By Ernest F - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1111256
The entire process between labour and delivery took less than six hours, although she has been having minor contractions before then. After complaining of seeing some liquid discharge from the vagina the previous day, the resident doctor recommended an urgent ultrasound scan, the result of which showed that the amniotic fluid has reduced to an unhealthy level for the foetus. Either naturally or by Caesarean sectioning, the baby had to be rescued. The expected delivery date has been surpassed anyway.
She checked-in to the labour ward around 7:00 pm together with her husband, a combination of pain, fear and anxiousness in her face. This is going to be her first experience. However, it is not totally new to her husband. For him, the moment is a reminisce of a painful past where he lost his first love to the Caesarean section procedures although the doctors claimed she died due to eclampsia. It is a combination of fear and hope for him.
The labour ward seems less busy at this period of the year. She was assigned a bed, told to lie down while a fraction of 200 mcg Misoprostol tablet was inserted under her tongue to further induce labour. In less than 30 minutes, the effects of the drug started manifesting as the contraction rate and magnitude increased. The nurses were coming at intervals to check the status of the uterus, whether it is opening or not. The expression on their faces showed that the night might end up being a pleasant one. They started making the necessary arrangement for a natural, vagina birth process.
The intervals between contractions kept getting closer and closer and around 12:30 am, she called on the nurses that she was feeling the urge to pass faeces. The nurses calmly responded by informing her that it is the head of the baby that is pressing on her rectum, making her get the urge to pass faeces. While they were preparing the delivery bed, they told her not to try any form of pushing for now.
Supported by her husband, she slowly and carefully moved from the bed to the delivery bed. She was quickly fitted with a drip set with normal saline infused with oxytocin to stimulate uterine contraction as well as induce lactation. While in the lying position with the head raised using a pillow, the nurses told her to focus on the top of her abdomen and push with her might as much as possible. After two trials, the nurse announced the appearance of the baby’s head and quickly poured some olive oil at the entrance of the vagina to ease the passage of the coming baby. Then, she was told to push for the last time. Almost immediately, the baby flew out with a gush of fluid and it took some efforts from the nurse in charge to catch it.
The umbilical cord was clipped and the baby taken to another section for cleaning up and dressing while the mother kept on receiving attention. The placenta was successfully removed after some minutes. A doctor was called upon to stitch the minor tear the mother had before the baby and the mother were transferred back to the ward. It was surprising to the nurses that the mother lost a very small amount of blood throughout the process. Little did they know that a huge mistake had been committed which will soon come back to haunt them.
Back in the ward and it was time for the new mother to pass urine. She removed the pad used to cover the vagina entrance and slowly filled the potty with urine. Apart from the fact that the pad was soaked with blood, the urine itself was bloody red, suggesting that something is not right. All these happened behind the nurses but no alarm was raised by the new mum and her husband. They both thought it is a normal occurrence for someone that just gave birth.
The husband put a call through to family and friends to announce the arrival of the new addition to the family. Both the mother and the baby are fine, he joyful told everyone. It was a busy and eventful night but he must resume working the following morning. Around 6:00 am while the mother and the baby were sleeping, he went home to prepare for the day’s work. He was about pouring water on his head in the bathroom when his phone rang in the sitting room. Knowing that the call could be from the hospital, he aborted his mission in the bathroom and quickly dash for his phone. There, the news was broken to him that the new mother has been bleeding and has been wheeled back into the labour theatre.
The husband abandoned everything else and dashed back to the hospital, the memory of his first wife loss running through his mind. Is it going to happen again? He got to the hospital and headed straight to the labour theatre where he saw his wife surrounded by a group of people consisting of doctors, nurses and an anaesthetist. Will she be fine? What happened?
One of the doctors (the consultant) announced to him that the new mother had both vaginal and cervical tear during the delivery process but unfortunately, the cervical tear was not noticed and only the vaginal tear was stitched. This led to her losing a lot of blood. The initial vaginal stitches had to be removed in order to tend to the tore cervix. When the pain became unbearable for the mother, an anaesthetist had to be called upon to sedate her before the anomaly could be corrected.
The consultant went further and informed the husband that the mother’s blood sample had been taking to the laboratory for pack cell volume analysis and depending on the result, a blood transfusion might be needed for the mother. Hence, the husband should be prepared to donate blood - that is if his blood group matches that of his wife. The result came a few minutes later – PCV was 25.
The couple decided to wait for about 24 hours with the hope that the blood count will naturally get boosted and there will not be any need for transfusion. Another PCV analysis was carried out on the mother’s blood sample and this time around, the blood count declined further, necessitating an urgent need for blood transfusion. The consultant recommended at least a pint of blood. After undergoing the relevant test to determine the blood compatibility between the husband and the wife, a pint of blood was obtained from the husband using the relevant procedure and the transfusion was done before the mother and the new baby were discharged few hours after.
Epilogue
Dear reader. Thanks for taking out time to read this humble submission of mine. The write-up is an eye witness report of events leading to the successful delivery of a woman in a typical Nigerian health system. It details how a small mistake could have resulted in the loss of the mother's life. The mistake from the personnel of the hospital also led to an increased hospital bill for the couple who were probably too happy to have pulled through. In a saner clime, the hospital should be facing charges for endangering the life of the mother. If you are a health professional and reading this, please feel free to leave comments on what should have been done differently during the delivery process.
Thank you!