Bara crisis as newborns die

It has now emerged that these were the details that prompted health minister Dr Aaron Motsoaledi to urgently intervene and dispatch five defence force theatre nurses to the busy maternity ward.

However, a internal letter leaked to Health-e from the head of the Department of Obstetrics and Gynaecoloy at CHB, Dr Eckhart Buchmann, to the academic head the University of the Witwatersrand, Dr Franco Guidozzi, has revealed that the shortage of midwives and maternity staff already became apparent in early November last year, precipitated by the non-payment of agency nurses by the Khalipha Agency, and the non-payment of Khalipha by the Gauteng health department.

‘€œHospital management, including the head of nursing services, were aware of the problem, but seemed unable to resolve it,’€ the clinician wrote in the letter dated January 23.

According to the letter, the Gauteng Health Department eventually paid its outstanding fees in late December 2011, but there was no increase in labour ward and nursing staff.

‘€œThe first two weeks of January were marked by increasing associated morbidity and mortality, with two avoidable stillbirths. The theatre queues became increasingly long and from 9 to 11 January the hospital transferred 16 women out for caesarean sections at other hospitals,’€ Buchmann wrote, adding that the addition of the defence force staff did not resolve the theatre space shortage.

The doctors also revealed that, due to staff shortages and resultant delays in caesarean sections, a number of babies who needed urgent deliveries died or were born asphyxiated resulting in brain damage.

The shortage of midwives and overcrowding saw women being in labour for excessively long periods, resulting in the health workers missing fetal distress and such babies suffering hypoxia (lack of oxygen to the brain).

Most women in labour who awaited beds in the ward had to sit on a bench in the admissions area for many hours.

Doctors have also reported that the labour ward beds stayed wet and dirty for extended periods, even resulting in maggots breeding in the blood-soaked mattresses.

Staff who worked under these conditions reported severe psychological stress, forcing them to deliver a ‘€œdysfunctional and unsafe service to users’€.

CHB’€™s labour ward, closed frequently at night, with diversions to Rahima Moosa which was already under pressure.

The memorandum detailed a number of cases:

JC, November 29: A 22-year-old with a term pregnancy was transferred to CHB from Chiawelo Clinic. In the labour ward admissions area she was found to be in the active phase of labour (6cm dilated). By 2pm on that day, the labour had not progressed. At 5.50pm there was still no progress and a caesarean was booked. The caesarean section was done at 8.45am on November 30, 15 hours after bring booked. The baby was delivered as a ‘€œfresh’€ stillbirth, weighing over 3kg. The last record of a fetal heart rate was made at 2.45am.

MB, January 5: A 21 year old with a previous caesarean section presented at term to CHB at 12.30am in early labour. A bed in the labour ward only became available at 5am on January 6. At 6.30am there had been no progress in labour (cervix still 3cm dilated), and an emergency caesarean section was booked. There was only one theatre available and a long waiting list. At about 2pm evidence of fetal distress was noted, but both theatres were occupied by long and difficult cases. Just after 4.10pm the fetal heart rate stopped. The operation was done at 8.30pm (14 hours after it was booked) where a fresh stillborn full-term baby was found in the abdominal cavity with the uterus ruptured.

The letter presented a long list of cases where the babies asphyxiated because there was nobody to attend to them or the theatres were full. One woman lost her twins on January 12 because staff failed to treat her hypertension, there was no bed in the labour ward and no fetal monitoring. Another women was only seen to 26 hours after arriving, by which time the baby had asphyxiated.

A furious CHB CEO Johanna More denied that she had been informed of these incidents or deaths and that they could be linked to the staff shortages.

‘€œI need to ask what these doctors were doing when the babies died. Maybe it is time for us to investigate the private practices of some of these doctors. What have they been doing to help me,’€ said the former midwife.

She said CHB delivered between 900 and 1 200 babies a month and accused the doctors of being happy to have woman deliver on hospital benches before she took the reigns three years ago.

‘€œWhere were they when these babies were dying? Where are these consultants? Spending time in conferences,’€ she said. ‘€œIf the gloves are now off, so be it.’€

According to doctors the following cases were related to the midwifery and theatre nursing shortage (the dates refer to when the mortality and morbidity meetings took place):

17 November 2011

–             Woman booked for caesarean section (CS) at 2.15am, only one theatre available, CS done at 4.25am, baby asphyxiated. (Perinatal asphyxiation is the medical condition resulting from deprivation of oxygen to a newborn infant long enough to cause harm. It results most commonly from a drop in maternal blood pressure or interference during delivery with blood flow to the infant’s brain.)

–             Woman arrived at CHB at 11am, 8cm dilated, delivered three hours later, no fetal monitoring. Baby asphyxiated, died three days later.

 Woman booked for CS, and CS done 6 hours later, only one theatre available, baby asphyxiated. Result is hypoxic ischaemic encephalopathy (HIE), a condition where the entire brain is starved of oxygen for a period of time, injuring the brain.

8 December 2011

–             Woman labored for 24 hours, not monitored and not seen on rounds, eventually delivered by CS, baby asphyxiated.

22 December 2011

–             Woman with normal labour, spent 6 hours in labour ward, no monitoring. Normal birth, but baby asphyxiated.

5 January 2012

–             Woman transferred from clinic for big baby, CS booked for obstructed labour at 1.25am, only one theatre available, CS done at 5am, baby asphyxiated. Result is HIE.

19 January 2012 (these cases from earlier in the month before defence force nurses arrived)

–             Woman booked for CS for fetal distress in labour at 11.20pm, only one theatre available, had normal birth at 2.35am, baby asphyxiated, HIE.

–             Woman transferred from clinic for poor progress in labour, admitted to labour ward, where for 20 hours received no monitoring, and oxytocin (a drug used for labor induction and to support labor in case of non-progression) was not started despite repeated orders. Eventually booked for CS, but only one theatre available, then had normal birth after 26 hours in labour ward. Baby asphyxiated, HIE.

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