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Stillbirth

The phone rings and I open my eyes blearily, attempting to focus on the clock: 3am. I stagger over and answer. It is Andrew – there is a Caesarian. I pull on my shorts and step out of the flat into the cold night air. The sky is clear and the stars are burning bright and splendid, the Southern Cross hanging directly over the hospital.

I walk down the dark road to theatre, the wind blowing cool and dry across me, whistling slightly in the palm leaves above. The patient has just arrived. “She had grade 3 meconium in the liquor,” Andrew explains. That is a sign of significant foetal distress and in our setting an indication for Caesarian in most cases.

I stick in the spinal anaesthetic – I am having a good run at the moment, it takes only one stab. I turned one poor lady two weeks ago into a veritable pin cushion – I could not feel any of her spinal bones through her ample skin. This lady is significantly thinner.

“Do you want to cut?” asks Andrew.

I have done four Caesars under close supervision. I feel a bit pathetic but at 3am, given the choice between Andrew and a 45 minute operation, and me and a 2 hour operation, I choose Andrew every time. At the start of my last effort I told the nurses that they should feel free to nip off for tea at the start of the third hour. They laughed, but at the end one of the sisters came to me and said with a grin, “Dr Moran, we thought you were joking. But you were not.”

I scrub in to assist. Andrew dissects down to the uterus and reveals the baby’s head. He delivers the head and quickly suctions the mouth before delivering the rest of the baby. There is no cry. The midwife plucks the child from him and takes it to the resuscitation area.

I eye what is going on, even as I hold the retractor. It is instantly clear things are not going well. I leave the operating table, pull off my bloodied outer gloves and join the midwife with the baby. There is no pulse and no respiration. The midwife begins chest compressions as I suction the airway and use the bag and mask to ventilate. I am getting good chest movements but there is no sign of the child getting pink. We give adrenaline and I grab the laryngoscope. I get a good view of the vocal cords and ask impatiently for the endotracheal tube. I pass it down throat through the small gap between the cords. Pulling the mask off the bag I connect it to the tube and ventilate the baby.

20 minutes, 1 naloxone and 2 adrenalines later and there has been no change. The baby never stirred, and never took a breath of its own accord. I ask the Sister in charge to explain this to the mother before we finish. Sister goes to the mother and with great compassion in her face and manner explains what is going on. I watch the tragic conversation, the mother listening even as, behind the green sheet the obscures her view, the surgeon continues to close her abdomen. Sister comes back. “She understands. And she would like to cancel her tubal ligation.” The surgeon nods silently.

The midwife and I stop resuscitation. She takes the baby and wraps it up. I go to the mother. She looks at me and whispers, “Siyabonga.”

The spinal anaesthetic is wearing a little thin now. She winces and give small gasps of pain. I give her a shot of sedative to ease the discomfort for the last 5 minutes of the operation. I time it badly: the midwife comes to show her the dead baby, carefully wrapped in a sheet. She is too spaced out to really notice.

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