I am a writer and I need to ask some medical questions ...

It would add more reality and spice if she had either poor or no prenatal care. If she had the still birth should have been picked up before she went into labor. You could of course dream up many reasons for her not to have gotten care. As for the hemorraging, she could have have had only partial expulsion of her placenta which can cause hemorraging after ward and also causes severe infection.The mother should be watched carefully for at least one hour after birth so that the health care providers are sure that the entire placenta has been expulsed by the uterus. Whe the placenta is expulsed it should be examined to make sure it is all there. If not then the uterus must be manually examined for any remnants of the placenta and then they must be removed. There could also be lacerations of the cervix or other immediate areas causing the bleeding, however, gross hemorraging would more likely be due to the partial placenta. Hemorrage is quick and often fatal. The mother must have immediate care with oxytocin (a drug that causes the uterus to contract. Sometimes the only way to save the mothers life is to do an emergency hysterectomy.

Good luck!

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Joni I Berry, MS, PharmD
Clinical Pharmacist

Joni, my character did not have medical care but she did deliver in a hospital. The baby needs to be either born dead, or died shortly after birth. She leaves the hospital without the staff knowing. She travels to a city 300 miles away where she is found unconscious by an urgent care doctor. What will work for that?

There is one condition which is fairly rare but can happen up to a month after delivery. It is hemmorage due to "subinvolution of the placental site (or uterus)" which usually occurs early but can take a month. This means that the uterus does not return to normal size, ie shrink as it should in the first week or so after delivery. A sign would be the woman still looking pregnant at 3-4 weeks after delivery. I am not totally sure but when the uterus stays large the extra blood vessels etc. that grow to accomodate the pregnancy do not resove as they usually do and hemorraging is one result. Having the baby born dead or die right after birth would not have any bearing on the cause of hemorraging. One thought is that the normal bleeding after delivery that does go on for several weeks (women use these huge maternal pads ,no tampons etc. after delivery) would usually have stopped by week three. Your character could continue to bleed and by not knowing what is normal could completely miss the warning signs. She would wonder about why her abdomen is so large but unless she knew or saw a doctor she may not know what is normal or not.

Hope this helps!

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Joni I Berry, MS, PharmD
Clinical Pharmacist

Great! Could it happen two days later and would the doctor that finds her know this after his examination? Could stress from being raped or having different blood types (mom from the dad) cause fetal dissress unto death?

Yes it could happen two days after and the doctor should know what it is after an exam. Stress from a rape I would think would lead more to a miscarriage but I could not rule it out in fetal death, its just not likely. Having different blood types is a good reason for fetal death but it has to be on the second or subsequent pregnancy. Ie she must have been pregnant at least once before this one. That is because when the mother is a negative blood type such a O neg, A neg, B neg or AB neg and carries a baby with a positive blood type (same just O positive etc) on the next pregnancy if the baby is also positive then the mothers body sees the baby as a"foreigh body" and the mothers immune system kicks in and causes Rh incompatability. Now mothers who are negative get something called Rhogam early in pregancy to avoid this. With no prenatal care she would not have gotten this. It used to be that babies who were born alive with this incompatability would have to have a complete whole body blood excange in order to live. With Rhogam this does not happen much any more. Also, the baby could have been born with the cord around its neck (more trauma for the mother) or sometimes its just a mystery why babies are stillborn. If the baby were born early then fetal respiratory distress syndrome, infections etc. could be the cause.

Let me know how it goes. I am at jberry@hospiceofwake.org.

One more thing. If the mother was only two days out from birth she could have just hemorraged. What I mean is that the uterus would not be down to normal by that time in anyone.

Thanks

Edited by joniberry on July 18 2006 at 2:24pm

__________________
Joni I Berry, MS, PharmD
Clinical Pharmacist