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By Elizabeth Chuck
The disturbing case of an Arizona woman who gave birth despite being in a vegetative state for more than a decade is not the first of its kind, experts told NBC News.
The 29-year-old woman gave birth in December while receiving long-term care at Hacienda HealthCare in Phoenix after an almost drowning incident. The authorities do not know who impregnated her and have opened an investigation of sexual assault in search of her rapist.
The case echoes one from 1995, when a nursing assistant raped a 29-year-old comatose woman in her nursing home near Rochester, New York. The staff discovered that she was pregnant from the beginning, a key difference between her and the Arizona woman.
Jeffrey Spike, a faculty member affiliated with the Center for Ethics and Biomedical Humanities at the University of Virginia School of Medicine, served as an ethics consultant for the New York women's hospital and spoke with her parents about whether They wanted to interrupt the pregnancy. They decided not to do so, and the woman gave birth to a premature but healthy child in March 1996, who was raised by her maternal grandmother.
In patients in vegetative states, Spike said that "cognitively, all human qualities are gone, but biologically, everything is quite normal," which makes it possible for a pregnancy to occur.
"What caused her daughter to be in a vegetative state was such a horrible tragedy, and then discovering that she was raped and then having to make this huge and very difficult decision was really very difficult," Spike said.
Other women have been in a vegetative state or brain death during pregnancy, but their brain function was compromised during pregnancy, not before, said Dr. Deborah Feldman, director of maternal-fetal medicine for Hartford Health Care in Connecticut.
In 2000, Feldman co-authored an article on maternal brain injury that reviewed 11 cases of irreversible brain injury in pregnant women and discovered that 10 of their 11 babies had survived. The cases included mothers with brain death and persistent vegetative states.
The difference between a vegetative state and a "dead brain".
Cases of brain dead women who remain artificially alive during pregnancy have made headlines, including Marlise Muñoz, a Texas woman who suffered a pulmonary embolism during pregnancy. Muñoz was finally disconnected from life support after a legal battle and the fetus, which according to the family showed abnormalities on ultrasound, also died.
Dr. Rezvan Ahmadi, an elderly neurosurgeon at the University Hospital of Heidelberg in Germany, investigated pregnant mothers who are brain dead and said that patients in vegetative states receive a very different treatment.
"Brain death in Germany is defined as the death of the human being, and each guideline refers to saving the baby's life and also to saving organs for organ transplants," he said. "Vegetative people are alive, so we can not do anything to end their lives, therefore, there is no doubt that everything must be done to save the life of a baby and save the life of a mother."
In a vegetative state, patients can breathe and regulate their heartbeat by themselves, but receive nutrition and hydration intravenously and show no signs of consciousness.
"You will see that the eyes open … but there is no capacity of the other parts of the brain in terms of understanding the language, expressions of the face of people, things of that nature," said Dr. Gregory O & # 39; Shanick, Medical Director Emeritus of the Brain Injury Association of America. "Nor is there any kind of intentional behavior that they are exhibiting, so they can see random movements, they can make a sound and they can move once or twice, but it is not reproducible or consistent."
"There is no personal and medical doubt in my mind that this was an assault."
O 'Shanick said there would be "no way" that someone in a vegetative state could consent to a sexual encounter and said that with the Arizona woman "I have no personal and medical doubt that this was a assault".
Pregnancy in patients with brain injury.
The brain injury that caused the vegetative state, O & # 39; Shanick added, probably does not contribute to any physical challenge in a pregnancy.
"Unless there is some other type of physical injury, a fracture or some other type of spinal cord injury, then everything else will probably be intact," he said. "The key problem is if she still has her period, and presumably the answer is yes."
And the lack of prenatal care, while important, may also not have affected the baby, said Feldman, the maternal-fetal director. Potential problems with a patient in a vegetative state would mainly focus on their lack of movement and would include restricting fetal growth, poor placental function, high blood pressure or gestational diabetes, among other issues, he said.
"It's hard to know for sure, but if there are no significant birth defects and if the baby grew normally, there is an expectation that the baby will thrive and be normal," he said.
How could anyone have known?
All the experts said that although it was surprising that the finance staff apparently had not realized that the patient was pregnant, it could have gone unnoticed according to the size of the middle section of the woman.
A doctor who examined her in April, eight months before giving birth, did not notice anything about a pregnancy, the Associated Press reported Thursday, although it may have been too early.
"I hope someone who was taking a bath noticed it, but I do not know what the level of attention was," Feldman said. "You would expect your belly to grow for nine months, but sometimes things like that appear differently in different patients."
If he had felt something different in his body, it would have been impossible to communicate those changes to his caregivers, said O'Shanick of the Brain Injury Association of America.
"Could they have noticed something in other secondary changes, in terms of the size of their breasts and other things? It depends on the staff and what they were tracking, but this is not something that is generally tracked," he said. "You do not think in those terms, I can guarantee that from now on, people will think in those terms."