Obstetrics in Nigeria: “They sure make Nigerian babies tough!”

In Jahun, North Nigeria, MSF / Doctors Without Borders obstetrician Jared is on call through the night. Today he blogs about an emergency call out and a determined little patient...

Another night call-out in Jahun. Another clumsy disentanglement from the mosquito net!

As I walk out to the compound gate, the watchmen and driver are ready for me. Here in Jahun, communication is mostly by radio. When they want the obstetrician after hours, the maternity ward radios the base watchmen: “Mike Hotel to Bravo, we need the O-B-G-Y-N.” The watchmen then come and wake us up. It is a good system as they can then have the car ready and gate poised to open.

 On the way, I often start wondering what I will find when I arrive. In Jahun you never know what type of case might walk through the maternity door.

It has been raining heavily, and we bounce along the puddled road for the few minutes’ drive to the hospital. On the way, I often start wondering what I will find when I arrive. In Jahun you never know what type of case might walk through the maternity door.

When I arrive I'm quickly ushered through to delivery by the midwives. They are dressed in red scrubs and like anywhere in the world, they are the bosses and the obstetrician must do as he is told! In delivery, I can see a woman who looks exhausted.

Image shows Jared & team performing an operation

Jared and the team at work. Photo: Jared Watts / MSF.

As I approach I greet her, “Sannu”. She glances towards me.

It is then I notice the bulge, or should I say, the baby's head. The poor woman has been labouring at home and the baby has become stuck with about half the head just outside the body. Her mother-in-law who has accompanied her informs us that this is her first baby and she has been like this, with the baby half-in, half-out, for the last eight hours. Very likely she was not able to travel to the hospital earlier due to the storms.

As you can imagine, this is not good for her or her baby, who has no foetal heart rate. The mother’s perineum and the area around her vagina is extremely swollen and appears to be breaking down. She also has a very large ulcer on the stretched perineum. The staff, very understandably and rightfully, are worried about her developing a fistula and ask me about doing a caesarean section. I reply that unfortunately I think the damage is already done and, as the head is mostly out, doing a caesarean would be extremely difficult. Pushing the head back in would likely cause even more serious problems for the mother.

 Yes, a pulse!

After my assessment, I make a careful lateral cut to release the band of tissue. With one more push, the mother manages to deliver her little girl. The baby is pale in colour, covered in thick meconium and has no movement or tone. Out of habit I grasp the umbilical cord. It is then I think I’ve felt something. I hold the cord for a few more seconds. Yes, a pulse!

“Get me a delivery set”, I yell.

It has all the clamps for the cord. The midwives are on it, and we quickly cut the cord and rush the baby to the resuscitation area. The monitor shows a slow heart rate of 50, and the baby is making no respiratory effort. After a quick rub, we start 'bagging and masking' the little baby. Within 30 seconds, the heart rate has risen to 70. Soon it is at 140 and we see some movement of the limbs. At three minutes, she gives a huge scream as if to say, “Get this mask off me!” We quickly wrap her up and send her off to the newborn ICU for further care.

Image shows a mother and child

A mother and her newborn a the MSF busy maternity unit. Photo:  Yann Libessart / MSF

The night is still busy, so I don't think of the baby and mother till morning and the end of the shift. I stop by the nursery after the morning round only to find the mother happily breastfeeding her little girl. All I can think is, “They sure make Nigerian babies tough!” I am still quite worried about the mother and make sure she has follow-up organised.

Prevention is definitely better than cure, and MSF continues to have outreach programs, to inform smaller centres without operating theatres and doctors when and how to refer patients. Other programs also exist to work with traditional birth attendants, teaching them when to recognise the need to get help.  Hopefully in the future women in the Jahun area will easily be able to access the level of health care they require and every mother and baby will have a happy outcome.