“Thank you to God and thank you to you, Doctor.”
It didn’t make sense. She should be mad, upset, angry...anything but thankful.
She is a young 18 year old and on her first pregnancy. 9 months. She started contractions the night before (but I later found out it was 3 days before), and had just started pushing when she got here.
She was fully dilated and seemed to be pushing well, although she looked very tired. The baby’s heart rate was good at 135 with a doppler. I went off to see patients in the office. After 2 more hours, I thought I should check on her just in case she hadn’t delivered. Nope, not yet.
I ask the nurse how the baby was.
“Ca va”, he said, or fine.
“How do you know? Did you listen to the heart since I last did?”
I listened. 175. No fever. This can’t be good. Three hours of pushing and not much more progress. I should have checked on her earlier.
I feel the baby is low enough for a possible vacuum delivery, so I have the mother go buy a syringe so I can give her some local anesthesia. Too many patients waiting at the pharmacy. So I run to the OR, open a padlock, 2 doors with keys, and find a syringe and lidocaine.
Back to the mom, I cut an episiotomy for space and have her push some more. She is too tired. I pull out the next to last remaining kiwi vacuum from the drawer and deliver the baby. Lots of soupy meconium.
“DeLee!” Nobody knows what I’m talking about. I take the precious 20 seconds to grab the suction device myself from a drawer with my gloved dirty hands. I clamp and cut the cord and bring the baby to a different table. I suction the baby, but no breathing yet. I fumble for the ambubag (without oxygen of course) and start breathing for the baby. Heart beat above 100. He starts to get some tone after I breath for him. I give him dextrose in his mouth. He’s living, but just not breathing on his own. I don’t want to give up. After 10 minutes I call Olen to help out with the baby so I can suture up the mom. My allstar nurse (actually she is, a new nurse came on now) is suturing up the episiotomy site, but needs help.
Mom has a huge vaginal extension in part from the episiotomy, and also the baby delivered with his hand by his face. I’m just using lidocaine, and I know it doesn’t work that well. Still she barely even flinches. She’s so strong. All of this and her baby is not even breathing!
Olen’s breathing for the baby. In the states this baby would be wisked up to nicu and intubated. How long should we breath for the baby? Olen gives him dextrose several more times intravenously. We pinch his foot and he pulls it back. He still has some tone.
I went to get the oxygen sensor from our office. High 80’s and even 95% while using the ambubag. 1 hour. He still wouldn’t breath.
I realize how hot is was in our little delivery room. Sweat had been pouring down my face and huge drops were falling on the table. My scrubs were soaked with sweat. None of this mattered if this little one would just breath.
1 1/2 hours. Olen and I discuss that we had to stop sometime, somehow. This little boy is so perfect though. He is a fighter. He just wont breath on his own! He is full term! This is not supposed to happen!
We explained through our nurse that when we stopped breathing for this little boy that he would not live more than a few minutes. I wrapped him in a brightly colored cloth the family gave me, then we put him gently in his mother’s arms. He died shortly after.
The next day on rounds she explained that she had been in labor for 3 days and had been so tired before she even came to the hospital.
“I thought I was going to die,” she said. Everyone feels like that when they are in labor I think. I felt awful when I was pushing, and I had an epidural! In the states, you may feel like you are going to die, but it’s rarely a reality. Here, especially if you deliver at home, it often is a reality. I don’t think anyone really knows the statistics on maternal mortality here. At least I don’t trust any statistics here after Olen went to a recent meeting on such things and they weren’t even doing basic math correctly! Not that they can’t here, but somehow the people who were adding up the national numbers couldn’t add correctly (and Olen was a nerdy math major so he happened to catch it).
She was just thankful to be alive. It’s probably harder for me to accept death here because I have seen how different healthcare can be. Pregnant mothers who come to the hospital with living babies are not supposed to go home to the funeral of their first baby.
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Olen Tigo: +235 98 07 46 28
Olen Zain: +235 62 16 04 93
Danae Tigo: +235 98 07 46 27
Danae Zain: +235 62 17 04 80
Olen et Danae Netteburg
Hopital Adventiste de Bere
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