Yvonne Thornton’s memoir

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Ready to Deliver and Morbidly Obese: One of My Most Challenging Cases

Wednesday, June 23rd, 2010

A recent article in The New York Times talked about how the obesity epidemic is affecting pregnant women and their babies:

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

New York City’s health department reported last Friday that half of the 161 women who died because of a problem with their pregnancy between 2001 and 2005 were obese. Black women were hit hardest, with a mortality rate seven times that of white women. While deaths are extremely rare in pregnancy, the city’s rate of 23.1 per every 100,000 births is twice the national average.

My new book, SOMETHING TO PROVE, is a personal memoir first, but because I’m a maternal-fetal medicine specialist and a surgeon, it also details a number of gripping moments in the operating room.

One of my most challenging cases involved a pregnant patient transferred to my care. When I walked into my new patient’s hospital room, I discovered she weighed more than 500 pounds and her baby was showing signs of distress on the fetal monitor.  The patient needed to be delivered. Let me give you a sense of the challenge with a brief excerpt:

…Many surgeons would begin their cut above her navel in an attempt to avoid that enormous layer of fat, while trying to find the uterus to get the baby out. …The area above the pubis, even in a morbidly obese woman, is usually flat and firm. Instead of a vertical incision from the navel down, I’d lift up the apron of fat and do a horizontal incision just above the pubis. That would allow me to get into the uterus and get the baby out. …We taped her massive belly to her chest, swabbed her with an antiseptic solution, and I went in. I was able to perform the cesarean quickly, without incident or excessive bleeding, and delivered the baby in only a few minutes.

The surgeon who handled the case recounted in The New York Times decided to cut through all the mother’s layers of fat, rather than using my technique of retracting and taping the massive layers of fat, which a colleague dubbed the “Thornton suspenders.” While there might have been excellent reasons for the physician’s decision, I hope more obstetricians learn to use the “Thornton suspenders” for such difficult deliveries in obese moms. Because, as the Times article explains:

… where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

– Yvonne S. Thornton, MD, MPH

Another letter from a reader of The Ditchdigger’s Daughters

Wednesday, July 29th, 2009

It always moves me to hear from readers that my book inspired them. But I’m amazed that I’m still getting such letters, 14 years after The Ditchdigger’s Daughters was first published.

Here are a few excerpts from what a young nursing/pre-med student named Maria, who said that my book changed her life, wrote me:

“I read your book last summer The Ditchdigger’s Daughters and I have wanted to email you for so long but I have been so busy with school full-time and working part-time. But I really want you to know that I admire you so much. My dream is to become a pediatrician, take care of children, and to encourage them, especially young girls, that they can become whatever they want, to never give up, have faith in God, and believe in themselves. I have three sisters and three brothers and my parents have really sacrificed a lot to make sure we could all go to college. Financially it has been difficult and for a while I even contemplated not going to med school because it was so costly …

“I will be graduating with honors and then enroll at The College of William & Mary to finish my pre-med courses… I love to read and I am truly blessed to have come upon your book.”

Hearing from people like Maria is especially gratifying because I know how difficult it is to keep such a dream in sight when money is tight.

I’ve heard from so many readers over the years. I can’t tell you what it means, knowing that my book helped someone get through difficult moments. What I can say to Maria and others is, I’ve been there. I know it’s tough. Keep going. You’ll make it. And when you do, you’ll inspire others.

– Yvonne S. Thornton, MD, MPH