No Birth Mirth – DUI – Death Under Ignorance

Sep 11, 2014 Letters

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DEAR EDITOR,
Once again my entire being contorted with grief on reading of yet another maternal death. Oh no! Oh no! Oh no, were not appropriate responses to the situation. My emotional competency had been dealt yet another blow. So many thoughts raced through my mind, some even attaining homicidal levels. With a return to sobriety or would that be sanity, I began to ask the question: Are the doctors in Guyana, especially those in Obstetrics in need of training or a draining?
In a previous article in the Kaieteur News I had addressed this issue, from a qualified standpoint, being a State Certified Midwife, who had held a Charge position in Obstetrics for over 25 years.
Following any death, whether maternal, fetal (intra or extra-uterine) or neonatal, are the staff subjected to any form of quality assurance review, maternal morbidity investigation and recommendations, upgrade of nursing standards, policy and procedural review? In fact, what is done to allay the fears of potential mothers-to-be, the general public and last but certainly not least those affected by the absence of the mother viz: husbands, children and parents?
Taking a slightly off humorous angle to this tragedy- With occurrences come a lot of baggage and sentiment and I can go on to posit the theory that this behaviour may be a succinct form of contraception. Birth is no longer time for mirth? A baby keeper has an appointment with the Grim Reaper. How sad, especially since it only serves to further depict Guyana’s descent into Dante’s inferno.
Now to the crux of the matter—-Pharmacology ignorance, stupidity, or plain downright unconcern comes into focus here and should be addressed. As a Midwife, Registered Nurse and Nursing Instructor I have administered the said drug Cytotec (Misoprostol) on multiple occasions.
As childbirth educators, doulas, midwives, nurses, and obstetricians and gynecologists (OB/GYNs), we all needed to be aware of the evidence-based interventions that are used in childbirth. The label for Cytotec lists a contraindication that it should not be used on pregnant women. By the way, the package insert for Cytotec actually has a pregnant woman with an x through it.
In 2000 due to the off label usage in the United States of America , Searle  (the manufacturer of Cytotec) distributed a letter warning against the use of misoprostol in pregnant women. In addition to citing the abortifacient nature of the drug, the letter cited reports of uterine rupture and death associated with using misoprostol to induce labour.
All cervical ripening and induction agents can cause uterine hyperstimulation, which can negatively affect the blood supply to the fetus and increases the risk of complications such as uterine rupture. Concern has been raised that uterine hyperstimulation that occurs during a misoprostol-induced labour is more difficult to treat than hyperstimulation during labour induced by other drugs.
A product monograph usually accompanies each drug sold, am I to assume that there is one specially printed for the medical staff in Guyana? One wherein the information differs to even more detrimental levels. Incidentally while a patient is under Cytotec therapy, strict supervision is imperative. After Cytotec is inserted in the vagina, it dissolves instantly. There is no turning back. There is nothing that can be given to reduce the severe tetanic (very violent and painful) contractions wearing on the mother’s uterus and depriving the baby of oxygen far longer than can be tolerated. The newspaper article does not state by what means the drug was administered,
Other side effects of Cytotec include: uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy) amniotic fluid embolism, pelvic pain, retained placenta, severe genital bleeding, shock and fetal bradycardia. This is certainly not personal information to which I am solely privy.
The recent death of Evita Singh and her baby was totally avoidable, and all responsible, every last one even to the very nurse administering the cidal drug should be held criminally accountable for both fetal and maternal death. Was the patient informed before she went into labour, of all the known side effects of interventions that would be used in labour and birth for both the mother and baby? Was Evita made aware that she had the right to refuse any drug? Is the right to informed consent not in practice in Guyana?
The use of misoprostol (Cytotec) for cervical ripening and induction of labour should take place in a hospital setting. All women should be carefully assessed before induction begins, with a minimum of 30 minutes of electronic fetal heart rate monitoring. At the time of each planned misoprostol dose, the mother-to-be should be clinically reassessed. Was this protocol in place and effected? Absorption is fast in all routes of administrations, but the most rapid action occurs
when misoprostol is given orally (peak concentration after 12 min, half-life 20-30 minutes.
On a final note of inquiry: what was the outcome or fate of those responsible for the previous multiplicity of maternal deaths, of which Evita has become yet another grim statistic? Families will endure the lifelong agony of waiting with joy-filled hearts for the birth of a new life only to ache endlessly because that day ended the life of the mother and/or the baby.
To quote John Stevenson “A mother does not become pregnant in order to provide employment to medical people. Giving birth is an ecstatic jubilant adventure not available to males. It is a woman’s crowning creative experience of a lifetime.” Pray tell me then why in Guyana are wombs being transformed into tombs?.
Only a public outcry, as well as exemplary punishment of a nature never before seen in the history of Guyana for the shoddy practitioners, will halt the use of Cytotec in the field of obstetrics, and the resultant increased maternal mortality. Let the buck, muck and luck stop here and now. In the interim, to humanize birth is to get to hell out of the hospital.
Aleuta— The struggle continues.
Yvonne Sam. R.N. R.M.N. S.C.M BSN. M.Ed. Dip.Ed. (Adult)

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