Sunday, 11 December 2016

Crying to give happiness

By. Dr. Bikash Gauchan

Mother in law, sister in law and a husband of 23 years old female brought her in the emergency department of Bayalpata Hospital in rural Nepal for labor pain at 9 months of pregnancy. It was very sad to know that she had lost her previous baby at 8 months of pregnancy because of intra uterine fetal demise (IUFD). When we examined her, she was in true labor pain, her cervix was 30 % dilated and membrane got ruptured on the way to hospital. Another bad news was revealed lateron, her baby was in breech presentation. We confirmed with obstetric ultrasound and we explained the difficulty of normal delivery and probable need of c-section delivery. The husband stood up and said, “She would need to work and if we do surgery it would be difficult for her.” Family doctor explained the breech delivery of baby might happen normally and might not lead to any complications. As the membrane was ruptured, the baby has less amniotic fluid. As soon as her husband heard us about the probable need of c-section, he ran away not to be found in the village and not to be contacted by mobile phone. His family members shared with us that he might have gone to India because he could not bear the stress. We waited her labor to progress. We waited till another 8 hours, monitoring her in between. Finally we had to diagnose as a case of Breech presentation with obstructed labor. It was very challenging to get the consent for c-section. Finally, mother in law and sister in law gave consent for c-section. After preparing well for anesthesia and giving medications she was rushed to operation theatre (OR). There was the presence of only one Family Doctor at that time. The only anesthesia assistant was on leave. The family doctor quickly gave spinal anesthesia and requested one of the medical officers to monitor for anesthesia. The family doctor scrubbed, painted and draped the lady. He started the c-section and delivered a baby who was passing meconium and little was found inside baby’s mouth. The circulating nurse and medical officer took care of the baby and the baby finally cried to give happiness to the lady on OR table, family members and whole medical team in rural hospital in Nepal. This story highlights the importance of family doctor in saving the lives of mother and neonates in rural regions. The is significant importance of training family doctors for c-section so as to reduce maternal and neonatal mortality globally.   

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