BLOG: An out-of-body experience

BLOG: An out-of-body experienceIn a 2004 study conducted among about 110 KwaZulu-Natal infants almost 90 percent had received an at-home enema within their first three months (File photo)

Our rural doctor takes a break from blogging about banting to relive the heartache and trauma of coming face-to-face with infant mortality in rural South Africa.

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in 2011, death rates among children under five years of age were triple the international target set out for South Africa in the Millennium Development Goals.
in 2011, death rates among children under five years of age were triple the international target set out for South Africa in the Millennium Development Goals.

I’ve been meaning to write but haven’t been able to because I thought it might be too gruesome, too real, too much.

I keep thinking about it though.I thought about it this morning.

And again when I mashed it up with a fork. This Banting Challenge has been a good distraction, but what I eat doesn’t change what I do – or what I think.

So, I have decided to start by telling you about what I cooked and why I cooked it. Then I will tell you a story.

It’s a sad and scary story so please don’t read it if you’re below the age of 16 –  or if you don’t like horror films or struggle to sleep at night.

I’m serious. Don’t do it.

The story

[quote float=”right”]”She understood and nodded in agreement, the tears still streaming down her face.”

So this is where my mind travelled when I cut into that sweet potato this morning.

It’s 4 pm in the afternoon and I get called back to labour ward. Three days ago I had admitted a 36-year-old woman, whose fully formed, term baby had died whilst still in utero. What makes this even more tragic is that it was her first pregnancy, and a precious one at that.

She was devastated when I told her the news. I was too.

I discussed the case with the obstetrician and then explained to her that we couldn’t leave the dead baby inside. We would have to induce the labour.

She understood and nodded in agreement, the tears still streaming down her face.

The next day when I examined her she had still not gone into labour, so I tried again to induce her. But it failed again. Eventually, on the third day, there were some signs of labour.

At 16:00, when I get to the delivery room, half of the baby’s head is out. I feel it and it’s soft, like a stress ball or a water balloon. I can’t feel any skull bones. They must still be inside. The midwife tells me that she has been like this for almost an hour and that with every push, the head is not coming down any further.

The mother looks exhausted and I give her some water to drink whilst thinking of my next move. I decide I need to drain the fluid from the bulging part of the head that is already delivered in order to assist the delivery. I stick a needle in but when I draw back on the syringe, nothing comes back. I call for some more advice and am told that I should try a destructive procedure:

“Yes,” he said “use a scalpel and the scissors.”

So I do.

An out-of-body experience

It’s an out-of-body experience. I look at myself and think, how am I standing here? How am I doing this? Why are my hands steady and why are my eyes dry? Is this real?

And yet the baby’s head does not move. I pull on it, but I’m worried it might tear and I can’t get a good grip, so I ask for the Wrigleys forceps. The midwife goes to fetch them and I call for help.

I’m so relieved when Dr. B arrives. He takes the forceps form me in his big, experienced hands and tries to deliver the head. I have my elbow on her abdomen, above her pelvic bone and I’m pushing down hard, as hard as I can, with my full body weight, whilst Dr. B pulls from below with the forceps. Eventually the head is delivered, and we’re momentarily relieved.

But then we realise, that unlike in most normal deliveries where the body swiftly follows after the head, here the shoulder is stuck behind the pelvic bone. We try everything we can think of to dislodge it, but we are unsuccessful.

Eventually, we take her to theatre.

She is left with a scar from her naval to her pubis, inevitable nightmares and no baby.

Edited and used with permission. Read previous posts by Lace, a rural community service doctor in South Africa here.