Potentially gross stories about babies getting born (although really you should just man up...)
This week has been filled with drama as per usual for the BMC. I've finished my 2 weeks in surgery and now half way through my final 2 weeks in obstetrics.
I've been trying to catch some more babies but kept missing them, so on Friday I left clinic every couple of hours to check the maternity ward. There were two women in labour, and every time I checked the midwives said they were each 8 and 5cm dilated (the cervix needs to dilate fully to ~10cm for the baby to fit out before the mother starts pushing, usually it takes about 1 hour/cm). I think it turned out that the first person who'd examined one had been a bit generous with her '8cm' hence apparent the lack of progression and the last person to measure the 5cm had been under generous. I missed that one at about 3pm so after clinic I sat in the labour room waiting, determined not to miss the other one. By this point another woman had arrived in labour so I was hopeful I would get at least one.
After about 4 hours neither of the women had made much progress, but I was determined to catch some babies having waited that long. For each of them it was all down to that last slither of cervix to dilate. Eventually they both did - at the same time. The primip (first time mum) was surprisingly much better at pushing than the lady who'd had 3 babies already so hers delivered first. When catching babies it's important to stop the head from coming out too quickly or it can cause a tear. Unfortunately, despite resisting the head to slow it down she still had quite a big tear, which bled a lot. The midwife gave me a suture expecting me to suture it up - something I've done only once before in that location, and with the consultant obstetrician talking me through it. This time there was no consultant and I could hardly see the tear due to the combination of bad lighting and the excessive amount of blood that kept covering it every time I wiped it away. I said I really wasn't comfortable doing it, but for some reason the midwife wouldn't take over. I put one stitch in, which seemed to make no difference, then luckily the consultant walked in the door. She'd been home for dinner but decided to check on how we were doing. I was incredibly relieved because the women had lost a lot of blood and I really wasn't confident about what I was doing.
At this point the midwife decided that the lighting wasn't good enough so the woman should sit on the other bed where there was the (only) lamp. This meant the other woman who was actively trying to push her baby out on that bed had to switch places with the one who had bleed all over the floor. Clearly this was a ridiculous idea, but Ghanaian women are strong and stoic. They barely make any noise when delivering; even the women being sent for emergency C-sections walk to the theatre, so the midwife wasn't about to get a stretcher any time soon. They both stood up, but due to the excessive amount of blood loss the one who'd delivered with the tear collapsed to the floor, luckily caught by the midwife and then me + Dr Coppola. At this point it was deemed reasonable to get her a stretcher and she was moved to by the light where Dr Coppola sutured her up.
While this was happening the first woman decided to push a little harder. Only the bed which she was meant to be on was covered in the other woman's blood so she set herself up on the floor, just centimetres away from the large pool of blood + amniotic fluid. So I delivered her baby on the dirty floor of the labour ward, kneeling on the nice skirt my mum sewed me! As I was waiting for the placenta to come out another midwife rushed in saying a women was delivering in the bathroom. Carmilla quickly rushed off and caught that baby on the bathroom floor. We'd waited all day for these babies to arrive then 3 came at once.
The bed the woman with the tear delivered on (old photo of Erin or Saly's minus the blood!)
The bed with the light - they're in the same room, divided by a thin screen (seen on the right)
I had a bit of drama whilst on call yesterday too which I was going to share, but I think it might be a bit much for some readers! Or at least I think it's a really interesting case from a medical point of view... but potentially upsetting for those of you who aren't quite as objective! Anyone who's interested feel free to ask.
Assabunteng (a Ghanaian PA) with a snake - we get a lot of patients with snake bites and often they'll bring the snake in with them to show us!
A different snake
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