Case Studies

Anna gives birth in Dhaka

Image © : Anna

“It was my second pregnancy,” states Anna, an American residing in Bangladesh. “I had a normal delivery for my first baby. So I expected to be able to have a normal delivery in the second time too”

At 38 weeks of her pregnancy, Anna’s water broke. She went to the hospital where she had received antenatal care and planned to deliver. She was initially attended to by a doctor in the emergency room. The doctor told Anna that the baby’s stool (meconium) had been mixed with the amniotic fluid in which the baby floats inside the mothers’ womb, which could lead to serious complications.

 “When I came to know about the presence of meconium, I remember thinking that I was not sure what the standard course of action should be, or what specific risks it presented. I was also aware that the hospital I went to, had a very high rate of C-section deliveries. I was hoping for a normal delivery, but the doctor recommended that I should have a C-section. In response to my query about whether I could wait for labor to start, the doctor said I could do that, but that I would be responsible for any negative outcomes.” This manner of communication came across as unsupportive and in some ways threatening to Anna. She felt that the risks associated with having meconium mixed in the amniotic fluid were not adequately explained to her. She wanted to wait for labor to begin, but the doctors and nurses did not consider this a safe option. Ultimately Anna told the doctors that they could go ahead with a Caesarean Section and they praised her for the decision.

As a public health specialist Anna works on maternal health issues in Bangladesh. After being discharged from the hospital, she herself tried to know about the actions recommended for providers when there is meconium present in the amniotic fluid. She learned that the standard of care is usually to wait for labor to begin and monitor the baby’s heart rate. If necessary labor may be induced. Learning this, she now feels that the doctors rushed the decision to conduct a C-section. Her care should have been provided with greater patience and a more nuanced understanding of the risk involved.

Nonetheless, the baby was born healthy and Anna recovered quickly. Both mother and baby are happy and doing well.

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