Not This One

“Not this one,” I said to myself.    

“Please God, not this one.  There are enough women who die in Chad,” I prayed a silent prayer to our all-powerful God as I watched a pregnant woman have her second seizure in the past 5 minutes.  

Eclamptic patient in crowded maternity ward
Photo by Adam Hernandez

Seriously, are we having a special on eclampsia this week?  Eclampsia is a condition in pregnancy with high blood pressure and seizures.  This is the third eclamptic patient in one week here at our 70 bed hospital.  Often, the mother will become comatose and develop pulmonary edema.  There is a high risk of death.  The cure for eclampsia is to deliver the baby. 

I tried to get some of the patient history as I helped hold down the actively seizing patient.  Two family members accompanied the patient.  It was her first baby.  While listening, I thought to myself that the history didn’t really matter.  I knew what I had to do.  Deliver the baby.  

That’s what I do.  

I deliver babies.  That’s my job, easy right?  

In the States, it goes like this... Oh... you’re here to have a baby... boy or girl?... Oh, so happy, happy ending for both mom and baby.  No, not always, but more often than here.

Here it goes like this... you have been in labor for HOW many days?  Who was helping you at the health center and didn’t refer you earlier?  The baby died, but we are just happy that the mother is living.  

So it’s not always easy to deliver babies.  But by God’s grace, we do our best.  

I do an exam.  Yay, she’s fully dilated.  But it’s her first baby... and she’s mostly comatose after that seizure.  Most women push for two hours on their first baby.  Fully conscious.  Do I dare wait the two hours with an eclamptic patient?

The head is not as low as I would like it, but a cesarean section is not ideal in subsaharan Africa for many reasons.  

I decide to do a vaginal operative delivery.   

We give 2 large injections in the buttocks of magnesium to prevent more seizures.  I give Simeon a call on the phone to come to the operating room in case I need a spinal for a c-section.  

Once in the bloc (operating room), we say a prayer before beginning.  This time out loud.  We think about a spinal for pain control, but she is pretty comatose.  I have Simeon, and 2 other nurses help hold her legs back.  

I splash some iodine on her and apply one forceps, then the other.  There isn’t much room, so I give some local anesthesia and cut an episiotomy.  Forceps look like giant salad tongs.  They surround the head of the infant so you can pull him or her out.  It sounds barbaric, but you’d be surprised what a baby will do to be born and get out into the world.  

I pull.  Nothing.  

“Please God,” I pray again, “not this one.” 

This one is stubborn.  I palpate her abdomen so I can feel for a contraction.  At least the contraction can help me even if she isn’t pushing.  

I wait a minute.  Even though she’s mostly out of it, she shifts around on the bed when the contraction builds.  The 2 nurses hold her in place.  

We have got to get the baby out! I think to myself.  

I firmly grasp the handles of the forceps and pull down and out.  I need to start working out, I think to myself.  

I put my foot up on the bed to get more force,  “Not this one.”  This is the world’s worst game of tug of war.  

Then, it comes.  I feel the forceps give a bit and out comes the baby’s head.  It’s a little wriggly with some tone.  That is good.  I remove the forceps blades and pull out the rest of the baby boy.  

He cries.  Praise God.  

Now for the mom.  After delivering the placenta, I sew up my huge episiotomy site that had ripped up further into the vagina.  

We take her back to our maternity ward and I trip over patients sleeping on the floor while trying to carry her, unconscious, to the corner bed.  All eight patients, along with several family members each, stand up to gawk at the newcomer.  After discussing at length the diagnosis and treatment, I negotiate my way through the maze of thirty people crammed into our 10 x 20 foot maternity room, stopping to make sure each baby was breastfeeding well on my way out.

Eclamptic mom and her baby
Photo by Adam Hernandez

The next day, her seizures continue.  I make sure that the family understand the gravity of the situation and reinforce to them the power of prayer.

Two days later, I walk in to a smile I had never seen before.  My patient is sitting up, eating and jabbering to me (in a local dialect I can’t understand), the doctor she has never seen before.

Here in Tchad, named worst country in the world for women, due to a maternal mortality rate through the roof, women face a one-in-eleven lifetime risk of dying from complications of pregnancy and childbirth.  But not this one!