Today was (mostly) an OR day. I scrubbed into 3 c-sections and was dripping
with sweat by the end of each of them.
There is an AC in the OR we were in today. And you can believe that I checked several
times to ensure that it was on. It
was. It is just really hot in these
ORs. It doesn’t help that the OR I was
in today actually has two cases going at the same time. There is a curtain separating the two
patients – but that is it. Probably it
has more to do with the heavy apron worn over scrubs, but under the heavy cotton
gown.
 |
| Dr. S and I in our aprons, awaiting the next case. |
(It isn’t actually that hot here. We are in the mountains and it rains all the
time. The combination makes for 70
degree weather, dipping into the 60s at night. I'm just guessing at this – I’ve not checked a thermometer. )
When I went back to the ward after the cases, I asked the
nurses what was going on. “There is a
patient requesting to speak to a doctor,” one of the midwives told me. “okay. What’s going
on?”
The midwife went on to tell me that a 42-week pregnant woman who had come in
the day before for induction of labor had had a fetal demise. The
story didn’t quite make sense, mainly because it was told by a nurse who had
not taken care of the patient (that nurse had gone home). The patient had been checked by Dr. S in the
morning. She had been on a medicine all
night to help soften and open the cervix.
In the morning, her cervix was measuring at 4cm, and Pitocin was started. At around 8am, the nurse
measured the baby’s heart rate at about 140 beats per minute (which is
normal). The next heart rate was not
checked until 11:30am. At that point, no
heart rate could be detected, so an ultrasound was ordered. Again no heartbeat was found. The baby was dead.
I reviewed the history (scant though it was) at least 3
times and then went into talk to the mother.
The mom was French speaking, and that made the conversation all the more
difficult. She was devastated. This was her first pregnancy. She told me she wanted a c-section, “Now that
there is no baby to look forward to, I cannot struggle like this any
longer.” It was heart breaking. I convinced her that a c-section was not a
good idea unless her health was in danger, but I had nothing else to offer
her.
I do not know why the midwife taking care of the patient did
not check for fetal heart tones for over 3 hours in the morning. Or maybe she did check, but didn’t
document? What did happen is not normal
– there are criteria for monitoring. The
loosest of which is documented fetal heart tones every half hour.
I think that we absolutely over-monitor patients in the
US. But this is a case of definite
under-monitoring. The nice thing about
having an OB on the premise if that if you notice a baby in distress (like a
slowing heart rate) then you can do something about it.
But, you can’t tell unless you listen.
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