Bruised and battered: Obstetrics in Nigeria

Pippa is an obstetrics and gynaecology consultant from the UK on assignment with Médecins Sans Frontières / Doctors Without Borders (MSF) in Jahun, part of northern Nigeria’s Jigawa state – an area where high numbers of women and children die during childbirth.

Sometimes obstetrics is bruising. By the end of your day, your body feels stiff, like you have done a tough session with a trainer.

It’s odd really because the outside perception is that obstetrics is a medical speciality full of joy and pink and fluffy stuff and newborn babies. But, today, I feel bruised. 

It may have been the baby I delivered with its head deeply impacted in the mother’s pelvis, the six hours solid operating with the table at the wrong height (my bad for forgetting to ask).

A compound presentation, in this case, means the hand is coming before the head, a sort of Superman approach to arriving in the world.

Or, it may have been the vacuum delivery on a dead baby, the CPR on the mother who died of end-stage heart failure whilst we were delivering her baby, the horrendous shoulder dystocia (when the baby’s shoulder is caught on the mother’s pubic bone, obstructing delivery) from the dead baby’s limp body and lack of contractions as the mother had arrested.

So, today I feel bruised and a dark stone sits in my chest because obstetrics here can be like that. 

A compound presentation

Then the next day, I walk into the unit, see a lady prepped for theatre, and the team on shift tell me: “compound presentation, needs a caesarean”.

A compound presentation, in this case, means the hand is coming before the head, a sort of Superman approach to arriving in the world. It is normally non-deliverable vaginally.

They must feel like aliens have landed and taken them away. 

The lady has consented to the operation, is in theatre clothes and a theatre hat, has had her pre-operation medication and has been waiting for a good few hours this morning.

I ask if anyone has tried to “reduce the hand” and I get blank looks back. 

So, I examine her, push the baby’s head up a bit and gently push the arm behind the baby’s head again.

I tell the team I’ll be back to review, we finish the ward round and I’m back… She’s delivered vaginally already, no bleeding, no complications, the baby is fine, I check the baby, the arm is perfect, no bruising.

The lady is happy, super happy in fact, which is nice. She thanks me, and I briefly think about the story she will have to tell when she goes back to the village.

Will that be a thing?

"What must it be like for the women?"

I often think of that; what must it feel like for these women from villages, who have lived in mud huts all their lives. No electricity, no real belongings, hand-to-mouth subsistence farmers... What must it be like for them to come to hospital?

These hospitals that are big structures with staff in uniform, circles that emit light, water that comes out of pipes. Then, if they come into theatre, an unnatural coldness, with teams in green masks, funny shower-type caps, eye-protecting goggles, plastic shoes and machines that go ping.

They must feel like aliens have landed and taken them away.