“Maybe she will grow up to be a doctor like you”
Dr Veronica Ades – MSF obstetrician South Sudan
It’s Friday night and I’m on call for any maternity complications. At 11.30 pm, one of the midwives calls to say he has a patient he is concerned about. ‘Dr Veronica, I have a patient who has had three previous stillbirths and is complaining of vomiting. She is worried about the baby. The foetal heart rate is 170.’ With three previous stillbirths, I wonder whether they were related, or if this patient has just had incredibly bad luck in a place with extremely poor access to obstetric care. I must do everything I can to ensure that this child survives.
When I arrive on the labour ward, we evaluate the woman. She looks weak and tired. She is having some contractions but doesn’t seem to be in real labour. I bring the ultrasound over to evaluate the foetus. It has good fluid and is measuring at full term. Back at base, I mull over this woman’s case. What could have caused her stillbirths? How can I prevent another one? A caesarean section isn’t the greatest option – most women here live several hours’ walk from the nearest health center and having one caesarean would make her next pregnancy much more complicated and potentially endanger her. I must consider the woman herself, not just the foetus. At the same time, I am very sympathetic to how devastating three prior stillbirths must be, especially here in South Sudan where for many women it is extremely important to produce six, eight or ten children. Here, a pregnancy after multiple poor outcomes is referred to as a ‘precious baby.’ I know all babies are precious, but I can certainly understand the term. I decide that the woman should be induced – I know that she will be relieved to give birth.
When I arrive on the ward the next day, another midwife, Roisin, relays to me that the woman is asking for a caesarean. I have no doubt this is the only way she can imagine that her baby is going to get out safely. I find an interpreter and go to see her. I sit down next to her on her bed and ask her more about her prior losses. From our talk, it sounds as if, in all of the woman’s previous pregnancies, her waters broke three to five days before the onset of labour, which can often happen in a normal pregnancy. Labour didn’t start, but she couldn’t easily get to a health centre. Infection set in. By the time she did seek care and go into labour, the baby was already dead. This is a terribly sad story, but it is also good news for her now. From what I can tell, it is a non-recurring cause of stillbirth – meaning that it will not necessarily occur again. If we induce her labour, she will, in all likelihood, have a healthy normal baby.
I explain to the woman my theory of what happened in her previous pregnancies. I say that I know she very much wants this baby to survive, and I do too. I tell her that there is a medicine I can give her that will make her labour start now, before her waters break, and that it should cause her to give birth within the next day. I tell her that I think she will be good at pushing. The interpreter relays this to her. The woman looks unfazed. The interpreter says: ‘She says this is okay. Pushing will not be a problem.’ I smile and offer my hand and she takes it, and we share the mutual, warm South Sudanese handshake, so deep it feels like a hug. I dissolve the induction agent in a bottle of water and tell the nursing staff to give her 60cc of the liquid every two hours. By the next day, she has delivered. I visit the mother and ask if the baby is okay. She shows me the baby and it’s a girl. ‘You need to make sure she is strong so she can grow up to be the President of South Sudan.’ The interpreter repeats this and she and the mother both laugh and agree. The mother says something and the interpreter relays it. ‘She says maybe she will even grow up to be a doctor like you.’ We laugh and I thank her. I hold out my hand to the patient and we shake hands – like a hug.”
Médecins Sans Frontières/Doctors Without Borders (MSF) is an international medical humanitarian organisation that delivers emergency life-saving assistance in more than 70 countries to people affected by armed conflict, epidemics, natural or man-made disasters.
If medical care were to falter, then common childhood killers like measles, malaria, and diarrhoea, would go untreated. Other essential services MSF provides, such as emergency room services, maternity and surgical wards, and treatment of patients living with HIV or TB, would go unmet. This would have a terrible impact on the people we serve.
And now, our teams, who were already providing medical assistance to some of the world’s most vulnerable communities, are now faced with the new challenge of responding to the COVID-19 pandemic and keeping our regular, vital medical assistance running.
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