This post is not for the faint of heart. I know I’ve mostly been posting about the difficult things here, but I promise that we’re doing well, and we’ll post some light-hearted things soon. It’s just that, when I think about what to post, I think of the things that are striking my heart. And this is one of those things.
During my month on maternity so far, I’ve seen many more dead babies than I did in the USA. Dead babies have always made me more sad than most of the other sad things in medicine, so it’s no surprise that these mamas and babies are making me sad here.
Almost every day there is a woman with a first trimester miscarriage. At least once a week there is a woman with a second trimester miscarriage. One day we were rounding as a group on the gyne patients. We were two senior doctors, three residents, two nurses, three nursing students, and the sister of the other senior doctor. Yes, all of us would crowd around each patient with the curtains shut to provide “privacy” to the patient from the other 3 to 12 patients and family members in the same room. When we walked up to this patient, she was squatting on the floor, saying that something was coming out. We got her onto the bed in typical Nepali style: she put one foot on the bed, then the other foot and then, standing on the bed, turned around and finally lay down. Sure enough, there was the 18 week baby, still in its sack, fully formed but apparently not healthy. Or maybe the mom wasn’t healthy. I don't know. While the other senior doctor put on gloves, a few people dispersed and the rest of us stood and stared. The poor woman was crying. It finally dawned on me to walk over to her and offer my hand, which she accepted. It’s difficult enough to say something in my own language, much less in Nepali, so I just looked deeply into her eyes and caressed her hand.
Then there are the babies who were born dead the previous night. We have to examine them to see if we can determine why they died in order to fill out a form for the country of Nepal to assess why their babies are dying in utero in order to try to improve care. One nearly full term baby supposedly had hydrocephalus by ultrasound, but on our exam his head looked normal, as did the rest of his body except for the fact that he was macerated, indicating he had been dead for a long time.
Another woman with a full term pregnancy went into labor one day, came to the hospital the next day, and the ultrasound showed a dead baby. We don’t know why. That baby looked very normal.
Another woman had an abruption at 26 weeks and a dead baby inside on ultrasound. This was her third dead baby: the first was at 8 months, the second at 6 months. She deserves a workup to know why, but many of the tests to determine why are not available here.
Two days ago a woman came in complaining of leaking fluid at 22 weeks. When she delivered her baby, she also delivered a 6 cm twig. Either she or a family member were so desperate to not have the baby that they attempted to induce an abortion with a piece of wood. Now she’s infected.
In this society, the ability to have a child is of huge importance to a woman’s worth. The ability to have a male child is even more important. The fact that the father determines the sex of the baby is still not always recognized. Many of these women have no other living children. It is always sad to lose a baby, but I can’t imagine the added stress of having a husband and mother-in-law who may give shame rather than compassion when these women return home to recover. Or rather, return home to work hard in the house and in the fields.
I can only say that I am thankful that I have not been directly involved in the death of any babies. Yet. I know the day will come when a baby dies during one of my deliveries or resuscitations. But for now, I think God is being kind to show me that these deaths occur regularly here even without my mistakes. So far He has blessed my efforts with living babies.
Midwives do all of the normal deliveries here, so I only get called if there is a complicated case. So far all the vacuum deliveries and postpartum hemorrhages have ended in happiness. During the delivery of a 31 week baby, I was waiting for our pediatrician to come, but she didn’t arrive in time. The baby’s heart rate was dropping quite low on our sporadic checks—there’s no continuous fetal heart monitoring here. All I could do was pray that God would protect this child. Just before he was finally born, his heart rate came up. As soon as he was born, he gave a good cry. His heart rate was normal on my first check; he just had a little nasal flaring. Praise God!
So I just keep praying when I get these calls because I know that I’m no special person in deliveries and complications. And I keep praying that I can provide comfort or joy to each mama. And I’m very thankful for our healthy little Jack.
During my month on maternity so far, I’ve seen many more dead babies than I did in the USA. Dead babies have always made me more sad than most of the other sad things in medicine, so it’s no surprise that these mamas and babies are making me sad here.
Almost every day there is a woman with a first trimester miscarriage. At least once a week there is a woman with a second trimester miscarriage. One day we were rounding as a group on the gyne patients. We were two senior doctors, three residents, two nurses, three nursing students, and the sister of the other senior doctor. Yes, all of us would crowd around each patient with the curtains shut to provide “privacy” to the patient from the other 3 to 12 patients and family members in the same room. When we walked up to this patient, she was squatting on the floor, saying that something was coming out. We got her onto the bed in typical Nepali style: she put one foot on the bed, then the other foot and then, standing on the bed, turned around and finally lay down. Sure enough, there was the 18 week baby, still in its sack, fully formed but apparently not healthy. Or maybe the mom wasn’t healthy. I don't know. While the other senior doctor put on gloves, a few people dispersed and the rest of us stood and stared. The poor woman was crying. It finally dawned on me to walk over to her and offer my hand, which she accepted. It’s difficult enough to say something in my own language, much less in Nepali, so I just looked deeply into her eyes and caressed her hand.
Then there are the babies who were born dead the previous night. We have to examine them to see if we can determine why they died in order to fill out a form for the country of Nepal to assess why their babies are dying in utero in order to try to improve care. One nearly full term baby supposedly had hydrocephalus by ultrasound, but on our exam his head looked normal, as did the rest of his body except for the fact that he was macerated, indicating he had been dead for a long time.
Another woman with a full term pregnancy went into labor one day, came to the hospital the next day, and the ultrasound showed a dead baby. We don’t know why. That baby looked very normal.
Another woman had an abruption at 26 weeks and a dead baby inside on ultrasound. This was her third dead baby: the first was at 8 months, the second at 6 months. She deserves a workup to know why, but many of the tests to determine why are not available here.
Two days ago a woman came in complaining of leaking fluid at 22 weeks. When she delivered her baby, she also delivered a 6 cm twig. Either she or a family member were so desperate to not have the baby that they attempted to induce an abortion with a piece of wood. Now she’s infected.
In this society, the ability to have a child is of huge importance to a woman’s worth. The ability to have a male child is even more important. The fact that the father determines the sex of the baby is still not always recognized. Many of these women have no other living children. It is always sad to lose a baby, but I can’t imagine the added stress of having a husband and mother-in-law who may give shame rather than compassion when these women return home to recover. Or rather, return home to work hard in the house and in the fields.
I can only say that I am thankful that I have not been directly involved in the death of any babies. Yet. I know the day will come when a baby dies during one of my deliveries or resuscitations. But for now, I think God is being kind to show me that these deaths occur regularly here even without my mistakes. So far He has blessed my efforts with living babies.
Midwives do all of the normal deliveries here, so I only get called if there is a complicated case. So far all the vacuum deliveries and postpartum hemorrhages have ended in happiness. During the delivery of a 31 week baby, I was waiting for our pediatrician to come, but she didn’t arrive in time. The baby’s heart rate was dropping quite low on our sporadic checks—there’s no continuous fetal heart monitoring here. All I could do was pray that God would protect this child. Just before he was finally born, his heart rate came up. As soon as he was born, he gave a good cry. His heart rate was normal on my first check; he just had a little nasal flaring. Praise God!
So I just keep praying when I get these calls because I know that I’m no special person in deliveries and complications. And I keep praying that I can provide comfort or joy to each mama. And I’m very thankful for our healthy little Jack.
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| A mom with her baby delivered by an old-fashioned vacuum in the hands of one of our new residents. Mom bled a LOT from a cervical tear that I just couldn't control, a pumper in a sea of blood. A more senior doctor struggled but finally was able to clamp the bleeder. With 20 minutes of pressure, the bleeding stopped. I was able to show the medical resident how to repair her complex perineal tear in a method other than interrupted sutures, which are commonly used here despite their increased risk of infection. Mama's milk was slow to come in, which is not surprising since she was away from her baby for a while after delivery, a practice I hope to change here in the long run. So I showed her kangaroo care. Mom and baby went home healthy, praise God! Plus they're both really cute. |
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