Recently, SPL member Mollie G. sent in a horrific July 11, 2013 alert from the Institute for Safe Medication Practices, entitled “In Utero Medication Administration to Fetus Presents Unique Safety Challenges.” The advisory relates a tragic incident that occurred when an unborn baby needed to be treated for erythroblastosis fetalis, a complication that can arise when the baby has Rh-positive blood and the mother has Rh-negative blood. The treatment required an infusion into the umbilical vein, for which the baby had to remain still (obviously):
In the recent case, an obstetrical resident asked another resident to order a neuromuscular blocking agent for the procedure. The resident ordered the drug in the mother’s medical record, but did not include the dose or route. It wasn’t clear that the drug was intended for intramuscular administration to the fetus in utero. Therefore, the order was processed for the mother, not the baby, and pharmacy dispensed a vial of the paralyzing agent. A medical intern, who was unfamiliar with the procedure and neuromuscular blocking agents in general, administered the drug intravenously to the mother since it had been ordered on the mother’s medical record. Apparently, the intern did not realize that the neuromuscular blocking agent would paralyze the respiratory muscles, and that administration of this class of drugs required concomitant mechanical ventilation. It is believed that the entire vial was administered, not just the small amount intended for the unborn baby. The mother suffered a respiratory arrest, which regrettably was not recognized immediately given prior sedation the mother had received. The mother died and the infant sustained central nervous system (CNS) impairment as a result of this event.
This tragedy could have been prevented in several ways. The order should have been clearer. The procedure should have been in the hands of an experienced doctor, not an intern. And above all, there’s the fundamental structural problem: why was a drug intended for the baby ordered in the mother’s medical record?
The author of the advisory states: “A separate account and medical record for the fetus seems appropriate, but there may be obstacles given the baby’s unborn status.” What obstacles? You don’t need a photograph of a patient to create a record. You don’t need the patient’s driver’s license. The patient doesn’t have to be able to communicate. Extremely premature babies in the NICU get separate medical records. The only “obstacle” I can think of is the cognitive dissonance that an unborn baby’s medical record might cause in the sensitive psyches of obstetricians who also perform abortions. You want to risk someone’s life over that? Get over it, or better yet, stop doing abortions.
Indeed, the advisory continues, “Some hospitals enter the orders for the fetus temporarily on a paper form or electronically as “Baby Doe” (or generic name with parent identifier) if the infant’s birth is imminent” (emphasis mine). So long as birth is imminent—so long as the baby is no longer “abortable”—a separate medical record is fine.
Constitutional law scholars sometimes speak of an “abortion distortion,” in which the ideological desire to maintain abortion access causes judges to twist legal doctrines and create lousy precedents. Sadly, the abortion distortion exists in the medical context, too. Our society is schizophrenic about life in the womb, to the detriment of unborn children and their families.