By Neil Murphy, MSF OBGYN in Aweil State Hospital, South Sudan
In labor and delivery suites around the world, we usually don’t create life. Rather we try to assist in the smoothest landing possible for the incoming baby; until I worked in Aweil, South Sudan, at the MSF maternity project, that is.
One day, an exhausted patient came in from an outlying clinic after being in labor for five days. It clearly had been a hard five days of labor, plus she then had to get to our facility. The patient was near her due date, but at some point in this five-day process the umbilical cord had prolapsed, or slipped out below the baby’s head.
When the umbilical cord gets compressed it stops giving blood to the baby within minutes, so the baby had died prior to arrival at our facility. This was especially sad because the patient’s last delivery had been of a set of twins who were both stillborn.
Our chief midwife was on duty that day, and feeling compassion toward the patient’s struggles, he hoped this patient could just get past this ordeal so she could start feeling better. He moved to expedite the delivery of the dead baby with the assistance of a vacuum device which allowed him to pull gently on the baby’s head in order to assist the patient’s own efforts while pushing.
Prior to the expedited delivery, we had performed a brief bedside ultrasound which confirmed that the fetus had no heart beat. But it also showed what might have been a previously undiagnosed second fetus, which also appeared to have died. This looked like a repeat of her last sad delivery. Rather than taking more time for further extensive evaluation, the midwife moved to make the patient more comfortable.
The delivery went quickly with his assistance, but there was one hitch.
As soon as the baby was delivered, he took a gasp of air. Then another gasp. And another.
The team quickly rallied around the infant boy and provided basic respiratory support. Within a short time the baby was breathing well on his own.
We all watched as the he grew and thrived. The staff throughout the whole facility referred to him as our “miracle baby”, right up until his normal discharge.
The rest of the story. The patient still had a prolapsed cord after delivery of our miracle baby. It now became clear that this was the unusual scenario of an upper twin’s membranes rupturing and prolapsing a cord past the lower twin.
The mother was finally able to get cleaned up and rest that day. When it was time for her to go, she was quite happy to leave the hospital with a live baby who she never knew existed.
One could say that the health care system should have diagnosed a twin pregnancy much sooner than at delivery, but the clinics outside Aweil do not have well trained midwives or ultrasound. Given the context and our daily challenges in Aweil, we prefer to just think of this as the one single day we created life.
Read more blog posts from MSF field staff.
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