Wednesday, June 17, 2009

Complications during VBAC and a terrible tragedy

The Mad Momma has posted Rashmi and Vivek's horrifying story of the birth and death of their second child. Attempting a vaginal birth after caeserean (VBAC), the delivery ran into complications resulting in the baby's death. It is an excruciatingly painful story, their grief amplified by what they say was the hospital's negligence and uncaring attitude.
I felt no urge whatsoever to push, yet was asked to do so. The stirrup on the delivery table kept breaking off – I was told that this is a recurring problem that “needed attention”. At 1.50 pm, the fetal heart rate dropped to 80 beats per minute. Dr. Prabha was called again. She checked the fetal heart rate on the CTG, explained that this was normal when the baby was passing through the birth canal, and asked me to hold my breath and push hard. I felt no sensation in my cervical area, but felt intense pain tearing my stomach apart. I felt like my baby had rolled into my stomach and could see its body pushing up against my ribcage. I was screaming, pointing at my stomach, and telling them that my stomach was hurting, and there was no urge to push. But she told me to “push, push harder”. I then heard Dr. Prabha saying “Get the OT ready”. She told my husband that she was going to attempt to deliver by forceps – if that was unsuccessful, she’d have to do a Caesarian.

The OT wasn’t on standby, wasn’t ready. I was numb with pain. They wanted me to get up and move to the operation table. I couldn’t move. They eventually slid something under my back and I pushed myself on to the OT table, as there was no transfer stretcher available. I complained of severe shoulder and chest pain. No one paid me any attention; everyone was busy preparing the OT, and the anesthetist was attempting to top up my epidural. The fetal heart rate was never monitored in the OT. Dr. Prabha unsuccessfully attempted a forceps delivery at 2.20 p.m., and then cut me open. I heard a deafening sucking sound, after which I must have passed out.

Later, I learnt that my uterus had ruptured along the scar of my previous Caeserian section. My baby was found floating in my abdomen. He had no heartbeat and he wasn’t breathing. He had been deprived of oxygen for a long time – 43 minutes. They “resuscitated” my son and put him on a ventilator.

When I opened my eyes I saw Dr. Latha leave, followed by Dr. Prabha. Dr. Shirley was suturing me while laughing and talking with another nurse. I felt reassured that my baby was okay, even though I had neither seen nor heard him.
After months of working with the hospital to find out exactly what when wrong, Rashmi and Vivek were met with stonewalling and assertions by the attending doctor that she would do the same thing over again in a similar case in the future. And that is exactly what Rashmi says she is looking to prevent.

Please do click the link above and read the entire post.

Wockhardt Bangalore, the hospital where Rashmi attempted to have her baby, is responding in the comments section to The Mad Momma's post. Girl on the Bridge linked to the post on her blog:
As someone who will be (hopefully) a mother soon, this story is my worst nightmare. Of course, my situation is not the same. This is my first child. What annoys me most is the hospital’s claim (Wockhardt has a long rebuttal in MM’s comments) that Rashmi chose Dr. Latha because she wanted a VBAC. This is conjecture and probably not useful to any lawyer fighting on facts but I know, I just KNOW that no matter how certain a woman is about how she wants her birth to be, no matter how much she is set on a certain type of experience she would not, would not put her child at risk.
I have said many times before on this blog that we need to be involved in the medical procedures that we go through, we need to ask questions, read on our own about the conditions and the procedures. Rashmi's story does not take away from any of that. If anything, it emphasizes the need to not only be aware of what's being done to us but also the need to be careful in choosing medical institutions and doctors.

Many times, in emergencies especially, we don't have a choice regarding what hospital we end up in or which doctor attends to us, but for the times we do, I wish there were some service that would rate the doctors on their competency and bedside manner and success in their field. I'm not saying that the tragedy that befell Rashmi and her family will never ever happen again, but it will arm people with the kind of information that I didn't have when I was getting ready to have my baby in Bangalore, the kind of information that parents-to-be come searching for to my blog (and I'm sure many others) on the backs of a google search.

I deeply admire Rashmi for what she is doing. She has lived through an experience so devastating that we would not wish it on our worst enemies and she is using her story to educate mothers-to-be. A story that, I'm sure, calls up her pain every time she recounts it, that reopens wounds that would heal faster if only they were allowed to stay closed. I do hope that her efforts result in a better experience with hospitals for anyone considering having a baby.

P.S. Thanks, Aaman, for alerting me to this story.


sujata sengupta said...

At a total loss of words. How is this thing even happening and I always assumed Wockhardt was a very reputed hospital. I think some doctors just don't remember their oaths anymore.

Kavi said...

I am just numb on reading this. Completely numb. And the words escape a shiver on the spine to take shape on the keyboard.

I hope there is healing. All round healing. Soon.

Eleonora Baldwin said...

I am speechless. How can this still happen in this day and age?

A few months ago a very dear friend lost her 32 year-old niece to childbirth in a public hospital here in Rome. The infant survived and is now in the care of the father and my friend, both Sri Lankan, waiting for citizenship and with low-paying jobs.

Stories like these are shocking and spike our lack of trust in worldwide health care providers. I don't like to generalise, and bad things happen everywhere, but this is unacceptable.

Gymnast said...

Very unfortunate indeed.
I admire the Rashmi's courage in sharing her story so that other mothers to be may gain from it.

Sylvia K said...

A truly heartbreaking account of a medical nightmare that all too many of us are all too familiar with. I do admire her desire to alert others. I have had some difficult experiences with the medical profession myself and do so relate. Thank you, Sujatha, for sharing this sad story, to help inform others.

Sands said...

Came across this on the MM's site as well. It is truly a sad case. What baffles me is that I know of so many cases where a VBAC has been successful. All I can think of in this case is sheer carelessness. Hopefully folks in India will find awareness through Rashmi's efforts and make well informed choices.

Anonymous said...

I feel very sorry for the family, but most doctors I know oppose VBACs. Well reputed hospitals in the bay area don't even do them..


Suj said...

I actually know Rashmi through another friend, and was shocked when I heard about this. The response posted by Wockhardt makes it even worse, it is a blatant cover-up on their part, without admitting to mistakes made, and twisting the facts around. For example, the fact that Rashmi chose Dr. Latha because she does VBACs. Rashmi had no idea what a VBAC was until Dr.Latha told her, and she only changed doctors in her 35th week, because until then she was in Jammu, with her husband who was posted there with the Indian Air force.
I feel terrible about this tragedy, and thank everyone who is doing such a great job of spreading the word. Hopefully, the hospital will take measures to make sure this doesn't happen again to another family.

Brian Miller said...

sad story...have little words other than i am glad she has the strength and heart to use her story for good.

thanks for stopping back by and clearing up my faux pau. so sorry. smiles.

Gauri said...

This is so heartbreaking. I came across your post last night and then hopped on over to MM's and this has been playing on my mind ever since.

I sincerely hope that some good comes out of this. The huge loophole that doctors and hospitals exploit (especially the private hospitals) is the fact that there is absolutely no accountability.

I hope Rashmi finds a closure to this. My heart goes out to her.

Choxbox said...

I had to force myself to read through it when I first saw the mail. Can't imagine Rashmi's state of mind.

Saying that I hope she finds peace seems so inadequate.

Anuradha Shankar said...

God!!! how horrible.... my heart goes out to them! i am going on to read the whole story.. i can imagine something like that happening at some small unknown clinic... but at Wockhardt!!! absolutely terrible! thanks for alerting me to this story.

Sunil said...

Heartbreaking. Thanks for sharing this story on your blog.

Doctors in India are careless because healthcare is in such short supply. Of course, the industry is also not immune to the corruption that is prevalent everywhere. Chaltha Hai...

Rosaria Williams said...

This was scary, left me wordless. Thanks for sharing this story.

Sujatha said...

What a terrible, terrible experience! It's evident that too many of the staff and doctors have become too jaded to the consequences of botched care. Offering mealy-mouthed platitudes like 'do japa, tapa and pranayama' show that the doctor would be better off retiring to the Himalayas, rather than dealing with high-risk pregnancies and deliveries.
The Wockhardt hospital has just had a SmartMoney (Wall Street Journal group) article praising it to the heavens for excellent care and facilities, especially for 'medical tourists'. Hence the vehement defense by the hospital authorities on MM's blog.

sumanbolar said...

The hospital's defense has been posted in several places. In return, I have asked them to answer several questions publicly, which they have failed to do. I'd encourage you to ask these questions anywhere you encounter their response:

1. Why is Dr. Latha’s notation in the OPD record regarding Dr. Prabha as her “co-consultant” made only on the 28th of Feb., AFTER Rashmi’s predicted due date? Would that be a good time for a patient who is past her due date to switch her obstetrician, or even make enquiries about the qualifications and credentials of the co-consultant?

2. Since Dr. Latha is such an experienced VBAC practitioner who follows ROCG and other foreign-body guidelines, please publish the guidelines she followed, and match Rashmi’s records against them.

3. Rashmi’s key question: “If I have paid for doctors who were fellows and members of the Royal College of Obstetricians, why was the registrar attempting to deliver me?”

4. Another key question from Rashmi: “Why did an experienced doctor like Dr. Prabha not recognize signs of uterine rupture? I was yelling with pain in the labour ward and kept pointing at my stomach and telling her that there was a ripping pain in my stomach. I complained of shoulder pain and chest pain in the OT she still did not recognize the rupture. She admitted that she knew of the rupture only when she opened me? Why?”

5. Registrar Dr. Shirley had announced that Rashmi would deliver by 1.30 p.m. What was Dr. Prabha doing in OPD at that time? Uterine rupture does not happen suddenly but over a period of time… during which Rashmi was attended by a registrar who is NOT an ROCG-qualified doctor.

6. Why did it take 43 mins to conduct an emergency C-section? Baby fetal heart rate was down to 58 bpm at 1.50 p.m. and baby was extracted at 2.33 p.m.

7. Why was the fetal monitor not connected in the OT? Is this what VBAC guidelines specify?

8. If the baby had a heartbeat of 180 bmp, how is it possible for the outcome to be a baby without heartbeat and respiration at birth?

9. Would an internal review with your own gynecologists and external gynecologists who are close aides of Dr. Latha be unbiased? Why have you refused to conduct a transparent review that includes the inputs of Dr. Prakash Kini and Dr. Narayanan, two doctors widely recognized as Bangalore’s seniormost obstetricians, as requested by Rashmi?

10. Finally: Please have this case put up for review in the next conference of BSOG and FOGSI and have the proceedings covered by the press.

Debbie said...

This made me feel truly sick. I am so saddened for that family. I have had two VBACs - one even a home birth. I trusted my care givers to monitor me and the babies appropriately. My heart breaks for them.

Frankie Anon said...

This is such a painful tragedy that I cannot bring myself to read the full story at the moment. What's especially tragic is that Rashmi knew and reported what was happening in her own body, but no one would listen. Patients, especially women, are too often treated as ignorant objects who cannot possibly have any insight into their own condition. I hope this couple will have the strength to keep pursuing this hospital until the full truth is told. My prayers go out to them.

sujata sengupta said...

have not seen you around Sujatha. All well I hope. Take care

Anonymous said...
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Madhu Rao said...

This is sad. I hope Rashmi and her husband can dig in and find the courage to over come this pain.

This brings back memories of when me and my wife were at this very door step on both of our kids' births. I had to argue with our OBGYN for 45 minutes to do a scan as we had a nagging feeling in the 34th week visit. True to our fears right after the scan my wife was wheeled to the OR for an emergency C-section. Two years later it was a repeat of the same scenario -- another fight to do a scan as we felt the baby had descended too low which again led to an emergency wheeling from the scaning table to the operation table at 33 weeks. This in one of the best practices in the US of A...

It pains when the doctors treat you as just a time slot and not a human who is bequeathing a precious life. Most doctors are in a constant quest to fit in as many patients as they can in a day and are in a perpetual run from room to room -- one of the rooms being the OR..

Shame on you Wockhardt..