Of a destructive delivery

So, I have been on a long sabbatical. It's been great ! Met a lot of cool people in the past year, Learnt a lot of surgery and other fancy medical stuff. Oh and I got to spend loads of quality time with family, wedding bands and beaches! 2012 was magical in every sense of the word.
Like every other good thing, it had to come to an end and I am now back to my passion, OBGYN! Yesterday, I was in labor ward all day, doing what I love....(well, today every muscle in my being is screaming murder). The boss came early to do the handover round as we all wanted to go catch the presidential debate(Very considerate Chap). We finished in good time and just as we were about to leave, a midwife calls us to go handle an emergency. *REALLY,????

This lady had just been wheeled into labor ward in Second Stage(meaning her baby was ready to be delivered any moment). Well, that happens a lot only that in this case, her baby was in breech( a condition whereby the baby is born feet and legs first instead of the head).  The very competent midwife had delivered the baby's body but the head was "stuck " inside. In such a situation, the senior most midwife first goes in and tries maneuvering the baby, when that fails, the wide eyed Resident (read me) takes over....then the Consultant is the ultimate.

So in we go, follow protocol by the book and we all fail miserably. See, we notice that the baby has spina bifida(a birth defect on the spinal cord) and no matter what we do, the baby's head refuses to come out, and we are left with only one conclusion. This baby has hydrocephalus (condition where the baby has an extremely large head from accumulation of fluid, goes hand in hand with the Spina Bifida). By this time, the pink baby body we were seeing initially has turned dull and lifeless....

We rush the woman to theatre and hope that as we put her under GA, her muscles will relax and we can try deliver the head. Unfortunately this too fails and by now, the baby is lifeless, head snugly tight within the mother whilst the body wilts away. What we do next, can not be described in this post.......but the mother's life takes precedence over everything else.

Ladies,  when pregnant, just do an ultrasound, know what state the baby you are carrying is in. Had this happened in a different set up without the facilities we have, a mother and child would have both died. We got to save a mother, but we all love to have a healthy mother and baby!

Am ecstatic to be back, albeit on a sad note.... Keep reading!

OF SUPERSTARS

So, it has been really long since I last penned down my feelings.... here we go.

so, about a week ago, a friend of ours underwent a c-section at one of the best hospitals in this country. She checked herself in, and seeing as it was an elective procedure spirits were up and everyone was happy. She went into theater, delivered a healthy and I swear that baby was actually bouncing!!! Handsome little man...the ooooohs, and aaaaahs, and so sweet...flowed  and flowed some more.

One hour post op, all hell broke loose. No doctor is perfect, neither is any procedure routine and as it so happened, the new mummy's condition suddenly took a turn for the worse. She got restless and listless, started throwing up, her level of consciousness started waning and within no time, her BP was so low it was un recordable. For a surgeon, this could only mean one thing.....we have to go back in. Our patient was wheeled back to theatre and so started the long and dreadful wait.

First person to run into theater was two anesthesiologists, then a cardiologist, then the Obstetrician and finally the Cardiothoracic Surgeon. We waited and waited and waited some more. Now generally, you don't want the doctors coming out too soon cause that would mean it was too late and she didn't make it. Again if they take too long, it could mean that they are probably in there too exhausted and scared to tell us the sad news. That was the longest four hours of my life...the wait! My only consolation was that we were in the best hospital in this country and surely, with the best doctors on board, our patient had to live.

And so, they started trooping out...The superstar Cardiologist, he told us about how he managed the shock with epinephrine and inotropes and some fancy big drug names and reassured us she was out of danger. Next was the superstar Cardiothoracic surgeon who told us how he made a midline extended incision on the abdomen and followed the aorta from the xiphisternum all the way down to the aortic bifurcation and checked the iliac vessels and he had arrested the internal bleeding. Next was the superstar OBGYN, who told us the uterus was intact, well contracted and our patient was out of danger. Last but not least, was the two anesthesiologists who I can swear I even saw their hairs being blown like in the movies...the real superstars who wheeled our patient to ICU, connected all those fancy gadgets, told us long tales of FFPs, Platelets transfusion, monitoring the two drains in-situ, the fancy drugs to stabilize the BP at a low level cause they did not want her to start bleeding all over.... Our patient spent three days in ICU, and now recuperating albeit slowly in the ward now.

My point? How many of us doctors have these facilities wherever we work? How many have lost a patient due to bleeding because there was no blood? Because there was no FFPs and she went into DIC? Because the hospital does not have enough staff to do the run around? Because we did not have the Cardothoracic surgeon to help identify and ligate a bleeder? Because we did not have a cardiologist neither the inotropes to correct the shock? Because we did not have an ICU? Because we did not work in the best hospital in the country? Because we were too tired from working all day and with not even a penny to show for it?

Doctors are superstars! We save lives! We do our thing and people live. Bwana Minister, all we are asking for, very simply......listen to us, meet our demands and please please allow us to be SUPERSTARS! Cause that's just what we are! #peremendemovement continues.

OF UNSUNG HEROES

So, I remember my first day in labor ward, as a big eyed, very green and inexperienced intern. I was overwhelmed with first and foremost the miracle of childbirth and all the woman screaming away in labor pains and even more distracted by those who were pacing up and down the corridors. As it so often happens, the resident doctor on call was called off to theater and suddenly the whole labor ward was left under me. 

Now I think skiving all those fourth year labor ward duties came to bite me back and it bit hard! I had no idea what to do, where to do it and who to do it to. All the midwives were on my case each wanting me to review their patients (I think they smell a newbie, green eyed doctor from a kilometer away and I think they also derive pleasure from seeing the poor hapless doctor sweat....seriously!) Sweat, I did. A whole lot!

All I remember about that night was a lady who was about 28weeks having preterm labor telling me that she had an urge to pass stool. I gladly took her hand and led her to the washrooms! You can imagine my horror when she squatted right inside the door and pushed out the tiniest little baby I have ever seen....Thankfully not inside the toilet bowl, she didn't quite get there. I also CLEARLY remember the midwives screaming at me, some ridiculing me and others just laughed at this 'doctor'. <DEVASTATION>. One particular midwife saw the anguish, confusion, embarrassment (there are not enough verbs to describe my feelings at that point) and decided to help me out. And since then, most of what I know about obstetrics, I owe it to the midwives I have worked with over the years. 

As an OBGYN, I have learnt that the midwife is the one most powerful friend I could ever have. She knows when things are going on smoothly, she can tell a fetal distress from a mile, she can see an impending convulsion from behind the curtain, she can tell whether a mother will manage to push that baby out, or we need to do an operation. A good midwife will make a doctor have a smooth delivery or a complicated one, she can sass out abnormal contractions caused by abruptio placenta from the normal contractions of an overtly sensitized patient, she knows when to intervene when things are not going on so well, she knows how to talk to and encourage the woman in labor. She provides the motherly,caring  and reassuring touch when am busy trying to beat traffic to get there on time, she will always offer a comforting word, a shoulder when the unexpected happens. She will definitely warn me well in advance when she thinks things are not right, ignoring a midwife at this point is suicidal. 

Today, I salute all the midwives, who risk it all, who give their all, who brave difficult situations, who work tirelessly, to bring forth the miracle of birth. And to the Ugandan Midwife, up for the Nobel Prize, you deserve it and so much more! SALUTE!

THE OTHER SIDE OF FEAR

FOR MY COLLEAGUES WHO DAY IN DAY OUT ARE IN THE BUSINESS OF CARING FOR WOMEN

In giving birth some must go to the other side of fear.

They do not always realize how close it is from here.

May we who care for women travel with them there.

Let us be their guide as they traverse this length

Searching for their power, discovering inner strength.

Help them see in their mind’s eye the place where they must go.

Walk with them through that door thoughtfully and slow.

Then looking back toward where they began

They will know, with confidence, they won’t be there again.

They will embrace their child in an ever-greater sphere

After finding power on the other side of fear.

-Joan moon, CNM,MSN

Certified Nurse Midwife

Of LABOUR

So picture this, am this very young and impressionable fourth year medical student, fresh faced and eager to learn, full of zeal and zest for life, notepad in my slightly over sized lab coat, stethoscope hanging around my neck and with these big curious eyes taking in everything going on around me. So Innocent......So good were those days....

So there I was, on one of those random days, hanging around the hospital with nothing to do,and since I was doing my Obstetrics rotation I decided to just take a stroll to labour ward. I had heard stories, a lot of stories but I was in one of those carefree moods, nothing could faze me. Immediately I got in, there was some flurry of activity towards some small room at the back of the ward and everyone seemed to be headed there. I of course quickly joined in the procession and in my tiny little self I caught myself thinking that wow am gonna catch some action, what I saw really stopped me dead in my tracks, action , I did get, lots!

I realized that I was in the delivery room right in the thick of things. There on the delivery room was a lady, in her twenties or so, her legs high up in the air, astride and the room had several students, more eager eyed and stupefied than I was..the door to the delivery room was wide open and the other nurses went on caring for the other patients. The primary midwife was shouting at the lady ordering her to push the baby out lest the baby gets "tired" in the birth canal. The room was such a flurry of action, students whispering and pointing at the baby's head peeping through from the nether regions, the midwife hurling orders left, right and center, another nurse stitching up a mother who had just delivered, a wailing baby crying on the receiver and of course this woman laboring away,screaming away the last and longest stretch. Oh and there was blood.......and other stuff! I caught a glance of her face and all I could see was confusion, pain, terror, anxiety and was that a fleeting look of shame? After a lot of "prodding" and pushing, she welcomed a bouncing baby into the world and we all sighed, some in fear, others in awe, a lot of us in disbelief but the more seasoned fellows looked happy, it was over and the little one shrieked away pinker than pink panther with a full head of hair!

I don't remember leaving the room, I don't even remember what I did after that. But I remember that woman lying there, astride, her womanhood splayed open in front of how many eyes? Students who just came to "see" what birth is all about. Like watching a movie. I remember the not so friendly midwife, hurling orders, clearing  the way, holding ominous looking scissors. I remember the look of terror, of pain and of shame on the woman giving birth to her precious baby, I remember how undignified she must have felt, I remember how vulnerable she must have felt, I remember how exposed her womanhood was, I remember how disrespected she must have felt to have all our eyes on her, I remember the look of anguish she had, I remember her trying to cover up herself.....

So today, I want  to remember to respect a woman in labour. I want to remember to cover up a woman at this very special moment. I want to remember to encourage this woman. I want to remember to give her privacy. I want to remember to allow her to enjoy birthing, I want to remember to allow her to deliver her baby in the most comfortable position, I want to remember to allow her partner to share this moment, I want to remember to be gentle, I want to remember to wait for the little one to make its way out, I want to remember to give her her dignity back, I want to remember my hand on her shoulder, urging her on, I want to remember receiving the baby in my hands but most of all I want to remember to smile with her when its all done!

Of babies, nether regions and sex

So this issue has been brewing in my mind for a long time now.....in my line of duty, I see a lot of nether regions, ALOT! And we are all different, it's actually amazing, kinda like the way we all have different facial features. There's abit of variation between those who have delivered naturally and the first timers. The best part being that the experienced ones are usually more willing to work with us as we bring the new life forth.

From my study of the human body, the birth canal has very strong muscles which also have the highest tensile strength. A baby's head passes right through it and it goes back to its original state. Since time immemorial women have done this, and men with their women have continually Engaged in intercourse and produced even more babies. Rumour has it that the sex actually gets better, you know, the more the muscle is exercised, the stronger it gets and the more it contracts end result PURE UNADULTERATED PLEASURE!

However, There's a trend in town that women are chickening out from natural birth so As not to 'ruin' the nether areas....so my question today is actually very simple, and I want all to have an input, men and women alike.... Is there a difference in the sex after natural childbirth?

OF A SPECIAL BOY

So two years ago today, I was a patient. I had been admitted at exactly thirty eight weeks for an elective Cesarean section. Woke up very early in the morning, my c/s was scheduled for midday and since I really don't love hospitals I promised my doc that I would be there very early. My hubby drove us there and we went through the rigorous boring process of admission. Now I was really not amused to be on the receiving end of the medical personnel. First, the labour ward was so busy, the place was just crawling with women, some looking more pregnant than I was. I was tossed into a waiting room to await admission or was it a free bed? For some reason, I didn't look like I needed urgent attention because it took us over two hours to get the basic vital signs taken, someone to listen to my little man's heartbeat deep inside my belly and eventually get a gown and a bed! Now we medics are the worst patients and you can imagine that I had started thinking the worst, like maybe there's a cord choking him and no one cares....my BP is rising and these people are not bothered...terrible!

So eventually I got settled in, even wore that gown that is open behind...(why is it even called a gown really????) and waited for my midday appointment(....with anesthesia....what if I wouldn't wake up, what if the anesthetist pushed the tube down the wrong pipe? what if I bled uncontrollably? DAMMIT). My sis and pals were there too, I guess for comfort but am sure they were more interested in the little life that was about to pop. Hubby threw in a comment of how ObsGyn would be an ideal speciality to pursue, I looked at him like SERIOUSLY??? I can't do that? Its too bloody, too messy, too painful every excuse I had in my brain. By the time Midday arrived, he had even drawn up my study timetable for those three months I would be home for maternity leave, an Old Currents Text Book which had been handed down through his family reappeared and let's just say that battle I lost!

So my flamboyant Obstetrician arrived, in full pomp, dressed to kill as always and announced to me that she was very sorry, theatre was occupied with emergencies and her midday slot had been taken by someone. The best she could do for me was schedule me for 7pm that night. Ordinarily that should have been understandable, but tell that to a term pregnant woman and its not the same. I waaaaaaaaaaaaaaaailllllllled!!!Wololo! (Yes I will blame it on the hormones)! OK, this particular pregnancy had been difficult. I remember I used to throw up even at the slightest smell of even water! SERIOUSLY! I remember working at the clinic and some women would come wearing designer perfumes(I sincerely hope they were though) and the moment she would enter my cubicle I would rush to the loo to throw up! and this was at the seventh month! Secondly, the little man inside of me would give me such intense hunger pangs that I actually used to get tremors. I actually walked away on patients in the consultation room to go get a bite. Thirdly, my tummy grew so huge so fast I got so tired of people asking me "you've not yet delivered?" Damn them! Fourth, I had a backache from beginning to the end, add the over sized belly to the equation and disaster! As for my Sex life.................(no words)! So, I was really tired, I wanted him out yesterday! and now, my appointment pushed to 7hours later, torrential downpour!

So at exactly 7pm, I was wheeled to theatre and my son was delivered. a Healthy baby boy, with a perfect APGAR score( I think this is the one and only question I asked when I came out of the deathly throes of anesthesia, ) Two years down the road, he brings us so much joy! He wakes up with a smile, he hugs me all the time, he obsesses over his sister like a brother should , he looks up to his father and tries to fit in his shoes...literally, he feeds so well, he tumbles and falls all over everything! His little mouth is full of teeth, of late, he has started throwing tantrums all over..terrible two at the peak! He has the cutest smile ever, little arms that hug so tightly and he now has a huge vocabulary of words, sometimes he says very funny things we keel over in laughter!

Two years down, am an ObGyn in the making. Loving every moment of this wonderful journey, and trying hard to always think of my patient as myself. Happy Birthday Baby G, I think it's time we dropped the baby and just said Happy Birthday G!