I made a post yesterday about Sarah Palin's 23 hour pregnant with ruptured membranes odyssey.  I was criticized by several people just for bringing up the subject, but I was asking legitimate questions about the judgment of a woman who is now running for Vice President of the US.  She will be the VP to a 72 year old man who has had malignant melanoma.  If McCain wins and Palin is the VP, she has a fairly good chance to become the President.

To summarize, I questioned her and her doctors’ judgment based on several articles in the Anchorage newspaper.  One commenter in particular felt that since I hadn't examined her or taken her history, then I didn't have any right to an opinion.  However, I didn't need to do that to question her judgment.  It was no different than if I had to answer a multiple choice question on my board exam:

Q: A 43yo woman, Gravida 5,  Para 4 with an intrauterine pregnancy at 36 weeks gestation experiences discharge of clear fluid and feels contractions.  She states the contractions do not feel like false labor.  You give her the following advice:

1. Get in the car and drive to the nearest hospital
2. Call 911
3. Take two aspirin and call me in the morning
4. Go back to sleep, get up in the morning, deliver a speech, drive to the airport, fly 4,000 miles, get in your car, drive 45 miles to the hospital

You don’t even need to be a doctor to answer that question!

In my original post, I never stated anything about her daughter, but there has been a lot of speculation about her.  Now we receive an announcement from the McCain campaign regarding Sarah Palin’s daughter’s pregnancy…

…seems odd to me. 

For those who have never been to Wasilla, it is a small town.  While some have described it as a suburb of Anchorage, it is not.  It is too far away and practically on the other side of a mountain and across a river.  Having lived in several small towns over the past ten years (in Alaska too), I can tell you there is no such thing as privacy in a small town.  There must be at least 50 people in Wasilla who know exactly what happened.  As I said yesterday, the whole truth will be known soon enough.

I have been following the speculation about Sarah Palin and her baby.  I just read this article about the trip from Texas

She claims she flew from Texas to Anchorage after she was having contractions and leaking amniotic fluid.  This simply doesn't make sense.

I am a physician and I deliver babies (my last delivery was about 36 hours ago).  I am only focusing on the question of this airplane trip.  I see two possibilities --

#1 - She wasn't leaking amniotic fluid, she was leaking urine.  This happens all the time.  Many women just can't tell the difference.  The way I see it, this is the only way the story in the article above could make sense.

#2 - She is lying.  There is very little chance that a 44 year old woman who was pregnant with her fifth child would last 8 hours with ruptured membranes and contractions.  Especially when the baby was approximately 4 weeks early; She would have delivered this baby on the plane.

The article states the following events (in Alaska time):

Thursday (April 17th, 2008?):
1AM - Palin (in Texas) calls her doctor (in Alaska) saying she is leaking fluid but only contracting occasionally.  "Palin said she felt fine but had leaked amniotic fluid and also felt some contractions that seemed different from the false labor she had been having for months." 

[Playing the back seat doctor here, my advice would have been get in the car and go to the nearest hospital with a maternity ward.  This is called Premature Preterm Rupture of Membranes (PPROM) and it is dangerous.]

Palin speaks with her doctor during a layover in Seattle.

10:30pm - Palin arrives in Anchorage (approximately 22 hours after membranes ruptured, you start to get worried at 12 hours).

11:30pm - Palin checks into Mat-Su regional in Wasilla, Alaska.  (It seems kind of strange that she wouldn't have gone to Providence in Anchorage which has the highest level maternity care in the state.  You would want a child with genetic defects to be delivered in a bigger place with more services available.)

Friday (April 18th?):
6:30am - Child is born.  It sounds like she was about 36 weeks along.  She was induced to deliver.  That makes it seem as if she really had ruptured her amniotic sack, otherwise you would try to stop labor with medications.

While this story has tabloid written all over it, I think it is important.  If Gov. Palin had a triple screen or quad screen test done during her prenatal care she would have known about the down's syndrome early in her pregnancy.  I didn't watch her speech, but from the stories I read about it, she implied she knew about the abnormality before the child was born.

That is the important point.  It is poor judgment to get on a plane when you are pregnant and leaking amniotic fluid.  If she knew her child had this disorder and got on a plane with leaking amniotic fluid, then she shows incredibly poor judgment.