A high-risk miracle
For such a small woman, Tristan Thomas was one big walking risk factor.
She was about 18 when she had her first child, and by the time she was 25, she had had another — and a third was on the way.
Those decisions would not have been so bad if she hadn’t smoked marijuana or used cocaine for a large part of her adult life.
“I was in deep denial,” she said. “When you’re doing drugs, you’re in a state of insanity.”
That insanity included smoking cigarettes, further jeopardizing the life of her unborn child.
Thomas readily admits that she was “a functioning addict” and she said she didn’t even know she was pregnant until her sixth month, explaining that her periods were always erratic when on drugs and her weight, usually around 115 pounds, didn’t change much.
It’s a miracle then that her third child, Tahkeel, was born healthy. He came early — 34 weeks instead of the normal 37 to 42 weeks of gestation. And he weighed about six pounds — a mere eight ounces above the minimal normal birth weight. More surprising, Tahkeel weighed more at birth then Thomas’ two previous children, both of whom weighed less than five pounds.
Thomas is fully aware these days of her past risky lifestyle. She was almost not allowed to take Tahkeel home; marijuana was found in his system. A judge ordered her to enter a substance abuse program and undergo random drug testing.
She knows it’s for the best.
Of all the risk factors associated with high infant mortality rates, substance abuse and smoking cigarettes are the most controllable. Smoking not only retards conception, but babies born to smokers have 30 percent higher odds of prematurity and are more likely to be born with low birth weight. Smoking increases the risk of miscarriage and a condition called placental abruption in which the placenta separates from the uterine wall — often resulting in early birth and sometimes neonatal death (death of an infant within 27 days of birth). The placenta is an organ that develops in the uterus during pregnancy to nourish the growing baby.
The infant mortality rate for infants of smokers is 70 percent higher than those born to nonsmokers.
In addition, infants who are exposed to secondhand smoke are more likely to die of sudden infant death syndrome (SIDS), the third leading cause of death in infants.
Drinking and using illegal drugs also have an impact. Fetal alcohol syndrome can cause low birth weight and mental retardation. Cocaine restricts blood vessels, which can lead to placental abruption. Babies exposed to heroin can be born addicted.
Not all of Thomas’ decisions were bad. She had a steady relationship with her boyfriend, the father of her three children, and she worked on and off as a painter for her father. She ate well — lots of yogurt and salads — and exercised frequently.
Good nutrition is not insignificant.
Foods high in calcium, iron, protein and other essential nutrients should be daily staples for pregnant women. Fortified breakfast cereals, dried beans, leafy green vegetables and milk products are all suggested. A daily multivitamin with 400 micrograms of folic acid is recommended before and during early pregnancy. Folic acid helps the baby’s brain and spinal cord develop properly.
Thomas simply needed help with her lifestyle choices. Her father tried. He had even admitted her to a drug rehabilitation center years ago. But as soon as she was released, she started right up again. It wasn’t until five months ago that she finally called it quits.
“I was just sick and tired of it,” she said.
She now has ample help and, most important, is ready to help herself. It started with the Mattapan Community Health Center (MCHC), where she is a patient. It was there that she met Beverly Jones, an OB case manager with the Center for Community Health and Health Equity (CCHHE), a program jointly run by MCHC and Brigham and Women’s Hospital. CCHHE was developed to decrease the disparities in birth outcomes in minority sections of Boston.
A trained nurse and certified community outreach educator, Jones not only performs a needs assessment of pregnant women but also makes sure that all appointments such as lab tests and follow-up visits are scheduled and kept.
If a patient appears to be high-risk, that is, has high blood pressure, diabetes, lupus or HIV/AIDS, Jones often refers her to an obstetrician specializing in high-risk pregnancies.
Hypertension and diabetes during pregnancy are especially serious. Preeclampsia or toxemia, the development of elevated blood pressure, protein in the urine and excessive swelling, is life-threatening to the baby and the mother. Currently, there is no treatment for preeclampsia other than delivery. “You have to deliver the baby,” said Dr. Laura Riley, Medical Director of Labor and Delivery at Massachusetts General Hospital.
Riley pointed out other risk factors that might be overlooked. Infections, such as urinary tract infections and sexually transmitted diseases, can increase the incidence of preterm births. Also significant are multiple births — carrying two or more babies — as well as spacing between pregnancies. Data suggest that intervals fewer than six months between pregnancies can increase the risk of prematurity.
Prenatal care is essential. The key is making sure appointments are kept, according to Jones. She makes the reminder calls in advance of each visit and follows up if the appointment has been missed.
The schedule of visits is once a month through months one through six of pregnancy; twice a month for months seven and eight, and every week of the ninth month until the baby is born.
The work doesn’t stop after the baby is born. Jones does home visits and works with families on other matters. She helps them find housing or apply for WIC, if necessary. If patients are smokers, she refers them to a smoking cessation program.
To her credit, Thomas signed up for several programs offered by the center.
She is on medications to prevent the cravings for nicotine. On June 26th, she entered Mom’s Project, a comprehensive community-based program for drug-addicted pregnant women. After child birth the program, sponsored by the Boston Public Health Commission, continues to work with women on parenting skills and recovery from substance abuse.
Thomas participates in five groups a week, although only two groups a week are required. “I need all the support I can get,” she said. “I like to keep myself busy. If I don’t, I don’t know what will happen.”
She has friends from school who are sober and provide her all sorts of moral support. And she has her family. As it is now, only the youngest child is living with her. But if she remains clean, her two other children will return to her care.
“I’m doing this for myself,” she said. “Unless I care for myself, I cannot care for my children.” |
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Tristan Thomas holds her son, Tahkeel, who, despite her history of drug abuse, was born healthy at 34 weeks of gestation.
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| Beverly Jones, OB Case Manager, Mattapan Community Health Center |
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