Learning On the Job

It’s a weekend call, rounds are done, a woman in labour is progressing well, everywhere else is quiet and I’m chilling in the call room. The next thing I get a call from the house officer telling me the fetal heart rate is dropping. Last week’s intrauterine fetal death is still fresh in my mind, so I all but race to the labour room.

So what happened last week? A woman was on admission for an elective caesarean section on account of pregnancy induced hypertension, and while I was busy seeing to the passage of an intracervical catheter to induce labour in another woman, the nurse told me she couldn’t hear the fetal heartbeat for this particular mother. I meant to cross check later but after successfully passing the catheter and carrying out a manual vacuum aspiration procedure on yet another woman, I forgot.

About six hours later, the house officer told me she also couldn’t hear the fetal heartbeat for the same woman, that was when I remembered I was told about it earlier, I went over to check as well and heard nothing. Then I asked the mother if she could still perceive fetal movements and she answered in the affirmative. What could be wrong? I informed the second on call then and even though I told her the mother could still perceive fetal movements, she suspected fetal death right away. In her experience mothers were not reliable judges when it came to intrauterine fetal death.

In truth, an ultrasound confirmed fetal death and I was so sorry. Sorry that the woman lost her baby, sorry that we didn’t catch it in time because I forgot to cross check when the nurse first told me.

When I got to the labour room, the midwife was frantic, according to her, there was fetal distress and we needed to intervene urgently. I had called the second on call on my way there to inform her of the development but I still had to ascertain the condition of the fetus.

So I listened with a sonicaid and behold, the fetal heart was there and it sounded okay to me. The woman was a primigravida with a short stature and the odds were not in her favour already, so we monitored her cautiously. Meanwhile we had gotten all things ready for a caesarean section if we had to resort to that.

But the midwife was not comfortable, she kept saying she didn’t want the woman to lose the baby and she was pretty sure that would happen if we didn’t intervene. I didn’t quite agree with her but I still called the second on call who was also of the strong opinion we give the woman more time since she was a first time mother and labour took longer in them.

So we waited and waited as she progressed in labour. Three hours passed, but she eventually delivered a vigorous female neonate with a very good apgar score.

There are at least three good reasons why I shared this story. First, I wanted to point out the need to give primigravidas more time in labour, to reiterate the fact that not all short statured women will require a caesarean section, and to praise the confidence and experience of my second on call.

But for her, this struggling family would have had to pay thousands of naira for a caesarean section which wasn’t necessary, not to mention the increased morbidity in the mother that would have followed an operative delivery. I also thought the woman could deliver, but I couldn’t withstand the pressure the midwife was mounting on me and I was afraid of being liable for an asphyxiated baby, or fetal death.

But my second on call had no such fears. She was objective, experienced, confident and calm, she reminded me of God. How he’s always so calm and unperturbed while I’m praying frantically and thinking if something isn’t done about my situation in time, something terrible would happen. And after all is said and done, I make progress against all odds and get a favourable outcome that costs me less.

Can you think about a time when you were so worried about something that eventually worked out seamlessly? Share with me in the comments.

Talk soon,

ajidara