HEALTH WORKER TALES: When a mother refused emergency C-section at 2a.m at a remote facility
Respectful maternity care (RMC), which is a universal human right that is due to every childbearing woman in every health system, is trending lately. And evidence shows that women’s experience with maternity caregivers can empower and comfort them, or inflict lasting damage. At a recent weeklong training of Health Centre IV personnel from select facilities in Eastern Uganda that are to be covered under our Maternal and Newborn Scale-up (MANeSCALE) Project, RMC was a captivating topic punctuated with several anecdotes. It from the many stories that Kakaire Ayub Kirunda recounts one from a medical officer (name withheld) at a Health Centre IV in Mayuge District- Eastern Uganda to kick start our “Health Worker Tales” series in which we shall be sharing short stories from health workers as they struggle to improve maternal and newborn health in a challenging health system.
“It is 2a.m and here comes a mother. A gravida 3 [three previous pregnancies] with two previous scars due to CPD [Cephalopelvic disproportion- baby’s head or body too large to fit in the pelvis] and she clearly needs an emergency C-section. The midwife calls me, I tell her to prepare the mother and would join them shortly for the operation. I review the mother and we head for theatre. But as we are on the table, the mother asks me whether I was going to administer general or regional anaesthesia. I am like, at this time we do not have access to an Anaesthetist. I would like to help you and save a life. I can give you GA [General Anaesthesia] and monitor you successfully. I request we do GA and conduct the operation. The mother says no. ‘For all the operations I have gone through I have been getting regional anaesthesia. Why do you want to give me general anaesthesia?’
“She refused. But this was a mother with a big baby. She had a very crooked pelvis and by the time I reviewed her she was 6 centimetres and was having persistent and strong contractions. But she has rights which I had to accept. I however explained to her the possible complications but she refused. I was left with no choice but to suggest to her referral which she accepted. We communicated to Buluba Hospital but they couldn’t answer the phone. So we advised them to go to Iganga Hospital. But even getting transport at that time of the night was hard. So they left only for us to discover later that they went to a TBA (Traditional Birth Attendant). We also learned that while there, the mother got obstructed. They eventually went to Iganga General Hospital. I followed up with a call to Iganga and I was told they managed to save the mother at around 11a.m. but the outcome was a fresh stillbirth. The baby was 4.8 kilogrammes.”
Such is the dilemma that health workers find themselves into in an era of respectful maternity care. In this case, while the rights of the mother were respected, this action resulted into a preventable death of a baby she had kept alive for nine months. Could the mother’s failure to appreciate the doctor’s advice have come as a result of bad antenatal?