RUMGINAE - I was sleeping when the buzzer on the two-way radio from Mid-Ward jerked me awake. It was community health worker Lorna calling to say there was a mother in labour and she was carrying twins.
The mother had just walked in, so it was too late for the normal process of arranging a blood donor. All mums with twins need to have blood cross-matched as they have a higher incidence of post-partum haemorrhage (bleeding).
It's my policy to be present for the delivery of all women having twins so it was probably about 3am but I didn't look at the clock as I’m used to being woken at all manner of times.
Lorna sounded worried on the radio but I assured her that as long as the first twin was cephalic and the membranes were intact, this was not going to turn into a serious situation. It was safe to allow labour to continue.
Then I went back to sleep.
At nine in the morning, I was buzzed that the mum had been pushing for 20 minutes with no progress of the baby through the birth canal.
After a quick shower and having advised Sr Tina Swokin to rupture the membranes I made my way to the ward.
When I arrived the contractions were not strong and I allowed the woman to continue.
After an hour, I determined it was time to intervene. I augmented the labour with oxytocin to strengthen the contractions. Before the delivery I did an episiotomy, where the vaginal wall is cut to make it bigger.
About 30 minutes later the first twin, a male weighing 2.5kg, was born. The second twin was born after a few more minutes, also a boy and weighing 2.45kg.
After the delivery, I checked for tears to the vaginal walls and found one that had to be sutured. Having done that, I left to attend a staff in-service session.
An hour later, after the in-service, I came to check the mother. Sr Swokin said she had been about to buzz me because the mother was still bleeding.
I rechecked the vaginal canal and sutured again. She had lost at least a litre of blood and thankfully Sr Maggie Parila had done a haemoglobin check and cross-match.
As the mother was now stable I returned to my other duties.
At the end of the day a unit of whole blood was available, so the mother was transfused. It was a great effort by the staff members to find the blood so quickly.
In the evening I was in my office compiling my HIV drug inventory with community health worker Mubbie.
After completing it at 8pm, I made my way to the MAF shed next to the airstrip to get some internet coverage to email my HIV report.
At 9pm community health worker Ori buzzed me to say the mother was bleeding. Community health worker student Kivence arrived at the shed and we went to the maternity ward.
When I assessed the situation, I was certain the mother would require another blood transfusion so, while checking the vaginal canal for the cause of the bleeding,I asked Kivence to find the on-call pathology officer to do a cross-match.
It was now 10pm and I knew it would be a frantic search for a blood donor at such an odd time.
Kivence walked to the two pathology laboratory officers’ residence on the station to locate the one on call. He came with Mr Dusi.
By this stage total blood loss was approaching 2.5 litres and I wanted two bags of Group O. I desperately asked Kivence to check if the students sleeping in the men's dorm could donate a bag. Kivence found one student, Nason, who was Group O and he agreed to donate.
It being after lights out, Nason also helped community health worker student Florence hold a torch while I conducted an examination.
The patient’s mother, a village woman, was present and requested that the mother be left alone and given tablets:- she thought the bleeding would settle.
But I was adamant that this mother needed medical intervention because maternal mortality in Papua New Guinea is the highest in the world second only to Afghanistan.
Women usually die due to haemorrhage or sepsis associated with child birth. Alarm bells were ringing in my head.
I asked community health worker Epami to ask the patient’s mother to check relatives on the station for a compatible blood donor. By now it was midnight. Thankfully a donor was found at this ungodly hour.
But there were still hurdles to jump. Dusi didn't have his key to the lab which meant Nason had to use my keys to open the pharmacy, scale a high wall and climb into the lab to open it.
All was done in record time.
By this stage I had diagnosed the cause of bleeding as lack of thrombin (needed for blood to clot). The patient had bled so much she didn't have any clotting factors.
Dusi came with Nason's blood which I transfused, followed by transfusion of the relative’s blood. It was 1am.
When I heard the blood was ready I raised my arms in victory and shouted "Yes!".
We transfused the blood and continued the antibiotics. The bleeding had subsided and I planned to review her later in the morning.
At the review, there was no more bleeding.
I was still in shock from having walked a precipice. I had never been so close to losing a woman after delivery.
I have known women in remote aid posts who have died during child birth but this was the first time I had come so close to a woman dying in front of me.
Pregnant women in remote Papua New Guinea should not have to fear death during labour. Pregnancy should not be a death sentence.
As I write this I am so glad to have been supported by the community health worker staff and students and lab and nursing officers.
The twins are absolutely gorgeous and doing well and mum is out of death’s clutches but still being closely monitored
She will survive.