The maternity ward here is staffed mostly by nurse midwives who assist laboring women in their deliveries. The doctors are called to step in only when there is a problem. Last week, a mother of 7 came in after being in the 2nd stage of labor, pushing for nearly 10 hours. She was exhausted and the baby still was not delivered. The midwives could not find fetal heart tones so they called the doctors. Deepa, one of the family medicine residents who is currently here, took the woman to get an ultrasound, and still could not find a fetal heart beat. Uterine rupture seemed the likely diagnosis.
After so many babies, the uterus is unable to adapt as well, and eventually may give out, especially under the stress of labor. Dr. Faile and Deepa did a c-section. The front portion of the uterus was still intact, but very thin. They delivered the baby girl, but she was already dead. The uterus had actually ruptured on the backside, losing the amniotic fluid into the abdominal cavity. Sometimes the baby itself will be expelled into the abdominal cavity where the baby cannot survive. In cases of uterine rupture the focus is on saving the life of the mother but her childbearing days are over.
About a half hour later, I scrubbed in to help Dr. Faile with another c-section. After having seen a still born child – it was uplifting to see a baby take his first breath. He was alive and doing well.