Wednesday, January 13, 2010

A new indication for induction of labour

It was always my dream to be a rural family doctor. That was until I came up against the reality of rural family practice. My epiphany came during a six month trial period joining a practice in rural BC. For various reasons it didn't work out, I decided to go into anaesthesiology and moved away to do locums.

The last night I was in town around 6 in the evening, I got a call from the hospital saying there was going to be an emergency Caesarian Section and could I come in an assist. When you have a C/S in a small town you need 4 doctors: the surgeon, the surgical assist, the anaesthesiologist and the baby doctor. This places a strain on a community with only 8 doctors.

The C/S was due to a prolapsed cord. I arrived to find my soon to be former partner, with his hand up the vagina. We crashed into an emergency C/S on the hospital bed, the baby came out in reasonably good shape and closed up. The baby was transferred to the regional referral centre as a precaution. Oh yes, the baby had a transverse lie, head obviously not engaged.

Coming out of the room, I decided to read the chart to find out exactly what had gone wrong. As it turns out, the mother who had had no prenatal care presented to my partner at around 40 weeks. He decided to induce labout. No ultrasound to check dates (at that time not available in that town). Of course when he ruptured the membranes after his office, the head was not engaged and the cord prolapsed.

I left town the next morning. I did keep in touch with one of the docs in town who told me a couple of weeks later that when asked why he had tried to induce labour and rupture the membranes, my now former partner explained that the lady's husband was going to be going to jail the following Monday so he indued labour so he would be able to see his baby in his last days of freedom!

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