A Terrifying Experience and A Miraculous Babu

I was working last Friday afternoon, usually one of the busiest times for our female clinic.  I was just returning to my room to see the patient I had abandoned in order to help a resident with an unusual case.  The phone was ringing, so I apologized—again—to the patient for making her wait. 

“Dr. Leona!  Primip footling breech ERmah chuh.  Chito aunos!”  (“There is a primip footling breech in the ER.  Come quickly!”)

“Hunchuh.  Muh aheh!”  (“Okay.  I’m already coming!”)  I grabbed my phone and my stethoscope, apologized—again—to the patient, and ran.  The clinic staff tried to tell me something as I ran out, but I interrupted and said I was going to the ER.

I ran into the only private room in our ER and found several residents, one of our ER sorters (like a nurse), and my excellent colleague and friend, Dr. B, surrounding a bed.  In the bed was a screaming woman—we’ll call her Aamaa, which means mother—with half of her baby already out of her.  The arms, shoulders and head were still inside. 

Dr. B informed me that this was the Aamaa’s first pregnancy.  That’s very, very bad news for a woman delivering a breech baby.  A baby’s head is bigger than its body, especially when born a bit early as we later found out this baby was, so even though the body may slip out, the head may get stuck.  This can result in a lack of oxygen leading to neurological damage and even death.  These babies are always supposed to be delivered by a cesarean section.  It was too late for that here.

I threw my stuff down and asked the sorter where the gloves were.  I put my hand over the baby—we’ll call him Babu, an endearing term for boys—said aloud that we needed Jesus to help us get Babu out, Dr. B moved to the other side of the bed, and I took over.   

The arms were very difficult to remove as the space was quite tight.  Babu wouldn’t rotate.  I tried being gentle by using just my fingers to reach the arms, but it wasn’t working.  I tried pushing Babu back in, a crazy but sometimes successful maneuver to go for emergent cesarean, but he didn’t budge.  I realized that I needed to get this baby out even if it meant tearing the mother or breaking Babu's arms; both of those things can heal, but lack of oxygen cannot.  I put my whole hand in.  The anterior arm wouldn’t budge.  I switched sides.  The posterior arm came out!  The anterior arm then came out more easily.  This gave me a sense of relief and accomplishment, as well as dread.  If the arms were difficult, that implied the head would also be difficult.

While I continued to work, we went through the doctors who might be able to help more than me.  Dr. B had never seen a breech delivery before.  I had previously been involved in three here in Nepal.  The first two slid out without any assistance from me.  The third required a bit of help, but not much.  And it had been at least six months since I had even thought about the maneuvers that can be used to get a breech baby out if stuck.  Knowing that the success rate of a breech delivery is absolutely and directly related to the experience of the doctor, it seemed clear that we needed a more experienced doctor, of which our hospital has two.

One of them left that morning for a much-needed vacation.  The other was off that morning, went on a bike ride, crashed and broke his clavicle and dominant arm in multiple places.  Everyone else we talked about had less experience than me.  “Surely that can’t be true!” I thought.  But it was.  

 It was me and God.

I had already inflicted a lot of pain on Aamaa by getting the arms out.  She was screaming, looking at me with eyes wide with pain and deep with fear.  In an extremely firm voice, I told her she had to focus and push to get her baby out.  She kept moving up in the dinky bed, farther and farther away from me, understandably and desperately trying to escape the pain.  Her head was off the bed and onto the windowsill.  As I attempted to remove Babu’s head by standing to the side of the bed, the non-obstetrical bed kept moving, unable to be locked because it was broken.  I jumped onto the bed with the mom. 

This was the first time I have truly panicked during a delivery.  I was overcome with fear that this baby was literally going to die in my arms as I inflicted pain on the mother.  Let’s not mess around: there was a mixture of prayers and curses coming out of my mouth as I tried to save Babu.  More and more residents came in to watch this debaucle of me struggling to remove this innocent child.

The umbilical cord still had a good pulse, and I received a renewed sense of urgency.  I tried multiple things to get Babu's head out and forgot some other things.  I knew I wasn’t doing as well as the other two doctors could.  “I’m not good enough!  I don’t know enough for this, Lord!  Please help!”

I couldn’t feel the cervix, so cutting it was not an option.  I did an episiotomy.  Dr. B again encouraged the residents to get the mother’s legs as far up and open as possible.  One resident gave suprapubic pressure.  I just kept trying and praying and cursing and trying some more.

The cord lost its pulse.

Dread.

Then the baby took a gasp from within the mother.

A renewed sense of urgency.  More trying, praying, trying.

Finally Babu came out. He had been stuck for at least 5 minutes.

He was blue, limbs limp, but taking occasional gasps.  Dr. Becca could hear a faint heart beat as I dried and warmed him.

Our pediatrician arrived just as we ran out of the room to the baby resuscitation area, which had not been pre-warmed.  The entire crowd of residents and now two knowledgeable doctors were caring for Babu.  So I ran back to mom. 

She was still lying with her head on the concrete windowsill, body on the bed, quiet.  I told her that Babu was alive but that we did not know how he would do.  We would do everything possible for her first-born child, a son, the ultimate gift as a woman in Nepali society. 

I moved her down onto the bed and put a pillow behind her bed, delivered her placenta, made she wasn't bleeding and her uterus was contracted, then left to check on Babu again.  He had already been whisked away but was apparently doing better than I last saw him. 

I went back in to mother to check how badly she had torn.  It seemed quite deep to me, and I couldn’t bring myself to be the one to inflict anymore pain on her.  I wanted her to have really good anesthesia, and I wanted to ensure adequate lighting and visualization (not nearly as possible outside of the OR in our hospital), so I called the surgeon. 

She teased me, figuring I was calling her for the third cesarean section of the day—yes, there was plenty of stress prior to this patient—but I told her this woman had spared her a cesarean and instead nearly gave me a heart attack.  The surgeon was kind and agreeable to suturing for me. 

I helped to clean off the mother.  I felt I needed to be a part of caring for her gently and helping to make her comfortable.  Even though I knew there were two patients waiting for me in clinic (besides the one I had abandoned, another was waiting for me to look quickly at a test result so she could get a procedure done that day before clinic closed), and clinic was likely backed up since we were missing the doctor with the broken arm, I needed to take some part in helping this woman feel better and in showing her compassion and in allowing myself time to calm down.

After clinic I went to the ward.  The baby was in the back room, wrapped in blankets, off oxygen, breathing smoothly.  The mom was surrounded by at least 10 family members.  Her mother-in-law, Sasu in Nepali, was the main person talking to me.  The sasu is a central figure in the lives of women in Nepal.  Women leave their families and stay with their husband and his family after the marriage ceremony.  Besides the husband, the sasu determines whether a woman will have a good or very bad life once married.  Many sasus were treated poorly themselves, often as slaves, so once they have the opportunity to be higher in the ranks, many take advantage of it.  But many are also kind and loving. 

This sasu seems kind.  She had tears in her eyes as we were talking, which made my cry, which made us hug.  I explained everything to all the people standing there but mostly looked at Aamaa and Sasu.  Aamaa seemed to be very peaceful, perhaps just glad the experience was over.  Sasu kept thanking me for what I had done.  I told her it was very difficult and I didn’t know how the baby would do, but that I would be praying.  Sasu let me take a picture of Babu to send out to our prayer team so that they could begin praying for this precious little boy.

Every day since then I have stopped by to check in on Aamaa and Babu even though I haven’t been working.  They have been very heavy on my heart.  Amazingly, Babu has not required oxygen.  He has been peeing and pooping.  He has been on antibiotics from the start but has not had any fevers.  He has not had any seizures.  He is moving all his limbs and head.  (Pulling on the neck, as I felt forced to do, can cause nerve damage.)  He wasn’t sucking when I visited yesterday, so I spent a long time talking with Aamaa, Sasu, Aamaa's sister and Aamaa's aunt, giving education, tips and encouragement.  I went home and prayed.  And prayed some more.  And prayed some more that night.  I was comforted knowing that many of you were also praying.

I asked a friend who is a speech therapist to stop by this morning to see if she could help out at all.  When she arrived, she found out Babu has been sucking since last night!  I don’t know how much my education helped, but I know prayer helped!

Every day Aamaa smiles and Sasu cries, and they both make me want to cry.  We chat and say how thankful we are for how Babu is doing.  And each time I tell them that we need to give thanks to Jesus because He is the only healer.

Babu is doing miraculously well considering what he went through.  Given my mistakes and lack of experience, I can only attribute this to prayers to God, the One True Healer.  Please join me in praying that Babu continues to do well, grows to be completely normal and knows that he is normal because of God.  Please pray that this family would know Babu’s healing is coming from Jesus so that they may believe.  Praise God for what He has already done in these lives!  Praise God for growing my faith in Him further.

And [God] said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me.  That is why, for Christ’s sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties.  For when I am weak, then I am strong.

~ 2 Corinthians 12.9-10