Last night we were called to do a ‘Ceasar’ on a woman who had a breech baby and was either retarded or mentally ill or both. Cesarean Sections are called ‘Ceasars’ by the staff. It was a bit of a mess because she did not understand what was going on and was jumping all over the table when we attempted the spinal. It took 3 people to hold her down and she still thrashed all over the place. Finally Dr. S gave her some diazepam and she calmed down enough for him to successfully do the spinal. He considered general anesthesia but she had just eaten (in the midst of labor?).
All went well with the Ceasar until Dr. S couldn’t get the head out. In a breech C section, apparently you dislodge the baby’s bottom from the pelvis and then pull out the head. In this case, he got the bottom, legs and body out but the head was too big. He tugged for quite a while. . .45 seconds at least. It was so excruciating to watch. Finally, just before he grabbed the knife to make a bigger incision, the head came out. The baby was floppy (diazepam?) for a while and eventually perked up with the assistance of Mrs. Chasvachi, the peds nurse, did a lot of vigorous slapping, holding the baby upside down, suctioning and more suctioning. Two hours later, we got another call. . . the patient was unattended for a few minutes and pulled her own stitches out! There isn’t much hope for this baby. Both of her parents are mentally out of it and apparently they don’t have any family to help or supervise them. Here, it’s a full time job for the average person to find enough to eat, work in the fields and raise their kids. I just don’t see how this disabled, mentally ill woman is going to do it. There are no social workers to refer her to.
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