Her baby didn’t make it. She had been in labour since Monday, and it was Thursday. We didn’t know how long ago her waters had broken, but we can only assume it had been at least a few days. She was an obstructed labour referral from a clinic far away from Hoima, an approximately four hour drive by motor vehicle.
“I’m tired,” she told me, as I gave her sips of her sweetened tea between contractions. My classmate and teacher tried to resuscitate the baby for over ten minutes, but unfortunately she never had a heart rate above 60 beats per minute, and even that slow beating eventually faded. “I’m sorry,” I told her as we handed her the baby, and she replied softly “No problem. She was tired too.”
Although we couldn’t save her baby from the likely infection and prolonged labour that had taken its life, we were able to give her a first dose of IV antibiotics to help prevent her from becoming ill as well. She received her first dose of IV Ampicillin but still needed two more medications before being taken to the postnatal ward where she was to receive regular doses for the next 24 hours. I finished up the paperwork and had another case to attend to.
When she was on her way out the door, I noticed she had forgotten her small bag of cotton and extra supplies, so I went outside to bring it to her. I assumed she was on her way to the postnatal ward, until upon returning to the labour ward I noticed her delivery chart was actually still there. When we put the pieces together that she was probably about to head home, I ran outside again and looked everywhere until I found her, IV lock in situ, standing at the pickup/drop off area of the hospital, about to hop on a Boda Boda to return to her village. I begged her to come back to receive the rest of her medication, and explained that she had an infection that could make her quite ill.
She told me that her transport wouldn’t wait, as they had to go bury her baby. I pleaded that she at least stay until we get her the rest of her meds, or at least explain to her more about her infection and what to look out for. I bargained with her for one hour - maximum - of her time, and she agreed. I brought her back to the maternity ward, where Cathy and I talked with her some more. We eventually called over the head nurse who helped us to ensure she understood the risks of infection, danger signs, and when to return to her local clinic for more antibiotics.
Sometimes we can only do so much to help our clients make informed choices, and sometimes that involves meeting them halfway in a “harm reduction” approach. Although this 18 year old mama lost her baby, she deserves to know that she has access to life-saving medications for herself, and respectful care even in a challenging situation.