Stuck

I'm calmly chatting with Doug in the air-conditioned OR in Bere. We are just finishing up a routine hernia operation. The external oblique is closed and we are preparing to close the skin. Before starting the surgery, I'd passed by the charge nurses, Augustin, deep in conversation with the midwife, Hortence. I briefly caught the words "breech presentation". I almost stopped to ask what was going on, but ignoring that still small voice I continued on to surgery rationalizing to myself that it must just be a prenatal visit or something or they'd come and tell me for sure.

So Doug and I take our time on the iguinal hernia repair which I do with mosquito net mesh as usual. Suddenly, Hortence's head pops into the OR through the swinging doors.

"There's a woman...the legs and body're out...the head's stuck...been that way for awhile...we can't..."

"I'm coming! Doug, close up the skin." I cry as I strip off my surgical gown and bloody gloves and race out through two sets of swinging doors, a screen door, around the corner, under the veranda, through another screen door and right into the tiny delivery room where I see a floppy set of legs and arms with no head plopped on the delivery table between a woman's bloody spread legs. The room is packed with Augustin, Hortence, a mid-wife student, another nurse, Dr. Jacques, a family member and now myself.

I start to shout out orders.

"Augustin, get me the symphysiotomy kit!"

"Hortence, bring me some gloves."

"Prudence, I need a syringe and some lidocaine."

"Jacques, a 20 blade scalpel."

As everyone goes off running I slip my hand in and with a few futile tugs confirm that the baby's head, extended on it's neck, is stuck.

Everyone back in a matter of seconds. I slip on the gloves, draw up the lidocaine, open the instruments, inject quickly over the pubis, put the scalpel on the scalpel handle and speak directly to the woman.

"Don't move whatever you do if you want this to work! Augustin, Jacques, grab her legs and pull them up and out!"

I slice through the skin and cartilage and feel the pelvis pop open. The baby slithers out. I clamp and cut the cord. I whisk him off to the exam table. He has no heartbeat, tone, movement, cry, respiration, color, nothing. I try and clear out the gunk in his mouth and nose and do chest compressions for a couple minutes before silently covering him with a rag.

I turn my attentions to the mother. I start to examine the position of the placenta and notice two things at once.

First of all, her belly's still really big. Secondly, there's a bulging bag of water in her vagina. Twins!

I break the back of water and out pop's a full head of hair. Within seconds the second twin is delivered, pulling up his arms and legs, grimacing and screaming his little lungs out. He's alive!