June 11th, 2018 by pamelaparker

If you do obstetrics, you know at some point someone will not survive – the premature baby, the woman so ill she should have never been pregnant. Some things you expect, though never get used to. Last Friday a term baby was delivered, lifeless and not resuscitatable. His mother is only 17 and hated every minute of labor. Here there are no epidurals and rarely any pain medications to ease the process. She had her mother and grandmother with her, trying their best to help her labor, and at the same time teaching her HOW to labor (which means no screaming).  She progressed to 9 cms and then got stuck….we took her to theatre and delivered a limp blue baby with no reason to be dead – and yet he was. The team worked on him (3-1 compressions to ventilation; oxygen). There is no high tech team to swoop in, place umbilical lines, incubate and get him “going” again. He was just gone. And his mother was inconsolable. I was told when I arrived in Kiwoko that if a woman has enough pregnancies, she will absolutely have lost one or more. Somehow that statistic isn’t comforting to me or that lost 17 year old girl who now has a Pfannenstiel incision on her uterus and nothing to show for her efforts. The bad luck returned for the call team last night. A women at 22 weeks gestation arrived with a severe asthma exacerbation. They were able to provide medical intervention to improve her oxygen status. Suddenly with no warning, she arrested and could not be resuscitated. At the request of the family, a hysterotomy was performed and the dead fetus was removed so it could be buried separately. Not everyone agrees this should be done, but this is where culture and reality collided. This family is now minus two of its members, and must go on in whatever way they can. Most of the time doing obstetrics is a thing of joy, until it is not.