Last week we had a mom transfer from Pentecost (an outer island - hours away by plane) after 48 hours of slow labor and 12 hours of SROM. Can you imagine getting on a plane in labor with none of your family to go to another island? she did travel with her nurse (which means that Pentecost was without any medical assistance - they do still have a nurse's aide and a dispensary- for several days until there was a flight back) and the govt pays for her flight to efate but she and her family must pay for the return ticket - about $140. I was assured by the midwives that this would not be a problem for someone from Pentecost. It is apparently a rich island because they are a main supplier of kava.
She arrived during shift change so it was just me evaluating her. her baby's baseline was 180+ with repetitive late decels to the 150s and virtually no variability. her BP was 140/120 then 140/100, plus 1 protein and she had a severe headache. she felt blazing hot and when i took her temp for 30 seconds on a mercury thermo (had to take it out as she had a contraction and started gnashing her teeth) her temp was already 102! geez! her cervix was 4 cm open, 100% effaced and the baby was at a plus 2 station - so low for that dilation. My hand was covered in what really looked like pus after the exam. obviously we called the OB and she had a cesarean. they had a really hard time getting her ROP ascynclytic 4kg baby out. i was shocked that once they decided to go to cesarean we just turned off the CTG. the baby was unmonitored for well over an hour before he was born (he reeked of a nasty chorio infection at birth). even more amazing was that his apgars were great 8,10,10. These details may not mean much to the non medical folks but for those of us who know... HOW could that baby been OK?
She arrived during shift change so it was just me evaluating her. her baby's baseline was 180+ with repetitive late decels to the 150s and virtually no variability. her BP was 140/120 then 140/100, plus 1 protein and she had a severe headache. she felt blazing hot and when i took her temp for 30 seconds on a mercury thermo (had to take it out as she had a contraction and started gnashing her teeth) her temp was already 102! geez! her cervix was 4 cm open, 100% effaced and the baby was at a plus 2 station - so low for that dilation. My hand was covered in what really looked like pus after the exam. obviously we called the OB and she had a cesarean. they had a really hard time getting her ROP ascynclytic 4kg baby out. i was shocked that once they decided to go to cesarean we just turned off the CTG. the baby was unmonitored for well over an hour before he was born (he reeked of a nasty chorio infection at birth). even more amazing was that his apgars were great 8,10,10. These details may not mean much to the non medical folks but for those of us who know... HOW could that baby been OK?
this mom had a single dose of IV antibiotics and i was really concerned about her. 4 hours after the surgery they removed the catheter and she was up walking around (fully upright not hunched) laughing and nursing her baby. they don't have toradol or duramorph just a regular spinal but these women just bounce back as if nothing has happened. it is truly mind boggling.
This was the first cesarean i have seen in Vanuatu. There were only 11 in the whole month of July. considering that there were several breech babies, and a placenta previa this is an astoundingly low cesarean rate for over 200 births.
This was the first cesarean i have seen in Vanuatu. There were only 11 in the whole month of July. considering that there were several breech babies, and a placenta previa this is an astoundingly low cesarean rate for over 200 births.
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