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Brain-dead woman gives birth to healthy baby boy Mother kept alive for 3 1/2 months


OAKLAND, Calif. -- In what doctors are calling a medical miracle, a healthy baby boy was born yesterday to an Oakland woman who had lain brain-dead in a hospital bed for 3 1/2 months.

Doctors at Highland Hospital delivered the 32-week-old infant by Caesarean-section at 12:20 p.m. yesterday, about two hours after Trisha Marshall's blood pressure dropped precipitously, threatening the baby's safety. But there were no complications during the surgery and the 4-pound, 15-ounce infant came out kicking and screaming.

"It's a bouncy baby boy," Dr. Richard Fulroth, a neonatologist, announced at a packed afternoon news conference. "The baby had a cute face. There's nothing to prevent this baby from having a complete life."

Doctors disconnected Ms. Marshall's ventilator after the delivery and her heart stopped beating a short time later.

The child's birth capped a tumultuous few months for the hospital, which unexpectedly was thrust into the medical limelight April 19 when the 28-year-old Ms. Marshall was rushed into the emergency room after she had been shot in the head during a botched robbery attempt. Police said Ms. Marshall had tried to rob an amputee and had threatened him with a meat cleaver; he fired at her.

When doctors discovered she was 17-weeks pregnant, they put her on a respirator and hooked up a feeding tube to try to prolong the life of the fetus, a rare and risky procedure.

At the time, doctors said it was unlikely the child would survive because they expected Ms. Marshall's heart and lungs to give out within two weeks. But the woman's stamina surprised medical experts. She carried the infant for 104 days after being declared brain-dead, just shy of a 1989 record set by a brain-dead woman in Vermont.

"There were a number of times we nearly lost her," said Dr. James Mittelberger, an internist who chairs the hospital's ethics committee. "There were many times we had to react quickly to changing situations."

Shortly after his birth, the baby went into respiratory distress, which is "not unexpected" in a 32-week-old premature infant, Dr. Fulroth said. The boy was put into an incubator and transferred to Children's Hospital in Oakland, which is better equipped to care for medically fragile children.

The decision to try to save the fetus sparked an ethical debate because the hospital run by Alameda County was facing a budget deficit and Ms. Marshall apparently had no health insurance. But doctors repeatedly said they could not consider the cost of treating a patient. They were morally obligated to try everything to help the fetus.

Ms. Marshall's hospitalization cost about $200,000, hospital officials announced yesterday, although they declined to say who would pay the bill.

As the medical battle ended, a new one began brewing: Who will receive custody of the baby?

Although David Smith, 32, of Oakland, maintained throughout the ordeal that he is the baby's father -- he and Ms. Marshall had two other children together -- Alameda County officials have doubts about the paternity. The hospital drew samples of the infant's blood to determine whether Mr. Smith is the father, said Dr. Floyd Huen, Highland Hospital's medical director.

The newborn boy -- whom Mr. Smith has named David Jr. and whom hospital workers call Baby Marshall -- officially was released into the custody of the county's Children's Protective Services.

Cathy Smith Rivers, Mr. Smith's sister, said she fears the hospital and social workers are challenging Mr. Smith's paternity because he was not cooperative and communicative with them during Ms. Marshall's hospitalization. Mr. Smith apparently procrastinated before submitting to tests to prove his paternity. He also refused counseling, she said.

In fact, relations are so frosty, no one alerted Mr. Smith yesterday about the C-section, forcing him to go to Children's Hospital on his own to try to see the boy, Ms. Rivers said.

"They didn't even call him or even let him know the baby was delivered," she said. "He may really have an attitude problem now."

Karen West, a Highland Hospital medical social worker, said both sides of the family had been notified of the operation and Ms. Marshall's mother and sisters were the only ones who chose to come to the hospital. Ms. West said she could not say more about the case.

Neither Mr. Smith's nor Ms. Marshall's mothers could be reached for comment.

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