-Letter from Dr. Wells -
Hospitalito's maternal child health program has been working with the local birth attendants to improve obstetric care in the community. During my month here doing obstetrics I've seen both the results of their work and areas where the work needs to go on.
A few weeks ago one of the "comadronas" brought in a patient in labor because the comadrona felt that the patient was not in a vertex presentation. The patient had not received prenatal care through the Hospitalito, but the comadrona had been trained to check position and bring in non-vertex patients. Ultrasound confirmed that the baby was in a breech position, and in fact had a very advanced case of hydrocephalus. The woman was having preterm contractions, but was not actually in labor. Unfortunately there is nothing that can be done for the baby, but we were able to help the woman and her family plan for this difficult birth.
Last week we took care of a patient who did not get transferred to us at an appropriate time. She had been laboring at home, pushing for 8 hours and had not urinated for 12 hours. Dra. Susanna (the Guatemalan staff physician) appropriately placed a foley catheter and ruptured
the membranes, diagnosing both urinary retention and meconium-stained amniotic fluid. She then promptly called me and together with the auxiliary nurse and medical student we made an attempt at resuscitating the baby inside the uterus. When it became clear that the baby was stressed and not improving with our interventions, I decided to do a cesarean section. Dr. Chuc came in and promptly put in a spinal anesthetic, the crew was also prompt and competent, and we were able to deliver a healthy though stressed baby that had the cord wrapped tightly around its neck twice. Susanna easily resuscitated the baby, and both are now home and healthy.
Steven Wells MD
