For Health Workers Trained by PRIDE-Jhpiego: Saving a Pregnant Woman’s Life in Rural Pakistan
Nurse-Midwife Bibi Ara had just finished a training class in newborn care at the regional health center in Khurshidabad when a distressed husband rushed into the facility. His wife, pregnant with twins, was in labor at home. She had delivered a baby girl but the second twin was stuck; his wife was in bad shape. The doctor in charge told the woman’s husband to bring her to the health center immediately.
Ms. Ara, a member of PRIDE-Jhpiego’s public health team, prepared for the worst. Funded by the United States Agency for International Development, the PRIDE project works to strengthen essential and emergency obstetric care in two earthquake-affected districts in Pakistan.
When the 35-year-old mother arrived at the health center on that April afternoon last year, her labor contractions were strong and three minutes apart. But she was lapsing into shock. A woman doctor quickly examined the mother. The baby appeared to be lying sideways, making a normal delivery at this late stage nearly impossible in this rural health center. There was another complication: the umbilical cord had dropped down below the baby and was being compressed, reducing the flow of oxygenated blood to the twin. The baby was in distress, at risk of brain damage or worse.
Ms. Ara and the other health workers gave the mother antibiotics, fluids and oxygen to improve her worsening condition. They knew they could only do so much and the woman had to be taken to a hospital that could provide comprehensive obstetric care.
An ambulance was called. Ms. Ara joined the mother in the ambulance as it left for the hospital in Bagh. About an hour into the drive, the mother’s contractions intensified and Ms. Ara told the ambulance driver to stop at a nearby rural hospital in the town of Kahutta so the woman’s condition could be reassessed. The hospital, however, wasn’t equipped to perform a cesarean section.
Ms. Ara telephoned the Bagh hospital to consult with a gynecologist, but the doctor was on leave. She called several other people to ensure that a female gynecologist would meet them at the hospital. None could be found. The next closest hospital was at least four hours away. The situation was too grave to make that trip.
A woman physician at Kahutta, Dr. Sadia, checked the patient’s condition for any possible improvement. The baby had shifted into a breech position, but there was no heart beat. With the baby lost, the maternal and child health staff moved quickly to save the mother. The health workers managed to deliver the breech baby and the placenta. As the patient began to bleed profusely, Ms. Ara and the others promptly began massaging the uterus and gave her oxytocin—as they had learned in their PRIDE training. Within 15 minutes, the mother was stable and the bleeding had been controlled.
The patient was closely monitored for the next 24 hours. The staff called her family and asked them to bring to her the infant daughter the woman had delivered at home. As the new mother reunited with her baby girl, the family was pleased and thankful for the quality care she had received on that April day. In saving the mother’s life, Ms. Ara and her colleagues improved the newborn daughter’s chances of surviving beyond her first birthday.
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