Friday, November 22, 2013

The fatal massage


The word 'massage' brings into most of our minds scenes of serenity and comfort. Quite a lot of us are quite familiar with traditional massage systems starting from quite complicated massage processes in the Ayurveda for which Kerala is quite famous to the massage you get at the barber's saloon. 

However, in quite a few parts of the country, including ours, there is a process of massaging the uterus just as the pains of childbirth starts. And they also do that when they feel that the gestational age of the baby has gone beyond term. 

The massage ranges from very tender rubs on the gravid tummy with oil to vigorous working up of the abdomen with ones fist extending to even using planks of wood. Even today, the last patient whom I've just seen in the Labour Room has had a massage. 

But, last week, we had a patient who had got the most horrible massage one can imagine. Yes . . . a massage with a plank of wood on her tummy. I had seen quite a few during my earlier stint at NJH. 

We shall call our patient PhD. A 30 year old mother of one, who had crossed her expected date of delivery of her fourth pregnancy came to us 4 days back. Yes, of her earlier three deliveries only one had survived . . . A 7 year old girl. 

All her previous deliveries were at home. And she had taken her fourth delivery as just another chore. But, this did not go as she had thought it will. When she reached NJH, she was already in labour for 48 hours. In addition, she had got quite a lot of massages, culminating in the massage with the plank of wood. 

The process was well evident on her tummy. The angry looking skin was quite obvious. And the uterus was tense. It was like a balloon. Couple of us thought that she had ruptured. The blood tests turned out to be very bad. She was in full blown sepsis (total leucocyte count of more than 30,000) and was anemic. I was sure that she was dehydrated and therefore the hemoglobin was more low than we expected. 

And she had a hand presentation . . .

The only choice she had was to undergo an emergency Cesarian to remove the dead baby and to repair if she had ruptured. My only fear was gangrene of the intestine. We had lost a similar patient couple of years back after she had intestinal ischaemia following massaging of the abdomen. 

We somehow got hold one pint of fresh blood and she went to theatre . . .

We were relieved to find out that she was yet to rupture. But, the lower segment of the uterus was totally battered into a pulp between the endometrium and peritoneum. There was a good chance that the lower segment will not hold well when I deliver the baby. After thinking it out, we decided to put a inverted T incision on the uterus. 

We were glad that we took that decision. As soon as I put a nick on the uterus, there was a gush of putrid gas which gave us quite a tough time. The baby was badly macerated. The surgery was over in an hour. Thankfully, the patient did quite well after surgery. She should be discharged over the next couple of days.  

I've been trying to convince our local community about this totally unscientific practice. Unfortunately, nobody seems to listen. I came to know that the procedure of massaging the abdomen is so much ingrained into the local traditional healthcare of the pregnant woman. 

For PhD, the massage brought in quite a lot of troubles. Her socio-economic situation made things even worse. She was from quite a remote area. When she was brought by the government nurse in her village, none of her relatives were accompanying her. Her husband was a tuberculosis patient. I'm sure that we'll have to write off quite a lot of her bill. 

Another story of one more live saved because of the Lord working through the team at NJH. 

Please scroll down if you're interested in seeing few snaps taken of the lady and her baby. May I warn you that the snaps are very very repulsive. Be warned . . . the snaps are horrible . . .

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Sr. Sushma, our Nurse Anesthetist praying hard before we start the surgery. 

The badly macerated baby

The uterine incision. You can see the vertical portion of the inverted T incision is sutured.
The lower segment was very very unhealthy and we just got the edges opposed.

2 comments:

  1. Aaraike is best Pre & Post Natal Care center for mother & Newborn Baby which provides therapies & bathing services in Traditional manner.

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