I had a few moments to speak to an obstetrical colleague this morning and lay out the circumstances surrounding the birth of Trig Palin. His observations were as follows:
Amniocentesis is generally performed sometime after fourteen weeks of pregnancy, generally from fourteen to seventeen weeks. In modern times it is always done in conjunction with ultrasound, which may or may not identify cardiac anomalies at that time, because the fetus is so small.
If the amnio comes back with a diagnosis of trisomy 21, or Down's, there are always followup ultrasounds done, because of the very high incidence of cardiac and other anomalies. Generally by twenty weeks gestation most such anomalies can be identified. Certainly by thirty-five weeks or so, any heart anomalies will be detected and characterized as to what treatment will be needed at birth, if any.
Family practice physicians generally deliver only low-risk pregnancies, however there are FPs who have done a one-year fellowship in OB, and they are highly qualified, so it is entirely possible Cathy Baldwin-Johnson, with proper training, could deliver a Down's baby with known cardiac anomalies. However, someone with this much training would never deliver such a child in the backwoods; they would need the pediatric backup provided at a large institution. Of course, IF there were ultrasounds done and IF there were no significant heart defects, she could certainly deliver the baby at more rural hospital, such as Mat-Su.
So, with all the proper circumstances, it is very possible to safely deliver a Down's baby in the backwoods, but after having said this, the good doctor observed, "This does not pass the smell test; there is something very wrong here."
Also, as a final point, I would like to say that when I was speaking to my colleague, I did not mention some of the other specifics of the birth that are known, for example that her amniotic membranes had been ruptured 24 hours when she arrived at the hospital, or that she was 4-5 weeks early. I will ask him about this the next time I see him.
From Audrey: When all is said and done, I still can't get past one simple fact: So much could be resolved by the press conference I have been asking for for a month: Cathy Baldwin Johnson, accompanied by the CEO of Mat-Su, standing up and stating that Trig Palin was born in that hospital on April 18th, that Cathy Baldwin Johhnson was the physician in attendance, and that Sarah Palin is Trig's biological mother. Three things. No embarrassing or private obstetrical details, just a basic statement of fact that should take less than thirty seconds to provide.
What is the big deal? Doctors speak to the press all the time. I lived in central Virginia during two *big* medical stories - Christopher Reeve's terrible accident and the infamous "baby swap" both of which involved the University of Virginia Hospital. Good Lord, those docs were on TV every day... you couldn't shut them up. HIPAA notwithstanding, there's no problem giving your physician permission to speak to the press if you want to.
Cathy Baldwin-Johnson's silence is the loudest proof of all that something is being hidden. What, I cannot say with confidence. But something.
Now we hear that Palin *might* release her medical records, and she went out of the way to state that her records will prove she had five children. We'll see. These are the same people that gave us WMD in Iraq, so pardon my pointing out that giving us Trig Palin in Palmer Alaska probably would not be too much of an obstacle.