MY EXPERIENCE AS A BIRTH COMPANION.

This past month I literally  got a chance to be on the other side of the table. My cousin had chosen me to be her birth companion( if you are pregnant and you haven't decided on who will be your  birth companion then you are not serious with your birth plan). I know that in most public hospitals, patients are not allowed to have companions in the labour room but it's something that should be allowed to some extent. I was excited about the honour that she had bestowed on me and I looked forward to it very much. When my entire family left the house to spend the weekend back home in Machakos like it always happens, I was a bit reluctant because I had given her my word to be around during the days approaching her E.D.D. (Note,a mkamba doesn't sleep in Nairobi on a Friday, this is a known fact; afterall Masaku NOO VAA!!)

I am an avid fan of all pregnancy related shows on TV like 'One born every Minute', 'I Didn't Know I Was Pregnant', 'Adventurous Deliveries' e.t.c mostly on TLC Dstv Channel 172 ; so I had an idea what birth companions go through.

The much anticipated phone call came in on Saturday at 8.00a.m and I was super excited. As a medical doctor, I get very irritated when patients come in with their 'medic relatives' who know it all and want to control everything so I knew that I had to play this very cautiously without crossing other medics  borders.

In the hospital where she was delivering, only the spouse is allowed into the delivery room but I gladly convinced them that I was stepping in on behalf of the spouse. Ofcourse I was a bit anxious not to let anything go wrong because I'm not sure if I would ever forgive myself, there's a sense of responsibility that kicks in when you are watching over your relative. We were in the company of her amazing friends but unfortunately they wouldn't be allowed in for as many hours as I, the 'spouse.'

I humbly introduced myself to the midwives and the 'Intern' (he was either a doctor intern or a very experienced nurse). I played it dumb and cool ; back in my mind I kept wondering if they knew that I practically run the maternity in my hospital and all decisions during working hours fall on me. They must have thought that I was meek and docile ; and that was excellent because I didn't want to intimidate anyone.

I noticed a few mishaps here and there that I would ordinary ignore but not with my cousin.  I literally kept bugging them in a friendly and flattering  manner until they did the correct things but without feeling pushed and intimated.

Again, my hand was sore from all the lower back massaging. At one point I would be told I wasn't rubbing the back adequately and at the other time I would be told I'm rubbing it too much; they are called women in labour, they are allowed to command the moment, haha! I also forgot to eat or drink anything till around 5.00pm when my cousin's friends brought me something to eat and I devoured it irregardless of the maternity environment. I thought I looked mean eating infront of an exhausted labouring woman but I reminded myself that I needed the energy to focus on the task ahead.

I was also very keen to feed her often and give her energy drinks so that she would have adequate energy when the time for pushing out the baby would come.


There are moments she caught me laughing at her but hey, the dramatics of a labouring woman can be comical. I'm sure every woman smiles over some of these memories. I also assigned myself the role of chief-photographer. I thought that she would want these life changing moments captured . I made sure I only took photos and videos with her phone and never mine to maintain privacy. I believe these are very intimate moments that only belong to her and her soon-to-be-born child.


When I felt like she wasn't being monitored adequately as need be, I would call the pretty nurse and request her to politely do what was needed, and we bonded well. I refused to enter the examination room as they did invasive examination because I didn't want to cross into another doctor's territory and I also respected her privacy.

Of course I have dealt with many pregnant women and I know when they are psychologically feeling things. When my cousin would tell me that she was at the point of pushing the baby, I would just sneak out and come back pretending that I have alerted the doctor. Of course you don't bear down so early until you reach a certain dilatation. This happens to us doctors a million times so when you tell your doctor that you feel like pushing and he ignores you, trust me he has your best interest at heart.

We laboured till evening and we reached a point where action (caesarean section ) was needed. I being a staunch supporter of Vaginal Delivery made sure we tried it fully but of course without putting the baby at risk. I would hate it to go home thinking that I contributed in unnecessarily rushing to a Caesarean Section. I had literally forewarned her not to mention the word Caesarean-Section infront of me because I was hoping that she had it the 'normal way.'  I had a partogram( a graphical monitor of labour) in my head, literally and I knew it when it was time to go to theatre. I anticipated a malpresentation, but behold it was a big baby coming out of what looked like a very small pregnancy bump; that caught me off guard literally. How could we have missed out on a Big Baby diagnosis? We had all relied too much on a scan done the previous week which had estimated a fairly small size baby.

In the labour room, I was able to calm down a husband who was very tense. He sensed that I was abnormally calm and he approached me for moral support. I did open up to him that  I am  a medic and with that, gave him the avenue to ask as many questions as he wanted to calm him down. They had lost their first baby at birth and were still traumatized and hoping they would be successful this time round. He managed to calm down finally and be strong for his wife who was clearly going through a difficult delivery. I realised that probably God was using me to wipe off fears from this family in my capacity as my cousin's 'spouse.'


I exited the birth companion role and entered the 'grandmother' role. I was alone at the bedside at the Post-Operative ward waiting for mother and child to come back from theatre. Those were long, tension packed hours. I expected them out in 45 minutes to 1 hour but they took a whole two hours. I kept re-assuring myself but as a medic, I kept going round and round on all things that could go wrong. Soon, I had the pleasure of being the first to hold and clothe the big baby together with the nurse as we waited for the mother to be 'sewed up'.

I would have jumped in to help if anything went wrong, whether with permission or not; I'm I not a licensed doctor in the country? This reminds me of a doctor friend whose child developed breathing complications immediately post delivery and she hastily jumped out of bed with placenta dangling in between her legs and resuscitated her child. By the time the doctor arrived, her child was sorted.

I left the hospital late in darkness but went home a very satisfied woman. Of course I carried home lots of my cousin's DNA, in form of amniotic fluid,  blood, tears etc in my clothes but those were marks of success and victory.

This task made me give a lot of respect to spouses who go through it all in the labour rooms. It's not easy sitting on that bed for more than 12 hours observing a loved one suffer. It's for the persistent, patient and strong at heart.

It also made me appreciate the importance of having a birth companion. I'm a medic and I know that patients who are accompanied are usually taken more seriously.

I also learned the importance of respecting colleagues when in their territories. The midwives loved me to the point of sneaking a joke or two when I went to enquire anything. The maternity guard(Askari) also liked me and praised me for my persistence till I had seen the end of the delivery.

I also learned to treat patients with utmost care because for us, it's an everyday job with 'objects' to treat, but to a patient, this is the first time in their lifetime to ever go through an unforgettable experience. When a doctor spoke harshy to my cousin, I was hurt, yet I do use such words frequently in maternity. For example, I don't like being touched by a labouring woman when doing a vaginal examination yet it's a painful procedure that they have probably never encountered in their lives. With this, I have become a more compassionate doctor especially in maternity.

I pray that my cousin Jacinta and her beautiful daughter have an amazing life together, full of wonderful memories and friendship.

'Dear Jacinta, should you require a birth companion for another pregnancy, I'm all yours. Thanks for trusting me with this very important role.'

BLIGHTED OVUM

             BLIGHTED OVUM
I have been spending so much time with pregnant women of late such that my body, soul and spirit is in pregnancy-mode, I'm actually awaiting my 'first delivery' 3 days from today.  2 close relatives and a best friend are pregnant so I have been bombarded with lots of pregnancy questions. One of the questions that has always come up is about a formed pregnancy with no baby (embryo). This might sound very impossible but it’s a frequent phenomenon. My patients look at me in disbelief when I tell them that they are indeed pregnant but with no baby forming. I have had to take them step by step on the ultrasound till they get it. In the hospital I work in, I see at least two cases weekly. For those who don’t believe the diagnosis, we always advice them to repeat the ultrasound after a week or so, or get a second opinion for the sake of psychological satisfaction.



WHAT IS A BLIGHTED OVUM?

A blighted ovum occurs when a fertilized egg implants in the uterus but doesn't develop into an embryo. It is also referred to as an anembryonic (no embryo) pregnancy and is a leading cause of early pregnancy failure or miscarriage. Often it occurs so early that you don't even know you are pregnant. The pregnancy appears normal on an ultrasound scan in its early stages, but as the pregnancy progresses a visible embryo never develops or develops and is reabsorbed. In a normal pregnancy, an embryo would be visible on an ultrasound by six weeks after the woman's last menstrual period.

WHAT ARE THE CAUSES?
The causes of a blighted ovum are often due to problems with chromosomes, the structures that carry genes. This may be from a poor-quality sperm or egg. Or, it may occur due to abnormal cell division. Regardless, your body stops the pregnancy because it recognizes this abnormality.

 For most women, a blighted ovum occurs only once in their lifetime but I have seen a few women getting it twice or thrice. It becomes very depressing for some.

WHAT ARE THE SIGNS?
With a blighted ovum, you may have experienced signs of pregnancy. For example, you may have had a positive pregnancy test or a missed period.
Then you may have signs of a miscarriage, such as:
• Abdominal cramps
• Vaginal spotting or bleeding
• A period that is heavier than usual.
If you're experiencing any of these signs or symptoms, you may be having a miscarriage. But not all bleeding in the first trimester ends in miscarriage. So be sure to see your doctor right away if you have any of these signs.

HOW IS IT DIAGNOSED?
An ultrasound test is usually needed to diagnose a blighted ovum -- to confirm that the pregnancy sac is empty. For diagnosis, the sac must be of sufficient size that the absence of normal embryonic elements is established. In case the doctor is doubtful, he can recommend one extra week of observation followed by a repeat scan to be sure of the diagnosis once a sufficient size of sac is achieved.

HOW TO TREAT IT

If you have received a diagnosis of a blighted ovum, discuss with your doctor what to do next. Some women have a dilation and curettage (D and C). This surgical procedure involves dilating the cervix and removing the contents of the uterus by curetting. Because a D and C immediately removes any remaining tissue, it may help you with immediate mental and physical closure. It may also be helpful if you want a pathologist to examine tissues to confirm the reason for the miscarriage.

Using a medication such as misoprostol ('the white tablet') to stimulate the uterus to expel the contents may be another option but this must be strictly done as an inpatient in case bleeding complications arise. However, it may take several days for your body to expel all tissue. With this medication, you may have more bleeding and side effects. With both options, you may have pain or cramping that can be treated.

Other women prefer to forego medical management or surgery. They choose to let their body pass the tissue by itself. This is mainly a personal decision, but it must be discussed with a doctor. I remember almost losing a patient who decided to wait for the body to expel but ended up getting life threatening bleeding and ended up being rushed to theatre for an emergency D&C and had to have urgent transfusion.

HAVE I EVER SEEN A NON-DEVELOPING EMBRYO??

I remember doing a D&C and of course after almost rupturing the amniotic sac on my face, the small embryo came out. It was so small, about 3 cm long, I put it aside to study it after the D&C but of course it had melted into a white matter by the time I was done. This fascinated me.

I hope this post was educative enough and I hope that Doctors also stop telling patients 'mimba imeharibika na lazima uoshwe' (pregnancy is spoilt) instead of explaining the exact nature of the condition that made them miscarry and telling them all the options available for them.

Have a fruitful week!!!