Saturday, July 16, 2011

Neonatal death.

Nyiriak has been coming to prenatals for months. She has probably heard my lecture about the importance of delivering at the clinic a half dozen times at least.

In that lecture, I warn of the high infant and maternal mortality rate in Sudan and how by coming the clinic such losses can be prevented.

Nyiriak listened.

So when she went into labor on Monday, she came to the clinic. Her face shone in health and expectation.


Expecting her fourth, I didn’t have to do a vaginal exam to know she’d deliver soon; her contractions were well underway. So I got her settled and asked her to call if her water broke or she needed to push.

Her baby was doing well and so was she, so I headed to devotions (we do a staff devotion each morning before the clinic starts). She promised to call me if anything changed.

Twenty minutes later, our guard called saying she was pushing. So I ran.

She was close but not fully dilated when I did a vaginal exam. Her baby’s heart was solid and strong. All was well.

So I called for Sarah to come help. I wanted her to get another ‘catch’ under her belt.

This month we’ve been using her as our pharmacist and she hasn’t been able to help with as many births as we would have liked. She came quickly, gloved up as Nyiriak continued to push.

Once the water ruptured, thick meconium oozed out. Not a good sign. So I got things ready for resuscitation and checked the heart tones once again. They toc-toc-toc-ed happily.

All was well. Or so I thought...

However, once the sweet girl was born she was flat. Sarah and I stimulated her and wiped her down in unison, but she didn’t respond. We cleared her airways, but she didn’t seem to notice.

Limp and growing paler by the second, she didn’t seem to want to live. 

What was wrong?

After a minute or two with no progress, I sent for Margaret, cut the cord and moved her to a table where I could work on her better.

Although we gave oxygen and pumped her heart for her, she didn’t take her first breath for over 10 minutes.

It was hard to watch her limp body turn blue then pink then blue then pink. When she finally breathed on her own, we rejoiced. But it was short lived. Her shallow breaths turned to gasps and her heart rate would plummet within minutes.

Not good.

We bagged her and did chest compressions for an hour and ten minutes in total. She couldn’t maintain her own breathing and died thirty minutes later in her mother’s arms.

Her pale frame lay peacefully as everyone gathered to weep.

I can think of no reason why she couldn’t breathe on her own. She was not premature; she did not appear to have aspirated any meconium; she had no indication of heart trouble antenatally. My best guess is that perhaps her lungs were not fully formed.

As I watched her family weep silently, I wanted to join them but I couldn’t.

I had no tears to offer.

Sure, I was grieving, but I could not seem to find even one tear. Why?

All I know is that this death felt very different than the others. This death was not marred with regrets. I gave my all and so did Nyiriak. In fact, the whole IDAT team worked tirelessly to get her to breathe. But in the end, she died.

Had Nyiriak delivered at home, her little girl would have died instantly. Coming to the clinic, her little girl lived just short of two hours. But they were hours spent fighting for life, giving our best and praying like mad.

I can live with that.

What I’ve learned is that grief is not always displayed with tears and it is somehow easier when not mixed with regret.

Please pray for all those involved in this terrible loss. Thank you.