Tuesday, December 1, 2009
"Two are better than one..."
I recognize that I am taking this quotation from Ecclesiastes, "Two are better than one.." completely out of context, but in the setting of vaginal deliveries one baby is better than two. Don't get me wrong twin deliveries are amazing, when they go well, but I still approach them with a healthy fear of what can go wrong... prolapsed cord, post-partum hemorrhage, malpresentation, head entrapment, etc. That brings me to why I'm blogging at midnight; I can't immediately go back to sleep after an exhilarating delivery.
Having been called for a "breech" presentation, I arrived to find a rather small scrotum presenting and a fetal heart being monitored near the mother's umbilicus. Asking if the mother knew she was having twins, the intern and midwife replied, "You think that there's two babies?" Well, generally you don't get a heart rate that high when a baby's that low, especially a premature baby. Thankfully the 1st baby delivered safely breech weighing 1000 grams. That left us with the 2nd. At this time the things going through my head are, "Position is footling breech, baby is small, but bigger than the first, head might get entrapped, C/S will take at least 30 minutes to prepare, baby's survival at this weight is only 50%, Mom doesn't want C/S, what should I do?" In the end, we started some pitocin and I grabbed the feet for a second breech delivery. While this twin was more difficult to deliver than the 1st both boys did begin crying after birth! The mom, upon hearing she had two boys, began to cry out asking God why He had not given her a girl. Apparently she already had 2 boys and as my intern explained now she needed to buy more land for her boys to inherit. Boys are expensive in the Kikuyu culture.
I kindly disagreed with her; a vaginal breech/breech delivery at 28-30 weeks with 2 babies that come out crying in Kenya means God should be praised!