Mother and baby in critical condition following "assisted delivery" at IGMH

Following a special "assisted delivery" at IGMH labour room in the early hours of sunday (3rd Feb 08) morning a mother and her baby are in a critical condition at IGMH. The mother, reported to us as a 35 year old first time mother who was past the due date for delivery, was admitted to IGMH for induction of labour.

We are able to confirm that both mother and baby are in intensive care following the use of a technique of delivery that is banned in modern obstetric practice. Apparently the maneuver is commonly employed at IGMH labour room by senior obstetricians, to bring about delivery of the babies where mothers have poor effort in pushing the baby out by herself. What is surprising is that a good number of nurses are also taught to use the technique at the labour room by the senior obstetricians. The maneuver includes applying excessive force on the upper part of the abdominal wall, over the fundus of the uterus, thus virtually squeezing the uterus between the mothers spine and the hands (and sometimes the arm and elbow) of the person applying the maneuver. This is apparently called "fundal pressure" a maneuver that is known to cause uterine injury, fetal cervical injuries, fetal cerebral hemorrhages, and significant other birth injuries such as Erb's palsy, fractured clavicle and major trauma to internal organs of both mother and baby.

In this case, a vacum machine was used to pull the baby out of the birth canal by attaching a suction cup to the baby's head and pulling on a cord attached to the cup. This is also a potentially harmful procedure, but one that is an accepted obstetric maneuver to effect delivery when the labour is prolonged and baby's condition deteriorating. In addition to the vacum application, nursing staff and obstetric doctors alternated in exhausting their stamina and strength in giving fundal pressure. The mother was subjected to this physical torture when the case could, and probably should, have been taken for a cesarean section delivery.

As would be expected from this extremely dangerous and traumatic process, the baby was born in a terrible condition. Even the senior pediatric doctor who was at the site could not revive the baby to a normal state. After a long attempt the almost dead baby was transfered to the new Newborn ICU for life support. The baby was in a critical condition when we got our last update; having found to have severe cerebral edema, intracranial bleed, seizures, pneumothorax and just barely hanging onto life. We were told that the baby could pass away any minute and that there wasn't much the doctors could do to avert such an end.

To add insult to injury, the family had to endure a grave turn of events for the mother as well. Apparently due to the excessive force used by the obstetrician and nursing staff in applying fundal pressure, the mother sustained injuries to her uterus and internal blood vesels. She had bleeding into her abdominal cavity and had to be taken up for emergency surgery to patch-up the injuries sustained in the traumatic birthing process. She remains in a critical condition in the adult ICU at IGMH, also fighting for her life.

The family is outraged at the horrific treatment they have recieved at the hospital with some members of the family unable to comprehend the gravity of the situation.

MMW understand that this "fundal pressure" maneuver has been a routine practice at IGMH since the department was taken over by the current head of department Dr Rabo Chako. We have also been told that a huge argument had broken up between the pediatric doctors and the obstetric doctors over the way this case was handled. We recieved reports that some angry pediatric doctors have demanded to have the case revieved, the "fundal pressure"  maneuver banned and some accountability established for these cases.

MMW learnt today that some of the nurses who were at the delivery were so traumatised themselves at the sight of a grown person virtually jumping up and down on the mothers pregnant abdomen that they left the delivery room in  protest.

These kinds of inhumane, unethical and potentially traumatic practices must be stopped and internationally acceptable practices established at IGMH. We call on the Maldives Medical Council, IGMH, MoH and other concerned authorities to investigate this case and bring those responsible to account. Dr Solih must take steps to get his house in order or leave the job to someone who can manage to acieve that.