Sunday, March 30, 2008

1st breech delivery

I was on call this weekend with Josh Adams, a 4th year medical student. He calls me at midnight saying there was a lady who had delivered a twin at a health care center and now is here because the 2nd twin didn't come. He said, "I am not really sure what to do," so I said "I will meet you there." So we go and see her, and find a mom fully dilated with a buldging bag of fluid and feel an extremity just inside it. I knew we had 2 options - either Csection or try and rupture her and stick my hand in and grab the legs and deliver the baby breech. Josh and I were talking about our options. All I could think of was a time in residency when a resident delivered a breech baby and then told us the qualifications for delivering a breech baby, which included having experience in doing this. I knew I had no experience in vaginal breech deliveries, but I had delivered breech babies in CSections. I had also never delivered a twin, nor a 2nd twin that I had to pull out breech. Thankfully, I had talked about this exact situation with Bill previously, so I felt like I knew what I was suppose to do even though I hadn't seen it or done it before. So I ruptured her, found 2 feet, and pulled the legs out and then delivered the baby breech. The baby was blue when he came out, and only about 1500gms. He wasn't breathing, so we had to resuscitate it, and thankfully he started crying and breathing on his own.
Josh was asking me about surfactant and what we do for this very small baby. I told him we needed to consult an experienced OB for the breech and now need a neonatology consult for this baby. Unfortunately, we don't have either of those here, we are them. That is one of the great things about mission work - you get to do it all. Pray for these twins - babies of Esther.