Missing clue: He's a Pediatric Neurologist

I was puzzled why the governor of Virginia thought nothing of saying if a child was born alive after a late term abortion that he would ask mom before resusitating it or even giving it routine care (i.e. the common practice alas is to put the kid in the cleanup room until it dies of hypothermia... or sometimes are rescued by a feisty nurse who takes it to the nursery and they survive).

The problem is that most of the late term abortions are done for social reasons so encouraging funding of groups to help these moms to carry the kid to term and have it adopted is the way to go.

But after I wrote the stuff below, I read that the governor was a Pediatric Neurologist.

These docs take care of autistic, mentally disabled, cerebral palsy and severe behavioral problems due to brain damage.

and a lot of neurologists get cynical and don't see the value of the lives of the handicapped (I often cite the case of one of our Chippewa patients with frontal lobe syndrome who needed a feeding tube. We had her checked by the neurologist to ask if her outbursts should be treated with medicine, and instead he spent an hour pressuring the family to pull her feeding tube and let her die. The family did not respond because of shyness, but their cousin, a nurse, on the way out told him off: that's the difference between we Indians and you white people. We don't kill our elders)..

Am I accusing him of doing such things? No, but given that he was so clueless on why so many got upset about his support of full term "abortions" including infanticide via neglect, it does make you wonder.

So I suspect the late term abortions he is discussing are not the social ones, but the ones done for things like Spina Bifida/meningomyelocoel, which might not show up on the early ultrasound.

These are "throw away" kids: see my note below about the Oklahoma Children's hospital study, but also the Baby Jane Doe case, where docs persuaded the parents not to treat her, and all the VIPS in NYC and NYTimes hailed the parents for their bravery... the kid however didn't die and did finally get treatment and is alive and well the last time I looked (which was about ten years ago).

so what he was explaining was how he would treat these kids: deliver them early so they will be hopefully born dead, and if they managed to survive, well, after all they weren't wanted by mom, so let them die in the back room.

but then another suspicion came to me.

How many of these kids did he treat in hospitals? And how many were denied ordinary care and died?

Yes, I've seen this too, and suspected it in other cases.

(I could put a long discussion on why not to give extraordinary care here, or treatment that would cause more anguish and pain for a minimal prolonging of life, which in Catholic ethics is optional).

it would be hard to prove, of course: The parents usually go along with the doctor's advice, and wouldn't realize they had an option that would keep their kid alive. And to realize they let the kid die unnecessarily would be something they would not want to face, especially since often the ambivalent feelings about the child would induce more guilty feelings.

Sigh.

The Showman who saved 6500 lives

via Atlas Obscura: When Infants in Incubators were sideshow attractions:

The premise of the attraction was straightforward enough: pay an entrance fee to see something you wouldn’t usually be able to see.

What set Couney’s sideshow apart was that his subjects were premature babies in incubators, receiving care that hospitals did not provide.

The entrance fees he collected went toward his operating costs, including round-the-clock care and wet nurses. Couney did not charge the parents of his tiny patients.

Couney visited the Pan-American Exposition in Buffalo with his baby incubators, 1901. PUBLIC DOMAIN

Reporting in 1903, The Brooklyn Daily Eagle described the “seriousness and value of the system shown.” A visit to Couney’s showcase revealed rows of warmed, glass-fronted incubators supplied with filtered air, containing “little pitiful pinched looking waifs… the only things that indicate that they are alive are the healthy color of their little faces and the faint flutterings of movement which are perceptible on closer inspection.”

===========

NPR story of one of these children:

Lucille Horn was one of them. Born in 1920, she, too, ended up in an incubator on Coney Island.
"My father said I was so tiny, he could hold me in his hand," she tells her own daughter, Barbara, on a visit with StoryCorps in Long Island, N.Y. "I think I was only about 2 pounds, and I couldn't live on my own. I was too weak to survive."
She'd been born a twin, but her twin died at birth. And the hospital didn't show much hope for her, either: The staff said they didn't have a place for her; they told her father that there wasn't a chance in hell that she'd live.
"They didn't have any help for me at all," Horn says. "It was just: You die because you didn't belong in the world."
But her father refused to accept that for a final answer. He grabbed a blanket to wrap her in, hailed a taxicab and took her to Coney Island — and to Dr. Couney's infant exhibit.Dr. Martin Couney holds Beth Allen, one of his incubator babies, at Luna Park in Coney Island. This photo was taken in 1941.Courtesy of Beth Allen"How do you feel knowing that people paid to see you?" her daughter asks.
"It's strange, but as long as they saw me and I was alive, it was all right," Horn says. "I think it was definitely more of a freak show. Something that they ordinarily did not see."
Horn's healing was on display for paying customers for quite a while. It was only after six months that she finally left the incubators.
Years later, Horn decided to return to see the babies — this time as a visitor. When she stopped in, Couney happened to be there, and she took the opportunity to introduce herself.
"And there was a man standing in front of one of the incubators looking at his baby," Horn says, "and Dr. Couney went over to him and he tapped him on the shoulder."
"Look at this young lady," Couney told the man then. "She's one of our babies. And that's how your baby's gonna grow up."

Fetal Alcohol syndrome

Science daily has an article on Fetal Alcohol syndrome.

Worldwide, an estimated 119,000 children are born with fetal alcohol syndrome (FAS) each year, a new study shows. The study provides the first-ever estimates of the proportion of women who drink during pregnancy, as well as estimates of FAS by country, World Health Organization region and worldwide.

I suspect this might be an estimate of the severe full syndrome, but like a lot of things, it is a continuum, and if you include all babies with some damage it is probably ten times that much.

You can see the problem in this description:

Globally, nearly 10 per cent of women drink alcohol during pregnancy, with wide variations by country and WHO region. In some countries, more than 45 per cent of women consume alcohol during pregnancy. In Canada, which has clinical guidelines advising abstinence during pregnancy, an estimated 10 per cent of pregnant women still drink, which is close to the estimated world average.

wait a second: If you include countries who routinely drink wine (or beer) with their meals, you get a huge number of drinkers, but not a lot of FAS. Whereas in Canada, I suspect their "First Nation" doctors see a lot of it, because drinking there is hard drunkeness although not necessrily daily alcohol.

Both exaggerated (no, one drink won't affect your kid) and underestimated.is much.

more from the article:

Nearly 15 per 10,000 people around the world are estimated to have FAS, the most severe form of Fetal Alcohol Spectrum Disorder (FASD). FAS is characterized by mental, behavioural and learning problems, as well as physical disabilities. 

In Canada, the estimate is 10.5 cases of FAS per 10,000 people.
 Not every woman who drinks while pregnant will have a child with FAS. "We estimated that one in 67 mothers who drink during pregnancy will deliver a child with FAS," says lead author Dr. Svetlana Popova, Senior Scientist in CAMH's Institute for Mental Health Policy Research. 

 She notes that this figure is very conservative and does not include other types of FASD that may occur from alcohol consumption during pregnancy, including partial FAS (pFAS) and Alcohol-related Neurodevelopmental Disorders (ARND). Although it's well established that alcohol can damage any organ or system in the developing fetus, particularly the brain, it's still not known exactly what makes a fetus most susceptible, in terms of the amount or frequency of alcohol use, or timing of drinking during pregnancy. Other factors, such as the genetics, stress, smoking and nutrition also contribute to the risk of developing FASD.

Spina bifida

Via Ann Althouse linking to a 
 a John Mellencamp interview

"They had to cut my head off basically, I have scar from ear to ear. That was my first experience." "You think circumcision's bad? Wait till they cut your fucking head off! But my grandmother told me for my entire life — everyday, 'John, you're the luckiest boy in the world.' And when you hear that everyday from somebody you actually start to believe it, which made me adventurous, which made me not afraid to try things, which made me not care about stopping myself from doing things that people said you shouldn't be doing." That's John Mellencamp, answering "What adventure changed your life?," the first question in an excellent interview.

the Spina bifida usually is fatal but at the lower spine. I assume he is talking about the problem of hydrocephalus. 


usually these are shunted with a tube that allows the fluid to drain into the blood stream or abdomen where it is absorbed.

 but the operation that slits you "from ear to ear" is the Arnold chiari malformation.

Surgical repair of myelomeningocele

Several surgical centers have attempted to lessen the effect of Arnold-Chiari II malformation, neurologic impairment, and need for shunting through the use of in utero surgical repair of the myelomeningocele. The first such repair was performed in 1997, after several animal models demonstrated a benefit from the procedure. Studies of the outcomes of these surgeries have been somewhat promising, although still inconclusive.^{[4, 5, 6]}

In the Arnold Chiari malformation, the stem of the brain is pushed down into the hole at the base of the spine...it not only can stop the fluid from draining but can put pressure on the brainstem that regulates your breathing etc...there are several types. LINK

Type II is usually accompanied by a myelomeningocele—a form of spina bifida that occurs when the spinal canal and backbone do not close before birth, causing the spinal cord and its protective membrane to protrude through a sac-like opening in the back. A myelomeningocele usually results in partial or complete paralysis of the area below the spinal opening. The term Arnold-Chiari malformation (named after two pioneering researchers) is specific to Type II malformations.

I haven't had any patients with meningomyelocoel that had this type surgery, but you do see this with other congenital problems, and so one of my patients with achondroplasia (a form of dwarfism) had this surgery.

What other disorders can occur with Chiari malformations?
  
   Chiari malformations can occur with other conditions. Some are:
  
     * hydrocephalus (excessive fluid in the brain)
     * spina bifida (opening of the spine usually associated with an
       abnormality of the spinal cord)
     * syringomyelia (excessive fluid in the spinal cord, leading to a
       cavity detectable by MRI).
     * other conditions, including some inherited conditions like
       achondroplasia (a type of dwarfism), Hajdu-Cheney syndrome,
       Albright hereditary osteodystrophy (pseudohypoparathyroidism), or
       other rarer syndromes.

 He had the hole in the base of his skull made larger. Article here.

this article has photos.

no, it's outside my area of expertise.