Another day in the life of Sarah the Medical Student:
The miracle of birth is wonderful, that’s the only word that I can use to describe something that even after working so many years as a doctor. I still get emotional and tears of happiness well in my eyes when I watch a child come into this world. My friends keep teasing me about the tears that spill over at times. They nudge each other and smile good naturedly when they see me get emotional. But the first cry of a newborn baby is the most beautiful sound that I could ever think of.
However, I have come across some New Age healers who think that a “gentle” birth where the baby doesn’t cry immediately at birth, is good for the future psyche of the baby and will ensure a healthy and calm growth. It’s a good idea, no, it’s an amazing idea…in theory. I wish it were true. The reality is that a baby has to take a deep breath and cry at the time of birth to organically switch from its Foetal Circulation to the mature or adult type circulation of the blood.
One has to understand that during a pregnancy, the fetal circulatory system works differently than the one after birth: It is a well-known fact that the fetus is connected by the umbilical cord to the placenta. This miraculous organ is rich in blood vessels that carry nutrition and oxygen from the mother to the baby. The point is that while the baby is still in the uterus, his or her lungs are not being used to filter or oxygenate the blood. The baby’s liver is also not fully developed. So, the circulating blood bypasses the lungs and liver by flowing via different pathways and through special openings in the heart called shunts. Once the baby takes a deep breath, along with a vigorous cry, the shunts close. It is the force of this first breath and the strong cries of the baby that expand the lungs and the circulation transforms almost immediately into the adult type as we all know it. From that point onwards, the lungs start working on oxygenating the blood as they are supposed to. Quite ingenious I dare say.
The first time that I was allowed to deliver a baby is still etched in my mind. I was still a medical student and was obviously supervised by one of my teachers. I was so excited that day, because I was told that morning that the next delivery in the labor room would be mine. Since our obstetrics ward was extremely busy, and we were the nearest and largest tertiary hospital catering to a wide rural and urban area, I didn’t have to wait long.
My patient was wheeled into the birthing room and to my consternation she was a frightened 16-year-old girl, and her confused and terrified husband was only 17 years old. I think they were too young to realise the implications of what was going on and they clung to each other as if they were trying to reassure themselves by having close contact with each other.
Her age and apparent pallor were evident that this was a high-risk pregnancy. Additionally, she hadn’t had any antenatal care whatsoever, and was extremely thin and fragile looking. Her bloated, pregnant abdomen looked almost obscene on her little malnourished body. She was so delicate that one would think she would be more comfortable playing hide and seek in the fields with her friends, rather than being here with us in the hospital. In the throes of painful labor pains, wracking her immature body.
As soon as I first saw her, I was galvanized into action and immediately started to make my patient comfortable. In addition to that I had to draw blood for a spate of laboratory tests. I was utterly horrified when I saw that the results of the bedside haemoglobin reading were only 4mg/dl, whereas the normal reading at her age should have been at the very least 11-12mg/dl. Therefore, after I took the requisite detailed history and conducted a thorough external examination, (students were not allowed internal examination at that level). Once I had some initial data, I informed my attending professor about the case and the unfortunate condition of the young mother. With her consent and guidelines, I swung into action and tried to arrange an emergency blood transfusion for her. (The emphasis is on the word “tried”).
Wanting to start my patient’s treatment as soon as we could, I asked one of her parents and her husband to accompany me to the blood bank so that we could arrange the required blood. It was thought to be cheaper and obviously better quality-wise if a member of the family donated their own blood for their patients. I also told them that in cases of emergency, we could get some stored blood from the blood bank for the expectant mother. While talking to them I looked up and saw that the family had terrified expressions on their faces when I mentioned a blood transfusion! It was as if I told them that I would be performing a voodoo spell on their patient. And donate blood? No way! How can the doctors even think of sucking blood out of their body! What if they died? The family continued to adamantly refuse to purchase or donate blood, saying that they were not comfortable with infusing another person’s or a stranger’s blood into their patient. (Bad karma?)
I tried persuasion, arguing, and even firmly admonishing them desperately for a long while but with absolutely no success. Finally, after a long debate and failed persuasion techniques, the real reason was revealed…an uncle confessed that they were as I had guesses earlier, all scared! They thought that they would die a horrible death if they donated even a teaspoon of blood!
Jamila, the young mother to be, by then started to fade and was getting weaker with each contraction that was wracking her frail body. I was getting frantic. There was no way that I would let my first obstetric patient slip away from me! I had to hurry! To save time I grabbed a cross matching kit from the laboratory and cross matched her blood with mine. It was a match! Once again, I dragged the father as quickly as I could to the blood bank, and donated 500ml of my own blood. I had the process rushed and the blood prepared for immediate transfusion. You have to realise that this was the pre-AIDS prevention period, so it was easy to get the blood almost immediately. The reason I took the husband with me was that I wanted to show him that donating blood wasn’t life threatening in case we might have needed some more.
We were just in time because by the time we reached back to the labor room once more, Jamila’s contractions came to the point that she desperately felt like pushing. As soon as we could, we hooked the blood infusion and a bag of plasma to her veins through two IV cannulas in both of her arms. The slow, painful progress of her labor seemed as if it was going to be a long and painful day. Not only for Jamila, but for all of us. As it is, it usually does take a bit longer with primigravidas (first time pregnancies). While listening for the foetal heart sounds, and recording the foetal heart rate during the contractions, I asked the midwife when the last foetal heart sound was measured by either a nurse or a doctor. She confirmed that it had been a short while ago, but she wasn’t exactly sure when since she had just started her shift.
Everyone was under the impression that this was a normal run-of-the- mill delivery that had been handed over to a hysterical medical student. Remember, we didn’t have any data or findings for Saira because she hadn’t attended any of the antenatal clinics, and she had just arrived as an unbooked patient that morning. She was already in the initial stages of labor. As I mentioned before, I wasn’t allowed to examine Saira internally. That was done exclusively by the attending obstetric resident or specialist, but when I did palpate and auscultate her incongruously enormous abdomen, I felt two heartbeats resonating within instead of the expected one. To be sure, I asked the midwife to show me exactly where she heard the baby’s heartbeat, and she pointed on the right lower quadrant of the abdomen, while I auscultated the upper left side. I was right!! There were two heartbeats!
As I was just a student, I didn’t want to take things in my own hands in case there were complications, I immediately turned (once again) to my instructor. The Obstetric Resident. After a quick examination, she confirmed my suspicions and promised to monitor me during the whole delivery. I was confident that my senior would jump in in case of any perceived complications or dire emergency. I was pleased that she gently continued to coach me in the background, thus increasing my confidence.
Trust me to get the complicated cases on my first day in the labor ward and for my first ever delivery!!
Since the first baby’s head was already engaged in the pelvis, it was already too late for a c-section. In any case she was considered too anemic and weak to go through the surgical procedure. Therefore, unless it was considered an emergency, or we thought that her condition was life threatening, we just continued to monitor the delivery process very carefully. If Jamila would have had proper ante-natal care, and we had enough relevant information, we could have prepared her as well as our own selves for the risky delivery. But there was no time for recriminations, she needed our help, and we gave it to her to the best of our abilities.
After a strenuous bout of pushing, we finally saw the head of Baby A who was born surprisingly easy considering it was the mother’s first pregnancy. The baby cried immediately and lustily as soon as she was born. Baby B took her time since she decided to come out upside down. Thankfully she came quicker than expected in spite of the small build of the mother, and we didn’t have to resuscitate her or provide baby Cardio Pulmonary Resuscitation (CPR). We were so worried, because breech babies could get very easily asphyxiated, or the umbilical cord could have been wound around the neck, causing the baby to choke. That is one of the reasons why breech babies are more or less born by elective c-sections nowadays to prevent any birth injury or other serious sequalae. Two normal and healthy babies! Both beautiful girls. We were so relieved that all went well. Saira was extremely lucky. Her babies were a little small for their gestational ages, but they were born with a lust for life, and thankfully thrived well.
Going back to the dorm, I was tired but exhilarated, because those babies were the first, I had ever delivered, and they were normal and healthy. Most of all, the whole team was thankful that the mother survived despite all the odds against her. I was thrilled and didn’t come off cloud nine for quite some time. On the way to my room, I told my story to anyone who would stop and listen. I must have sounded quite annoying!
That evening, I was surprised to receive an unexpected visitor. The husband of Jamila met me at my dorm and handed me a large ornate basket filled with a cornucopia of fruits. He said that he was grateful for all I had done that day, especially that I had donated my own blood to save his wife’s life. He said he had brought me the fruit because he heard from the nurses in the ward that it was a good idea to eat fruit or anything sweet after donating blood. I was touched and thanked him but so that he wasn’t offended, I just took just one apple from the selection and told him to take the basket back to the hospital. I made him promise to feed the fruit to his wife. Having just given birth to twins she would definitely be needing the extra nutrition. Oh, at least it was nice to feel appreciated.
Another day another drama, but such a blissful feeling. THIS was why being a doctor was such a good idea! The circle of life begins here, and though we also have sad stories, the good ones outweigh the bad, and most mothers go home with their bundles of joy firmly tucked lovingly in their arms.