Kuwentong Unang Yakap

Kuwentong Unang Yakap chronicles the first-hand experiences, inspiring testimonial and personal anecdotes of doctors, health professionals, patients and other healthcare providers narrating their “Unang Yakap” stories.  

by Dr. Donna Capili

Sept 13, 2010. It was almost half past one o'clock in the afternoon and my stomach grumbled its complaint. I just finished clinic and was set to see my in-patients, never mind my tummy. From a distance, I heard the siren.  I didn't think any of it.  I was on my way up to the patients' rooms on the second floor when the undeniable peal of the siren seemed very tangible...I retraced my steps downwards and saw that the ambulance was by the emergency room entrance.  What could it be now?

The ambulance driver was shouting that his patient, a pregnant woman, was about to deliver her baby.  He opened the back door and my eyes zeroed in on the crowning head. I yelled for sterile gloves, clamps and clean towels.  It seemed like magic that a pair of gloves appeared in my hand.  I told my resident doctor on duty (ROD) to put on his own pair of sterile gloves. Next thing I knew, I was doing perineal support -- my right thumb and index finger formed a C-shape, pressed inward and down – picturing Dra. Cynthia's demo in my head...I didn't do any of the massage nonsense.  It was quite quick.  Lucky me! I held out my hand to hold the baby's head down as he made his entry into the world. Baby out! I slipped him into the towel and put him on mom's tummy.  The ROD started to dry and stimulate the baby. The baby then let out a scandalous cry and I knew he was going to be alright. The baby was positioned further up on mom's chest. Meanwhile, I felt for her uterus and started to massage -- no complicated digging movements but just nice and simple circular motions. A voice quipped that ice was on its way, to which I quickly added, "No ice. Don't need it." (Dr. Howard Sobel would have been so proud.)

What was the next step? Number 3: cut the cord. It was a good 3-4 minutes when that was done. Uh-oh, I hope he doesn't get too jaundiced. Now, where was I? Hmm, exclude second baby… It didn't seem like there was anyone else in there.  I asked the mom if she was just expecting a singleton to which she replied “Yes.”  Ok, so no second baby. Confidently I ordered to give her oxytocin 10 via IM please.  (Thanks to our recent meetings, I appeared to know what I was doing)

I rolled the cord unto my clamp and applied traction and counter-traction steadily.  At first, it felt like I was going to tear the placenta out of there but it didn't!  I just needed to be patient. I examined the perineum and glad to see that there was no tear (vernacular: rat-rat)! I examined the placenta and its membranes and it was "clean", smooth. 

When I finally raised my head, I saw that the baby was latched and suckling away. Yipee! A smart boy for a change! Time: about 30 minutes post delivery. He stayed with his mother and avidly breastfed. I told mom that'll be the only way we feed her baby in this (my) hospital.

Oh, did I say, that all this happened at the back of the ambulance?

Mother and baby were brought down and into the hospital. The ROD was already instructing for IV fluids. He looked stupefied when I said, "No IV." and I added, "we'll talk about the CPG for uncomplicated vaginal births later."

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** Mother was actually en route to a provincial hospital after being asked to leave another LGU-run hospital, citing that the baby will be born preterm and they have no incubator. (certainly, they need to know about KMC).  Pediatric age was 36 weeks, birth weight 2450 grams. Both mother and baby are well and due home.**

Dr. Donna Capili completed her subspecialty training at the Hospital for Sick Children in Toronto, Canada.  She is a practicing Neonatologist in Bulacan and a Co-Convener of Team EINC.