Earlier in the semester, Monica told me she was second-language learner.  Now, she is a first-language writer.  She chose a research topic close to home.  In deciding who to profile in her community, she wrote about her second daughter.

 

Monica Garcia
Professor: Lewenstein
English 1A
19-October-2016

                               Paulina and Her Congenital Birth Defect: Gastroschisis

      Eight years ago, I was expecting my third baby. I went to an ultrasound appointment excited to meet my precious baby. There I was, in a dark quiet room, waiting for the ultrasound technician to proceed with the exam. When I felt the warm gel on my stomach, I knew she was ready to proceed with the exam. As a matter of fact, there she was performing the test showing me the baby, the light of the screen illuminated her face, and suddenly I noticed by her expression, that something was not right. I asked her, is everything ok? She stuttered, I got worried, and I insisted on her telling me what was wrong. My heart was pounding so hard. I was so scared, thinking the worse.  In fact, the doctor was there he immediately to perform a second ultrasound. The doctor took a few minutes to analyze every part of my baby. While performing the ultrasound he explained, that I would have to follow up with a specialist because it looked, like my baby had some type of birth defect. Subsequently, she would have to be monitored closely to keep her safe. I felt like someone was tearing my heart apart. I never thought something like this would happen to me. Indeed, we always hear these kinds of stories happening every day, and we never imagine that something like this can happen. 

     Many women do not realize how high is the risk of having a baby with a birth defect, and most important they don’t know, what is Gastroschisis and how can it be prevented? The importance of prenatal care, their lifestyle and environmental hazards can contribute in having a baby with a birth defect known as Gastroschisis. Gastroschisis is a birth defect in which the baby intestines stick out of the babies’ stomach. Women between 15 and 22 years of age are at greater risk of having a baby with this particular birth defect. Women need to realize the importance of prenatal care during pregnancy to help reduce the risk of having a baby with Gastroschisis.

     Consequently, I was sent to see a specialist at Loma Linda. They were going to explain to me what was wrong with the baby, and the process of what needed to be done. Indeed, I had my appointment right away. The doctor at Loma Linda was very kind. She explained what type of birth defect my baby had and the procedure she would need. It was a malformation of the abdominal wall called Gastroschisis, in which the intestine of the baby are kept outside of the stomach. She also explained that once the baby was born depending on the severity of the damage of the bowls; they were going to be able to repair the condition with a surgical procedure, in which the intestines are put back into the stomach, right after the baby is born.

    As a matter of fact, this was the reason why I would have to be monitored so often during my pregnancy. After that day, I was constantly seeing a different doctor. I had to drive twice a week to Loma Linda to see the specialist and the surgeon that would do the repair. Twice a week I had to see my regular doctor here in the valley. Believe me it was difficult to hear the doctors saying that “maybe your baby won’t be able to make it.” All the time, I was worried about my baby, thinking about what I did wrong that could have affected my little girl. I am a healthy woman, who don’t drink, and don’t use any type of medications or drugs. It is a horrible feeling, not knowing the reason why my baby had to be born like that. 

    My inspiration to write about this theme is my daughter Paulina Lucero. At only eight years old she has being through a lot. Since the moment she was born, she started fighting for her life. Her weight was 3lbs 12oz and a length of 15 inches. She was born at only 32 weeks, had two surgeries performed in her first three days of life and a hospitalization of forty-five days. She fought for her life. God showed the doctor how amazing he is by allowing Paulina to survive the condition she was born with. Paulina Lucero was born with her intestines out of her abdomen, a birth defect known as gastroschisis. When Paulina Lucero was only a few months many doctors were not giving me hopes of her surviving. I was 12 weeks pregnant when I received the news about the condition that my baby was going to be born with. Since that moment my life changed. Clearly, at that time I didn’t understand what exactly was going on, more specifically what the condition was that my baby had? Time had passed by and Paulina has grown. She is a very strong little girl. Most of the time, she is very active, but she constantly complains of stomach pain. Paulina has to have a very special diet to help reduce her abdominal pain, and to prevent any other complications with her condition. Base on my experience today, I am writing this paper with the intention to educate people about Gastroschisis.

    The article “Management of the Infant with Gastroschisis: A Comprenhensive Review of the Literature” by Trace Williams, Rachel Butler Tara Sundem, MSN, RN, NNP, explains some of the possible causes, repairs, and outcome of children born with this condition. Gastroschisis is explained as a malformation of the abdominal wall in which it exposes the babies’ intestines, and in some cases, it may also expose other organs. Indeed, the article also gives some of the history of gastoschisis. Gastroschisis can occur on the first 16 weeks of formation of the fetus. In fact this can happen due to a possible occlusion of the omphalomesenteric artery in the utero, weakening the abdominal wall and causing a hold of the baby abdomen. Although the real cause of gastroschisis is unknown it has been proven that most of the cases occur in young mothers. The article also discusses the process and diagnoses, and management during and after delivery. It also discusses possible outcomes of the affected baby. Furthermore, the article remarks on how uncommon this condition is in children. Not to mention, how medical advances, have made surgeries, follow ups and treatments for these children to live a normal life. I can test from my personal experience, that what this article explains about gastroschisis, is true. Many people don’t know about this defect and the process that it takes to keep your baby in the best health conditions after such a traumatic process. Actually, the group of medical professionals that wrote this article, also explains how uncertain the way of delivery, can affect the baby outcome. Additionally, the article argues how “The incidence of gastroschisis is higher in young mothers and declines remarkably with increasing of maternal age. Women less than 20 years of age are eleven more times likely to have an affected infant.” It is amazing how medical professionals acknowledged how younger women are affected they didn’t say anything about how to identify more deeply the causes of gastroschisis. 

     Furthermore, in the article “Physical therapy treatment planning approach for a medically fragile child: A case report involving a child with complicated gastroschisis” the author, Janna Tamminga, PT, MHS, PCS, is introducing a case of a child with multiple complication after being born with gastroschisis. Clearly, this article shows that not all children with gastroschisis have a good outcome. Jonna Tamminga, shows how the child was referred to a serious of physical therapies to help with the delay in his child gross motor development. Do to his complicated health, his therapies were constantly interrupted do to child hospitalizations. After receiving several therapies a significant difference was notice on the child gross motor development. It is obvious that this not only affected him physically but it did interrupted his gross development. Although theses cases are rare I thank God for my child good outcome. The writer explains to his audience how the child was exposed to different complication before delivery, with mother condition of preeclampsia, maternal HELLP syndrome, in which mother liver enzyme were elevated and her platelets were low. After gastroschisis repair was done, 10 hours after birth, a required surgery was done at 7 weeks old, due to a bowl obstruction that end up with a ostomy bag, a tube feeding followed by multiple infections, liver dysfunctions, that required a liver transplant and other organs. In the article, the author explains how the program of physical therapies that analyzed the child gross development, continued persistence after each of the child hospitalization. 

    Janna Tamminga gives examples, of how the child demonstrated internal motivations, how she was able to adapt to her impairments. The author, also writes how the child developed an abdominal mass complicating child pulmonary functions ending in more hospitalizations. The writer states that therapies did not stop, and eventually child was able to stand and walk at 19 months, complications with the child health continued ending in more hospitalizations and frequent infections. After more therapies the child was able to demonstrate skills for independent mobility before her death. It is surprising how one birth defect can contribute to multiple complications. The author also states that “although gastroschisis and the resultant medical complications were a regular part of this child’s life, this conditions were not factors of her death.”

     She also explains how the child before her death had a blood clot disorders. The author explained how weeks before her death she developed a blood clot causing the amputation of her left lower leg and 12 hours before her death she passed a blood clot to her brain which left her on life support that was terminated, death occurring shortly after. I disagree with this statement of the author because, even dough, he says that the condition of gastroschisis didn’t had to do with the child death. I think it had to do a lot with it because that was the problem that she was born with, that lead to all of her complications.

    The author also states that children born with gastroschisis not typically receive early intervention with physical therapy because the survival rate is higher. But few of them have chronic complication and required intervention of physically therapy. The author states how important is to assist each child to reach their gross development and endurance conditions. Although the author in this article is trying to show he process of multiply therapies, the child received to help with her development, it also shows how being born with gastroschisis can have such a bad outcome, complicating the child health and overall life.

    I was at Eisenhower Medical Center performing my duties, like any other regular work day when I met Alejandra, a seventeen-year-old female born with gastroschisis. She was being seen for chronic abdominal pain; consequently, she was assigned to my team. When I was looking at her chart I noticed the condition she was born with, and after a few minutes passed, I went into her room. I began by introducing myself and performed what I was supposed to do. While drawing blood from her our conversation began. Her mother was in the room, so I explained to her how my daughter was born with the same condition as her daughter. At that moment I took the opportunity from our conversation and I started asking her questions that I always had wondered. Alejandra explained, that most of her life she had been able to live a normal life, but she also remembers how she had been suffering of constant abdominal pain. Most of the time her condition would affect her activities. She also adds, that she had to deal with this pain because doctors had not being able to help her, and find a reasonable medical explanation other than her congenital birth defect. Alejandra states how different she feels from other people, she said “I can’t eat regular foods like most of normal people do.”

     What do you mean by normal people? You are normal to me? I said. She replied “yeah I look normal but most of the time I can eat foods that people born without this condition eat,” “for example” I said, “well” she respond to me “I can’t eat any bread, pasta, or regular milk, I have to look at people eating all of this food and I can’t because if I do, I develop stomach aches.” She continued by telling me how being born, like this had lowered her self-teem because of the scar in her stomach. She told me, how one time when she was six years old she was at a pool party with her friend. Alejandra describes how she was wearing a two-piece bathing suit, she adds “every little girl was looking at me, making weird faces.” Alejandra revealed to me how hard it was hearing them, making fun of her, and how others would ask her why she had the scar on her belly. When she would tell them, they would make nasty sounds.

    She told me “I remember I used to hate being born like this.” At that moment I felt so sad because it reminded me how my daughter must feel, also because just like her, she gets this constant abdominal pain. At the moment, one of the transporters came into the room because they need it to take her to an ultrasound test. Since her mother was in the room, we started to talk and I told her it must be really hard for you, she replied “yes, you should know”. Alejandra’s mother told me, how she did not know about her daughter’s condition, she said, “seventeen years ago technology was not advance.” She then told me that she delivered her in a hospital in Oklahoma, and how lucky she was to be in a good hospital because they were able to repair her daughter defect.

     Everything was a surprise to her. “The doctors were worried,” she adds because of her not being monitored constantly. Doctors didn’t know how bad her intestine were affected. My daughter had to stay in the hospital about three months because they had to cut part of her intestines. “She had a difficult time recuperating, “Yes, that is why she has constant abdominal pains.” She adds, “I’m scared, she may have a block.” Then I thought to myself how lucky I was because all my pregnancy I knew how my daughter was going to be born. That helped the doctors to prepare her delivery method and planed her surgery repair. Thanks to that my daughter only stayed one month in the hospital for her recovery.

    By the time the transporter was bringing Alejandra back into the room. We continued with our conversation. I told her how often these cases are seen now. She responded to me by saying, “it is kind of upsetting that this continue to growth because first of all there is no specific diagnoses why this is happening.” The mother adds, “Many times doctors try to explain this as a condition that happens because of a mother’s nutrition, and the way they live their life.” Alejandra then argues, “But what about when you know, you as a mother do everything to have a healthy baby and instead you deliver a baby with a weird condition.” I replied, “You are absolutely right Alejandra”. At the moment I thanked her for sharing her experience with me. I explained to her how meaningful that was to me, not only because of my homework, but because it will help me to better understand my daughter. 

     In the article Maternal Residential Atrazine Exposure and Gastroschisis by Maternal Age by A.J. Agopian, is trying to show the audience about the link between Atrazine (a common pesticide) and the risk of Gastroschisis (a birth defect in which the baby intestines are outside of the baby abdomen). In the article, the author explains how atrazine affects the endocrine system and how this product is being responsible for various types of birth defects. Examples of studies conducted were given in which women from ages less than 25 years old, and women older than 25 years old were analyzed on the exposure of atrazine depending on the country of residence. The writers provided a study done in Texas in which 1,161 cases with isolated gastroschisis and 8,390 controlled, deliveries were analyzed from 1999 through 2008. Consequently, findings on the analyzed cases found, that women less than 25 years old who were exposed to atrazine were at a higher risk, due to a higher level of estrogen. In comparison, women older than 25 years old, who also were exposed to atrazine, who had a lower level of estrogen, were at a lower risk compared to younger women. The author also reinforces how further studies are needed to reveal the etiology of gastroschisis and the relationship of exposure to atrazine and the estrogen levels among younger women before any recommendations. 

    It is true that much research done about gastroschisis argues, that most of the cases are seen in younger women. According to the Center of Disease Control, some of the factors that contribute to this risk are: low socio-economic status, low body mass index, poor nutrition, and smoking, use of alcohol, and illicit drug and pain medication. Furthermore; another argument regarding the method of delivery in a gastroschisis infants, remain questionable. In an article, “Routine cesarean delivery does not improve the outcome of infants with gastroschisis,” by Helen Flageole. An analysis of babies born with gastroschisis was reviewed. Findings in the article argues that infants born via Cesarean had a higher risk for distress at birth, and an incidence of bowl stenosis. In another analysis of routine Cesarean by Montreal Children’s Hospital and Hospital Ste-Justine, Montreal, Quebec, Canada, show that those born by CS were at higher a risk to have gastrointestinal dysfunction, as well as Respiratory Distress Syndrome. The analysis between cesarean and vaginal delivery showed that the rates of preterm induction, atresia, and mortality were similar.

     Although some may think that delivering the baby does not makes a difference by theoretical standpoint, the article, “Management of the Infant with Gastroschisis: A Comprehensive Review of the Literature” argues that cesarean may minimize the risk of damage to the intestines due to compression of the bowel through the birth canal. Another reason may be the, risk of infection to the exposed bowel is higher through vaginal delivery. Additionally, the article adds that C-Section is preferred if a large defect is present with possible liver involvement, may decrease the risk of avulsion injury. Even though, the idea to promote C-Section delivery sounds good from theoretical standpoint, there is no clinical evidence that supports this idea. In my own personal experience, I agree with the theoretical standpoint of delivery because the baby is at less risk of getting an infection from the mother.

     Furthermore, in response to the argument about some of the causes of gastroschisis in the article, “Facts about gastroschisis,”by Center for Disease Control and Prevention, argues that some of the causes of gastroschisis it may be due to a change in their genes or chromosomes. Additionally, it also explains that it can also be caused by a combination of genes or other factors, like things that the mother comes in contact with, the environment or what the mother eats or drinks. As previous discussed, I am a healthy woman who does not drink, smoke, use any other type of illicit drugs or even take pain medication. I agree with the fact that environment has to do with this birth defect in some cases because to my knowledge that was the only thing different of my previous pregnancies. At the time of my pregnancy, I was living in a different city. I was constantly able to smell all the pesticides that were used for many of the plantations in that area. 
    Although many of the causes of gastroschisis are unknown, and the cases of gastroschisis continue to rise. I believe it is important to educate the audience, especially women. Indeed, women need to know about this condition that keeps affecting many families; especially those that become parents at an early age. It is important to find the cause, so we can prevent the rise of this condition. Alternatively, it is important to plan pregnancies, eat healthy, take multivitamins, and protect yourself from STDs. Although toxins in the environment are uncontrollable, you should stay away from harmful chemicals. And if your pregnant or plan to have a child, you should not consume any alcohol beverage, and avoid smoking or using illicit drugs. If women take care of themselves before and during pregnancy, the chances of having a healthy baby, will be at a higher level.

 

                                                               Words Cited

Agopian, A. J, et al. “Maternal Residential Atraine Exposure and Gastroschisis by Maternal Age.” 25 Nov. 2012. EBSCOhost. Web. 8 Oct. 2016.

Flageole, Helen, et al. “Routine Cesarean Delivery Does Not Improve the Outcome of  Infants With Gastroschisis.” 2016: 1-4. Web. 6 Oct. 2016.

Flocks, Joan, et al. “Female Farmworkers’ Perceptions of Pesticide Exposure and Pregnancy  Exposure and Pregnancy health”. 18 Nov. 2011: 626-631. EBSCOhost. Web. 8 Oct. 2016.

“Facts about Gastroschisis.” 12 Nov. 2015. Center for Disease Control and Prevention. Web. 20 Sep. 2016.

“Gastroschisis in Babies, Causes, Diagnosis and Treatment.” May 2016. Cincinnati Children’s. Web. 16 Sep. 2016.

“Key Finding: Gastroschisis Increased from 1995-2005.” 22 Oct. 2014. Center for Disease Control and Prevention. Web. 20 Sep. 2016.

“Make a PACT for Prevention: Commit to Healthy Choices to Help Prevent Birth Defect.” 26 Oct. 2015. Center for Disease Control and Prevention. Web. 20 Sep. 2016.

Tamminga, Janna. “Physical Therapy Treatment Planning Approach for a Medically Fragile Child:  A Case Report Involving a Child with Complicated Gastroschisis.” 1 March 2007: 55-63. EBSCOhost. Web. 10 Oct. 2016.

William, Tracey, et al. “Management of the Infant with Gastroschisis: A Comprehensive Review  Of the Literature.” 2003. Web. 10 Oct. 2016.