Thursday, October 24, 2013

Life is Sacred

You probably all already know about this case that I have entirely missed until last week.  I has been haunting me all along since I read it.  This woman shows up at 17 weeks of pregnancy with back pain and fully dilated.  She does not progress on to delivery, but instead stays that way for days, with the uterus exposed to vaginal bacteria, and nobody does ANYTHING about it despite her ASKING them to.  The baby is doomed to certain death but they are continuing to monitor the baby's heart beat and wait, and wait, until she dies of sepsis.

That's kind of the picture I have in my head.  I have a suspicion that cervical incompetence was actually her problem, I mean it sounds so much like it from where I am sitting.  And I know one can die from incompetent cervix, because were I left without any medical intervention, I probably would have died as well.

Contrast this with my situation:  as soon as the cervix was noted to be dilated, the OB tried a cerclage, but told me it probably won't work, and that the biggest risk is that of infection.  I was on two IV antibiotics in doses high enough to kill a horse, and monitored for fever or white cell count increase.  The moment I decided that it was not worth it anymore (because I was in labour), the cerclage was removed, despite the baby being alive at that time.  That is because, guess what, it was not going to work anyway, and I was in danger of shredding my cervix with labour+cerclage.  And we were all (me, MrH, my OB, my GP) very, very worried about infection.  Labour = infection, often, often, often.
Then, at 9 cm, I started bleeding very heavily, and the baby had to be manually removed.  Then I had a retained placenta that needed oxytocin and manual removal in the OR.  I needed so many things because a uterus at 20 weeks (or 17 weeks) does not behave very smartly and cannot contract always effectively, which is why the retained fetus or placenta can happen.

I got so much care that I would not have survived without!  And I am so thankful to have been in the right place, at the right time (haha, in a small Northern town in Canada, with one old OB a GP anesthetist.  Better care than University Hospitals in Ireland).  Women who are pregnant need a lot of medical attention when things don't go according to the usual nature's ways.  Or wait, dying is one of nature's ways too... Anyway, if the doctors at the University Hospital in Ireland did not feel able to deal with this case because of ethical issues involved, why did they not simply transfer her to England?  That happens all the time, we from Canada transfer to the US if there is greater expertise or if all the NICU beds in the province are full, etc.  Why would this not be possible elsewhere?  I am so baffled at this case, and so sad and angry about it, probably because I identify with it too much.

Wanna know what we would have done in my hospital?  Have a talk with the mom about the zero survival chances of the baby.  Given the parents a moment to make up their mind.  And then, when they are ready, break the waters, and help the delivery along with some misoprostol or oxytocin, including operative extraction if needed.  Is this not kind?  Is this not right?  How would the outcome been any different?  Mom walks out of hospital alone anyway.  But at least she walks out...  Because we all know that LIFE IS SACRED.

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