In this episode, Dr. Becket Gremmels discusses a success story involving a pregnant teenager and her parents.

To learn more about Dr. Gremmels, check out his podcast Ethics Lab here: https://www.missiononline.net/ethics/ethics-lab/

Transcript

0:00  

Before we begin, Please note that the names and specific details of the clinical cases we discuss in this episode and in all of our episodes have been altered to protect patient confidentiality.Now on with the episode.Welcome to this episode of Bioethics for the People, the most popular podcast on the planet according to Grandma Nancy. 

0:22  

I'm joined by my Co host Doctor Tyler Gibb, who if he weren't here recording right now, would probably be golfing.And I'm joined by my Co host Doctor Devin Stahl, who dutifully completes the same 5 New York Times puzzles every day.So Tyler, we have a very special guest today, somebody who I probably text at least every other week because I have a question about clinical ethics. 

0:52  

This is my absolute go to person and the first person who trained me in clinical ethics.Did you know that?No, it actually like taught little baby Devin how to do clinical ethics.That's right, I was in the final year of my PhD program.I moved back to be with my husband in Tennessee and this person was working already as a clinical ethicist at the hospital and I begged him to let me shadow him. 

1:19  

Really.I had no idea.All right, so who is it?It's our good friend Beckett.Welcome, Beckett.Beckett, thank you.Glad to be here.Yeah, introduce yourself with all of your positions because you're a very important person.Oh.I don't know about that, but so I'm the assistant vice president for theology and ethics at Common Spirit Health, which is a large Catholic health system. 

1:42  

And I've also been at CHRISTUS Health.I was the system director of ethics there and then also at Saint Thomas in Nashville, which is where I met Devin all those years ago.I think you actually first met me when I was a chaplain, right?Yeah.You were in the CP program. 

1:58  

Yep.And then you came back.Yep.I would definitely remember.That so Common Spirit is a large healthcare system.What makes it unique?Tell us more about Common Spirit.The size I think is part of it.I mean we've got I think 143 hospitals in 24 States and 180,000 employees. 

2:14  

If you include contractors and stuff like it's, it's it.It boggles my mind still.I've been here 4 plus years and it still shocks me how large the organization is.So that that in of itself makes it unique.We're the largest nonprofit health system excluding the VA. 

2:31  

Wow.And I think the third largest even when you include for profit.So it's it's huge.I think another unique factor is, I mean, we are a Catholic health system.So that certainly has its own unique elements to it.Definitely.But even within that we have non Catholic hospitals within our Catholic health system. 

2:48  

So that that's a unique feature too that that follow most of of Catholic teaching, but there's going to be some pieces that they don't follow so.Which could be, I imagine, a whole episode on its own.That that could be as well.It's very different.Yeah.So even within Catholic healthcare, we're pretty unique. 

3:04  

Yeah, but we asked you here today because I imagine you, in all the years of practice, have many, many success stories.I've heard great stories from you, but we asked you today to just pick one.And actually, Tyler and I have no idea what you're going to talk about as is our, you know, way. 

3:23  

So you have a case that you feel particularly like shows a success that you had in your work.So this was a case I had quite a while ago.So not not anytime recently.And it's one of those things where somebody says something and you're like, really like that's happening. 

3:41  

I didn't ever think that could happen sort of a thing.So this was a young woman who came in to deliver a, a baby, I think I believe she was 15 years old and didn't have any clinical complications with the pregnancy itself. 

3:58  

The she had prenatal care, everything went went fine as far as that's concerned.And she had a whole birth plan written up, which is many people do nowadays.It's rather common to have this is kind of what I'd like to have.I definitely want this.I definitely don't want that.And I mean, you can Google and get a whole checklist about that kind of stuff right now. 

4:17  

Part of her birth plan was that she wanted a natural birth, and that means something very different to everybody who says that they want that.And for this particular patient, what she wanted was no pain medication as part of her natural birth.That's what Tylers wife said too, right Tyler? 

4:34  

She never took any pain medication.Yeah, my I, I'll brag about my wife for a second.Three kids, all natural births and like she walked herself from the delivery room to the recovery room, usually with like a nurse standing behind her, but and they were like nurses like slow clapping like as she was walking down the hallway. 

4:54  

She's awesome.I want to brag on myself that I had, I asked for the most unnatural birth plan possible.I was like, give me all the drugs.Give me.I don't want to experience any of this.That's impossible.You experienced quite a lot of it, but I have a very low pain tolerance and took all the drugs I could. 

5:15  

That that's my wife give me the drugs she's we have 4 kids and and for one of them it didn't take so she ended up doing it naturally.Unbeknownst to her, at least one side didn't take so.All right, so 15 year old wants all wants to experience the the pain. 

5:32  

No pain medication whatsoever and comes in kind of spontaneous delivery, no induction, right.And around term, I want to say it was like 30 and a half, 39 weeks and uncomplicated pregnancy.Everything's going fine and labor's going fine. 

5:48  

She's progressing just as you would normally expect.Baby's doing great, everything's going well.And then she stalls and she gets to 9 centimeters and she just kind of stuck.The contractions are still there.They kind of are not as frequent as they would be that increasing in frequency and intensity that you would typically expect. 

6:06  

She stops dilating at she's kind of stuck at 9.And I mean, that happens.That's not that unusual.It occurs.Not what you want to happen necessarily, but it certainly can happen.And content labor continues.And the doctor just kind of says, let's assess it, let's talk about it. 

6:22  

Let's just kind of see where we are.Let's give you some more time.Well, more time turns into more time turns into more time.And now she's been there for almost 24 hours, stuck at 9 centimeters.Oh my gosh.And, and just so we're, we're all on the same page, 9 centimeters is 90% there, right, 10 centimeters, yeah, 10 centimeters is considered fully dilated and. 

6:45  

The baby's not in transition yet.Partially not, not completely, not enough to really obviously push through.Because usually what happens is my non physician understanding is the head pushes on the cervix, which is really what kind of forces the dilation in effacement to really go all the way complete to where she can actually start pushing and and deliver. 

7:06  

Poor thing, this is a lot of pain for a long time.Yeah, well, and I I mean, I don't mean just not an epidural.She didn't have Tylenol, she didn't have non opioid pain meds, no opioid, nothing.Wow, just and 15 years old, mind you.Right.So but what I would do, but more power to you. 

7:23  

Like great, go for it.That's what you want all the way.Let's do it.Do you have any any insight into why she was doing that?Was it like a natural?Was it religious?Was it any idea like what her motivation was for?Not taking the drugs, no, I I think it was just personal. 

7:38  

I I don't know what her exact reasoning is.That's a good question.I would imagine it's not religious to simply based on how the rest of the story unfolds.OK, but that's what I would imagine.And the physician gets to the point to where they say that, look, if, if you don't deliver soon, we're going to have to do AC section because you're, you're not, you're not progressing or it it and, and the baby's kind of getting stuck. 

8:09  

It's not really coming through and you're going to get an infection.If we don't, 24 hours is about the time where they start saying, OK, we need to start having a conversation about how do we precipitate delivery?How do we make delivery happen one way or another?Because you're going to start getting infected. 

8:24  

And that historically is one of the most common causes of maternal and infant mortality around delivery.Is that child bed fever, purple fever, right?Because you labor stalls, they can't make it go faster.And bacteria does what bacteria does right? 

8:41  

And the patient?Sorry, go ahead.No, just so we're at a crucial point right now and you'll probably say this, but at some point they call you because I don't know why they would call you, but I'm eager to fin