Nov 15 2012
Frist Global Health Leader
Reporting from Les Cayes, HaitiNovember 15
Most days (or I should say nights rather)—I forget I’m working in Haiti. We have normal, beautiful deliveries with happy, healthy moms and babies. I got to catch twins the other day (!!), and the first was breech—which was quite exciting/stressful for me, as breech babies typically are sectioned in the U.S. and so the breech delivery skill-set is a dying art. Sure we have the occasional loss of power, or we run out of gloves, but overall things at the maternity run in a manner pretty similar to how they would back in the U.S.
And then there are nights where I am harshly reminded that I’m in a developing country, in a hospital with limited resources, where standards of patient care are—at times—very different, and where things happen that wouldn’t occur in the developed world. Below is a sad, frustrating, and a bit graphic example of such a case.
Last night a woman was carried into the delivery room with an IV already in place and fluid dripping. She had been brought from another hospital that was about 45 min away from Cayes. She had had an obstructed labor for the past three days. As a result, when she arrived her baby’s head (the baby had died—how long ago no one knows) was right at her perineum, but wouldn’t come out. Her vulva was terribly swollen and she looked incredibly worn out (which was more than understandable given what she’d been through). She was still having contractions—probably due to the fact that she was getting pitocin through her IV—but they weren’t doing anything but cause her pain.
We called the doctor on call to see what he wanted to do about this woman. It was clear to me—and the nurses—that no amount of pitocin was going to make that baby come out (unless the baby decomposed enough to be able to be pushed out with the pitocin induced contractions). I was concerned about her increasing risk for infection and for fistula formation—among other problems—and so was hoping the doctor would come in to perform a c-section (given that we had no vacuum or any other way I could think of to try to extract the baby vaginally). The doctor however, got mad at the intern for calling him, and said that the woman just needed pitocin and that was that. After the call, the nurses all lamented the doctor’s decision, but said that this was just how it was in Haiti—that women suffered. They were much more laisser-faire about it than I was—in large part I think because this is normal/expected to them, and (obviously) not for me. I think also because I knew what materials we didn’t have, and how they could have changed the situation—and the nurses probably didn’t as well—that it made it that much more frustrating for me.
I struggled with trying to think of something we could do for her—but I couldn’t think of anything. (Being a new/inexperienced midwife is hard at times because I wanted to help this woman so very much, but have never been taught about how to address obstructed labor—I’ve only read about it and its consequences—and don’t have any experience with it (until now), or anyone to offer me advice as to the best treatment plan.)
In the end we—tragically—monitored the woman all night. She made no progress and didn’t get any rest because of her contractions. I happened to be at the hospital this afternoon (around 3pm) and saw her finally heading back for a c-section. I can only hope that she has no long-term consequences of this birth—though I’m not too optimistic about that.
I realize this is not an uplifting post, but it is a reality that any healthcare worker who has the privilege to work—or wants to work—in the developing world will have to continually confront. My hope is that with time the norms will change, and appropriate resources/trainings will be provided to decrease the frequency of such cases, and ensure that women don’t have to just suffer.