Difficult C-section delivery

At the end of the day, as I thought back to the morning, I couldn’t believe that it was still the same day.  We woke up early and with sadness said our first goodbyes as our team started to break up.  Amy, Emily and Heather left for the airport. We had a leisure breakfast as we looked forward to a relaxing day in Cap Haitien and the Citadel.  As it turned out it was not a relaxing day at all, yet we are all grateful for the experience we had. At the end of the day, as I thought back to the morning, I couldn’t believe that it was still the same day.  We woke up early and with sadness said our first goodbyes as our team started to break up.  Amy, Emily and Heather left for the airport. We had a leisure breakfast as we looked forward to a relaxing day in Cap Haitien and the Citadel.  As it turned out it was not a relaxing day at all, yet we are all grateful for the experience we had.

Matt and I were told that there was a woman doing poorly.  It turns out that a young pregnant woman whom we had seen the day before had returned.

She had been hypertensive and suspecting pre-eclampsia, Dr. Brinvert had advised that she go to Limbe for delivery.  It is not clear what had happened in the interim.  What we do know was that she was very hypertensive and convulsing ie she had full blown eclampsia, a condition both life-threatening to the mother and the baby.  We had almost nothing to treat her with besides tablets for hypertension that we managed to get into her when she was awake enough between convulsions.   She needed urgent transfer to a hospital with the right medications and the capability of performing an urgent C-section.  Transport is not something usually readily available.  However, our van was about to arrive and when it did the team loaded up quickly and made room for her to lie down.

To say the least, it was a ride filled with tension.  The blood pressure remained sky-high and the woman had another convulsion. 
Dr. Brinvert had taken a motorcycle ahead of us to the clinic in Titoit to see if they had intravenous blood pressure medications or magnesium, but neither was available.  It took 45 minutes to get to the hospital in Limbe; it seemed like an eternity.  Fortunately she was quickly assessed by a French midwife and an obstetrician from Minnesota.  Matt perused the pharmacy and found the right medications.  While he was pushing them through the IV, the obstetrician was searching for fetal heart tones, evidence that the baby was still alive.  Finally we heard them, and she was rushed into the operating room for delivery.

I was assigned to take care of the baby.  I had done neonatal resuscitation in the past, but it had been at least a decade. 
Admittedly I was quite anxious.  However, I then realized that I was surrounded by helpful, capable people and we organized ourselves with regard to tasks we could each do as soon as the baby arrived.  Just prior to the operation the mother’s blood pressure dropped significantly as did the fetal heart rate.  The neonatal resuscitation table was in a different room, and I was waiting there, mentally preparing myself for the worst, when the door swung open and Matt walked in with a crying active baby.  My eyes filled with tears and I immediately became covered with goose bumps.

The whole team had been on edge.  The news of the healthy baby brought on emotion for all of us.
Jean-Brunelle had stayed with the woman throughout the whole time providing translation.  It was no small task for a nonmedical person to watch a C/section.  For him, the experience was particularly moving.  He had never seen abdominal surgery or a delivery before.  Most moving, however, was that he was the one to go out to the family and deliver the news of the health of the baby.  He said later that it was an amazing experience.

We did make it to the Citadel and it was wonderful, but without question, for all of us, the experience of coming so close to losing two young lives, and the miracle of sustained life and new life, was the highlight of what was an absolutely wonderful medical trip.  We are so sad to see it come to an end.


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