Amniotic Fluid Anyone?

I can't remember if I wrote a blog about 6 liter lady or not. So I'll give a brief description just for background purposes. A while back we had a lady come in to deliver her baby. Most Chadian pregnant women are large, but not very large. They could be nine months pregnant and look like they're about 6 months pregnant.

Anyway, this one woman came in, and she was huge. I looked at her and wondered if she was going to have twins. We had some trouble finding the baby's heartbeat, but we could hear it. Her water hadn't broken yet, and she was fully dilated, so Augustin came and was going to artificially rupture the pouch of water. We got a basin to empty it, got her all ready, and he poked a hole in the sac.

As I watched it drain, I wondered if it would ever stop. I had never seen so much amniotic fluid. By the time it was finished, we measured it, and there were 6 liters of fluid, which is an incredibly large amount. After all the fluid drained, we could hear the baby's hearbeat fine, and she was significantly smaller in the stomach area. The birth continued normally and I don't think there were any more problems.

So yesterday, Sabbath afternoon, I was summoned to the OR for an emergency c-section. As I walked in and saw the woman lying on the OR table, I immediately thought of 6 liter lady. This woman was, believe it or not, even larger than 6 liter lady. We were doing the c-section because at first they couldn't find a heartbeat for the baby, and when they did it was about 80 beats per minute. A normal fetal heart rate is about 140 beats per minute.

We had a new missionary come in on Friday evening whose name is Caroline. She's from Loma Linda and was an orthopedic nurse there. Dr. Bond had her come in to the OR so that she could get some good experience (what a first day of work....). We use different shoes in the OR to cut down on tracking in germs and to keep the environment in the OR more sterile. So, Caroline had no shoes, and I let her use mine. This meant that I was going in barefoot, which we are allowed to do, but I don't usually do.

Dr. Bond allowed me to scrub in as second assist (Dr. Jacques was first assist), which meant that I was standing right next to him to help him hold back retractors, hand him instruments, and other helpful things. I was watching intently as he made incisions through the different layers. Then he got to the layer just before the baby, and he went to rupture the amniotic sac. No sooner had he made the cut than a stream of amniotic fluid literally burst out, showering everyone and flooding the floor. I had tried to turn my head, but must have been just a little late because I got the brunt of the shower; fluid went in my ear, inside my face mask, soaked the top half of my scrub shirt, and I found myself standing barefoot in a puddle of amniotic fluid and blood, with the bottom part of my scrub pants dripping as well.

To say that I was shocked would be an understatement. Everyone else was also rather shocked and wet themselves. Even Ansley who had been doing anesthesia at the head of the table got a pretty good shower.

Unfortunately, the baby came out barely alive. I un-scrubbed to help revive the baby. We must have worked on it for 20 to 30 minutes with no results. We tried everything-- chest compressions, ambu-bagging, oxygen, suctioning, stimulation-- but all to no avail. Every once in a while he would take a deep gasp, but he wasn't breathing regularly, and his lungs were full of amniotic fluid (he must have aspirated some of it) that we just couldn't drain no matter how much we tried.

At one point, his heart rate stopped, and we almost gave up. But it came back at about 40 beats per minute. So we continued reviving. It was really difficult to decide when to stop, but eventually we just knew that there was no more that we could do. The whole time we were working with the baby, I just knew that he wasn't going to make it, but I kept hoping.

It was a really sobering experience, and difficult to deal with. Thankfully the mother was alright, but it was still really sad not to have been able to save the baby as well.