Wednesday, July 8, 2009

Today I saw a woman give birth...

Martes 7 Julio 2009

Today I saw a woman give birth. Rather, I saw a doctor pull a baby from a woman’s stomach by means of a Caesarian section surgery. This is basically what happens. I never really understood what a C-section was until now, though I knew it involved some type of surgery and a cut related to an abnormal birth.

Well, Doctor Gonzalez got a call (I’m guessing from the Center for Public Health in Barillas. They’re funded by the government, but don’t really have the capacity to do a whole lot so they outsource most of their patients. They had to refer another woman to Dr. Gonzalez last week because they don’t even have an ultrasound) today to expect a woman needing a C section. She arrived around 11:30 and was wheeled in on a stretcher to one of the examination rooms (aka the doctor’s office. There was another patient in there at the time, but they were escorted out after their prescriptions were filled out. Only one of the two examination rooms/doctor’s offices are large enough for the stretcher) where her blood pressure was checked, Dr. Gonzalez listened to the heart beat of the baby (Remember how I said 135 was normal for the womb, but high for a born person? Well this baby’s heart rate was 150.), and examined her vagina. He found that the umbilical cord was starting to come out, which is not a good sign. He then had me put on a glove so I could also palpate the umbilical cord and understand what was happening. The reason the placement is so dangerous is because if the baby comes out of the birth canal umbilical cord first, the cord can wrap around the head or stomach of the baby and it can suffocate to death. A normal birth is head first, feet first, or knees first. So, with the consent of her husband we prepared for surgery. There is a clean, surgery room in an outbuilding to the clinic. Outside the surgery room in small closet-like space, we robed up with pants, shirt, cap, mask, and shoe covering for me. The two doctors (including Dr. Arribas, the other clinic doctor who had returned from a short vacation/descanso) had other, surgery shoes. Once in the surgery room, the future mother was hooked up to a machine to record her blood pressure and pulse. Her blood pressure was about 150 over 100 or 120. I asked if this was a bad thing (normal blood pressure is 120/80, though here the norm is higher due to the geneology-140/90) Dr. Gonzalez said no, it would lower after they started surgery and some pressure was released. However, it is bad if the pressure is too low, that is when the mother can bleed to death. Her pulse was also very high, 80 or 90, I think? The surgery site (her abdomen, just below the belly button) was cleaned and prepped for surgery-covered with multiple cloths to make the clean-up process easier. And the doctors and their assisting nurse (Dr. Gonzalez’s wife) washed and robed up with sterile robes and gloves. Gonzalez informed me that this surgery (c-section) is usually not performed in Guatemala because of the lack of supplies or technicians (such an anaesthesiologists), but because of his specialty (he’s specialized in surgery in medical school) they could perform the operation.

So, away they cut going from the epidermal layer (skin) past two inches of cellulose (fast) into the gastrointestinal cavity (where all the major organs lie-we saw the small intestine, large intestine (stomach), as well as a small organ they called the trompa? (I didn’t quite understand what it was or did, but it was somehow related to the duodenum, I think. All this is in Spanish, so I didn’t always catch everything.) Then, Dr. Gonzalez cut into the placenta and the blood started gushing. The placenta is rich in blood and nutrients for the growth of the baby. Next, he stuck his hand inside the placenta, fished around a little bit, and with one hand pulled out a baby by its head. He then turned it upside down like a trader showing off a rabbit he had hunted (a strange metaphor, I know, but it really captured how he was holding the baby) patted it a few times on the back until it started to cry. He then took a little suction bulb to pull some liquid from the baby’s nose and throat, to clear the airways. Then he handed the baby off to the nurse like a football and she continued to “work-up” (for lack of a better word) the baby, cleaning her, pulling more liquid from her nose and throat until she produced a nice, healthy cry. The doctors then pulled the placenta from the woman’s stomach and further cleansed the uterus. After sufficient cleaning, mostly by means of suction, they stitched up the uterus cleaned the gastrointestinal cavity some more, and stitched up the stomach lining and skin over the mother’s stomach.

Overall, the entire procedure took about an hour, and just twenty minutes to extract the baby girl. There were a few complications as the woman’s blood pressure would often rise to high and they would have to administer medication then wait for it to act before proceeding. The mother was 35 years old and was having her first child. She had not been in to see a doctor, have an ultrasound, and hadn’t been taking pre-natal vitamins or folic acid, which are very important to the success of a healthy pregnancy. So, the placenta hadn’t attached well to the uterine wall causing insufficient blood flow to the baby. The woman’s poor health contributed to a condition they called “preeclampsia.” I don’t know exactly what it is (symptoms-high blood pressure, swollen ankles…), I couldn’t find it in a LARGE medical dictionary, so while it sounds familiar, I guess it translates into something completely different in English. Then, later in the surgery her heart rate greatly fell and she had stomach fluid come up through her throat. Then, her heart rate started to skyrocket (because I’m guessing she couldn’t breathe). This had something to do with a reaction to the surgery and may also be related to what they called “eclampsia.” (I have a little research to do when I get back) In the end, everything went okay and both the mother and baby girl are fine, but there were a few complications either because the family didn’t have access to the necessary basic medical attention prior to the birth, or couldn’t afford it, or didn’t know/think visiting the doctor during the pregnancy was necessary. Possibly all three could have been true.

1 comment:

  1. Some verification on the medical terms that I mentioned above from my Mom, who is also an extremely good nurse practitioner:

    Preeclampsia is an old term that describes a condition in pregnancy in which a woman develop hypertension, protein in the urine, and abnormal edema (swelling). It develops after the 20th week of pg. No one knows the cause. It can affect the liver and in some cases cause seizures. If seizures happen the condition is then called eclampsia. There is no cure except delivery of the baby. Usually bedrest is recommended. Careful monitoring of the BP, weight gain, urine etc is done. Delivering the baby prematurely may be done in the interest of the mother’s health. The current term is Pregnancy induced hypertension.

    This makes things a little more clear for me.