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

Monday, February 4, 2008

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.


DeJoker said...

Crede manoeuvre is controversial, yes; but am afraid it's not so simple. It is often a judgment call and individual circumstances will dictate its application.

As for vacuum extraction or forceps delivery (assisted vaginal birth), this cannot be compared with fundal pressure- brutal as suction may sound, again circumstances will dictate the line of intervention, and once again MMW needs to state the points where it is objectively stating facts and where it is speculating and where is is reporting. Three are different.

DeJoker said...

DeJoker said...

Personally myself, i wouldn't recommend Fundal either..

Anonymous said...

I find it disturbing that even in developed countries some people try to make sure tooo hard that natural births takes place. It is obvious that this is a case for a C.

And MMW what do u mean by "potentially " traumatic? As if you are not sure whether it will be traumatic.

mmw said...

dejoker, you 3rd comment is not just your opinion. please googleand you'll find several US and European medicolegal cases where obstetricians havebeen found guilty for having used this maneuver. please don't confuse this withthe suprapubic pressure application recommended for shoulder dystocia. and also, our source within the LR confirm that this a routine practice

we said potentially traumatic because there are cases where, possibly by sheer luck, mothers and babies have escaped with no injuries. this procedure is so common at IGMH that we are greatly concerned that continued practice would lead to further misadventures. we believe the practice should be stopped.

Maldiveshealth said...

So stop it . As simple as that.

Maldiveshealth said...

So are the parents going to do anything about it?

DeJoker said...

Thanku MMW, but am aware what 'Fundal pressure' is.
And as I've said this is a controversial method, which some Obstetricians everywhere continue to practise; but i think it's best avoided especially considering the effects it has on the mother & nurses psychologically, if not in any other way..

Am also against it.

DR.FA said...

its sad but true. no point in talking about this. IGMH will practice what ever the management is happy with. Dr.Aseel is here to save us from any problems. ): our loved Sir was in the labor room during this procedure.. so go to hell .. he is better then anyone..

pachas said...

Dept of Obs & Gynae is the worst dept in IGMH by far I know. With docs who are not even O&G specialists are given a free hand there since central hospital time. One of the main reasons is the influence by Dr Naila Firdhous (Senior Consultant O&G, Founder member SHE, best friend of First Lady, wife of Dr Firdhous who is president’s doc).

Though she may be sitting somewhere in her AC room near Reproductive Health Centre/IGMH, she coordinates everything in O&G dept. She is an out-dated self centered old timer, still orchestrating all other specialists. No Head for O&G can be instituted without her consent. In short she keeps her puppet as the head there.

I can still remember in the earlier days of Dr Solih as the Acting DG; when Dr Cherian (Senior Consultant O&G/HoD) was questioned about his new plans for the development of the dept upon renewal of his 10 yr long contract, Dr Solih had a hard time explaining himself to VVIP phone calls!

Anonymous said...

here we go again...Drnaila-best frnd of first lady-wife of president-husband of firdous yada yada..ergo...

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A life of maldiivan mothers and babyis are less important than the job of Dr. Naila and her ego. At every point and everywhere in public services if you come accross the relative or frind of president than you can say by by to improvements you want to make. President and his cronies are what is standing between our poeple and civilization.

air head said...

well LSCS at IGMH is no different either... they give fundal pressure most of the time when they do LSCS and i have expereienced it myself and seen it done on a lot of cases... specially when the beloved "SIR" gives too small an inscision and the baby cannot be pulled out... after pulling pulling on the baby's head and giving fundal pressure for a thousand times, he makes the inscision a lil' bit bigger... oooh.. but they all love "SIR".. so can't do anything...

Sometimes they are soo hard headed u know.. sometimes they will take up an LSCS just for no reason and other times when the life of the mother and the baby hangs by a thread, even than they will wait for the baby to go into fetal distress before they do anything or wait till SIR says GO...

OBS GYN dept at IGMH sucks... as long as those who sit in the AC rooms stays there nothing will improve... So if u can take ur wife abroad to have a safer delivery u'll be glad u did it... cause when u go to IGMH for ur delivery u are taking one big risk...

suhaana said...

miee nuvaakamekey bunaane evves jaaa eh nei. hama vee gothah liyea thi othee.
mihaaru hospitalun mikan balaniyyoves eba kiyaa. mashah heevanee anekkaaves meeting bavvaafa emmen ekachcheh kiyaa meegen bodhamaigannaane gotheh raavaane hen. e'ee hama aadha viyya.
mikahala kanthah higaathaa ethah zamaaneh vejje. bounnah engigen higanee. kuda kudinge doctarunnah ves engigen hinganee. mifaharu mi mmw ge sababun habaru hiluvaaleema mi maaka vareh aruvaalaigen e ulhenee.
ey mmw, engeytha ekujjaa fulhu niyaa vejjeyey. valhuves laifi. ekhabareh nulibeytha? emmennah ekan anga bala.

shizu said...

Update: Child passed away on 4th feb afternoon.

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Dhen fennaanee e kujjaage bappa valhi eh koohthaalithan. Microscope in kanneyge balanjeheynee kihaa rojje kan kedunee.ciao

Anonymous said...

leave outdated doctors like cherian and Dr neena out of practice pls. Dr cherian will not hardly see the patient face during check up..and Dr neena is like a running lightining.. in hurry burry...

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