Tragedy

Woman presents in labour. Ominous past history: five pregnancies with two micarriages, one stillbirth and one live baby. But all seems well.

Baby's heart recorded at 9am as 150 beats a minute, normal for a fetus. Mother progressed slowly but steadily.

At 1340, the nursing notes say that the baby's heart rate was 122, still normal; and on vaginal exam they say the mother had reached 6cm, but they thought they felt placenta, so they sent for the clinical officer.

I showed up by chance. Nobody had called for the doc yet as the iCO was still examining the patient. He looked up with that nervous African smile that it takes people forever to understand does not mean happy, and said two of the most dreaded words in obstetrics: "Cord prolapse." I turned and ran for the doctor, who grabbed her dopplex and came.

Cord prolapse is when the baby's blood and oxygen supply, the umbilical cord, slips ahead of the baby's head into the mother's pelvis. When mum has a contraction, the force of the baby's head compresses the cord, cutting off baby's oxygen. You have very little time, minutes to get a baby out in that situation. It's hairy in the best of hospitals.

She handed me the dopplex, and ran to grab her ultrasound, ordering everyone to get ready for an emergency cesarean. I searched frantically for a heartbeat. I could hear placenta. I could hear mum's vessels.

But nothing. Nothing.

The doctor returned with the ultrasound and quickly visualised the heart. We were too late.

The intern clinical officer explained to the mother in Chichewa that her baby had died. She began to cry. The commotion around her stopped.

In Malawi, to respect the family's grief, only the immediate family are allowed to cry when someone dies. Imagine holding the hand of a woman who has just had her baby die, watching her cry and offering her words of sympathy while keeping dry eyes. Because to do otherwise would be to take something away from her.

And there was more pain to come. She still had to deliver the dead baby.

But there was no urgency now. We let her rest. The nurses didn't comfort her, and I had little to offer in her language.

A beautiful baby girl.