Understanding is impossible

8 PM phone rings: Hi, Dr Dan. It's me, Paula. I'm in labor. Could you please send the ambulance.

Paula is a midwife who worked for 2 years at BPC. It's her 4th child: previous one by C-sect resulting in 4 kg stillborn. I call immediately to put the ambulance in motion. One driver is close by so he goes directly to Paula's.

Meanwhile I get a frantic call reporting in one contraction feet and body delivered and arms and head undelivered. As I try to instruct by phone how to do a breech extraction to lay people, the ambulance arrives and quickly heads to the clinic to get a midwife. 10 min later she arrives to find a unresponsive baby now lying delivered outside the birth canal… limited resussitation to no avail as APGAR 0.

Paula, distraught, transposted to BPC maternity. Minimal PP bleeding but placenta stubbornly retained til 1 hour later when spontaneously expelled. Vitals stable, eating and drinking. 1 AM frantic call as Paula felt her legs go numb then almost immediately dyspneic. 10-15 min drive to clinic and frantic scene… Paula no pulse, no resp effort, pupils fixed and dilated.

Pulmonary embolism… 1 in 7000 pregnancies… half pre-delivery half post partum… either from deep veins of lower extremities or from hidden pelvic veins… mortality in range of 80%. Makes up 10 % of all maternal mortality.

A friend of the clinic, a mother of 3, now a statistic in the most devastating of all categories… maternal mortality. As we reflect it seems understanding is impossible. Yes we keep fighting but forces much greater than ours often come into play.

Dr Dan Murphy is the head physician at Bairo Pite Clinic

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Ed: 28 Dec 11 Updated with missing paragraph. "Pulmonary embolism…"