Hanging on...

One of the the difficult decisions we often have to make here, is the best mode of delivery for babies that have to be delivered prematurely either because they are sick or their mother is sick. In the UK that was rarely such a difficult choice. Our good neonatal intensive care units mean that most babies more that 28 weeks gestation would survive, and that means even if you started off inducing a mother, if the fetal heart was abnormal we would generally do a caesarean section in the confidence that we had a good chance of a living baby. That, however, is not the case here. Since I have come to Africa not a single baby less than 32 weeks of age that I have delivered by caeasrean section for fetal reasons has survived. I have had some live that I have delivered for maternal reasons (e.g. bleeding placenta praevia), but not even one if it was the baby who was sick.

So when this lady came with severe pre-eclampsia at 28 weeks gestation I explained to the mother that she needed delivery and I thought we should induce labour. I also explained that in my experience, either babies were strong enough to survive labour at this age (in which case they often have done very well), or else they weren't strong enough, and in that situation I have always seen them die within a few days if I did a caesarean section. We agreed therefore, that we would not operate even if the baby seemed to be sick during labour, and we decided it would be best not even to listen to the baby's heart during labour - because it would be aweful for her and for us if we heart a bad heart rate and didn't do anything about it. Then we spent some time praying together, and started the induction.

During the next 24 hours we started labour, and when she got near the end we call the paediatrician, explaining that we weren't sure how the baby was, but could she please be there to receive it. A little boy was born, a bit flat at first, but he responded very well to resuscitation and was taken to nursery where he is slowly growing strong and healthy. His mother has learned to feed him through the tube from his nose to his stomach, and carries him 'kangaroo' style with great patience.