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    On Autumn's Wing, A Story of Birth Trauma, Brain Injury and Miracles.
    On Autumn's Wing, A Story of Birth Trauma, Brain Injury and Miracles.
    On Autumn's Wing, A Story of Birth Trauma, Brain Injury and Miracles.
    Ebook133 pages2 hours

    On Autumn's Wing, A Story of Birth Trauma, Brain Injury and Miracles.

    By Heather Winkeljohn

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    About this ebook

    On Autumn’s Wing, A Story of Birth Trauma, Brain Injury and Miracles, concerns the use of the controversial vacuum extractor and the irreversible damage it can and does do. Too many families and children have paid a heavy price from the misuse of this device, used in hospital delivery rooms across the country without the formality of a signed or even oral release from patients. Ignorance in this instance is not bliss and raising awareness is the difference between life and death for some infants.
    This is the story of a hemiplegic child, Autumn, now twelve years old. Autumn was a normal baby until delivered by vacuum extraction. As a result, she lost seventy-five percent of her left brain, from a massive stroke. In this book,her mother chronicles their personal experience, struggles, and accomplishments from birth to the present. Its a story of valuable lessons but raises many questions about our health care and legal system. The foreword was written by a highly respected physician, a neonatal specialist and adjunct professor at University of California, Irvine. Proceeds go to Autumn's trust.

    LanguageEnglish
    PublisherHeather Winkeljohn
    Release dateNov 6, 2011
    ISBN9781466047228
    On Autumn's Wing, A Story of Birth Trauma, Brain Injury and Miracles.
    Author

    Heather Winkeljohn

    Heather Winkeljohn resides in Albuquerque, New Mexico with her husband Mike and two daughters, Autumn, Teagan and step-daughter Michelle. She works as a Developmental Therapist to infants and toddlers with special needs. She takes an active interest in her husband's career, as a world renowned, mixed martial arts trainer. She also works and trains clients in the martial arts gym that she and her husband own and operate. Most importantly she is a scattered but well intentioned mom.

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      Book preview

      On Autumn's Wing, A Story of Birth Trauma, Brain Injury and Miracles. - Heather Winkeljohn

      ON AUTUMN’S WING

      A STORY OF BIRTH TRAUMA,

      BRAIN INJURY, AND MIRACLES.

      by

      Heather Winkeljohn

      ©2011 by Heather Winkeljohn

      heather.weinberger@comcast.net

      Published on Smashwords

      * * *

      All rights Reserved.

      No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of the publisher, nor be otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser.

      Smashwords Edition License Notes

      This e-book is licensed for your personal enjoyment only. This e-book may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each person you share it with. If you're reading this book and did not purchase it, or it was not purchased for your use only, then you should return to Smashwords and purchase your own copy. Thank you for respecting the author's work.

      * * *

      FOR HELEN

      my grandmother

      whose shoes will never be filled

      and

      to all the parents of children with special needs

      who stand in the center of the fire

      * * *

      TABLE OF CONTENTS

      FOREWORD

      INTRODUCTION

      CHAPTER 1: The Beginning

      CHAPTER 2: In the Delivery Room

      CHAPTER 3: What’s Wrong with My Baby?

      CHAPTER 4: Finding Help

      CHAPTER 5: Justice for Autumn?

      CHAPTER 6: In the News

      CHAPTER 7: The Trial

      CHAPTER 8: Early Learning and Growing Problems

      CHAPTER 9: A Single Mom

      CHAPTER 10: Autumn’s Day

      CHAPTER 11: The Future: Three Views

      AFTERWORD

      GLOSSARY

      REFERENCE LIST from the Foreword

      AUTHOR’S COMMENTS, NOTES, AND RESOURCES

      Basic requirements for assisted vaginal birth

      How vacuum extraction works and why it can do damage

      Internet resources

      About courtrooms

      ACKNOWLEDGMENTS

      * * *

      FOREWORD

      This book brings into focus several important issues. The first has to do with instrumentation used to assist delivery of an infant; second is informed consent to use instruments for delivery; third is the patient/healthcare-provider relationship. Last, but hardly least, is how these first three issues affect the family in the long term. Let us consider each of these concerns.

      Instrumentation used to assist delivery of an infant. To begin, a little history: To facilitate the delivery of a living child, obstetrical forceps were developed as early as the seventeenth century by the Chamberlain family of British physician-midwives (who maintained the forceps as a proprietary secret through four generations). During the next three centuries, the design of the original instrument was gradually improved for functionality. The development of another type of obstetrical instrument, called the vacuum extractor, has been credited to James Simpson (1849), a Professor of Midwifery in England. For a century, this instrument did not receive general acceptance for its use, but based on the same concept, in 1953, Swedish obstetrician Tage Malmström developed the modern vacuum extractor.

      Since its introduction, the vacuum extractor has been modified and further refined. Currently, in the United States, the vacuum extractor is used two to three times more often than forceps. In a retrospective study, published in 1999 in the New England Journal of Medicine, D. Towner and others reported the types of deliveries in 583,340 singleton (single baby, not twins) nulliparous women (first-time mothers) in California from 1992 through 1994. The rate of spontaneous (natural) vaginal deliveries was 66.5 percent, while 20.1 percent required cesarean sections. In 2.7 percent, forceps were applied. In 10.2 percent, a vacuum extractor was used. The combined use of forceps and vacuum extractor occurred in 0.5 percent of vaginal deliveries. What is notable here is that the authors reported a statistically significant increase in brain hemorrhages in babies delivered by vacuum extractors compared to the spontaneous vaginal deliveries.

      In May of 1998, a Food and Drug Administration (FDA) Public Health Advisory cautioned healthcare providers—including obstetricians, nurse midwives, birthing centers, pediatricians, Ob/Gyn nurses, family practitioners, hospital risk managers, hospital Ob/Gyn departments, and others—about possible life-threatening complications to the infant with the use of the vacuum extractor to effect vaginal deliveries. Following the FDA’s advisory, in September 1998, the

      American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice wrote:

      The Committee on Obstetric Practice believes that, as with any other obstetric procedure, obstetric care clinicians using vacuum-assisted delivery devices to effect operative vaginal deliveries should be appropriately trained and familiar with the indications and contraindications for the use of the device, as well as with its proper application and traction procedure. The Committee on Obstetric Practice strongly recommends the continued use of vacuum-assisted delivery devices in appropriate clinical settings.

      During a six-month period following the FDA May advisory, M. G. Ross and others, upon examining the FDA database, noted a 22-fold increase in the rate of reported adverse events, such as infant deaths due to hemorrhage, either intracranial (in the brain) or subgaleal (below the scalp but above the skull bones). The rate of these rare but potentially lethal events could increase further in the presence of 1) a large fetus with shoulder dystocia (fetal shoulder too big to fit easily into mother's pelvis); 2) a prolonged second stage of labor (from complete cervical dilatation to the delivery); 3) the application of the vacuum cup over the anterior fontanel (the soft spot) of the head; 4) excessive pressure and force of traction; 5) multiple pop-offs of the vacuum cup; and most important, 6) the misuse of the vacuum extractor by a poorly trained operator.

      The author of this book, Heather Winkeljohn, was a nulliparous woman bearing a large fetus (Autumn’s birth weight was about 4200 grams, or 9 pounds, 4.5 ounces), exhibiting occipital posterior presentation of the fetal head (back labor) with probable shoulder dystocia, and a prolonged second stage of labor.

      Informed consent to use instruments for delivery. In his December 1999 editorial comment about birth injury and method of delivery (the study by D. Towner and others), Dr. Thomas J. Benedetti, from the University of Washington in Seattle, stated, The decision to attempt operative vaginal delivery should not be made without knowledge of the risks involved for both mother and infant. The question of how and when these risks should be discussed with the mother remains unanswered.

      In 2000, at a medical meeting on perinatal care, sponsored by the University of New Mexico, Dr. William F. Rayburn stated, Educating pregnant women and their partners about the potential risks of operative-assisted delivery, using good technique, and thoroughly documenting the procedure can help reduce the physical and medico-legal risks associated with these deliveries. The article quotes Dr. Rayburn further: It’s essential that parents are fully aware of the available options, including vacuum and forceps deliveries and cesarean sections, the reasons for taking these steps during labor, and the potential complications for both the mother and fetus.

      In a paper published in the Southern Medical Journal in 2006, C.M. Nichols and others conducted a retrospective study reviewing 346 medical records from 1992 to 2005, assessing the documentation frequency of informed consent for women undergoing a trial of nonemergent (where there was no emergency) instrumental delivery. In 61 percent of the cases they found only general hospital consent for instrumented vaginal delivery. Documentation of any maternal or neonatal risks was found in three percent and zero percent, respectively. A 2009 technical review paper by Ali and Norwitz from Yale University stated, Once the obstetric care provider has confirmed that the patient is an appropriate candidate for an operative vaginal delivery, informed consent should be obtained. This can be either verbal or written. Either way, the potential risks, benefits, and alternatives to operative vaginal delivery should be discussed, and the discussion should be clearly documented in the medical record.

      Patient/healthcare-provider relationship. During labor and delivery, mother and fetus are in a vulnerable state. Although a physiologic and natural process, parturition is associated with pain and anxiety. A professional, courteous, and compassionate attitude should be maintained by the healthcare providers toward the mother in labor to ease and alleviate both expressed and unexpressed concerns, in order to develop a trust relationship between the healthcare providers and the patient. Any intervention being considered by the healthcare providers should be for the benefit of the patient. The patient should be fully and truthfully informed, and the intervention method should be chosen by mutual decision of the patient and the healthcare provider in order to respect patient’s autonomy. Occasionally, time may not permit for an in-depth explanation of benefits and potential dangers of obstetrical intervention for delivery; however, some explanation, no matter how short, should be made in consideration of the best interests of the patient.

      Long-term effects on the family. After nine months of a normal pregnancy with hope and anticipation of a joyous event, a poor delivery outcome brings about very deep emotional distress and a grief process. For a dedicated mother, the stage of guilt process is long and may be interminable, even though she did not bring about the problem. What Mrs. Winkeljohn describes about the disintegration of her family unit may be typical in these types of circumstances, rather than unusual.

      I have great admiration and respect for Mrs. Winkeljohn—for her tenacity, intellectual ability, and expression of her thoughts. Her book brings to focus certain issues with medical care in general and obstetrical care in particular. She describes a lack of respect for human dignity and autonomy in making decisions about her health care and well-being. Her book may not change obstetrical care drastically in the United States, but it does empower expectant mothers to retain their human dignity and autonomy. It gives them essential information that is otherwise sorely lacking. Expectant mothers should participate in making decisions about their obstetrical care during this crucial period of their lives.

      Houchang D. Modanlou, M.D.

      Newport Coast, California

      December 2010

      Note: Houchang D. Modanlou, M.D., is presently Clinical Professor of Pediatrics at Loma Linda University and Adjunct Professor of Pediatrics/Obstetrics and Gynecology, Retired, at the University of California, Irvine (UCI). Dr. Modanlou retired in 2010 after 38 years at UCI. From 1977 until mid-2010, Dr. Modanlou was Chief of the Division of Neonatology and Program Director of the Neonatal-Perinatal Medicine Fellowship Training Program. From 1972 to 1977, he

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