The Unwelcomed Baby

It was quite a busy outpatient day few days back, when the duty doctor got a call from Labour Room about a pregnant lady who had come in with a hand prolapse. The history of the hand prolapse was quite short and we found out that the baby was alive and kicking. 

The patient was from one of the nearby villages. This was her fourth pregnancy and her previous three children were girls. The family had expected this one to be a boy. Couple of relatives of the family worked as servant maids in the homes of our staff and they had ensured that the lady was rushed to us. 

We ensured that the baby was delivered within 20 minutes of YD's arrival to the hospital. Unfortunately, the baby turned out to be very sick. 

And the fact that this baby turned out to be a girl ensured that the relatives were hardly interested to keep the baby alive. When we got her intubated and taught one of the relatives to mechanically bag her (we don't have a neonatal ventilator), this lady kept on asking if this was really necessary. We did everything that was possible. 

The baby died on International Woman's Day . . .

All around the world, quite a lot of us were celebrating emancipation of women. But, the sad fact remains that in many a family, the girl child is seen as a burden. And I can only imagine the plight of the first 3 girls in this family if the next child is a boy.

The family did not agree for a tubectomy although we had advised it. They wait for a boy . . . 

Heart wrenching . . .

5 days back, there was a 17 year old who walked into the Emergency  Room. She was not able to pass urine since the last 24 hours. We thought that she must have a bad Urinary Tract Infection. We put a rubber catheter and drained out the urine and sent a sample for microscopy. 

Later, the doctor who saw her suspected something amiss and found out that she had missed her periods for 3 months. And then the story about a rape and a probable attempted abortion came into the open. The girl was send for an ultrasound. Sure, there was a dead fetus in her uterus. It was surprising that there was no bleeding per vagina when we put a catheter to drain the urine. 

After obtaining consent from the girl, the father was informed about the pregnancy. Blood tests were also sent which showed that she was in sepsis. 

The call I had to take was about informing the law about the rape. I took the family to my office and explained the process that I had to take as the head of the institution. 

The girl and her parents would not have any of it. They did not want the police or anybody to get involved. The errant boy was from the same village. 

'His family could harass us.' 

'Let the issue die out. Our daughter will not get married.'

They went out reassuring me that they would get back in couple of hours. They never came back. 

The family returned after 2 days saying that they did not want any treatment. 

There can be a myriad of possibilities here. The girl may have been actually raped . . . she may have consented to the relationship . . . the boy's family may have given her the abortifacient . . . they may have paid the girl's family off . . .

The bottom line is that the exploitation of women is no big deal in our country. Many a time, even when they want to fight back, their options are too limited.

I remember the lines of one of our mukhiyas (village headman) while the Delhi rape case had just occurred and there was the unprecedented public ire in the whole country.  

'Doctor saab, patha nahim ye itna halla kyom ho raha hai. Gavom mein ye sab hoote rahte haim. Ladki ha ijjat rakna hai, to chup chap settle karna hi accha hai.' (Dear doctor, I wonder why such a noise is being made about the whole issue. In villages, such things are quite common. If the girl should keep her honor, such things should be settled quietly). 

Over the last year since the Delhi rape case, we've had umpteen number of cases reported in the media involving the high and the mighty where women had been humiliated or exploited in some way or the other. 

Please take a minute and wonder about how many such cases occur on a regular scale in the whole country which never go reported . . . 

Does this bother us . .. ...

The girls nobody want

One of the ladies who regularly attended antenatal care at NJH came in labour today morning. She was quite a complicated case. RnD was 30 years old. This was her fourth pregnancy. Only couple of months back, she had lost her only son to malignancy at the tender age of 4 years. She had 2 daughters.

During her antenatal check-ups, she used to insist that she have a normal delivery although her second delivery was through a Cesarian section. We had mentioned to her about the possibility of a Cesarian section.

When RnD arrived today morning, she had already been in labour at her home for almost 12 hours. She was dilated about 8 centimeters and a uneventful vaginal delivery appeared on the offing. However, I was a bit doubtful about the rotation of the head. I gave the option for a Cesarian section to the relatives. However, they were quite vehement about not going for a Cesarian section. I managed to convince them that the maximum we could wait was 3 hours.

Unfortunately, things did not progress as all of us wanted. She got fully dilated but there was a poor descent of the head. I had to take a call for a Cesarian section. To my surprise, the relatives were quite vociferous in opposing the surgery. Later, I found out that the baby had passed meconium . . . thick pea soup colored meconium.

I reviewed things with the relatives. They did not want anything to do with a Cesarian section. After a lot of haggling, they agreed. It was only in the middle of the haggling that it struck me that most probably the relatives knew that RnD was expecting a girl baby. I mentioned it to few of my colleagues. They also agreed.

Then after I had talked with the relatives, I came to the Labour Room and found to my dismay that the patient was arguing with the nurses for having to undergo a Cesarian. One of the nurses scooped up a blob of meconium and showed it to the lady and told that the baby was eating this stuff. She agreed.

We had the baby out in about 10 minutes. There was meconium aspiration. The theatre team did a good job at resuscitation. However, the process of labour had done the damage. A second stage Cesarian is many a time an obstetrician’s nightmare. There were tears of the lower uterine segment which extended to the pelvic region. It was very much similar to the Cesarian Ihad in the morning, but tougher.

Post surgery, I went to talk the relatives to tell about the sick baby and the difficult surgery RnD had to undergo. The family was distraught. They very well knew it was a girl. The husband confessed that they had found out that this pregnancy carried a girl fetus. I gave them the option of taking her to a higher centre to ensure that she did not develop Meconium Aspiration Syndrome. I could not believe my ears when they told that they did not mind even if the child died.

I wondered how many more Indira Gandhis, Pratibha Patils, PT Ushas, Sania Mirzas, Sainas, Kalpana Chawlas etc we need to see before we realise how precious our little girls and sisters are for each one of us.

As I sign off this post, one more story which could end up true . . .

I just had a lady in her fourth pregnancy nearing 8 months of pregnancy who has walked into Labour Room complaining of lost fetal movements. The ultrasound has confirmed a fetal death. As I announced it the family members I was quite taken aback by the shock and the disbelief that enveloped them. The grief was much more than what I usually witness. 

I suspect that the lost baby is a male. They must have known earlier. The first three children are girls.

I shall let you know tomorrow. I’ve induced labour for her . . .

The Great Escape

I was going through old snaps from my previous stint as NJH and found this great story. 

It was a Sunday afternoon, when we had a young lady come in with a very peculiar complaint. I appreciated that she was quite forthright. The family had decided that she would abort her baby. It was her second pregnancy and her first baby was a girl.

She was already into her third trimester. 

Her in-laws had taken her to a quack. The poor guy did what he knew best. And he did not know his anatomy. 

He pushed in a laminaria tent into the urethra instead of into the uterus. And the laminaria tent had gone through the urethra into the bladder. The peculiar design of the laminaria tent ensured that it got stuck. 

We were in a peculiar position. 

The baby was about 28 weeks old. And there was a laminaria tent inside her bladder with the thread sticking out. 

Our surgeon thought it best to do a cystotomy (opening the bladder through a small operation in the abdomen) and remove the laminaria tent. 

And that's what we did. 

The lady came back and delivered about about couple of months. I was away on leave. But everybody remembered her. 

And of course, the baby was a beautiful girl . . . a very very lucky girl. 

My Introduction to Female Feticide

The snaps contained in this post are quite hideous, repulsive, very sickening . . . very unpleasant . . . all synonyms one can think about something very nasty and distasteful. Please view with discretion and ensure children are not around when you view this post. 

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The following incident was my first exposure to the ghastly practice of female feticide in the country.

This happened in 2003 while I was in NJH as a junior doctor. I had lost all these snaps till I found them in a old CD which was kept in our office. 

I took some time deciding whether I should post this here. 

It was towards winter of 2003 when a lady was brought in by her family in vague complaints of bleeding from the vagina. She was in shock and sepsis. We did an ultrasound which showed a contracted uterus with some retained products inside. The relatives agreed that she had an abortion. They said she was 3 months pregnant. 

One of our senior consultants took her in for a curratage of the uterus. In the theatre, he discovered that the uterus was perforated after the sound he put into the uterus went all the way in.

He took a decision to operate her. 

And this was what we found inside the peritoneal cavity. 

 

A macerated dead GIRL baby of approximately 28 weeks gestation

And this is the posterior wall of her uterus. 

The photographs say it all. An attempted septic abortion where the abortionist had perforated the posterior wall of the uterus and baby slipped into the peritoneal cavity. 

Such incidents continue to happen. Couple of weeks back, one of my local acquaintance confided that there was a maternal death in our nearby village about 6 months back after the lady tried to abort more than half way through her pregnancy. 

Please excuse if this post has hurt you. But, this is reality. 

Abandoned . . .

This is the story of a lady with a very bad burns who was brought to us about 2 months back. 

Initially, we did not know why she tried to commit suicide. Now, we know. 

Her husband had another woman and it was difficult for her to accept it. We came to know about it only towards the fag end. 

TD had doused herself with kerosene and set herself aflame. She sustained about 40% deep burns mainly of her face and trunk. It was very difficult

However, she fought valiantly . . . before she gave up. She gave up as she realised that there was no adult to whom she could look up for support. 

For about couple of weeks, her husband came on and off. Then, her constant companion was her daughter. She had a teenage son whom we never say.  

It was a sombre atmosphere during rounds each day when we could not tell much to this little girl. 

The staff eating in the mess shared their food. But, that was not enough. She needed blood . . . more food . . .  someone to hold her when the dressings took place. And there was none. 

The bystanders of her fellow patients said that she better be gone as her life is going to be miserable. 

Another story of the abandoned and uncared woman in the household. 

In another room near to where TD died lies CD, the new mother with 2 girl babies . . . both of them weighing not more than 1.5 kilograms. Every day I visit CD, the gloom pervades the room. It's very obvious that the family looks forward to CD getting pregnant again soon and try to deliver a boy baby. The fact that she went through a difficult pregnancy (twin pregnancy with eclampsia) does not hold any value for the family. 

Yes . . . another example of women being left to fend for themselves in a male dominated world. 

The total cost of treating TD was about 75,000 INR for almost 2 months. Her family had raised about 25,000 INR. We're glad that we've been able to write off the rest. However, this would mean that we need help to subsidise the care of such patients.