72 hours

Tenwek is a referral hospital. The patients referred often come by their own transport without a letter explaining the problem and without a qualified person to transport them. Last night I was called for a referral from a nearby hospital for CPD. Basically the referring hospital thought the pelvis was too small for the size of the baby. What lead them to this conclusion? The patient had been at their hospital 72 hours laboring without progress completely dilated. The patient arrived and the baby still had a heartbeat. We rushed to emergency C/S. When I tried to get my hand in to get the baby out and I realized there was no space for my hand and the head I was worried. The next 10 minutes were some of the most exhausting of my career. Thankfully a surgical resident came in to also help retract the head as I pushed from below and the baby boy delivered. After chest compressions, intubation, epinephrine the boy began to weakly breath and the heart rate improved.  

I didn't sleep well the rest of the night. How could a "hospital" allow a patient to labor this long before intervening? How will we convince mothers 

to come to the hospital for delivery if this is the care they receive? (60% deliver at home.) What else could I do when a baby is stuck? Does this mother understand this is not her fault? Who should be blamed?

I went to see him this morning, his face looked bruised, but he was breathing without assistance and pink. Thankfully he had not seized and seems to be neurologically intact. I believe it is only by God's grace this baby is alive.