Thursday, October 20, 2011

Stillbirth.

I’ve only seen Achan since mid-September for prenatals. She came the first time because malaria was burning through her body. However the first treatment was not effective... or she was exposed to enough mosquitoes to get it again just 3 weeks later.

Either way, she came in again last week, but this time the malaria was worse. She was vomiting and had been for days.

I stabilized her with IV meds then sent her home with orals, but her recovery was slow.

So when I saw her in my prenatal line, I was worried. Perhaps it was something worse than malaria, and I’d misdiagnosed her.

She said she wasn’t having contractions but felt really bad. So I asked Margaret to look into it.

Margaret checked her out and laughed at me for not doing it myself. She was definitely in labor she said, and was already 8 cm dilated.

Since my hands were full with prenatals, Margaret promised to keep an eye on her. But just as she was getting pushy, another woman came in to deliver.

So Margaret took over her care, and I turned my attention to the gap-toothed mama on my bed.
She was very active, and before I had a chance to do a vaginal exam, she was pushing.

Not 15 minutes later her girl was born!

She hemorrhaged which took several medicines and maneuvers to control, but eventually things calmed down and I transferred her to the recovery room, cleaned up, and went to see if Margaret needed my help with Achan.

I found Achan trying to push as a friend supported her back. Margaret kept insisting she needed to push harder and longer. I wasn’t sure how long they’d been at it.

Picking up the doppler, I found the heart tones with ease. They were steady at 120 bpm but dipped when she pushed to 90s. I suspected head compression since the head was passing under the pubic bone, and wasn’t initially concerned.

However, as she pushed the heart tones continued to drop. Margaret kept trying to get her to push harder; I suggested new positions.

Achan’s eyes flashed wildly in fear, so I comforted her with gentle words. The tension in the room thickened the air; emotions were high. So I prayed.

As I listened to the heart tones again, I whispered to Margaret that they were dropping still. They were in the 60’s and 70’s. The baby needed to get out quickly if we hoped to have any chance at resuscitating him.

Although Achan pushed her best, the baby was slow to come. Five minutes before he was born, I could no longer find the heart tones. They had dropped to the 50s; then were gone.

My hope was that he was just too far down in the birth canal to be found, but my gut told me otherwise.

He was born pale and limp.

Margaret cut his cord immediately, and I took him to resuscitate. Though his color was pale pink, his heart was completely stopped.

Tom came to give rescue breaths, while I pumped his tiny chest. This went on for several long minutes, as the room silently watched.
    --Would the Kowajas get the baby to live?

After 10 minutes with no heartbeat, we pronounced him dead, wrapped him in a blanket, and handed his blue-tinged frame to his grandmother.

The grief in her eyes was too great to look at directly, and I furtively studied my shoes.

“Malesh mama. Malesh. (I’m sorry mama. Sorry.)” I said softly.

She nodded that she’d heard, reached for him, and sat down slowly on the edge of the bed.

I had to leave the room to breathe again --my chest, tight with grief, needed the sun, the air, the song birds. It gasped for it in panic, and I sobbed.

Fortunately, Nancy (a wonderful Christian woman here to help with the pastors) was near by and she let me blubber while she prayed.

Later the pastors and staff surrounded Achan and her family in mourning. We prayed and loved on them as best we could, and then they returned home.

This death was particularly hard for both Margaret and myself. Although I could see he was declining, there was no way we could get the baby out any faster. And once he was born, there was no clear reason as to why he died.

Please pray for Achan and her family as they grieve, and particularly Margaret. This death has rattled her severely. Thanks.