This is me delivering a baby by caesarean section at Jahun on Thursday morning.
The mothers story is unremarkable – for this place – but back home, a million alarm bells would have been sounding. For a start, this is baby number seven ; two of her babies were stillborn and one died as an infant; she has had a caesarean in the past, she has not had any antenatal care, she is anaemic, she has malaria, and she has been in labour at home for many hours and the baby is stuck.
Any one of those items of history would mark her out as high risk in any setting but to have them all at once – this is the sort of woman that comes in the door every day, a woman with not one but a handful of dangerous processes at work, a potential stillbirth or maternal death, an obstetric disaster hovering like a darkening thundercloud over another poor family. Fortunately they brought her here in time – the baby was still alive though jammed down awkwardly in the pelvis, serious infection had not set in, and the scar from the previous caesarean hadn’t quite ruptured. The operation was quite tricky because all the tissues were stretched and thin and fragile, her bladder was pulled up high and at risk of injury from the surgery itself, and there were lots of adhesions from the earlier operation which had been done by a vertical cut down from her belly button. It was a very different procedure from the one I did on the Fistula patient the other day, but it went well, and I was hugely relieved at the end.
What I would have liked to do as well as deliver the baby, was perform a sterilization procedure so she wouldn’t ever have to come back to the edge of the cliff. Maybe she would have wanted me to do it too – but as her husband wasn’t available to give me permission, her wishes were irrelevant. Community leaders have forbidden MSF doctors here to talk to women about contraception, apart from in the setting of an emergency caesarean, as in this womans case. They don’t want us to introduce the proven western concept that fertility control is a huge benefit to the health of women and babies and families – these are just women after all. I take it you all noticed the fistula patients record showed she was already married and living in her husbands home when she had first period. I was told that if these girls aren't already married at puberty, and have husbands who make them pregnant they just start having rampant sex with anyone. Oh really? And would it be men they would be having sex with?
God help us! What hope is there for women when community leaders have attitudes like that?