This week our case comes from the maternity unit at Kivunge Hospital.
This mother was referred to Kivunge from a smaller health facility, as she was in labour with her 4th baby but the baby was in a breech position (which means the baby’s bottom is facing down rather than the head).
Unfortunately the labour was not progressing particularly well and her cervix was fully dilated for a number of hours - usually a normal labour results in delivery of the baby around an hour after full dilatation, especially if it is not the mother’s first time. The decision was therefore made for a Caesarean section, and even though it was in the middle of the night all of the necessary staff were available on site.
The surgery was straightforward, however when the baby was delivered it was clear that she was not in a good condition. She was blue, floppy and not crying.
We started the neonatal resuscitation in the theatre building by drying the baby and suctioning out some of the mucus, but then decided to move the baby to the maternity unit to a better environment with oxygen and other supplies. This involved a bit of speedy walking with the (still unresponsive) baby in the dark to the maternity building, where we continued with the resuscitation.
After a short period of chest compressions and ventilating the baby with oxygen, her heartbeat picked up and she began to breathe on her own, and we all breathed a sigh of relief!
However this relatively prolonged period where she was not breathing or receiving oxygen (as well as an unknown period of distress prior to her delivery) is likely to have caused some adverse effects such as a hypoxic brain injury.
But we are now planning to continue the work of previous HIPZ volunteers to reinforce neonatal life support teaching for the local staff, as it is a skill that needs constant practice and updating. But when done properly, it really can save a baby’s life!