Chad #2 2019
It’s 92 degrees as I drip from my shower to my bed. The fan is just outside the mosquito net pointed at me. Totally wet, and the fan on me, I don’t feel hot for the first time!
At midnight I get a call from Dr. Sarah from the maternity ward that there is a patient with a uterine rupture. Apparently this patient is in her 3rd pregnancy and has been at a district health center clinic and has been in labor 5 days (way to loonnngggg)! She had had a previous C-section so this was especially to long. This mother was sent here after developing more intense abdominal pain. There is no baby heart beat. They are putting in the spinal. As we start the surgery her blood pressure was 7/4. Which in our usual terms is 70/40, low. She’s lost a lot of blood and I hope that she got enough fluids before hand to not go lower. People can die from a spinal that have lost to much blood or they haven’t gotten enough fluids before it’s placed. As we get into the abdomen we get a lot of blood as expected and immediately see the back of the baby. I see the umbilical cord and there is no normal blood flow palpable in the cord confirming that the baby is dead. The baby, cord, and placenta are all free floating in the abdomen. We pass all of this off to the nurse in the room and continue on to the uterus. The mother wants more babies so we try our best to save the uterus. It is torn across the front where she had a previous C-section and then down the front of the uterus towards the vagina. The part down there was very thin and difficult to separate from the bladder. Suturing the bladder into the uterine repair is a bad thing! We put clamps on each side laterally on the uterus where the uterine arteries are bleeding. We suture the large hole shut and reinforce it with more stitches. Dabbing and looking, dabbing and looking…there is no more bleeding. I massage the uterus to help it contract. About this time we hear of another mom in labor that isn’t progressing, and we ask that she be given a good IV with IV fluids running. We close the fascia and then as I close the skin, Sarah takes off to check out this other woman. Within about 5 minutes Sarah is back and confirms that we need to do a C-section on her. As we take off the drapes we see a “code brown”, with the relaxation of the spinal there is a huge pile of poo between the legs. It takes a little while for the nurse and anesthetist to clean it up, before we can start the next case. By now I am sweating more than ever. The air conditioner in the OR, is the only one in the hospital, and it’s not working for 3-4 weeks now. It was “fixed” last week only to fail after 30 min of use. It is now 94 deg in the OR, as it appears to be warming up with the lights and machines on.
The next girl is lying on her stretcher and is moaning and rocking back and forth saying, “I can’t do it”, in French! She is taller than average and muscular and lays there naked with an IV and urinary catheter in place. She holds out her hand in a pleading gesture of requesting help, reaching towards me. I find out this is her first delivery and she’s not pushing any more even when contractions are coming. She gets her IV fluids and spinal and she doesn’t drop her blood pressure to much. Her baby had a good heartbeat on the maternity ward. We do an incision across the lower abdomen in the “bikini” line. Skin, tiny bit of fat, fascia, muscles are all opened to see the uterus. We make an incision above the bladder and push it down with repeated motions to separate it off the front of the uterus. Then we make an incision in the uterus and see a baby. The head is really stuck in the pelvis. Sarah asks the anesthetist to push up in the vagina to push on the baby’s head to dislodge it. I’ve not ever done that before. This help is successful and she pulls out a living, crying baby. This is the only time I really appreciate a crying baby! I really dislike pulling out a limp, non-breathing, baby in a C-section when we had thought the baby as alive at the start of the surgery. This baby is crying and we pass him off to the nurse to dry him and tie his umbilical cord. We close up the uterus and the subsequent layers as we work our way out. It’s now 3 AM, I’ve lost a lot of sweat in the OR, and so I drink a lot when I get back to the room I’m staying in. Next is the shower again, and off to bed dripping wet!