I knew I had to call the SROC immediately. But meanwhile, I had to find out some things about the patient.
‘’Is this patient booked, matron?’’
‘’Do you know where she is coming from? Another hospital, perhaps? Any referral?’’ I asked, as I quickly pulled on elbow length delivery gloves and stole another glance at the sight I soon must deal with.
‘’None of the family members was willing to say at first, but her scared mother eventually said they were coming from a TBA.’’ The nurse adjusted the delivery mat as she answered.
‘’Oh my goodness, and I’m guessing she is a primi. Why on earth will these traditional birth attendants not take their hands off things they cannot deal with? They must have attempted delivering the Breech when she was still in the first stage.’’ My irritation pounded in my head as I felt the cord for a pulse. It was pulsating faintly, but it was there. That meant I was favoured to try a delivery as opposed to a craniotomy if the baby had come in dead with a non-pulsating cord.
I spoke to the young mother for the first time in the midst of the emergency. ‘’Hello, how are you?’’ I didn’t wait for an answer as I continued. ‘’My name is Doctor Nkem and I’m going to try and bring out your baby, Ok? So, just be strong and don’t worry, we will do our very best. I may give you some cuts to help release the baby’s head eventually. Ok?’’ I spoke quickly but clearly.
She did not seem to understand everything I said, her English was not that good and since she was Ishan, neither I nor the Tiv matron could really translate. But she repeated four words after me as she nodded vigorously: ‘’Release baby head. Ok.’’ Tears escaped from her eyes as she kept saying, ‘’Ok, Ok, Release baby head.’’
This was my very first Head entrapment case, even though I had seen it once during a village outreach. The woman happened to be in labour at the time the team of doctors for the Christian World Medical Missions arrived. She had been attended to by a TBA who, after delivering the body too early, could not deliver the head. She was eventually brought to the Mission’s tent, it would have been too late but mercifully the baby survived. The mother was lucky to have two obstetricians there that day. This thought reminded me again of the need to call the ’second on call’, a Senior Registrar. I quickly called out to the porter and asked her to dig out the cell phone from my Denim pocket. She did and located the number of the doctor who was the second-on-call. As she was dialling the number, I checked again and confirmed that the cord was still pulsating. However, I was sure it would not last long if I did not do anything. The call got through and I described the scenario to my chief while he gave a few instructions and said he was on his way immediately.
I turned to the midwife and said, ‘’Matron, we have to do the MSV manoeuvre now. If we don’t. . .”
She nodded with calm understanding. Slowly I reached in and searched for the baby’s face. Next, I located the jaw, then. . .
Five minutes had passed and the head still did not budge. Without saying anything, I reached for the forceps in the tray and tried coupling it a few times but it would not set. I looked closely and saw that a part of it had been chipped off. The forceps was obviously spoilt. Precious time was slipping away, every minute now mattered, this was clearly a case of Head Entrapment and I had only one option: a Duhrson’s incision.
If this baby died, if this cord finally stopped pulsating, if our efforts failed, then I would have no choice but to do a. . . I could not think about it! A destructive procedure was never any doctor’s joy but it was something one must have at the back of his mind, just in case it came to that.
I remembered the prayer from outside: ‘’Lord please, help this young doctor to help our sister.’’ I soon started praying my own version, ‘’Lord please help me to help this woman.’’ I said it over, and over as I picked out the instruments I would need for the Duhrson’s incision. Twice, the matron thought I was speaking to her as she asked, ‘’Did you say something?’’ I said no and continued my prayer.
Locating the 2 O’clock and 10 O’clock positions, I made my incisions, and in less than two minutes, the head came out. Relief flooded my soul as I carried in my hands a complete beautiful female baby – head, hands, buttocks, legs and all! Somewhere to my right, the matron squealed a very appropriate ‘’Thank you, Jesus!’’ She quickly double-clamped the umbilical cord and cut. I put up oxytocin infusion for the mother and also gave some IV.
The baby did not cry immediately, somehow I did not expect her to, she had been in that perineum for too long and would have her airway full of secretions. I took her to the warmer, turned on the suction and started clearing her airway. It was at the third time of putting the tube through her nose into her pharynx that she burst into glorious sounds of indignant wailing. I turned and looked at the mother as she said to no one in particular, ‘’Baby Ok, Ok, baby Ok.’’
Once she was looking all pink and healthy, and in no danger whatsoever, I handed her over to the assistant nurse who cleaned her with olive oil and wrapped her in the spare baby shawl in the ward. The mother had come with nothing but a wrapper for the baby.
I turned my attention back to the mother as I began to think of how to start the task of repairing the incisions I made. The matron was maintaining the controlled cord traction, and the placenta was almost fully separated. I busied myself with finding the local anaesthetic and suture I would need for repair when a quiet voice said from two delivery beds away: ‘’Doctor, my baby has come out.’’
I paused in my tracks. The mother of five!
I dropped everything and rushed to her. In our battle to save the other woman’s child, we had forgotten this patient altogether. I pulled fresh gloves on and helped cradle the baby’s head. The baby started crying even before suctioning was done. Standard procedure was to check for cord around the neck and seeing that it was not there, I asked the mother to push one more time. Oh, he was a beautiful boy.
We were all happy and jubilant afterwards. According to labour room policy, no family and friends were to be told until about an hour after delivery. The idea was to ensure mother and child were stable before anyone outside the staff was told, that way the team was sure the danger of a possible postpartum bleed had passed. That day was different though, the mothers were okay, the baby girl was alive and well, the baby boy too. Even though the ‘second on call’ had not shown up, I did not mind, everyone and everything was alright. So, the matron cheerily danced out to announce to the relatives. I could hear their rapturous shouts of joy as it went up.
My attention was already turned back to the suture selection for the repair when the excited chatter of the assistant nurse and porter suddenly stopped. It fell strangely quiet but I did not make anything of it until the nurse said, ‘’Doc, see blood o, she is bleeding.’’
I turned to look at the young woman that had just delivered and saw that blood was dripping from the delivery couch. It had pooled into a large amoebic shape on the floor.
– Written by Aida Scribbler