think a kid has cancer and I’ll push that. But if the lump has been there 6 months and hasn’t changed and mom isn’t concerned, then I’ll say ‘come back later’.
Trig and Trisomy G:
I don’t remember hearing that about Trisomy G. I remember a kid I knew when I was 10 years old who parents named Twig Snodgrass. I’m not joking. And of course there’s the famous Ima Hogg. Trig? Hmmm. So? We see a lot worse names than that. There was a baby named Meconium in the nursery. I’m not kidding. The mom liked the sound of the word. You know how psychotic parents can be.
Ruffled ear defect:
That kind of surgery isn’t going to get done by someone in the boondocks in Alaska. If the ear was crushed in the uterus it can look really weird and 4 or 5 months it can look perfectly normal. Kids heads look weird when they come out too, especially if there’s been a prolonged labor. And over time they straighten themselves out and look pretty good. How much of this is artifact from the picture itself? The lighting or shadows or who knows what. And if it looks like the opening of ear canal is farther forward? Is it the ear canal or a shadow?
An ear defect does not necessarily have to do with Downs.
I find the woman distasteful to say the least. But there are more important things to worry about with her than this. There is no flag for me here. In a lot of ways she is a modern woman. And not in the sense that she is looking out for women’s rights but rather that she is making decisions for herself and family and the public be damned. If you have a question about it, that’s too bad.
As a doctor, I would have no ethical quandaries about this.
It just seems like people trying to make something out of, not necessarily nothing, but certainly something that wouldn’t be at all a question if she wasn’t who she was. Would Child Protective Services be looking for her because she got on an airplane? Probably not. When you’re in the public eye people will question anything you do. Obama has the same problem. No matter what he says or does, people will disagree. It has nothing do with him. It has to do with we want to make noise.
There are far worse things going on and people being far more abusive to their kids than this is anywhere near. So from the perspective of someone who has seen parents neglectful to the point of abusive, this is nothing. There are moms who have 5 or 6 kids in foster care and the next thing you know there’s another 30-week preemie in the nursery for the State to spend a million dollars on. There are good moms and other moms. And when do you tell a mom they can’t have another kid? It’s America and we don’t do that. It’ may not be in the kid’s best interest to be had by that mom. But the fundamental basis of America is liberty.
Downs and age:
Downs kids are far more likely in older parents. So, the chance that the teenager had a Downs baby? It’s possible but probably less than 5%. Teenagers might have more babies, but on the basis of the babies they have, how many have Downs? It’s much smaller.
She’s weird in some ways. But she’s not that weird. To do things like fake a pregnancy. Those kinds of people don’t get through a nomination process because there would be too many flags. Because it’s not that they do one thing that’s weird. There would be a history. There’s politically weird and then there’s outrageous behavior. Did she baptize her kids in local stream in middle of winter? Did she have the kid at home? No. Politically I don’t like her. But she’s not that weird.