In 1983, one of the House Officers woke me up at midnight. I was a Registrar available in campus, and she wanted me to go assist her perform a cesarean section.
"What is the indication?" I asked her.
"Previous two cesarean sections" she said. It was believed then widely that a cesarean section was the only option in such a case. I knew a vaginal delivery could be achieved.
"Is there pelvic contraction or threatened rupture of the uterine scar?" I asked.
"No" she said.
"Is blood available?" I asked.
"Um... no. I have just sent her blood sample to the blood bank" she said.
"OK" I said "call me as soon as bleed is ready". I went back to sleep, ready to go as soon as called. The call never came. When I met her in the morning, I asked her why she did not call me.
"Actually the patient delivered vaginally while I was waiting for her blood" she said with some embarrassment.
There was another patient yesterday, who had had a cesarean section in past, was near term and in labor now. She was anemic. There was no blood available. Finally they got one unit from another hospital's blood bank. She needed more. They were watching her progress, which was quite tardy. The fetal heart rate dropped in between, and they wanted to perform a cesarean section in fetal interest. But there was no blood. The patient's husband was running places to get blood for her. They had to wait. In the meantime the fetal heart rate improved. When they called me at night, the patient's action line on the partogram had already been crossed.
"Perform a cesarean section when you get blood for her" I told them. When I asked about that patient the next morning, the Registrar told me that they shifted the patient to the operation room when the husband came back with blood, but she delivered vaginally there. Her facial expression and tone of voice reminded me of the other House Officer 30 years ago.
Both of these patients were spared cesarean sections by lack of blood. By the grace of God, both mothers and their babies went home fine.
"What is the indication?" I asked her.
"Previous two cesarean sections" she said. It was believed then widely that a cesarean section was the only option in such a case. I knew a vaginal delivery could be achieved.
"Is there pelvic contraction or threatened rupture of the uterine scar?" I asked.
"No" she said.
"Is blood available?" I asked.
"Um... no. I have just sent her blood sample to the blood bank" she said.
"OK" I said "call me as soon as bleed is ready". I went back to sleep, ready to go as soon as called. The call never came. When I met her in the morning, I asked her why she did not call me.
"Actually the patient delivered vaginally while I was waiting for her blood" she said with some embarrassment.
There was another patient yesterday, who had had a cesarean section in past, was near term and in labor now. She was anemic. There was no blood available. Finally they got one unit from another hospital's blood bank. She needed more. They were watching her progress, which was quite tardy. The fetal heart rate dropped in between, and they wanted to perform a cesarean section in fetal interest. But there was no blood. The patient's husband was running places to get blood for her. They had to wait. In the meantime the fetal heart rate improved. When they called me at night, the patient's action line on the partogram had already been crossed.
"Perform a cesarean section when you get blood for her" I told them. When I asked about that patient the next morning, the Registrar told me that they shifted the patient to the operation room when the husband came back with blood, but she delivered vaginally there. Her facial expression and tone of voice reminded me of the other House Officer 30 years ago.
Both of these patients were spared cesarean sections by lack of blood. By the grace of God, both mothers and their babies went home fine.
