Picture yourself is this situation reported today from an INMED Graduate in Haiti: “A 30-year old woman, G7P6 without prenatal care, came to our clinic in labor. Her pain was greater and more constant than I’d expect. Normal vitals and fetal heart rate. Cervix was fully dilated and high. Then suddenly, the fetal heartbeat disappeared and she started pushing. Baby presented face up and with shoulder dystocia.”
“With leg flexion and supra-pubic pressure baby delivered, but floppy, blue, and no heartbeat. I did resuscitation, but no response. Then the mother hemorrhaged. I massaged her uterus, gave oxytocin in her IV fluids, and assessed for tears but there was none. I did a manual placenta removal, but she was still hemorrhaging. Couldn’t find an accepting hospital. She passed away the next morning. What could we have done different and what could the causes be?”
Sound frightening? Indeed, and yet most maternal death is preventable and treatable. For these reasons, maternal-newborn health is part of our core curriculum. What could have caused the death of this mother and baby? Most probably she suffered from placental abruption. Ultrasound and Cesarean delivery – unavailable at this clinic – may have prevented such outcomes. But I’m encouraged that this INMED grad recognized the emergency and responded with the best at hand.