AmyTuteurMD

AmyTuteurMD
Bio
Dr. Amy Tuteur is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School.

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MARCH 20, 2009 8:19AM

She tried to flush baby down the toilet; then it gets weird

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  flush

Working in a hospital brings exposure to the human condition in the way that no other job can. Of course you see birth and death, but you also see the results of human foibles like rage, anger and despair. All too often, mental illness plays a (usually harmful) role. Eventually, patient behavior, no matter how bizarre, loses the power to shock. That does not apply to the behavior of the staff. It’s still shocking when they begin to behave like they are crazy.

The story of The Baby in the Wonderbread Bag begins like so many stories of teen pregnancy, with a young girl who has successfully concealed her pregnancy from family and friends. In this case, the 16 year old girl also had a history of mental illness. She appeared in the emergency room complaining of intermittent abdominal pain. Because she looked well, she was advised to wait while patients who were seriously ill were seen before her.

No one paid her much attention until she went to the Ladies Room and blood was seen to flow from beneath the door. When Security broke down the door, the doctors found that the girl had given birth to a premature baby. She had stuffed the baby in a Wonderbread bag, and, at the moment Security had broken in, she was attempting to flush the baby down the toilet.

They rescued the baby from the toilet bowl and pulled him out of the plastic bag. The neonatologist rushed down from the neonatal intensive care unit and resuscitated the baby. He appeared to be about 7 weeks premature, and smaller than expected for this stage of pregnancy. Nonetheless he was healthy and vigorous, despite his brief time in the toilet, and was swept off to the NICU for further care.

That’s when the story gets weird.

Several days later, in my capacity as a chief resident in obstetrics, I was called to the weekly Social Service meeting to provide my input in difficult cases. When I arrived, I found that the Social Service staff calmly discussing whether the Wonderbread Baby should go home with his mother, as if it were perfectly reasonable that she had tried to flush her baby down the toilet. That shocked me.

It’s not that the Wonderbread Baby was the most bizarre thing we had ever seen; it didn’t even come close. The combination of youth, concealed pregnancy and mental illness is all too common at an urban hospital and the results are usually far more deadly. Indeed, even during my years of medical school and residency, the results of this toxic combination had been getting steadily worse.

When I started medical school, a baby born addicted to cocaine had been a standard reason for removing the child from the mother’s care. During the intervening years, cocaine addiction had become so common that it was no longer considered a reason to remove a child. We had been, in the words of a famous sociology essay, “defining deviancy down.” As abuse and neglect of babies had become more common, we kept readjusting the definition of abuse and neglect, so we could continue to send babies home instead of into the foster care system.

Even so, I was not prepared for a staff meeting with participants calmly discussing flushing a baby down the toilet as if it were some sort of reasonable response to an unwanted pregnancy. They asked for my input, and they got much more “input” than they had bargained for. I had been on call and awake for most of the previous night. Therefore, I exhibited somewhat less restraint than I might have otherwise.

“My input? MY INPUT?” I replied, my voice rising in volume, “Have you people lost your minds?”

“This teenager put her baby in a plastic bag and tried to flush him down the toilet!” I continued, “Is it really that hard to figure out that she should not be allowed to take this baby home?”

The lead social worker seemed defensive.

“You don’t have to get so angry about it,” she chided.

I wasn’t finished with my tirade.

“Evidently I do have to get angry, since you don’t seem to realize how bizarre it is to ask for input about whether flushing a baby down the toilet is a risk factor for abuse.”

The whole team looked hurt.

“It is a risk factor. It is a very big risk factor!” I went on. “I’m going to put myself on the line here and state unequivocally that anyone who tries to flush their baby down the toilet should not take that baby home.”

“Well, if you feel that way about it,” the team leader huffed, “then we won’t send the baby home with her.”

“Yes, I feel that way about it,” I huffed back.

The meeting ended on that less than cordial note.

Looking back on it, I can see that what filled me with anger and despair was not the fact that a teenager had tried to kill her baby. Mental illness and desperation are often a lethal combination. What filled me with despair was that seemingly sane people were discussing whether or not flushing a baby down the toilet was acceptable, as if the conclusion might be in doubt.

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This is exactly the reason I am not a social worker. In my first social work class in college, in 1968 at the University of Michigan, at one of the initial classes the teacher posed a similar question. The class supported the position equivalent to sending the baby home, above, and I took the Doctor's position, alone. When the teacher supported the other students, I realized I was headed for a career in the wrong field. I immediately went to my counselor, and dropped the class. My reason: I didn't want to be locked in a career in a field filled with morons.
I teach a five year old this:`
Flush the public commode.
Use the right foot. O, void.
Avoid all verbal germs too.
Toilets gets all stopped up?
A children's Marshmallows?
No stuff any candy and flush.
Dedicate next novel to a GOP!
Go become a cat Veterinarian?
Become Friend to a human race!
King Ferdinand warns of quacks.
O, Isabella began the Inquisition.
There has got to be more to the story. What was psychiatry's opinion? How about neonatology? Peds/adol med? Risk management?

I cannot believe that you were the only person providing input that returning this preemie to her teen mom was not a good idea. If that was indeed the case that says more about the quality of your training institution than anything else.
I'm sorry, but I just don't find this story believable. I believe the part about the girl's actions, but the extreme behavior of your colleagues just doesn't ring true.

I find it hard to imagine a whole room full of people of any background calmly discussing this. Were your colleagues all soulless automatons? What hospital was this? Our Lady of the Twilight Zone?
What finally happened to the baby?
I worked in the field of psychology for about 8 years. I absolutely find this story believable, and sadly so. The reason I got out was because I found my fellow staff members to be unstable. This article just demonstrates how true this is.

The problem is that one ends up working with so many strange people and situations, that you forget what "normal" is. I also found that psychiatric staff developed such a fear of "judging" others that they would end up trying to look at every truly bizarre situation as just one more variant of normal, certainly nothing to be judged negatively. I found that any comments I made that indicated that I did not see such bizarre behavior as normal or acceptable were used against me and caused them to ostracize me.

As sad as this story is, it just goes to demonstrate the difficulties in working in this field.
xDavex:

"The problem is that one ends up working with so many strange people and situations, that you forget what "normal" is. I also found that psychiatric staff developed such a fear of "judging" others that they would end up trying to look at every truly bizarre situation as just one more variant of normal, certainly nothing to be judged negatively."

That was certainly my experience.

The fact is that in any urban hospital many of the patients have pathology far beyond physical illness. There are not enough psychiatrists in the state, let alone the individual hospital, to provide the care that many of them need. If every mother who was on drugs during pregnancy, or had mental illness, or was accused at some point of abuse of neglect, got a psychiatry consult, the psychiatrists would do nothing else.

Regarding the social service professionals, many of them did a tremendous amount of good for patients, and they were certainly well meaning. However, their understanding of "normal" changed after exposure to so much abnormal.

The discussion was not simply to send the baby home with a 16 year old. As in all these discussions (and there were way too many) a great deal of emphasis was placed on the fact that the mother would live with the grandmother who, it was presumed, would take care of the baby. Of course, she was the one who had "taken care" of the mother, so in my judgment, that was meaningless.
I can't imagine having to come home at the end of a day like that and trying to feel positive about the world again. rated
Seriously. Rated. I know that this stuff happens. A student at a school nearby delivered her baby in the bathroom and tried to flush it, as well. So sad.
I think this is the result of a policy to 'reunify' children with their biological parents at all costs.

I was a CASA (Court Appointed Special Advocate) for 2 years for a family of kids in foster care. After trying to meet the biological mother half way (hell all the way) I spent nearly the whole 2 years trying to get those kids released for adoption -- the mother was a serial prostitute and drug addict, plus a liar. They were eventually released, by the mom, after my tenure, due to the efforts of another CASA.

What I found so frustrating is that policy of 'reunification,' which drives the state social workers and the court's decisions, which leads to their readiness to 'give the mom another chance,' over and over again. It's just bizarre.

I wouldn't count on that baby not going back to the mom.

denese
There are a few things happening in this story that made it an interesting read for me. You were called in to the Social Service staff meeting for your input, and to hear their discussion would turn one on one's ear immediately and set a tone of, "are you kidding me?!!" I would feel the way you did about what I was hearing too. "Defining deviancy down" is a terrible way, if not, "morally unjust" thinking. It's a difficult world you live in Doctor. I hope the world knows that if it weren't for "honest" moral reactions, negative or not, we would all be in a bigger mess. Consulted by others, or trained by ourselves, we must react to what is wrong in each and every discussion and uphold our own moral character.
My first impulse was to ask if you were frickin' kidding me... but of course you're not.

Good grief.
I've had the pleasure of working with some fabulous social workers. However...

A social worker from protective services tried to investigate my hospital for keeping children in "cages" in the Children's Hospital. Apparently, she didn't understand the risk of the little ones climbing out their hospital beds. And didn't know the difference between high safety rails and a cage.
I agree mental illness can wreak havoc on the innocent. But you refer to a "harmful role"... what do you mean by this? I worked as a counselor in a psychiatric facility for many years. Patient behavior can be shocking when one witnesses psychosis at its worst. Staff is trained to be subjective. Staff is absorbed into the aberrant behavior with mixed results-- some staff become judgemental; others become "healers". I've never sat in on crisis assessments where only voice was heard.
I was once in the room when a group was deciding whether or not we should feed a cute baby kitten to a ravenous wolverine. I don't think they quite understood why I got so upset, but I was a hero because by getting mad I stopped it from happening.
denese:

"What I found so frustrating is that policy of 'reunification,' which drives the state social workers and the court's decisions, which leads to their readiness to 'give the mom another chance,' over and over again. It's just bizarre."

I agree.

Of course it should be difficult to remove children from their parents. We don't want the state "punishing" people for different religious or cultural values. However, abuse and neglect cut across all religions and cultures. Everyone agrees that it is inappropriate behavior.

In addition, the foster care system is pretty bad. A child should only be removed when it is clear that the situation in the home is life threatening.

I'd wish I could say that this was the worst case I have ever seen, but it wasn't. More egregious were cases where the mother had multiple children removed from the home for severe abuse, and every time she had a new baby, she was given "another chance" to see if she could care for that child. It never worked out.
This is just a suggestion: you might want to find out if your area has a CASA office, and if they do, contact them on behalf of children you see, like the baby almost flushed down the toilet, that will likely be placed in foster care.

Volunteers are non-professionals (however, I was a non-practicing attorney) but are well-trained and are literally court appointed special advocates (similar to a guardian ad litem) for the children and report to the court on children in foster care from one, and only one family.

When OFS (Office of Family Services) case workers have caseloads of hundreds, the CASA can really make a difference, keeping on top of what is happening with the children to whom they are assigned. Many CASAs are committed, like I was, and spend 20 hours a week or more working their case for a minimum of 2 years.

You can't watch all of these children, but you can see to it that someone does.
Amy: I am still waiting to hear whether any of the other physicians/caregivers involved in the care of the baby and the mother gave opinions on this situation or whether only the OB/GYN chief resident was asked to participate in this disposition conference?

Did the mother have a psychiatry assessment? What was his/her input?

Neonatology/Peds must have been caring for the infant. NICU teams take potential harms against preemies very seriously. What was their input?

Since you were a chief and not an attending, did your attending participate? What were his/her thoughts?

Again, there had to be more people in the meeting than social workers and one OB chief resident. That just does not make sense (having been on the pediatric side of this equation).

And Denese, Amy hasn't practiced in quite some time. A situation like she described would not go on in any reputable institution today since social work alone does not dictate discharge disposition. A case like this involves a full team of providers from multiple disciplines. Ethics aside, there is way too much legal liability for a hospital to just be as cavalier as is implied here.
teendoc:

"A situation like she described would not go on in any reputable institution today ..."

You must work in very different institutions than the Boston hospitals where I worked. Every day we treated mothers who had drug problems, mental health problems and no visible means of caring for a baby and we sent those babies home.

When I was a medical student at the old Boston City Hospital, we saw children in the Failure to Thrive Clinic that were victims of unimaginable neglect (an infant whose 14 year old mother had been trying to feed it bologna sandwiches and chips, among others) and no one even thought of removing those babies.

Where, exactly, were they going to send them? There aren't enough foster parents to care for all the babies whose mothers are currently neglecting them or are incapable of caring for them.

People think that the big issues of our time are war and economics. Personally, I think the big issues of this time and any other is the vast number of small children brutally victimized and neglected each and every day. The idea that any hospital could possibly address each and every case, or could even try to address each and every case is ludicrous.
Want a comparable situation that is being played out in our media right now? Octomom.

This woman has no visible means of support, mental illness, preemie babies and six unhappy other children. Yet she got two of her babies home just this week.

Social workers err so much on the 'rights' of the parents, that children's needs get lost.
You must work in very different institutions than the Boston hospitals where I worked. Every day we treated mothers who had drug problems, mental health problems and no visible means of caring for a baby and we sent those babies home.

OK Amy, I'm not going to get into hair splitting arguments with you. This quote from you above is quite different than what you presented in your posting. Your posting was the story of a disturbed teen who tried to flush her preemie infant down the toilet and, but for your intervention, would have had the baby discharged to her care. You painted this as you against the social workers.

What I was referring to when I said that this wouldn't happen in a reputable hospital is the concept of social workers deciding a discharge disposition for a premature infant of a mentally disturbed teen taking only into account their opinions and the opinion of one OB chief resident and no one else on the treatment teams of either the infant or the mother.

This is my one and only point.
new blog:

"so was the girl charged with attempted murder?"

No, that issue never even came up.
Worse, and weirder stuff than this still happens in hospitals today, particularly in overcrowded, understaffed not-for-profit hospitals in urban areas that get the poorest patients and the patients without healthcare.

I've worked in hospitals where the nurses basically prescribed everything because the doctors were too busy or could not be bothered to make decisions themselves. The nurse familiar with the patient, medical history and current condition would call the doctor, tell him what was needed and get the OK. Despite the fact that the "treating" doctor was supposed to come in to at least sign the telephone order, more often than not they would all be signed by the chief medical officer in order to comply with regulations.

Discharge planners would meet with a patient alone and make the decisions regarding what the patient would need, without consulting the different treatment departments (physical/occupational therapy, etc.). The nurses would decide when it was time for the patient to go home, and would get the telephone order from the doc.

So, I'm not having that difficult a time believing the story from this post. In fact, I'm aware of a similar situation.

A girl from my high school hid her pregnancy from everyone except the father. She even started for the varsity basketball team at the time; her pregnancy didn't show. She had her baby at home, in the toilet, where he remained for several hours. Her sister found the girl on the bloody bathroom floor, and rescued the baby from the toilet. There was never any question about removing the child from her care. That was the right decision in that case though; the girl was just scared and confused. She ended up being a wonderful mom, with a chubby, happy, developmentally advanced little boy.

Social workers can go the opposite way, too. Lack of specific laws regarding what constitutes abuse and neglect has resulted in many children being removed from happy homes and being placed in unacceptable foster homes, where they may be exposed to undesirable influences, drugs and alcohol use and physical, emotional and sexual abuse.

The lack of foster parents combined with so many children being "placed" has resulted in less stringent requirements, bad foster homes and foster parents who should never be allowed around children.
When everything becomes acceptable watch out, it is this generation that is being back washed with some sorry pre-used soap, that doesen't applay to any type of common sense. The generation today is spared any consequence, and the rest of the generation is left to shake it's head in wonder of where have we gone as far as our moral compasses are concerned. There are many problems that stem from the way in which teens are handled in todays society, and to make it a finer point to the way teens themselves translate the latency in seperating fact from fiction. Today most teens don't sweat the small stuff, and apparently not the big stuff either. It's all like stuff man, that is the talk I experienc with my almost 17 year old daughter, my oldest son, used to say, "it's all good" is it? Disgusting is what I find it, and sad to think that people who are paid quite sufficiently to determine if abuse exists, would equally go after a mother shoving her child out of the car, becauce the kid is tired or just not complying than a mother who is underage, has mental issues, that is a great bandage, very nice to wear, proud aren't we of two little words that can camflauge anything from attempted murder to being OCD with putting on make-up or other product. It's a joke, your tirade was completely justified, it is not okay flush your baby down the toilet. Had someone not noticed the blood coming from the other stall, that baby may have ended up dead.
sickofstupid: please note that I have asked and have not received an answer as to whether any other physicians or caregivers involved in the baby or mother's care were asked their assessment of the discharge plan. No answer was given by Amy. As such I cannot take this to mean that the involved personnel were too busy, too unconcerned, or too jaded (all but Amy, that is) to provide input as you describe in the sad conditions in which you've worked. Were that the case, I'm sure she would have no trouble indicating as much, but she has not.

And while I do understand that these type of behaviors can happen, I do not believe that they do or should happen in reputable hospitals. What I mean is this. I am not trying to say that every scenario of underskilled or clueless or neglectful parenting gets dealt with appropriately and the child gets placed in foster care. What I am saying is that in the case of an attempted murder of an infant, the ante generally gets upped for all parties and more systems get activated. At least that has been my experience in pediatrics since I started my residency in 1988 until today.

We had some pretty major cases end up in the various hospitals I've worked in, and no social worker team would ever think of deciding a discharge disposition all by itself for such a case and no treatment team would ever allow such a thing to happen.
sickofstupid:

"The lack of foster parents combined with so many children being "placed" has resulted in less stringent requirements, bad foster homes and foster parents who should never be allowed around children."

Unfortunately, that is all too true.
On this issue teendoc is right.
Amy, I ask this as an honest " writing process" question to you, neither pro or con to what you wrote here.

Tha back and forth in comments elicited an interesting piece of information: The baby and the mother would have been sent home to another adult (the baby's grandmother). You're judgment was that this is meaningless because the grandmother did a poor job raising the daughter. My speculation would be that other's in the team might have argued differently, given that the daughter was 16 and not a legal adult.

My question to you: Did you consciously leave this info out of the post because you judged it meaningless and not key to the story? Or, did you think you sub-consciously left it out?

Your many readers who come here to challenge and argue with you often get most upset because the posts paint very black and white situations and conclusions. I am curious whether this is somewhat intentional because it certainly does make for lively Q&A's and which brings more traffic?

On the other hand, if you get tired of people accusing you of being rigid and domineering, maybe you could try to figure out what you are leaving out that someone else might think should be part of the gray.

Like I said, I'm curious about your process.

I rated because you do write interesting pieces.
Teendoc:

You're preaching to the converted.

Please don't hold your breath waiting for a response that appropriately addresses your specific response, because it's not likely to happen here.

These posts are provocative, but not always factual. Facts that are presented with "supporting evidence" linked often turn out to be statements taken out of context and misrepresented to support the author's opinion. This is ignored if pointed out, or is responded to with a statement that fails to address the issue raised or legitimate questions asked, the answers to which would force her to deviate from her stated opinion.

In no article by this author have I ever seen her admit even the possibility that she was wrong about anything. Fine when you're dealing with opinion; not good when you're supposedly dealing in fact.

The ability to admit when you are wrong is essential for credibility, but losing readers doesn't much matter when the provocative nature of your posts continually attracts more.

I'm with you if you want to continue to try. =)
First time reader/commenter. I stumbled upon this and found it interesting, especially the discussion going on in the comments. I'm a social worker that works with teens in foster care. I have no first hand experience in the child protective services arena, but my job makes me familiar with the unit, policies, and workers in my county.

The pendulum of Child Welfare is always swinging, back in forth between parental rights and child safety. Depending on who you ask, CPS workers are either snatching children from good parents or not vigilant enough protecting the safety of children. I am thankful that CPS is not my job. In my agency, we are really striving to find a balance between family-centered practice and child safety, but it's difficult because we're always trying to dodge that damn pendulum when it comes swinging past our heads.

I can't give a professional opinion on the Wonder Bread baby. My initial reaction was, of course, that there is no way the girl should have her baby back. However, there is way too much case information that the team members at that meeting would have had that is not included in the article. I'm very curious about the grandmother that was mentioned in the comments, who was dismissed by the author, though no information was given about her. How many parents have struggled to control their 16 year old children? Then add serious mental health issues on top of it. If this were the case--that she was a healthy, appropriate parent who had an out of control teenager, but is entirely capable of taking care of a young child--I could see social services supporting a plan that the baby going back to the home, in the custody of the grandmother, while involving (court ordered) in-home services to ensure that the mother's mental health needs gets addressed. Or even involving the grandmother to have the mother placed in some kind of residential setting to meet the mental health needs, if they are that severe.

I'm also curious, as teendoc said, about other members on the the team. As a social worker, I want as much information as possible before I'd make decisions. Psychiatric/psychological evaluations, doctor reports, police reports, background checks, CPS history, school history, work history, family supports and resources, possibly substance abuse evals, etc.
When I clicked on this, I couldn't believe that there could possibly be anything weirder than attempting to flush a baby down the toilet but clearly there is. It's incomprehensible to me that you were the only one who considered attempting to flush the baby as a red flag for potential child abuse. It's a bizarre world, isn't it?
I am skeptical. First of all, where did the mother get an empty Wonder Bread bag if she was locked in the bathroom? It seems like an odd item to bring with you to the hospital and I doubt the ER has Wonder Bread bags just laying around. Secondly, there is mandatory reporting of crimes like child abuse so the police had to have been involved at some point. If the police were never called about this situation, any medical professionals involved could be brought up on charges for not reporting child abuse that could result in death. It just doesn't make sense to me.
Lisa Kern:

"It's incomprehensible to me that you were the only one who considered attempting to flush the baby as a red flag for potential child abuse. It's a bizarre world, isn't it?"

I doubt that I was the only one, but I was the only one at the Social Service meeting. I suspect there were not many doctors and nurses who thought that the baby should go home with the mother.
"I suspect there were not many doctors and nurses who thought that the baby should go home with the mother."

So this was not a meeting where decisions were made, since no one with sufficient authority actually attended.
K Shechter:

"So this was not a meeting where decisions were made"

No, this was the meeting where the decision was made to file for a child protective order. The ultimate decision, of course, was made by the State.

You, and several others, are laboring mightily to miss the point. The point of the post is that women guilty of egregious child abuse and neglect routinely take their babies home. There is simply no doubt about that, as many others have confirmed.
You, and several others, are laboring mightily to miss the point.

No Amy, we are not laboring to miss the point. We are laboring to make sense of the story you have told us. You've painted this tale as another Amy versus Goliath encounter in this particular case of attempted infanticide. Now you are saying in the comments that your point was actually about how infants and children go home with parents who are less than fit to care for them.

Perhaps you might have framed your story a bit better to make your point because as it stands, there are too many holes in the attempted infanticide story for it to hold on its own as proof of your thesis.

Now to your true point, I actually agree with you (shock of shocks, I know). It saddens me to no end the people I see parenting some children. However, since I don't live in a world of extremes of judgment and reason, I still have to ask, is a mentally unstable, fearful teen someone who cannot be taught to be a better parent? Can she not be redeemed now that the whole situation is out in the open and the disaster she feared would happen (many of the teens who hide pregnancy fear overwhelming disaster will occur when their parent finds out) has not transpired? Is it possible she could grow to love and learn to be a good parent?

I suspect that your answer would be no. You'd look at her race, class, unmarried status and/or her heinous act in the bathroom and say, that's it, no further chances for you! Yet I believe in growth, in learning, in becoming more than you were. So I'd have a hard time saying that it isn't possible for this kid. I'd also have a hard time saying that even if her kid went into foster care, that there'd be no hope of reunification for them.

Sometimes people are evil and sometimes they just need help.
teendoc:

"You've painted this tale as another Amy versus Goliath encounter in this particular case of attempted infanticide. "

"I suspect that your answer would be no. You'd look at her race, class, unmarried status and/or her heinous act in the bathroom and say, that's it, no further chances for you!"

Will you grow up already? You don't know anything about me. Stop projecting your own prejudices onto me.

If you don't like my posts, or don't agree with them, or don't believe them, don't read them.
Amy: "As in all these discussions (and there were way too many) a great deal of emphasis was placed on the fact that the mother would live with the grandmother who, it was presumed, would take care of the baby. Of course, she was the one who had "taken care" of the mother, so in my judgment, that was meaningless."

My response: The added element drastically changes the flavor of your story. You left it out because you thought it was meaningless but it was intrinsic, obviously, to the reasoning of the staff. I suppose that's the folly of opinion blogs.
Teendoc, kudos to you for being so considerate and patient while repeatedly restating your point. I thought your approach was clear, intelligent, and conducive to the point. I would have liked to hear an answer as well.
Teendoc: "Now to your true point, I actually agree with you (shock of shocks, I know). It saddens me to no end the people I see parenting some children. However, since I don't live in a world of extremes of judgment and reason, I still have to ask, is a mentally unstable, fearful teen someone who cannot be taught to be a better parent? Can she not be redeemed now that the whole situation is out in the open and the disaster she feared would happen (many of the teens who hide pregnancy fear overwhelming disaster will occur when their parent finds out) has not transpired? Is it possible she could grow to love and learn to be a good parent?"

After hearing that her grandmother offered to care for the baby, it's another matter entirely. I would want to know specifics about the 16 year old girl, namely was she having a Bipolar episode? Has she been treated? What are the living conditions in the home? What resources does the grandmother have? There are so many factors involved that I really don't think Amy's post elucidated a significant lack of reason on the part of the staff, particularly because it's evident that her blog post was a work of art in "Amy's perspective" and clearly not accurately reflective of the situation. I agree with you that there are too many holes. There are too many questions that need to be answered.

Again, I think you were completely reasonable in your approach here. The grow up already comment was inappropriate and rude.
Will you grow up already? You don't know anything about me. Stop projecting your own prejudices onto me.

If you don't like my posts, or don't agree with them, or don't believe them, don't read them.


Amy, we are almost the same age, and as such I'd like to think that we have both grown and matured quite well already with more learning and growth to come.

I never pegged you as a person who needed a bunch of yes men and women or sycophants as blog readers. I thought you could handle critical dissent. But your essentially telling me to go play somewhere else is beneath you.

Snailgoop: Thank you.
I'm with you Teendoc. If you're going to be an "OS Sensation" and be at the top of the most read list CONSTANTLY, be prepared or some critiques. Teendoc/R always provides validity. It's hard to run from another professional.
Kind of Blue:

"If you're going to be an "OS Sensation" and be at the top of the most read list CONSTANTLY, be prepared or some critiques."

Don't worry. I understand that the "critiques" are motivated by jealousy, not by the substance of the posts. Evidently, it it much easier for some people to complain about other's work than to improve than to improve their own.
Don't worry. I understand that the "critiques" are motivated by jealousy, not by the substance of the posts. Evidently, it it much easier for some people to complain about other's work than to improve than to improve their own.

As if I would be jealous of you, Amy! There is nothing you have to which I would want to lay claim. This nastiness from you is unwarranted and unfounded. Either you can handle reasonable dissent in your blog or you can't. There is no need to descend into the recourse of the lazy and uninspired: name-calling.
"Will you grow up already? You don't know anything about me. Stop projecting your own prejudices onto me.

If you don't like my posts, or don't agree with them, or don't believe them, don't read them."

"I understand that the "critiques" are motivated by jealousy, not by the substance of the posts. "

HA!!!! Amy pulls out the Jerry Springer guest defense.

"You don't know me! You're just jealous! Talk to the hand!"

You've evolved from absurdity to comedy! Low brow comedy, but comedy nevertheless.

Your stream of ad hominem attacks highlight your complete lack of credibility.

You should just tag this post as fiction and be done with it.
Any valid point you may have had has been completely undermined by the manner in which you responded, or failed to respond, to reasonable, logical questions about your story.

It is impossible to take anything you have to say seriously when you show yourself so unable and/or unwilling to engage in genuine dialogue on the facts and issues.

You've made it clear that you do not welcome those who dare to disagree with you or ask questions about your alleged facts, and this tells me everything I need to know about your intellect and your character.
The Dr. Amy Guide to Winning an Argument (Revision 2):

1. Start with extreme contrarian and/or judgmental opinion

2. Support with unrelated anecdotes, often of reprehensible behavior

3. Challenge others to prove opinion wrong

4. Deny validity of all arguments and evidence provided by those who disagree, AND

(a) Launch personal attacks against "critics"
(b) Support personal attacks with Jerry Springer defense
"You don't know me! You're just jealous! Talk to the
hand!"

5. Proclaim victory

6. Run away
"Don't worry. I understand that the "critiques" are motivated by jealousy, not by the substance of the posts. Evidently, it it much easier for some people to complain about other's work than to improve than to improve their own."

After reading the comments, I could say that perhaps it wouldn't hurt you to take your own advice.
Amy: "It worry. I understand that the "critiques" are motivated by jealousy, not by the substance of the posts. Evidently, it it much easier for some people to complain about other's work than to improve than to improve their own."
My response: I wholeheartedly disagree that every person that makes any critique of any part of the content of your blog posts is nothing more than "jealous." Do you apply the same "critique" toward yourself when you respond with insults to those who comment on your blog? Or is there one rule for Amy and one rule for everyone else? I think it would be fascinating to see you be honest about it and list all the ways in which you think yourself so superior and flawless in your opinions that all critiques are automatically misrepresentations and reflect negatively on the person posting them.
As a social worker I see this attitude from MD's all too often. I agree with the previous poster that social workers are seen as either the person who takes your kid away or the people who let a child die in foster care. Ignorance is the word we use for this type of representation but it's not the public that's ignorant in this case, it's this doctor. I appreciate that she notes that our hearts "are in the right place" but those kinds of comments are a way of diminishing the skills and training we have. I and my colleagues have numerous personal anecdotes regarding dismissive and elitist treatment from psychiatrists and psychologists alike. I think people forget that social workers provide the overwhelming majority of clinical care in this country. God bless clinical psychologists and psychiatrists but they are the minority in terms of hands on care. Yet social workers are marginalized and ignored in stories like these. Whatever the intent, the animosity toward social workers was clear and recognizable to those of us who have worked in hospitals. The medical profession is currently struggling with how to represent expertise while eschewing responsibility (because of liability obviously) which is good I think, they are no longer allowed to represent themselves in the role of God. But as we see here it is still a constant temptation. If it wasn't for this hero what atrocities might be committed if the world was left to lesser professionals. Social work as a field goes far beyond social services, we provide in excess of 90% of all psychotherapy in this country while psychiatrist provide less than 10%. It's time we were treated with more respect than this woman has here.

Incidentally, Dr. Tuteur, you are the only MD I've every known who subscribes to a strictly social constructionist philosophy. You disregarded the suitability of the grandmother as a parent based on the functioning of the daughter, a more critical ear might have heard you say that bad parenting caused serious mental illness. Without knowing what illness you were referring to we can't say how likely that is. But as it stands most MD's err on the side of biology as the primary determinant. Your rejection of that attitude is both refreshing in it's novelty, and disconcerting in it's extremism.
NYC Social Worker,

You have no way of knowing whether it was appropriate for that baby to be sent home with the mother or not. You're simply taking the "side" of the social workers out of reflexive sympathy for them, and conveniently ignoring the fact that you have literally no idea what was best for this baby.

Let's hope you take the facts of the case into account when dealing with your own patients, as opposed to reflexively agreeing with your colleagues.
I am a victim of child abuse, but to save my little brother from foster care I had to just live with it. Since I was the only one suffering I didn't want anyone else too.

Social workers are idiots. They were called three times and the third time they were all prepared to take us all away but they got fooled so easily into believing we were one happy family...
I made no argument in regard to whether the baby should have been sent home. I sided with nobody in that regard. As has been noted, you did not provide enough information for anybody to comment on what should or shouldn't have happened. And of course, no one person ever has to (or gets to) make that determination in any ethical agency or hospital.

You are right though that I did let my heart get in front of my head. If anything I was trying to side with the baby in this case. As you are I assume. Calling you ignorant and implying that you are elitist does nothing to bridge the gap between our professions. Without mutual respect neither of us is on the side of those in our care.

Kittyluck, I'm sorry for your experience, it must have been terrible. CPS is a difficult job which I wouldn't wish upon anybody. Unfortunately most highly qualified and educated social workers won't work there, for many reasons, not the least of which is that they don't want to be put in the situation you described. CPS might be the hardest job in the mental health field and yet funding requires that we staff it with inexperienced and under trained professionals. You have seen the result of that policy personally, for that I am sorry.
Well stated. Sounds like the mother's mental illness is just a few steps above that of your co-workers.
Amy's response to NYC Social Worker:

"You have no way of knowing whether it was appropriate for that baby to be sent home with the mother or not. "

Neither did you. You consulted with whom? No one. Pot, meet kettle.

"You're simply taking the "side" of the social workers out of reflexive sympathy for them, and conveniently ignoring the fact that you have literally no idea what was best for this baby."

See Amy tactic #4: Deny validity of all arguments and evidence provided by those who disagree

"Let's hope you take the facts of the case into account when dealing with your own patients, as opposed to reflexively agreeing with your colleagues."

and 4(a): (a) Launch personal attacks against "critics"
To add a little bit to NYC Social Worker's comment. There is a difference between a social worker and a person with a social work job. A social worker is required to have a degree in social work, with an increasingly emphasis on a Master's degree in the field. Then, there are licensing requirements, as well. However, due to the lack of people with social work degrees and/or licenses, there are often times when people with other backgrounds are employed in "social work" jobs. In the social services arena, I often see "social workers" falling into two categories. One, as mentioned above, are case workers with degrees in history, business, education. In Maryland, there is a 18 day "competency" training for those without a social work background before beginning child welfare work. Eighteen days versus six years of college and intern experience? Hmm. The other case is people who are licensed social workers, but are in their early to mid 20's and just out of college. These young social workers stick around social services to get a few years of experience, receive the supervision and work time they need to upgrade to their clinical social work license, and then move on to greener pastures.

That said, Kittyluck, there are social workers who are idiots. Just like there are teachers, doctors, construction workers, etc. who are idiots. But not all of us are. I've met social workers who are an embarrassment to the field, but I also know a lot of social workers who picked their job because they want to help people and are great at what they do. I'm sorry that your experience was with the first type. I'm also very sorry that you were a victim of abuse.

Back to the topic at hand, I still stand by my opinion that there is too little information presented to make a decision on what should happen to the Wonder Bread Baby. Nothing I've read since I comment several days ago has changed my mind.
Amy,

As I've said before, when you choose to add the initials "MD" after your name, and choose to outline your fancy Harvard education and the name of your medical school in your bio, nothing you write with regard to medicine will be considered "opinion" by most folks.

There are those who read your blog who were raised during the years where it was unthinkable to question a doctor.

There are those who assume that you wouldn't publish anything other than factually correct information.

There are those who may wonder why you won't answer reasonable questions about the "facts" you state, but assume that you mean well.

As long as you're going to disseminate incorrect or misleading information, someone who actually knows what they're talking about and is willing to prove it--not misrepresent statistics from a linked study to make it seem as though you are correct, but prove it--needs to be here reading it in order to prevent readers from being harmed, or from passing on the damage to someone they care about.

If you don't like the questions you get, I suggest you change your username and bio rather than hiding behind them in the attempt to appear credible, or post a disclaimer in big bold font that any information on your site is for entertainment purposes only, and should not be considered a substitute for professional advice from a qualified healthcare provider.
i hope she doesnt get charged with murder, or atleast heavily charged. i had a friend who was ill, always seemed paranoid and desperate. desperate people do attempt silly things sometimes.

in the case of this story, maybe we can help the mother. it doesnt have to be a lose-lose situation for the mother or baby. surveillance is not what i intentionally mean when i say, "a nanny!" or you know, anything relatively synonymous. to me it sounds like a good idea, its like shooting down 2 birds with one stone, in this situation a teen mom and a baby. figuratively.

free... hell even subsidized care-giving could be great for the long run too. i just hope the parents of the teen realize they need to help sooner or later. i hope no one thinks i am out of line. i really feel for the mother here.
I'm sorry to say this, but I believe this story.

Recently an acquaintance was allowed to take her fourth child home from the hospital. This was in spite of the fact that during this pregnancy, she had been going through the process of having her third child permanently removed from her care. (Children 1 and 2 had been permanently removed from her care several years earlier.)

During the pregnancy (and court proceedings) she missed her court required drug and alcohol tests. This was a smart move on her part, because she was using - alcohol for sure, and crack probably - again.

She left the hospital with her new daughter two days after the birth. Apparently there was never any question about whether she should take the child home or not. Since she's on the state Social Services health plan, they had to know of these issues.

There does seem to be a distinct tendency to let hope triumph over experience in these matters.
I also believe this story. Based on things I have seen it rings true to me.
New - why charge with attempted murder. What is the difference between flushing a 2 month premie due to premature delivery and
an abortion.
She obviously didn't want he baby. Show could have just had it aborted and plenty of docs would have been happy to oblige.
If you going to kill a premie baby that cant survive without
a high tech NICU and lots of special care, what difference does it makes who does it. Well there is the big technicality that the baby actually fell out of the womb. At that moment it became a person.
2 mo. premie still inside and its just a piece of meat to be aborted at the mothers whim by the proper licensed people.

Oh, you have to be a MD to perform that task.
So I guess the charge should be practicing medicine without a license. I cant see why the mother cant do the abortion herself. If she wants to injure or kill herself in the process hat should be her choice. All this woman did was perform the abortion moments after the technical deadline. After all, docs perform abortions
because they have the skill to protect the mother from injury, not he baby.

In one case its just a girl not fit t be a mother and maybe an attempted murderer, but not likely . In the other, its just a girl not fit to be a mother who chooses to definitely do away with the premie before the unexpected delivery and no one would consider charging her with anything.

Something to think about? I doubt most here will think anything except that I am an ass.
@joseph cole time, for starters. and if it looks like a baby and breathes like a baby and is outside the womb, like that other cute little baby, who is to say its not a baby. tomatoes are still vegetables to me, but im going to say its a baby.

anyways, the teen was mentally ill right? i think they shouldnt give the baby back right away, but u no, give the new mom a second chance when shes more in control and less...desperate. more often than people think, things do happen on an impulse. like shopping (ugh u girls and ur instincts to burn my wallet!). we see a situation, we see an opportunity and we become mislead to believe its a bargain. i think this was what happened, and if she was serious enough, she wouldnt of got caught per se by a security guard. if it was planned it could possibly be counted as murder, and chances are she wouldnt of got caught. less likely, anyways.

the more i think about this story, the less im starting to believe it. the doctors, social workers, etc didnt give the baby to her, like cold turkey did they. i can understand they giving the baby back...but ...u know..

ps i dont think ur an ass. high five!
I'm in total agreement. There seems to be a serious disconnect with people in social services these days. Perhaps they have seen too much and hence have become jaded or dulled to reaction, perhaps we have de-activated the "compassion" button. Whatever the reasons, the understanding of what is right for the good of all has been seriously eroded.
Man, this kicked up some dust. I am for now, and just because their is some strange shit going on in this world,going with Amy. I don't know if she exaggerated or not. The point is, the poor baby lived.
Hi,

This is a wonderful opinion. The things mentioned are unanimous and needs to be appreciated by everyone.

robinson

Baby Gear
This is one of those instances, where you realize the weirdness of our culture. We speak about how every child has a right to be born and everyone should have children to fullfil their destiny or what ever. Children are seen as the most important thing on the planet, and motherhood a sacred way of being. But this is where the child's rights get stepped on, the mother's right to their baby always seems to go in front of the child's right to a normal happy childhood and life. This is not a puppy dog we're talking about - and if it was, nobody in their right mind would allow a person take a puppy dog after trying to flush it down the toilet. Sometimes the rights of an animal are better seen to than the rights of a child. (Not that I'm against that really, just saying that it is a bit backward.)

You had every right to be angered and shout at them. They needed a wake up call, badly. The baby was lucky to have you around.
Yes, she did try to flush the baby down the toilet. However, did anyone ever see the girl's side of the issue?? She may have been afraid of her parent's reactions to the pregnancy in the first place; after all, she DID hide it. What she did was probably out of shock and confusion...contributing to her actions. She was getting rid of the baby because no one knew about it and she did not get any counselling about the whole issue either. There's a lot more to this than anyone here commented about, including myself. I believe once everything is figured out as to why she tried to flush that poor baby, I know that she would have had a chance to keep it. Such a sad story. :(
A lot of people said this couldn't be true, but I think it's all too believable. I would bet that one person in the room, probably the lead social worker, began the meeting by expressing the view that they had to consider the mother's rights, or some other plausible sounding defense of what obviously should be indefensible. After that, it took guts, and maybe a certain amount of sleep deprivation, to defy the group. Basically, you had to be the one person in the room willing to look bad for violating rights, or whatever they'd decided they were doing there.
I must say it's beyond tiresome to come read these well-written posts whose points, grosso modo, have little or nothing to do with whether or not Dr. Tuteur rode off into the sunset on a horse all by her lonesome, only to find that the important stuff is, indeed, being jettisoned by people who seem hell-bent on getting into tangles with her--including other obviously intelligent and articulate health professionals. Yes, Amy, you _should_ do one of two things: Either write a disclaimer at the beginning of an article indicating _exactly_ what it is you're focusing on (i.e. the notion that some people you worked with seemed to have had their perspectives warped severely by their experiences to the point where sending home an infant with a woman who'd attempted to murder it was acceptable), or provide more contextualising detail. It would be helpful.

It would also be largely excess to requirements here. The point here is that in cities all over North America (especially in the United States), hospitals are indeed aiding and abetting the dangerously sentimental notion that children are always best off with their biological parents, particularly their mothers. There's an extent to which, sadly, this is understandable--the foster system in the US is so overcrowded and underresourced that flipping a kid into it isn't something anyone wants to take lightly. But the notion that kids from hopeless backgrounds (sorry) and suffering from (usually untreated) mental illness can just learn to love their children . . . well, you go ahead and take that chance if you want. I simply could not assent to it with any intelligent fibre of my being.

And finally--and this will prove the most unpopular assertion of the day anywhere on OS, I'll warrant--sexuality needs to be "demonised" _more_, not less; if more people of all ages were taught, however harshly, that it is a powerful thing that has as much power to harm and twist and ruin our lives as it does to make us feel all loved-up, and that it is connected to our reproductive systems (which we still often seem genuinely to forget), and that girls, fairly or not, need to be guardians of said systems, because they get pregnant while guys just walk away, we _might_ actually make a slight dent in some situations like the above. But who'm I kidding? We'll never do that.

Happy New Year.
Most people do not want to take responsibility anymore, nor do they want to get involved in fixing or handling difficult situations. This is systemic, since it is not only people, but institutions as well. The lack of accountability and responsibility has spiraled downward ever since the second half of the 1980's. The same lack of commitment, of the sense of community and of a common project is what allows people to even fathom having a conversation like this. We have lowered our standards in every possible way and on every aspect to deny that may make us look or feel bad. I thought we had hit rock bottom, I remain puzzled out how we continue to go down.
Thanks for standing up and telling them, honestly, the truth. I am sure you may feel like the others were not listening, and that you were the only one thinking this way, but I am certain that at least one other person in that committee thanks you for having the guts he or she did not have.
The first sentence of the second paragraph is beautifully crafted. What I find truly scary are the comments of disbelief. It's amazing that anyone can't find a similar moment of severe thoughtlessness in their own lives. For me it was the faculty meeting where "the need to teach critical thinking" was discussed. I finally asked "shouldn't critical thinking be the main byproduct of what we do in the classroom." Thank you for writing this. I hope many walk away from this in thought.