1. Leah
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    Leah Member

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    Medical explination required

    Discussion in 'Research' started by Leah, Aug 3, 2011.

    Good morning all..

    Looking to pick your collective brains. I have been working on a story since the age of 15, picking it up every few months, pounding out some thoughts and putting it away again. It is however one piece that I would like to finish and publish along the way.

    My main stumbling block is one that requires some medical knowledge above what I currently have. Google search is FANTASTIC for ideas, but I want to be sure my explination is believable to the average reader.

    Let me cut to the chase...

    My storyline involves someone who is paralyzed from the waist down after childbirth and ends up in a wheelchair. I don't want to use childbirth as the reason, however. I would like it to be a pre-existing condition that was "hidden" and only manifested upon the onset of labour.

    Otherwise healthy woman, early 20's when this will happen.

    Any thoughts?
     
  2. EdFromNY
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    EdFromNY Hope to improve with age Supporter Contributor

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    I'm not a doctor, but my work in the insurance industry many years ago provided me with some medical knowledge beyond that of a layman. The kind of paralysis that you mention comes about through damage to the spinal column or through a brain injury. Commands can no longer be transmitted from the brain to the legs, nor can neural information be passed from the extremeties back to the brain.

    About the only thing I can think of that is related to childbirth that could result in this kind of paralysis would be either a mistake with general anesthesia (which I wouldn't use, since they try not to use general anesthesia even in the event of a C-Section) or a mistake in the administration of an epidural (local) anesthetic, in which the anesthetic is injected into the area surrounding the spine. I suppose it is also possible that a mother giving birth could suddenly suffer from an aneurysm in the brain resulting in paralysis. That might actually be the better way to go.

    I would suggest you check the website WEBMD (you can Google it). I usually use that for any medical research I need to do.

    Good luck.
     
  3. Steerpike
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    Steerpike Felis amatus Supporter Contributor

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    I think Ed's suggestions are good. Also, I suppose you could have a pre-existing but unknown injury, maybe a cracked vertebra or something from a fall or other accident, and during the physical stress of childbirth it gives way and severs some nerves in the spinal column.
     
  4. Leah
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    Leah Member

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    Thanks for the replies and the great ideas!

    I was leaning to something like a spinal column injury that only manifested upon childbirth, so I think that is the most believable and fits in with the story.

    Now on to the writing...
     
  5. mammamaia
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    mammamaia nit-picker-in-chief Contributor

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    i agree that steerpike's idea is the most logical...
     
  6. BFGuru
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    BFGuru Active Member

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    Another thought is to have an accident occur close to term that triggers labor. If your baby is an integral part of the story, it would add a dimension of tension to the birth and give another layer of character development. Possibly an epileptic mother who took a seizure while driving (if you are using a modern era as your time setting) or fell down the stairs fracturing the lower thoracic vertebrae. (I actually met a patient a few days ago who was riding bike and was hit by a car shattering T12 and splintering T11 who was paralyzed from the waist down). Obviously, if cars are not a part of your tale, you could have her riding horseback. After all, that's what took out Christopher Reeves.

    Another risk of pregnancy, and actually birth control pills (since they use pregnancy hormones), is increased risk of stroke since the blood increases in a pregnant woman. The hormone relaxin kicks in during pregnancy to counteract this issue causing blood vessels to relax and giving more room for blood to flow. This helps prevent stroke, but it still happens, none the less. I had this happen to a friend and she was also paralyzed after her second stroke during the pregnancy. First one was a mini stroke called a TIA (transient ischemic attack) which left no traces of injury, but made it highly probable she would have a full blown stroke. She did, and although the baby was fine, she was in a wheel chair for a while post birth. It was not permanent however, so I think the idea of traumatic injury may get your permanent wheelchair situation more concrete.

    Good luck!

    Susan (aka EMT, and nursing student with a lot of work with pregnant and lactating mothers).
     
  7. Leah
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    Leah Member

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    BF - thanks for that. I had not actually considered an accident ~ I think that might fit in quite nicely, actually. I prefer that over what I had been considering. Now to pick the method - I am thinking maybe an accident that causes no instant complications but are aggravated in labour.

    Many thanks...now if I could get the day off work to go home and write write write!!
     
  8. BFGuru
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    BFGuru Active Member

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    An injury that causes paralysis, is definitely going to cause immediate issues. There will be initial pain, followed by "holy F*** what just happened?!" and possible loss of conciousness. The body is phenominal that way. It compensates and knocks us out to prevent us the painful agonony of dying nerve cells. The birth may or may not go without a hitch. If it's far enough away from birth and she ends up delivering at term anyway? Well, she could give birth naturally stilll...with a lot of medical support. Women birth in comas all the time.

    However, more than likely a ceasarean will be performed. After all she's paralyzed from the waist down, how can she push effectively (though the body again surprises us in many cases and simply takes over).

    Once the swelling in her spinal column has receded she may develop some sensation, but the verdict is out as to if she will ever walk again.

    If she is pregnant, regardless of method of paralyzation, it's going to be a serious medical emergency. She will be rushed to an ER where a slew of trauma/stroke doctors will meet them in a trauma room...which is more intense than a regular ER exam room. A neonatologist will be in there, and an OBGYN. It will be a packed room. Someone will be monitoring mom...or maybe even breathing for her with a bag valve mask and high flow oxygen. They will have her monitored for contractions which may have kicked in full force if she is late term. They will also be monitoring the baby. It's a pretty intense situation. If the birth is not emminent, they will try and stop any contractions (which will more than likely be occuring due to the trauma) and she may be placed in a medical coma until the baby's due date arrives. Regardless, she can't move so...it's not like she's getting out of bed rest LOL. If they can't stop labor, obviously, the tiny, slimey alien will burst forth in all it's vernix covered glory. Babe may or not be breathing...your choice. However, if babe is not breathing, neonatologist and crew kick into full gear. Again baby is given oxygen via bag valve mask again (I sadly speak from experience here with a former patient), if this does not wake up and pink up baby, then they go straight to intubation (assuming baby is not premature and they have tubing small enough for the babes trachea).

    APGR scores are done. I can give a break down of those if you like or you can google them. It's important at birth as it assesses need for addition interventions. (My blue birth baby was at a 1). After breathing, and possible CPR if baby comes back, they all squeal "shwoo we saved another!" and whisk tiny little thing to the NICU for observation. APGR is being assessed at 5 minutes after birth as well to hopefully gain a higher score. Many times intervention is soon enough that a full term baby, born in a traumatic experience is still fine. So feel free to play with that or examine possible scenareos affecting the wee bairne.

    While neonatal crew is in their glory...back with mom is an entire crew of individuals trying to stop potential excessive bleeding. An accident strong enough to cause paralysis, may very well have caused a uterine rupture or separated placenta (called placenta abrutptio). There is a massive amount of bleeding in either case, and cause for alarm. Blood may be ordered...and a trauma surgeon is probably freaking out, yelling at the OBGYN for not being more careful as he knows he's got a lot of work to do on this woman once this baby is delivered. They will massage her stomach, administer pitocin and work to remove any placental fragments...possible surgery to repair a uterine tear would be done if you go ruptured uterus route. After that's all done, trauma dude takes over, or neurologist if you go the stroke route. Surgery is done to repair the busted vertebrae or brain bleed, she is wrapped up and whisked to ICU since she is way too unstable for the post partum wing.

    With any luck and lots of begging, when mom wakes, they will take her to the NICU on the actual wheeled bed to see the baby since she can't sit up yet. She will be in a brace of some sort if it's back you go with or have her head wrapped in bandages if you are going stroke route. Eventually she may be permitted to room in with the baby once it's stable. But maybe not due to her own health issues. Breastfeeding will be discussed. Assistance in helping her pump or even nurse laying down would be considered. There is a strong push for breastfeeding in NICUs hence me mentioning it.

    Eventually, mom goes to a rehab hospital and babe is discharged from NICU and into daddy's/grandma's whoever's arms until mom is healthy enough to return home. How you handle breastfeeding is up to you. Bring babe to rehab hospital for nursing, or mom pumping or go straight to formula (though the lactation educator in me may cry LOL).

    When mom is deemed stable enough to return home and has undergone enough Physical Therapy, they will set her up with her own wheel chair, she will more than likely have a transport company called that deals with specialized transport conditions for wheelchair bound patients, and allowed to go home...there will be out patient PT for years, though.

    O.k. now that I've detailed all the nitty gritty and (probably made you mad cuz I said the birth probably won't be as affected as you think), feel free to take what you will and use it as you see fit. Good luck!
     
  9. Peerie Pict
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    Peerie Pict Contributing Member Contributor

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    There is a specific condition called symphysis pubis dysfunction (SPD), which affects the alignment of the pelvic joints and is a common complication of pregnancy. If you Google Lucilla Paull you should get a newspaper article explaining her story (I don't think we're allowed to post links here?). She had two children and now uses a wheelchair.

    I think this might be your best fit.
     
  10. BFGuru
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    BFGuru Active Member

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    Peerie, I totally forgot about that condition. It may work as well.
     
  11. chatterbox
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    chatterbox Member

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    If you were going for an accident maybe the mother was in labour and she was being driven to the hospital in a rush and they had a car accident
     

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