Friday, December 12, 2008

Birth of a Child-II

Contd..from the last article

As I was stating earlier the time of 36 weeks inside the mother's womb is very crucial. As I experienced recently that even if the baby comes out after 34-35 weeks it is a considerably immature baby! These babies are very likely to have breathing troubles and in the baby that I am observing off-late he had to be put into an incubator in a ICU immediately after birth. Even after 34 to 35 weeks the lungs can be highly immature and unable to supply enough pure blood to the body. The alveoli in the lungs may simply be unable to expand enough and the baby might have to put into artificial breathing machines. Contrary to prevalent ideas and very surprisingly recent research has shown that these artificial breathing machines when used on new-born babies can affect brain development! So the situation is really complicated.

If the lungs seem to be maturing fast and the situation is not very bad then doctors can try to do some chemical treatment where they use chemicals called "surfactants" which little that I understand from the viewpoint of a physics student is that they reduce the surface tension of the alveolar bags and hence help them expand to full capacity.

The point is that birth just 2 weeks earlier than the typical 36 weeks can lead to pretty complicated situations. Over and above these lung problems another very common problem with pre-mature babies is that they may be born with holes in their heart! If the hole is large then chances of survival can be very slim given that already the lungs are under performing. If the hole is small then gradually the correct tissues grow and the holes get filled but if this does not happen then pretty complicated and risky operation might be required.

The baby I am observing now and whose situation has prompted this blog seems to have both the troubles of a under-developed lungs and has 2 holes in the heart!

Further if the premature baby is not of a good mass and is not physically very healthy then he/she might not be in a position to even survive these complicated medical treatments.
If the baby is very pre-mature then even after birth she/he needs to be kept in similar humidity and temperature conditions after birth like she/he was inside the womb. That is maintained these days by artificially creating such conditions inside glass chambers in which the baby is put.

Obviously these processes are very very expensive and not every family will be able to afford these treatments. And in these treatments there is no guarantee of success, further with things like late crying and convulsions the baby is likely to grow up to be a spastic child which no treatment can cure. Then why should the parents keep trying to save their child when it is sure that there is no cure and the fatal damage has been done within the first few minutes of birth!

Isn't it better for them and the world that in such a situation the parents decide to opt for mercy-killing of the baby?
Isn't euthanasia for the new born baby a much better thing in such situations than let her/him grow up to be a mentally handicapped person?
Shouldn't parents in such situations let hard sense of logic dominate human emotional instincts and take the bold step?

On the little brighter of my grandmother's elder brothers was born a very pre-mature baby and in those days about 75 years ago there was no such technology as talked of earlier. He was supposedly kept inside wet-cotton inside a shoe box and the room was covered with wet-clothes which were constantly kept wet! I feel a sense of extreme scientific thrill that they could save the baby in those days! Even one of my childhood friends was also born a very pre-mature baby. She is very much alive today and very much running around with her life.

And to top it all I had read that even Newton was born a pre-mature baby! I feel completely excited at the idea that in the early 17th century, some 300 years ago they could save a pre-mature baby!

In fact various research works have shown that pre-mature babies if are free from any other health complication at birth like lung dis-functioning etc then are likely to grow up to be very intelligent people!

The point of this article was to share from my almost non-technical viewpoint (that of a student of science with formal training in mathematics and physics but nothing formal in biology after class 10) some of the various non-preventable factors at birth that determine the health of the baby and have an irreversible effect on the person.

The point is that all these scary things can happen at birth and the couple has almost no control over it and can do nothing to prevent it. And if they can't go for hard options like euthanasia at birth then they have a very very painful life ahead, further society has collectively a terribly difficult task of bringing up a mentally handicapped child.

This reminds me of a Spartan custom. During the times of the roman empire the Spartans were supposed to be the most skilled warriors and probably the first civilization to have election and a democratic government and they supposedly had greater women-men equality in the society than it exists even today. Already in those days they supposedly had elected women representatives in the parliament! These Spartans had some specification about the minimum health standards of a child at birth and if the baby was below it then it was immediately killed.

What they did definitely does not seem appropriate today since today we need not have an entire society of warriors. I don't see why to do mathematics one needs to have a herculean figure. But the point is that given their needs Spartans did have the courage to overcome normal human instincts and use hard logic.

Given all this huge gamble that exists with the health and intelligence of the child, is this entire adventure of having a child worth it?

Couples unable to conceive naturally take all sorts of expensive and sophisticated help from medical professionals to be able to have a child.


What justifies all this effort and emotion and expenditure when on the bare minimum one can't ensure that the child will not be mentally handicapped?

(especially in India where the nation is already crippled by this luggage of 6 billion people!)

reminds me of the lines of a famous hindi song:

"...Tujhse naraz nahin zindagi se, Hairan hoon main..."

Birth of a Child-I

I have been planning to write about the idea of "Single Parent" for a long time but almost every time something or the other happens that distracts me to some other topic. Single parenthood is a concept that has been very close to me ever since I have memories of and I have experience of almost single parenthood from pretty dangerous proximity. Today when I have some sort of a standing in life I have the courage to write about this took me 21 years to build enough courage to do it. But probably not enough to get into personal details. That might have to wait for more years.

But this time round, again there is some other topic boiling around me that seems to have a greater immediate force on me. The issue is of a newly married couple and them having the idea of having a child.

With due apologies to all the people who think that I am inexperienced, I have a simple question to ask. Why?

Why most newly married couples are so eager to have a child? Given the phenomenal development that has happened in the science of contraceptives and abortion, there is no reason why people can't have a happy sex-life without conceiving.

I am still waiting to hear a convincing argument from anyone as to why they would want to have a child of their own. I have of course heard of a lot of flimsy arguments like the need to have an heir to carry forward the family and things like who will carry on the family business? and then things like it is somehow the necessary completion of a marriage. Some people seem to be more driven by the social stigma that a marriage is successful only when the couple has conceived. Then there are arguments that the child is the essential bonding in the marriage and that without a child the marriage is unstable and is likely break down.

I simply can't buy all these arguments. I am sure that a very compatible pair of people in love with each other can remain happily together whether they have or don't have a child. At some point it seems that the stigma of not having a child is created by the society to back up its reservations about love-marriages. It seems that getting the couple to have a child was a way to seal an arranged marriage forced on the couple.

Why am I suddenly perturbed by this idea? The immediate reason is that I am currently seeing from a very close distance the troubles of child birth. I am seeing on a day to day level how complicated the birth of a child can be and how very subtle factors at birth can determine the health of the child and how easy it is for a potentially healthy baby to suddenly become a spastic and become a burden for his/her family and the society at large. {Of course one can say that a spastic child is million times better than a healthy baby growing up to be a criminal or a terrorist.}

Last few days have been very revealing to me in terms of medical knowledge about the complications of child birth thanks to such a situation having risen around me.
It seems to be so much of a risk to me and so much about the health of the baby is in the hands of probability! The couple has so little or practically no control over it.

Given this huge gamble why would a couple want to have a child when they can't even at least prevent the new born child from being a spastic?

I never studied biology officially after class 10 but given that my mother is a doctor I always keep hearing of the details of the human life processes from the million discussions at home. I suppose I can be excused if I am not technically very correct but let me try to get the basic idea that I can understand as a science student although with no formal training in biology.

Probably because of my lack of formal training I can communicate the essential idea to people who have very little idea of biology. I think these are issues that everybody should appreciate.
Let me talk of some of the subtle risks that are involved. Of course I am not counting the obvious risks that are involved if say the mother is very young or malnourished or suffers some accident during the period of pregnancy or is HIV positive.

Even if the mother is healthy there are these 3 very subtle factors determining the health of the baby:

{There are a million other almost non-controllable factors that can affect crucially but these are the 3 that I am seeing closely during the experience that has inspired this blog post.}

a) The time elapsed between when the baby first cries and when he/she first comes out of the mother's womb.
b) The number of weeks the baby has spent in the mother's womb. The typical time is 36 weeks but I recently came to realize how important that number is. If say the baby comes out after 34 or 35 weeks even then there is considerable risk.
c) A large baby might happen to gulp in some of the amniotic fluid and that can complicate matters a lot.
{something that I am told that I did as a foetus!}

The idea is that the foetus when in the mothers' womb is floating inside a fluid bag. The fluid being called the amniotic fluid. So this baby is not breathing when inside this fluid and his/her lungs are collapsed and non-working. It nourishes itself completely by diffusing in oxygen and nutrients and diffusing out carbon-di-oxide from her/his mother's blood through the vessel, umbilical chord that connects from his/her navel to an organ called placenta on the mother's womb.

Even though it is slightly off-point here, I would like to note that the general practice has been to cut the umbilical chord at birth. One should remember that for other mammals there is no doctor around to cut the umbilical chord and the baby is born with that. It gradually dries up and falls off. So it is not clear why we humans have devised this artificial method of cutting the umbilical chord! In fact some recent research has shown that this process of cutting the chord gives considerable mental shock to the baby at birth and this is completely preventable. More and more doctors are of the opinion that like other mammals human babies should also be let born with the chord and let it naturally fall off.

Further inside the mother's womb the baby is in a fluid environment and when she/he is coming out he/she is having an environment shock from fluid to atmosphere. For quite a few years it has been shown that this environment shock is bad. Hence the concept of "Water Birth" has been going on for quite some time. In this process the mother gives birth to the baby under-water and the child doesn't have this shock. The baby is cleaned inside the water and is then brought out. Statistics has shown that this process is much more pleasant for both the mother and the child. In fact most doctors are of the opinion that water born babies are much more peaceful and intelligent. It is becoming increasingly popular in the west but somehow India doesn't seem to adopt this process. I don't understand the reasons.

{In the same strain one might note that many researches are pointing to the fact that use of diapers (Huggies kind of thing) might be harmful. The idea is that these diapers seem to inhibit urination and hence suppress the micturating center in the brain and the speech center is very close to it. Scientists more and more have the feeling that this harms speech development in the child. This is not very well established conjecture enough of a warning.}

Now when the baby comes out he/she breathes for the first time and air gushes into his/her lungs for the first time. Now the fact that we all have to live with is that the human brain requires the maximum amount of oxygen and it can't tolerate even the least of oxygen deficiency. When inside the womb the baby's brain has no oxygen deficiency but if the baby cries after a long time then the brain remains devoid of oxygen for that time and this can crucially ruin the baby forever.

But how long is a "long-time"? Its just a minute! If the baby cries after 1 minute of coming out then probably already some damage has been done to the baby' brain and if he/she cries after 5 minutes then the damage might be severe and the child is very likely to be highly mentally challenged.

In general it is expected that the baby will cry immediately as he/she comes out.
Now during the operation given that the mother is not very conscious she can't know exactly as to how soon the baby cried and hence this information is solely present with the doctor doing the delivery. It seems that there are corrupt doctors who try to suppress this number if the baby did cry late! But this data becomes a very crucial information in the process of diagnosis if the baby has breathing troubles after birth or shows mental disability as he/she grows up.

{It seems that I cried immediately :) I started speaking very early too. By 1 year I could speak fluently complete sentences and I used to talk a lot and ask a lot of questions. Apparently I asked "Why?" and "How?" for everything that I was told or saw. People tell me that they got tired completely of they had to baby sit me since that effectively involved answering the million questions I would ask}

Now there is this further risk that the baby might be very large in size compared to the mother's womb and if the delivery is getting delayed somehow then the mother's body might find it increasingly difficult to keep with the oxygen demands of the baby and the baby might run into oxygen deficiency. Then this triggers the breathing reflex of the baby even when she/he is floating inside the amniotic fluid. Then it is a very risky situation. The baby might just gulp in some of the fluid and get choked to death or some of the fluid might get trapped in the lungs or somewhere in the trachea. In someway one can say that the baby is getting drowned inside the mother's womb.

Now even if the baby comes out safe and healthy as soon as it starts breathing in the atmosphere this trapped fluid will cause it to choke and again the brain runs into oxygen deficiency. Now very commonly the baby runs into convulsions and if the convulsions happen for a long time it can severely affect the brain.

This precisely what happened to me at birth. I was a pretty large baby at birth. I had those convulsions but somehow due to the prompt action of the nurse it was stopped very soon.

Continued into the next writing.....