I followed the trail of blood into the delivery room. Clots of red jelly hidden in the grass, star-shaped red drops leading up the cement steps and down the hall, a pool of crimson splashed beneath the delivery bed. Social the nurse was already in the room with patient. “Placenta previa,” she said. Placenta previa, a condition where the placenta is between the baby and the birth canal and causes hemorrhage, is a common and unfortunate enough finding at the clinic – the patients are immediately given IV fluids and referred to the nearest hospital for C-Section. This case, however, was more complicated. Social gently separated the patient’s knees to show the bloody placenta prolapsing out of the birth canal onto the delivery table. The baby inside was already dead. The mother cried with the pain of her contractions.
I racked my brain. The health officer who did C-Sections in Bonga was out of town, so the patient would have to make the 4-hour journey to Jimma Hospital for surgery. Already her heart rate was fast and her blood pressure was low from all the bleeding. I stared at the placenta and tried to remember anatomy – could I remove the placenta and have the patient push out the baby? Was it safe to manipulate the placenta at all, or would she just hemorrhage more? The baby was already dead, but the mother could be saved. The family began to gather money for the expensive trip to Jimma. Edwin and I pitched in 100 birr of our own, fearing that the family may choose to let her die over paying the exorbitant fees for transport and surgery. They were clearly very poor.
Then Social said, “it’s moving.” Sure enough, the mother was pushing and crying with each contraction, and the bleeding placenta was emerging further with each push. To our shock, the baby’s buttocks appeared right behind it. The baby was delivering frank breech. “I’ve never delivered a breech baby,” I told Social truthfully. “Me either,” she said. So, we both put on gloves and grabbed the baby. Our concern was mostly that the already dead infant would get its head stuck, and then the mother would be even worse off than she was before – still hemorrhaging, but now with a half-delivered baby between her knees. “Put your fingers in the baby’s mouth,” I told Social as I tried to remember diagrams I had seen of extracting breech babies. Inch by inch, the baby appeared. After the baby was completely delivered, the womb immediately shrunk down and the bleeding stopped.
I couldn’t read the mother’s face; I can’t imagine what she was thinking at that moment. Her two companions stood beside her with their faces turned toward the wall so they didn’t have to see. I felt a surge of relief, relief that the mother was alive and didn’t have to try to make it to Jimma for surgery. I felt shame because I hadn’t recognized what was happening sooner, and because I didn’t know what to do. But mostly I felt gratitude – gratitude that the situation had turned out ok despite my inexperience. I turned and followed the trail of blood back out the door.
I racked my brain. The health officer who did C-Sections in Bonga was out of town, so the patient would have to make the 4-hour journey to Jimma Hospital for surgery. Already her heart rate was fast and her blood pressure was low from all the bleeding. I stared at the placenta and tried to remember anatomy – could I remove the placenta and have the patient push out the baby? Was it safe to manipulate the placenta at all, or would she just hemorrhage more? The baby was already dead, but the mother could be saved. The family began to gather money for the expensive trip to Jimma. Edwin and I pitched in 100 birr of our own, fearing that the family may choose to let her die over paying the exorbitant fees for transport and surgery. They were clearly very poor.
Then Social said, “it’s moving.” Sure enough, the mother was pushing and crying with each contraction, and the bleeding placenta was emerging further with each push. To our shock, the baby’s buttocks appeared right behind it. The baby was delivering frank breech. “I’ve never delivered a breech baby,” I told Social truthfully. “Me either,” she said. So, we both put on gloves and grabbed the baby. Our concern was mostly that the already dead infant would get its head stuck, and then the mother would be even worse off than she was before – still hemorrhaging, but now with a half-delivered baby between her knees. “Put your fingers in the baby’s mouth,” I told Social as I tried to remember diagrams I had seen of extracting breech babies. Inch by inch, the baby appeared. After the baby was completely delivered, the womb immediately shrunk down and the bleeding stopped.
I couldn’t read the mother’s face; I can’t imagine what she was thinking at that moment. Her two companions stood beside her with their faces turned toward the wall so they didn’t have to see. I felt a surge of relief, relief that the mother was alive and didn’t have to try to make it to Jimma for surgery. I felt shame because I hadn’t recognized what was happening sooner, and because I didn’t know what to do. But mostly I felt gratitude – gratitude that the situation had turned out ok despite my inexperience. I turned and followed the trail of blood back out the door.
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