Alix: No births today. At least not directly. The ward was quiet when we arrived. A woman was pushing with a Ugandan student attendent. After 45 min with seemingly no progress I gently inched my way in- taking blood pressure and pulse, listening to the fetal heart. I had asked the woman's history but the student just shrugged. It is delicate because I didn't want to undermine the local student. I finally did a VE to find what I had expected- the poor woman had been pushing on a lip of cervix which had begun to swell. I had her lie on her side and not push. After an hour the cervix was gone. After another 40min the head had only come down 1/2cm. I had discussed the dystocia with the student who continued to shrug- I had asked her if the pelvis was adequate, if she thought oxytocin may help, if she thought the head was low enough for a vacuum. Finally I announced I was calling the doctor for a consult because I suspected the baby's head was too big for the woman's pelvis and the student told me that the doctor had already come in early this morning and said that was the case and the woman was scheduled for cesearean. Why she had not told me earlier I don't know. When I asked he why she hadn't shared this info hours earlier or charted it, she left the room in a fit of laughter. I was so upset I missed the IV twice when preparing the woman for the OR. Thankfully the doctor came in at that moment and kindly helped me with the IV and did the catheter himself.
This was one of the most frustrating moments of my life. This isn't the first time that we have assessed women before having a chart. Its not the first time that we didn't know a woman had been obstructed for many hours before we arrived. I am not sure why this particular instance was so frustrating.
Upon closer examination of the chart I realized that at 11pm the night before a doctor had suggested a cesearean. I had written in the chart several times but found the first entry illegible and hadn't tried to decipher it, not to mention that she was pushing when I came in so I jumped into action anticipating a delivery soon. Had I read the chart I could have spared the woman the wait & see. She still would have waited just as long for the OR to be ready for her cesearean though. Thankfully, she and her baby were well in the end.
I have now learned my lesson. Handover/debriefing from one shift to another does not happen here. We always assess the supplies when we first arrive on the ward and now we will check the charts too-no matter what action is ongoing when we first enter. I now know that I mustn't give up on illegible writing on a chart. Thankfully this student was the exception, most are wonderful and we will miss the current batch, whose rotation on maternity ends tomorrow.
Carolyn: Alix mentioned an indirect delivery...I was doing some charting, I don't remember what I was charting, when someone rushed into the room to say that someone was delivering in the antepartum ward. I prepared the oxytocin and ran to the other room; when I got there, the head was already delivered, but unfortunately the baby was obviously stillborn. I gave some suggestions to the midwife who was delivering and and I also delivered the placenta. Despite the sadness, it was also a satisfying moment for me to feel that I actually knew what I was doing!
Today we heard some rather unsettling news. We have long known that Ugandans do not accept blood from foreigners and we didn't know why. It appears that many Ugandans, including educated ones, believe that blood from the Muzungu tribe is weaker than Ugandan blood, and is therefore not good for Ugandans. I'll let all of you to decide what to make of that.
Some of our days here are so positive, enriching, and inspiring. (Ie. yesterday's post) and other days are disheartening beyond belief. Disheartening, frustrating, where you want to leave the ward screaming. Today was more of the later.
We are off to Mbale tomorrow- the journey will take the whole day. Alix willl then do interviews on Sun/Monday. We are very excited to be reunited with Sarah and Lyanne. We will miss Cathy and Mickey. We are humbled.
No comments:
Post a Comment