Only One Wee Foot

Women's Health Project

Penny here! Have encouraged John to send out his women's health mailings to our journal list, as many have said they were interested on his perspective also. Be alerted that this tends to lean more to the medical stuff, if you are squeamish! I told him after reading this that I could probably deliver a footling breech with these explicit instructions!

A couple of weeks ago I had opportunity to visit with a prospective full time missionary. As we talked, I shared that never, before coming here, do I "recall" seeing a miracle. I have overheard others verbalize the same. Does our lack of resources teach us to pray and see differently than we otherwise do? I suspect so. Do we understand a bit better than ever before the work of the LORD? I think so. Among my observations about such occurrences is that they do not occur when I am expecting them.

I went to bed that night having no reason to think that I would not get a good night's sleep. As I drifted off, the radio quickly brought me to alertness. Nelsy, the night nurse who is always gracious and patient, had a stressed rapidness in her speech. A mountain village midwife had brought in a patient who, after three days of labor, was ready to deliver. However, "only one wee foot came out". This we call a "single footling breech".

This is not a pretty picture. One foot out... the other foot probably up by the baby's ear. In the absence of a cesarean section the prognosis is grim. Most of the time we do not have anesthesia here and that was indeed the case that night.. The city is at VERY BEST an hour away. This is not the best time of the year to travel.

The trip down to the hospital is quick, a half mile. But I had time to pray for wisdom and grace. Prayer is something that has not come natural for me, but I rarely miss it as I go down the hill. I recall the text books of nearly three decades ago and the few of these cases that one ever sees.

By GOD's design the head (the biggest part) normally comes first, the rest comes easily. In our four plus years here, I have heard (among the village midwives) of only one live breech birth. The picture is so grim that one begins to ask questions. Does GOD not want babies who are born breech to live? Are those born such inherently evil people? (If my picture here is not clear, if you wonder what I am thinking about, the question is: ?Infanticide?)

The single foot complicates it. Get the other leg out, straight, without breaking or dislocating something. The distal half of your of your index finger behind the knee, now flex the lower leg with your middle finger as you gently rotate the hip and pull it down.

Now the arms, carefully, as it’s easy to cause permanent nerve damage at the level of the shoulder.

Now the head, if it is not trapped by an incompletely opened cervix. Don't break the neck. These processes are named for those who first thought out and described the maneuver, I remember the name of this one, the Mauriceau, Smellie, Veit maneuver. With middle finger in the mouth and the ring and index fingers below the lower orbits of the eyes (careful with the eyes) keep the head flexed as an assistant pushes down on the bladder area and you lift the body up so that the head emerges, as it rotates.

You do all this while you are trying to work around the woman's stress: contractions, pain and not easy to control "thrashing about". Do not scare her, hurt her, cause a laceration, break something inside of her. Do this without your own stress (yelling, throwing things) making things worse.

Three days? Maternal dehydration, exhaustion, infection, probably a dead baby. (I had one of those this week also.) To be honest, even recounting such a case raises your pulse. This is why relatively few doctors or nurses want to do OB.

The first miracle was that she was healthy and having no contractions and the baby was alive. Maybe that is three miracles. But time is on our side. The ambulance was there in only 40 minutes (sometimes takes a couple of hours). Nelsy woke up Ritza, another Honduran nurse to ride in the ambulance with me. She woke up Dr. Renee to follow behind the ambulance, to assist, if we had to deal with a delivery en route and get to us home from La Ceiba.

Denia started have some mild contractions a few blocks from the hospital. We arrived there (the public hospital) in 55 minutes; in the rainy season, there is no way! It’s hard to make that kind of time in the dry season. The Labor and Delivery folk at Atlantida have learned that I bring bad news. They were on this lady quickly, gently and kindly. We listened to the baby's heart beat with my electronic stethoscope (they do not have one). I suspect that they held back some tears along with the cheers, but you could hear the sighs. She was whisked off for a Cesarean.

A week later we took out her stitches at the Health department clinic and passed around her quiet and content daughter.

I have recounted some of the miracles. Denia's health, a live baby, no contractions, timing absolutely the best and an L&D staff able to hop on it. It took me a week or so to realize another miracle. The same fairly dry weather that permitted our incredibly fast trip had also made it possible for Denia to cross the streams and get out of the mountains. Without that, the outcome for the baby and mom would have been different. Praise God.

John Alden
The Women’s Health Project
Hospital Loma de Luz,
Balfate, Colon, Honduras