Strength and Resiliency

On Monday, Lyanne and I arrived on the ward in Mbale for the first time in almost three weeks. At rounds we had heard that there were many women awaiting cesarean (seven, as it turned out - in a ward with eight beds, that's pretty significant). Five of these were emergency cesareans (as previously stated, ‘emergency’ means a woman will wait at least two hours, often much more, before going into theatre). Throughout the morning, EVERY SINGLE ONE of the women waiting for emergency cesarean section delivered vaginally, three in very quick succession (there was 15 minutes at most between each birth). Three of these babies did not require any amount of resuscitation whatsoever. Unfortunately, the remaining two babies had died in-utero (one mother had a prolapsed cord, the other a placental abruption).


Yesterday, Lyanne and I assessed a primagravida first thing when we arrived on the ward. She was 9 cm dilated, and had been very slow to progress throughout her labour. The doctor on call came in and assessed this woman an hour or two later, and determined that when her membranes ruptured, she would deliver - he did not suggest an oxytocin augment. (Perhaps I should mention that it is rare for health care providers to artificially rupture membranes here - there are no amni-hooks. When they want a woman's membranes to rupture, they get them up and walking around). Things got a bit busy on the ward, and it was several hours later before I returned to reassess this woman yet again. Her cervical dilatation was the same, and her membranes remained intact. I managed to rupture them myself, which revealed thick meconium stained fluid (for those not in the know, this can often indicate fetal distress). Throughout the day, the baby's heartrate had remained in the normal range, though we were listening only every few hours. At this point I needed to consult again, and so waited an hour for the doctor to arrive. Minutes after his arrival, Lyanne and I noticed this woman was pushing and that we could see the head coming. Lyanne did a beautiful job catching the baby, and this lovely little boy came into the world as healthy as you could wish, no resuscitation required.


So all of this makes me think - in Canada, our lady yesterday would likely have had an oxytocin augmentation, an epidural, possibly a cesarean section. Every one of the ladies for cesarean on Monday would have made it to theatre. Perhaps the babies that did not survive on Monday would have survived in Canada; it's impossible to know. I think most people would agree that doing six cesareans to save two babies is reasonable. However, I can’t help but feel we are giving women’s strength and babies’ resiliency too little credit. Birth works, so well, so much of the time, even if it doesn’t go according to our expected timeline.




Posted by Sarah