What Drives Them?

A maternal instinct is a understandably a very strong instinct. But one would expect sensible people to understand that if they have to choose between life and having a go at having a baby, they would choose life. Apparently that is not so. In the last week I had two patients. The first one weighed 130 kg in nonpregnant state. One and a half years ago she underwent a cesarean section with another consultant in my hospital. They had to join two OT tables side by side to accommodate her. She lived and went home with the baby. Then she got pregnant again and registered with me. I advised to go back to her own doctor, but she said she would prefer to be with my unit. She still weighed the same. I asked her why she got pregnant without losing some weight first. I could not understand her answer because she answered quite vaguely. She underwent a cesarean section while I was on leave. Four days after the section she started soaking her dressing with copious amounts of blood-stained fluid. We suspected a burst abdomen. Removal of sutures confirmed the diagnosis today. We resutured her abdomen. She wants her stitches to heal. I want her to live. The other woman had afibrinogenemia. She had had four abortions in the past. She had bled in a life threatening manner all four times, ending up in an ICU at the last time. She presented with massive hemorrhage vaginally in the first trimester in her fifth pregnancy. She was transfused 12 cryoprecipitates, blood, and FFPs. Then the pregnancy was terminated. Both of these women seem bent on having babies, apparently not caring whether they live or not in the process. If they themselves want it, they are either driven by their maternal instinct beyond reason, or stupid. If their spouses, in laws and parents are driving them, they are victims and their relatives need to be booked for abetting suicides. In the meantime we-their treating obstetricians continue to toil and despair.