It's a girl . . . so why bother?

I had been waiting for some time to put up this post. For beginners, it is just another post where I expose our double standards when it comes to respecting the Indian women. Many think that it is a problem only among the poor. But, it is an open secret that girl babies are not welcome into most of the middle class homes of the country.

It was another Sunday afternoon. We had one unbooked patient in our labour room, who had been progressing fine. However, we had given the family an option to take to a higher centre, the main reason being her Negative Rh blood group. They were no forthcoming.

The lady progressed well till her birth canal was fully dilated. Then problems started to happen. The baby just refused to come down. It was around 4 pm that we had kept a deadline for the baby to delivery. The head of the baby was too high for a forceps or a vacuum and it looked like an occipitoposterior presentation. We had to go for a Cesarian section.

That was when the tamasha started. The family did not want to have a Cesarian, They wanted a normal delivery. I bluntly told them that she could end up with a rupture uterus if they insisted for a normal delivery. The lady was having quite unbearable pain. On one hand I had the relatives refusing for a Cesarian section whereas the lady was shouting at the relatives to allow us to do a Cesarian section on her.

After about half an hour of pleading, they started to call up multiple people over the phone. Then they wanted me to talk to some doctor. They claimed that the doctor was the elder brother of the patient. He started in a quite rude way on why Cesarian was being done. I told him about the partogram and the way we do things. He told me in a huff that if that was the only way, I could go ahead.

It took the family another 10 minutes to give us consent.

Ultimately, we did the Cesarian. The blog post title gives away what came next.

Yes . .. .. it was a girl baby. The mother was not at all interested to see the baby. ‘I know it’s a girl, is'n't it’? she sighed. ‘My brother had helped me do to find out the gender.’ ‘The doctor brother’? I queried. ‘Yes . . .’ she replied as she drifted to sleep.

As I sutured her skin, she had woken up for a short time. She told me, 'I got married to a family who is not educated. They treat me like filth.' After the discovery that she was carrying a girl, nobody bothered to take much care of her. Her husband had gone off on a business trip although he was well aware that she could go into labor any minute. 

I told her, 'But, it was your own brother who helped you find out the gender of the baby.' 

It is no secret that healthcare workers especially doctors in developing countries have more boys than girls. I'm told that there are at least couple of surveys which prove that. 

I wonder what use are laws like the PNDT Act when we (health professionals) ourselves murder/neglect the girl child. 

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 . . . 

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 . . .

Patient who taught me - 2

Anotherpatient who taught me something important.

This again happened during my previous stinct at NJH.

It was midnight of a really hot summer. The hospital was not very busy. I was called to attend to a girl, about 12-13 years old who presented to emergency with severe breathlessness.

On attending to this girl whom we shall call AK, I realised that I was dealing with a long term cardiac condition,  most probably a congenital cardiac disease with end stage cardiac failure.

The X-ray confirmed it. Her heart occupied almost the whole of her chest. The veins in her throat were all bulged up. Her eyes were bulging and was very congested. She had central as well as peripheral cyanosis. I could not record her blood pressure.

I put her on the bed in the acute care. I called one of my colleagues who confirmed that nothing much can be done other than make her feel comfortable.

I talked to her parents. In fact, AK had been sick from the day she celebrated her first birthday. They had not shown her to a proper doctor. Only quacks (jhola chaps) and faith-healers (ojhas) had seen her. The family appeared to understand that there was nothing much to do other than pray.

I went to talk with AK. To my surprise, AK also was sure that she was dying. As I told her that I shall see her in the morning and was leaving, she clinged to my hand.

In between her breathlessness she told me, ‘Please ensure that I die here in this place.’ I told her that my nurses will take care of her well. Then she continued, ‘Doctor, I’ve never slept on a bed. I never knew that it is so comfortable. Please let me die on this bed’.

AK died early morning, before I reached for rounds. Her face was so peaceful. Not the contorted faces that I’ve seen in many of my patients who die a horrible death after being breathless.

All she wanted was to remain in the bed on which she ultimately died.

Tells a lot about basic human needs and wants, especially those of the poor. 

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. 

I just wonder . .. .

It has been quite a long time since I posted something about the maternal and child health care we do at this place. We do quite high risk obstetric care in spite of all the limitations we have. And it has been some time since we got any sort of high risk patients. 

However, today we had two bad cases. 

The first lady, RB - a primi at term with regular antenatal check ups had been trying to deliver at home since the last 24 hours. The reason for trying to deliver at home - 'she's had a normal antenatal check up' - according to her brother. 

Dr. Johnson was on duty. RB's was dead and was in a face presentation. And she was running a fever. Blood investigations showed sepsis. It was a tough call. Mother in sepsis and a dead baby with a very difficult presentation. We called up Dr. Shalini who is in charge of Obstetric Care in EHA. A craniotomy was the best option. 

I had never done one for a face presentation. However, Dr. Shishir had experience of doing couple of them on a face presentation. I have never liked doing these destructive procedures and to do one for a face presentation was all the more unthinkable. Thankfully, the procedure went well. 

Late evening, we had another of our routine eclampsia patients. With a twin pregnancy and having been having fits since more than 12 hours, CD was a very high risk patient. And being quite well off, it was quite surprising that the family did not want to take her to a higher centre. 

Again, Dr. Titus, our doctor on duty got in touch with Dr. Shalini and she advised to go in for a Cesarian section. The surgery went off uneventfully. The babies needed active resuscitation - but they are doing well for the time being, although both are around 1.5 kilograms. 

Well, what did I wonder? 

As you can see, both the women had received sub-standard care. RB should not have been in labour at home for over 24 hours and CD should have gone ahead to a higher centre. It was quite risky for CD to have given a high risk consent for us to go ahead with the surgery. . . however lengthy the consent was . . . the family even accepted that CD could die on the table. 

All the 3 babies born were G I R L S. I find it difficult to accept that neither RB nor CD's did not know that the babies were girls . . . although I may be wrong . . . Dear Lord, I pray that my hunch is absolutely wrong . . . 

The preference for the boy continues . . . 4 stories

There were 3 cases last week, where I was almost sure that the relatives quite well knew the gender of the fetus that the respective patient was carrying. That was when the 4th one came. 

The snap above is that of RD's baby - born sometime early morning today by emergency cesarian section. Yes, you have diagnosed correct. It was a case of Hand Prolapse. She was lucky to have made it alive although sick. However, there was no reason that this baby should have born sick by Emergency Cesarian. 

Because . . . RD had come yesterday sometime in the morning with leaking per vagina. And Dr Ango had correctly diagnosed a transverse lie and had asked the relatives for a Cesarian section immediately. The relatives told her that it was RD's fourth pregnancy and she should deliver normal as her birth canal should be quite large enough. 

They left for elsewhere. The next thing we know is that RD came with a hand prolapse early morning. I'm yet to find out what all happened in between. 

Later, in the afternoon, I had a pep talk with one of the relatives and it was well evident that the family knew the baby was a girl and a Cesarian section was considered too expensive to deliver a baby girl. 

However, I'm happy that they came just in time to deliver a live child. 

The other 3 cases where it was also quite evident that the family knew about the gender of the child are narrated below - - - 

1. 5 days back, some time early morning, there was SD who came with a foot presentation with severe intrauterine growth retardation. SD had been leaking since late night. She had been around for antenatal check ups to quite a number of places - - but the family claimed that no one told them that the baby had growth retardation and had an abnormal presentation. To make matters difficult, they did not have any papers of her antenatal care. The baby was alive . . . I gave them the option of doing a Cesarian section. With much reluctance they gave me permission. The baby came out with great difficulty . . . and was a girl. The family showed no interest in keeping her . . .  Yesterday, they got a discharge against medical advice and left . . . Here again, it was quite obvious from the way the family was behaving that it was well known to them that the fetus was a girl . . .

2. 3 days back, I got a call from Titus who was on duty. There was a very rich family who had come with their daughter who was 8 months pregnant. RS was leaking and was having severe pre-eclampsia. Her husband was working in one of the metros. Titus was trying his best to refer her. In fact, the patient wanted to be referred. Her relatives would have none of it and wanted the treatment to be done here. Her blood pressure was rising and Urine Albumin was already 4+. We gave them the option of a Cesarian immediately. The surgery went well. The baby was in fact term but had severe growth retardation. We offered a referral for the baby, which was not taken was the relatives. However, the husband arrived yesterday evening. Our doctor at NICU, Dr Johnson explained about the baby and he readily arranged for the baby to be shifted to a higher centre. I was glad to see him quite furious with his in-laws for the way they dealt with his wife. 

3. Yesterday, we had a lady who came early morning with labour pains. The doctor on duty decided that the contraction were not good enough and gave medicines to accelerate labour. I reached the labour room at around 8:30 am and was a bit concerned with the extra attention that the patient was receiving from her relatives. I also found the uterus a bit funny shaped. As I was examining her, her male bystanders were making a fuss about knowing her latest status. I decided to do a Per Vaginal examination after which I was almost sure that she had an Occipitoposterior Presentation and there was minimal meconium staining of the liquer. And she had not progressed at all from early morning when she came. I told the relatives of the predicament. I could have waited for couple of more hours as this was her 3rd pregnancy and both her previous deliveries had occurred normally. As soon as I dropped the 'Cesarian' word, the family wanted to immediately have the surgery and get the baby out ASAP. I went ahead with the surgery. The baby was a boy. It was quite unusual for the relatives to agree for a Cesarian section that fast

We are all quite aware about the fall of the child sex ratio in the country. The stories I tell here are only the tip of the iceberg. We've had worse experiences. And there are some hilarious experiences too . . .

I'm not sure on where we are heading with regard to the care of the girl child . . . But, someone has to do something . .. ... The issue of the neglect of the girl child is much more serious than what we perceive . . .

The Unborn Girl . . . Murdered

(User discretion advised due to snap of macerated baby)

KB, a 40 year old came to us at around Saturday midnight with a history of term pregnancy, labour pains and loss of fetal movements since one day. Since, Titus, who was on duty, did not get a fetal heart sound, he did an ultrasound which showed a dead baby in a transverse lie. 

He did per vaginal examination was surprised to find a 70 cm long rubber tube coiled inside the uterus. 

There was no fetal pole palpable through the vaginal orifice and there was a foul smell. 

He called me telling about the rubber tube. I felt that something was amiss. 

Considering that KB was in labour for more than 1 day, I did not think it as wise to try a internal podalic version which we regularly do. One of our doctors, Dr Shishir is quite an expert in doing it.  

I posted her for a Cesarian section. 

I was surprised to find out that the uterus looked very much preterm. It looked quite unhealthy too. I was glad that I did not go for the IPV. 

As soon as the uterus was opened, stench of decomposed flesh filled the room. The baby was badly macerated and was at least 3 days dead. The baby was female. . . 

The dead baby and the orange colored rubber tube which we found inside the uterus. . . 

It was not complicated to piece the events together. Someone had helped the family diagnose a female baby. And they had tried to abort it. 

Considering the patient's age, I asked if we could do a tubectomy on her. The family was outright against the suggestion . . . The husband told me that they needed to have a boy. . . 

I wonder if she had been aborting like this for sometime since the delivery of her previous 3 daughters the youngest of whom was about 15 years old. . . 

I informed the civil surgeon's office and the police. 

The civil surgeon had informed the press and they were all over the place by Sunday afternoon. 

It is sad. Girl babies are not wanted . . . And they are killed ruthlessly. But, it is not only girl babies who are killed. Kindly read a very good article against abortions of any type.  . . 

The occasions when we've witnessed clear instances of prejudices against the girl child are umpteen. . . And I'm sure that the cold blooded murder which came to light is only the tip of the iceberg . . . 

Bizarre Obstetric Care . . . The Sad End . . .

Sometime around 12 in the afternoon, we declared AD clinically dead. She had been struggling after the surgery. She could hardly breathe on her own and she was hooked onto the ventilator. 

We had trouble maintaining her blood pressure and was on ionotropes. 

Per-operatively, the abdomen was a mess. According to Nandamani and Titus who did the surgery, the uterus was like 'putrefactive minced meat' and the peritoneal was all stinking with dilated bowel loops. There was no way the uterus could be removed as the uterine vault was all necrosed and flimsy. They closed the uterine rent and came out after putting in couple of drains. 

The nasogastric tube was draining all stinking coffee ground material. 

As I sat with the AD's husband to fill up the Facility Based Maternity Death Review, it was very obvious that he had hardly been caring for his wife. Married for 10 years, the only thing he had to say was how burdensome his wife was for all these years. The tone was bordering on how good it was that she died . . . 

It did not need much questioning to realise that he hardly bothered how his wife fared. The first baby born by a Cesarian section had died at birth as the labour pains were happening at home and he took her late to hospital. The next delivery he tried at home and when nothing much happened, he took her to hospital, where she had a normal delivery. The third delivery was again tried at home. 

That was his excuse for trying the fourth one at home . . . there was some problem. So, he took her to hospital. Delivered in hospital where nobody picked up the rupture uterus. They brought her here as she was not feeling good after delivery. Then, we asked for blood. I found out that the husband's blood group was same as that of AD . . . but, he was hardly bothered about donating blood. 

He took her back to the place where she delivered rather than to Ranchi . . . They transfused 3 pints of blood without doing any surgery. . . It was already 4 days after the rupture uterus when she came here a second time. The family told us that they were not willing to take her anywhere else. . . If she dies, she dies . . . 

She died. . . The husband was worried about the children . . . 2 girls aged 3 years and 2 years. . . They would be orphans . . . . more so if the husband remarries . . . 

Talking about girls, over the last week, we've had enough stories of violence related to the female gender. The one which happened in Bangalore was very very sad . . . The second incident which happened near Kolkotta crossed all limits of cruelty one can witness . . . 

And after I had penned this post, yesterday night, I had this unfortunate lady being wheeled into emergency. She was beaten up by her alcoholic husband . . .Bones in both her hands have been crushed into multiple pieces with some foreign body lodged in one of the hands . . .

The unnerving aspect of all such incidents is that one gets the feeling that such incidents are on the rise . . . which is not a good sign for the society. . . When I look at Maternal Health care, I'm quite convinced that things would not improve until we give more respect and value to the women and girl children around us . . . 

The Girl Child . . . Positive Deviance . . .

Today, I had a very unusual patient. ZA had come about a week back with his wife, KZ who had an abortion and we had to do a curettage of the uterus. That was when ZA asked me whether I was from Vellore. He told me about his 8 year old daughter, BZ who was specially abled after she suffered from a delay in normally reaching developmental milestones.

This was amazing. In a society who gave quite a lot of prominence to male children and treated its female children with lesser care, ZA and his wife, KZ stood out. It was quite encouraging.

They had invested quite a lot in the well being of his 8 year old daughter so much so that KZ underwent a manual termination of pregnancy (MTP) couple of years back, so that they could give extra care for her.

It was quite a long time since I was seeing a specially abled child in outpatient. The child was quite smart. As seen with many of the special children, BZ was also quite interested in music and stories . . . It was quite unlike quite a majority of parents who have girl babies with a probability of not being 'normal'.

It was wonderful that I could get through to one of my old friends at CMC, Vellore who readily agreed to review BZ. I know that there may not be much happening, but it is encouraging to know that attitudes are slowly changing for the better. I wish this change would be infectious and a time will come when the girl child is cherished and valued more in Indian homes . . .

I had already planned many things in administration today, and therefore did not find much time to talk with the family. However, the major finding I had about the family was that the mother was a graduate. . . and the father a teacher. . . There must be other factors too . . . I’m going to probe into them some time, but if it is female education which will make a difference, then we have miles to go . . .

Unwanted girl babies . . . and the sought after male heir (2)

I was wrong about SA in the blog I wrote yesterday. SA delivered a boy and that too uneventfully at around 7 am today. Since the pregnancy was complicated the nurses had called me for the delivery. As I walked back home, I berated myself on the tendency I’ve to jump into conclusions. I was very sorry that I ended up writing about SA on my blog. I mumbled an apology to the good Lord about my evil heart.

I reached back to the office at around 8:30 am. There were a host of male relatives of SA waiting to see me and they were so profuse in thanking me for ensuring that the delivery went well without any complications. There was quite a lot of things to do and since I did not have anything much to do with SA, I became immersed in the office work and a quick review of the sick patients. It was sad to see that PD continued to be sick.

At around11:00 a m, I had a surprise with the RSBY officers from Ranchi coming in to sign the papers related to implementation of RSBY in the hospital. It was a surprise. In between the signing of the papers, I could see SA’s father peeping on and off into the office. Considering the complications SA had, I called him in and asked him what the matter was.

SA’s father wanted me to review the baby. I asked him if there was any problem which he immediately denied. I told him that I would come in a couple of minutes. SA had got admitted in the general ward the previous day. Therefore, I went there in search of SA. The nurse told me that SA’s family took a private ward in the morning.

I went to the private ward. SA and her relatives were there. The husband was beaming as he handed me a box of sweets. He told – ‘we thought that the baby was a girl’. I asked if they knew for which he gave some vague answer. Well, I put things together. I could see no other reason why they shifted out from the general ward to the private ward.

During my last stint in NJH, we had received a very sick mother about whom we could not get a diagnosis. Her only complaint was that she had attempted to abort and then her bleeding was not stopping. Dr Colin Binks, our consultant surgeon during that period started to do a curettage of the uterus. And then, he found out that there was a perforation of the uterus.

And so, the patient went in for a laparotomy. And what we found out was gruesome. Inside the peritoneal cavity was a macerated female fetus of about 30 weeks. And there was a large rent on the posterior wall of the uterus. Somewhere, they had made a diagnosis of a girl baby and had attempted to abort resulting in the gruesome end result. The mother made it after a closure of the uterine rent and a long recovery period.

Then few months, before I had taken over, there was a attempted abortion at 32 weeks – the relatives were given a diagnosis of a female fetus from some ultrasound clinic. And when the delivery happened, it turned out to be a boy – which had died during the process. Many of the staff still recollect the unforgettable expression of grief by the family – one of the senior sisters had told me that the cries of the family members still echoes in her ears.

I’ve my fair doubts if SA and her family had got into a similar predicament. But, they were lucky.

Or is it again my intuitions. I’ve been reading Sherlock Holmes and his exploits of late. . . But, here I’ve enough evidence to support my intuitions . . . Haven’t I? Before I sign off, a penny for your thoughts for PD who continues to be on the ventilator . . . Request your prayers . . .

The boy longed for . . . and the unwanted girl(s)

Yesterday, there was the news about an unfortunate incident in Afghanistan in which a woman strangled her daughter-in-law to death for giving birth to a third daughter. 

At NJH, it is quite common to be reminded about the preference for girls . . . 

3 instances . . . 

The first one, PD, the mother of four girls was brought last Friday afternoon - unconscious and frothing, almost at the edge . . .  The fact that there were 4 little girls at home waiting for their mother to come back home made our doctor on duty to try the best to save her life. PD had a blood pressure of 200/120 and Urine albumin was 4+. The baby was already dead. And there was no indication of her delivering normally for the next 12 hours. 

Dr Johnson made a decision to deliver the dead baby by surgery. She was already intubated and being mechanically ventilated. The surgery was uneventful - but PD could just not be weaned off the ventilator. Over the last 2 days, she has also gone into renal failure. . . I've discussed with the relatives that we shall keep her in the ventilator for another 24 hours. . .  Kindly pray that PD will make a miraculous recovery. 

The family had been wanting a boy - the reason for PD getting into the present state. And the dead baby was a boy. . . It is unthinkable for 4 little girls to grow up without their mom. . . 

The second one is KD. KD was in her second pregnancy. KD's last baby was born 5 years back. In spite of being only 2.5 kgs, the baby was born by an instrumental delivery. The second baby looked bigger - but then she had an ultrasound which showed that the baby was smaller. But, clinically, the baby looked big. . . 

I explained to the relatives that she could end up with a Cesarian section. The relatives were begging me to somehow ensure that KD delivers normally. We have seen quite a lot of our antenatal patients who beg us to somehow ensure a normal delivery end up with having a girl baby. 

I'm not sure whether it is my prejudice - but I've a gut feeling that most of such families are quite sure that they have a girl child. And, I'm sure that there are many an ultrasound facility to give the sex of the baby to the family. (It is illegal to divulge the sex of the baby in India as quite a lot of girl children are aborted off)

And I've seen the vice versa happening too - families agreeing for Cesarian section at the drop of a hat and even taking all possible efforts to salvage a boy baby who is born moribund sick. 

Now, I've one more lady in the labour room. SA, a primi with nephrolithiasis, severe hydronephrosis and chronic urinary tract infection - we've been advising the family from the very beginning to have her delivery at a tertiary or teaching hospital in Ranchi. The advice has fallen to deaf ears and they want to do the delivery here.  

She came to outpatient today with post dates. And her blood pressure is on the higher side. I made one more effort to convince the family to take SA to Ranchi for the delivery. I've quite sure that they've discovered that the baby is a girl . . . Maybe, I'm wrong . . .  I shall let you know when the delivery happens within the next couple of days. . . 


Well, this line was put in much later . . . What happened with SA? It was hilarious. . .