Starved Baby Boy

Can I just tell you another ridiculously shameful story of crap that happens in the Philippines that I have the joy of witnessing? It would be oh so easy to assign 100% of the blame on the poor excuse of a city hospital here but in this case the mother herself left me bewildered.

Last week we had to transport a patient to the hospital because she was in early labor and the heart beat of her baby decelerated to a dangerous level. This patient was 38 weeks pregnant with a fundal height (belly measurement) that reached 30 centimeters at its largest. At the time of admission her fundal height was 28 cm. This is incredibly small.

During the first half of her pregnancy her belly was growing as expected but since about 20 weeks or so, the growth of the baby really started to lag and never caught up. All through her chart there is evidence that our staff advised her to eat well and take her vitamins. Numerous midwives explained to her the importance of good nutrition in pregnancy and the risk to the baby if it doesn't get the nutrition it needs and doesn't grow well. She claimed she didn't have money for food, yet there was evidence that she actually did have more choices available to her.

In fact, she was spending her money on white bread and fortified, powdered chocolate milk drink, which has a lot more sugar than protein. We know for one that the milk powder is a lot more expensive than fresh vegetables and eggs, for example. And since she apparently had no problem paying for meds we prescribed for an infection she had and the lab work we required, several of us agreed that something just wasn't right about her story.

We have numerous women in our clinic who have very little money and who truly struggle to eat well and pay for needed labs and meds but this woman didn't fit the usual profile. Most of these patients still find a way to eat at least three meals a day. It may not be the ideal diet but at least it's not one that induces the level of malnutrition seen in this woman and her baby. In addition, our women who are truly impoverished do not have a husband with a decent, stable job like this woman does. And this was her first baby so it's not like she had many other mouths to feed. Each midwife attempted to get to the root of the problem but she maintained that it was a financial problem that kept her from eating.

So that brings us to this point, where we were last week with this patient in early labor and her baby giving us some very nonreassuring signs of its well-being. Unfortunately she was only 2 cm dilated so there wasn't much we could to facilitate delivery. We hooked her to IV. We filled a bag of medical supplies and gave it to her husband to hand over at the hospital to alleviate some of the cost just like we do for all of our patients who get transported. I called the OB resident and told her we were coming. We took her to the city hospital. After waiting over 30 minutes for a doctor to see our patient, the OB finally determined she needed an emergency C-section.

They informed me that the provincial hospital (the only other public hospital in the city) is closed for two weeks for fumigation just like it does every year and that because of this our patient was 5th in line for C-Section.

24 hours later... Yes, 24 hours later our patient had her C-section. Although I haven't confirmed this, we heard that the woman just ahead of our patient, in line for C-section because of dangerously high blood pressure (preeclampsia), went into eclamptic shock and died - waiting for C-S.

As for our patient, she delivered a three and a half pound baby boy. He required resuscitation at birth. Once he was stable they did a gestational age exam and determined that he was indeed 38 weeks (full-term) and therefore was confirmed to have suffered from intrauterine growth restriction (IUGR), which is in most cases a result of extremely poor nutrition. It was exactly as we had suspected. That in and of itself is more than enough for a little baby to be up against.

Unfortunately though, in addition to this the baby clearly experienced hypoxia due to the decelerations of his heart beat and was likely in metabolic acidosis at birth. (Acidosis is what happens when there is deprivation of positively-charged oxygen molecules in the tissues and organs, and there is a subsequent build up in hydrogen ions, which have a negative or acidic charge. Organ and tissue damage is certain when prolonged.)

God knows what additional damage has been done just by leaving him in so long. His heart rate was dipping down to 80 beats per minute when we took them to hospital, which is always an emergency situation. A normal fetal heart rate is 120-160. Since then (a week ago) the baby has stayed in the ICU (which is really just a small room adjacent to the pedia ward with 3-4 babies to a bed, no incubators, and only 1 oxygen tank) and has been receiving meds for metabolic acidosis. We learned yesterday that he coded again and had to be resuscitated again. So far, he's still alive.

According to the obstetrician that works closely with our clinic and who saw our patient in the hospital, the patient admitted she didn't eat because she didn't want a big baby. I can't say for sure that this truly was the reason why she decided to starve her baby but the thought of it is heart-breaking. Awful. Awful. Awful.