Dangerous childbirth

A woman in our neighborhood just died in childbirth of eclampsia (aka Toxemia of pregnancy)... they did a CSection but the baby died too. Sigh.

She was in her 30s and had high blood pressure, so was at high risk for this.

There was a delay in getting an ambulance and in sending her to the hospital in the next town due to the coronavirus blockades and discouragement of going outside.

Sigh. 

This is the third death from Toxemia/Eclampsia in the last ten years in our neighborhood: another one in an older ladies who had a history of high blood pressure ( with twins) and one a teenager pregnant out of wedlock who was too ashamed to see a physician or midwife for prenatal care. In both of those cases, however, the babies were saved.

Article on the problem LINK

more here about childbirth in the Philippines by a western midwife,  although things are improving since when that midwife wrote this in 2010.

one of the problems here in the Philippines is the lack of prenatal care for the poor: Many deliver with midwives or even with poorly trained "hilots", and many more just don't go for prenatal care because they don't realize why then need to get care. But even with prenatal care, this problem can appear suddenly or be missed.

When a person develops signs of pre eclampsia (swelling, headache, etc) the treatment is bedrest, anti seizure and anti high blood pressure medicine, and deliver the baby as soon as possible.

Here, this means going to the larger public hospital in the next town that has specialty services. If you can afford it, you can get a C Section in the local private hospital (but no ICU for the baby).

The next town is only 10 miles away, and the roads are paved, but still it may take 30 to 69 minutes for transfer, or more if you live in the rural areas. 

When one of our farmer's wives developed edema/tremors, it took 3 hours to arrange an ambulance and get it to her house, and another hour to transfer her to the hospital, and she too died on the operating table.

Dr. Angi said frustratedly: Why didn't you just put her in a car and send her to me (she is an OB/Gyn who does a lot of charity work at the private hospital here)? But of course, that assumes the mother wouldn't have gone into convulsions in the car, and the transfer would still have taken time no matter what.



Few American doctors have cared for a complicated case of eclampsia: We did see it in the IHS, but a prompt C section usually prevented the mom from going into the seizures that are often fatal.

Ironically, in Africa, the women did not develop the typical signs of edema/swollen legs and high blood pressure: I'm not sure why: Maybe due to the low salt diet in the area where I worked.

 They would come in without problems and then suddenly start having brisk reflexes, then tremor, and usually a prompt injection of medicine would stabilize them so they could deliver safely, but not always...So some would still go into a seizure. Sometimes too the seizures happened after the delivery (one third of cases).

The argument about a C section vs waiting a short time to let her deliver normally was a sub plot in Downton Abbey... Back then, in the days before antibiotics and blood transfusions, there was a high death rate from the surgery, and if it had been done, the mother might have died anyway.