Let’s say you are CPR certified and the woman next to you on the morning commuter train goes into cardiac arrest. Is your first thought, I had better let this woman die because if I perform CPR, I might hurt her fetus? Apparently this is the attitude of many health care providers.
The Society for Obstetric Anesthesia and Perinatology (SOAP) has issued a new consensus statement regarding cardiopulmonary resuscitation (CPR) for pregnant women. Pregnant women may have special needs regarding CPR, especially later in pregnancy when the size of the fetus compresses veins sending blood back to the heart.
Sometimes a hysterotomy (basically a cesarean, but the idea is to get the fetus out of the woman’s body) is the best way to preserve the woman’s life. Some might be concerned about hysterotomy because of the concern for the life of the fetus being born prematurely. We might then ask, what happens to a fetus inside of a woman who has gone into cardiac arrest and dies? Well, the fetus generally dies too.
One of the things the new guidelines state is the importance of administering care that prioritizes saving the pregnant woman’s life. Generally when a person goes into cardiac arrest, saving that person’s life is the goal, and it is alarming that it has to be stated that the life of a pregnant woman is equally valuable to the life of any other person who goes into cardiac arrest.
In a Q & A with Brendan Carvalho, Chief of Obstetric Anesthesia at Stanford University Medical Center, Dr. Carvalho notes that pregnancy CPR guidelines are important because pregnancy can increase a woman’s risk for cardiac arrest (and all women, pregnant or not, are at some level of risk). It is laudable to recognize the normalcy of pregnancy in a woman’s life and determine how to provide appropriate medical treatment. While Carvalho notes that U.S. maternal mortality has decreased dramatically over the last century, he does not mention that it has increased dramatically over the last two decades, with a rate that is now among the worst in the developed world. The U.S. rates 60th nationally–59 countries have lower maternal death rates.
Perhaps part of rising maternal mortality stems from an attitude toward pregnant women that their humanity is suspended while they perform as vessels for fetal growth. Such an attitude has been evidenced in the case of Marlise Munoz (see here), the Texas woman whose dead body was kept artificially functioning against her wishes and those of her family so that it could serve as an incubator for her fetus. Louisiana has created an official law (which is expected to be signed by the governor) that mandates women’s dead bodies be artificially sustained as incubators for any fetus inside them that has reached 20 weeks. Pregnant women are routinely criminalized for behavior that is not prosecuted in other adults, such as alcohol consumption or refusing to follow the recommendations of a physician (see here), indicating that pregnant women cannot be accorded basic human rights–the kind of rights accorded to all other adult humans.
Caregivers are often reluctant to administer medication to pregnant women because of potential harm to the baby. The consensus statement emphasized that caregivers can use the same drugs they typically give to a nonpregnant patient who has a cardiac arrest. The best thing you can do for baby is to provide the mom the best possible care and not withhold any drugs or procedures that would normally be used managing a critically ill person.
The key word here is person. What justification would there ever be to intentionally withhold treatment from a critically ill person whose life could be preserved? If pregnant women were truly viewed as people, no one–not Carvalho, not anyone–would ever have to make this statement.