Unreal World: ‘Hart of Dixie’s’ emergency delivery

“Hart of Dixie”

9 p.m. Sept. 26, CW Network

Episode: Pilot

The premise: Dr. Zoe Hart (Rachel Bilson) completes her surgical residency at a prestigious New York hospital but doesn’t get a coveted spot in the cardiovascular surgery fellowship program there. The program director tells her that she has great surgical skills but that she needs “to learn to see patients as people to help, not puzzles to solve” and suggests that she spend a year working as a general practitioner before reapplying for the fellowship. She heads to Bluebell, Ala., to work with an elderly physician who has been trying to recruit her since she graduated from medical school. Zoe proves herself by helping Mabel (Ann Mahoney), an obese young woman who has been dumped by her boyfriend and is withdrawn and upset. Zoe realizes that Mabel is hiding a pregnancy after she notices dark patches on her face, which expectant mothers often get. The next day, Mabel is stricken with pain while serving food at an engagement party. Zoe arrives and discovers that her patient is in labor, with contractions only 15 seconds apart. Zoe decides there isn’t enough time to go to the hospital and gets ready to deliver the baby at the home where the party is being held. But the baby’s shoulder is stuck in Mabel’s pelvis, a potentially life-threatening condition that usually leads to an emergency Caesarean section. Zoe gives Mabel a local anesthetic and performs an emergency symphysiotomy. Mabel delivers a healthy baby girl.

The medical questions: Can an obese woman hide a pregnancy for nine months and give birth to a healthy baby if she didn’t have any prenatal care? When is it too late for a woman to travel to the hospital to give birth? What causes dark spots during pregnancy? Can a patient progress to the final stages of labor without warning? What is a symphysiotomy, and can it be performed safely outside of a hospital?

The reality: It is possible for an obese woman like Mabel to hide a pregnancy and give birth to a healthy baby without prenatal care, says Dr. Brian Koos, a professor of obstetrics and gynecology at UCLA. But studies show that the lack of prenatal care is associated with a 40% increased risk of neonatal death as well as a higher risk of preterm birth and low birth weight. Children of mothers who didn’t see a doctor during pregnancy also are more likely to develop respiratory-distress syndrome, bleeding in the brain and eye and lung problems.

If the baby has already begun to emerge from the birth canal, it is too late to travel to the hospital, says Dr. Mari-Paule Thiet, director of the division of maternal-fetal medicine at UC San Francisco. Otherwise, she says, an attempt should be made to get a pregnant woman to a hospital delivery room. If a woman is going to have a home birth, she needs to make preparations in advance.

In the show, “they should have called 911,” Koos says. Emergency medical technicians can transport the woman to the hospital in an ambulance and provide care or deliver the baby if needed on the way.

Dark spots often appear on the faces of women who are pregnant, says Dr. Manny Alvarez, chairman of obstetrics and gynecology at Hackensack University Medical Center in New Jersey. The condition — known as melasma or “mask of pregnancy” — can be triggered by increased levels of the hormones estrogen and progesterone; exposure to ultraviolet light also can be a factor. In women who are not pregnant (and possibly some who are), melasma can be caused by an increase in melanocyte-stimulating hormone in the pituitary gland, he says.

Labor is unpredictable, and a patient could find herself in advanced labor without warning, but it would be unusual in a woman who is giving birth for the first time, Thiet says. In such a patient, the first stage of labor — in which the cervix dilates from 1 centimeter to 10 centimeters — usually takes 18 hours. But advanced labor could seem to occur without warning if, like Mabel, the patient is ignorant of labor symptoms or ignores them, Koos says.

A symphysiotomy is a surgical procedure in which the cartilage in the center of the pelvis is separated with a sharp surgical instrument to make more room for a baby to pass through. It is commonly performed in parts of Africa, where modern medical facilities are scarce and it’s difficult to perform C-sections. In America it is a very rare procedure that is only used as a last-ditch effort to save the baby, Thiet says. “I have never met anyone who has done one,” she says. It can lead to maternal trauma, making it hard to walk afterward and possibly injuring the bladder. It could conceivably be done outside the hospital, but this means less anesthesia and more risk of infection, bleeding and other complications for the mom.

Siegel is an associate professor of medicine at New York University Langone Medical Center. His latest book is “The Inner Pulse: Unlocking the Secret Code of Sickness and Health.”

marc@doctorsiegel.com