Faith over reason
Posted on 24 September 2012 by Aidan O'Donnell
Hannah was 26, slim and healthy, and this was her second baby. I was the labour ward anaesthetist. The obstetric registrar had just been in to see her. He came out, threw his gloves into the bin, and then kicked it hard, sending it flying along the corridor.
Hannah had come to the hospital that morning in established labour. The midwife had performed a vaginal examination, and found the cervix was moderately dilated. The membranes had not ruptured, and the forewaters were bulging. The umbilical cord was easily palpable in the forewaters.
The midwife explained that Hannah needed a caesarean section. Hannah declined. The midwife explained again: as soon as the waters broke, the cord would fall out; it would get trapped between the baby’s head and the rim of the pelvis, and squashed; when that happened, the baby would suffocate and die before it could be born normally; the only solution was a caesarean section.
Hannah shook her head.
‘I understand all that,’ she said. ‘But I don’t want an operation. God will take care of my baby.’
The midwife pleaded, at first calmly, then more forcefully.
‘Your baby is healthy, and you are healthy,’ she said. ‘The risks of the operation are low. We can save your baby’s life, but we need to act now. If we don’t, your beautiful, healthy baby will die.’
Hannah did not budge. God, she persisted, would take care of her baby.
The midwife called the obstetric registrar, who spent 15 minutes in the room. He emerged furious, and kicked the bin in frustration. He called his consultant, but there was nothing we could do.
It is enshrined in law that a pregnant woman can accept or refuse any intervention at any time, and for any reason or none, even if refusal means her death or the death of her baby.
We all knew that already, but I had never expected to see the law tested in such an unequivocal manner. Hannah was educated, informed and calm. She was not affected by pain, exhaustion, illness or drugs. She had offered a reason for her position, which from her perspective was quite sufficient.
I had my emergency anaesthetic drugs drawn up, and my equipment laid out, just in case. I hovered around the vicinity of the birthing room, unable to stray far away. Several senior midwives and obstetricians came and went. I did not go in or attempt to add my voice to the crowd.
Eventually, the waters broke. The fetal heart immediately dropped sharply. The midwife became hysterical, and I heard her voice through the wall. She begged Hannah to have a caesarean section. Hannah refused.
After more than half an hour, the doors burst open. The midwife was bringing Hannah out on the bed.
‘She’s changed her mind!’ she shouted.
I was right there, and everything was ready. I gave Hannah one of the quickest inductions of my whole career, and the baby was delivered only a couple of minutes later.
The neonatal team did their best, but the baby was already dead. The midwife had believed the fetal heart was still beating, but it was probably the maternal pulse she had been monitoring.
As a result, we had, with the very best of intentions, created the worst of all possible outcomes to this scenario: we had made a hole in a healthy uterus to deliver a dead baby.
Almost everyone in the theatre was weeping, but the midwife was inconsolable. The baby had been a healthy boy.
The rest of the operation was uneventful. I went to see Hannah the next day on the postnatal ward. How would she be feeling? How would these events affect her beliefs? Surely God had failed her?
I was surprised to see her up and about. She looked well. More importantly, she looked at ease with herself. Some members of her family were in the room, and the atmosphere was sombre but not funereal. She had little pain, she told me, and she was looking forward to going home.
‘What happens now?’ I asked. ‘Are you going to be all right?’
‘Yes, I think so,’ she answered. ‘God will take care of my baby.’
• Aidan O’Donnell is a consultant anaesthetist from New Zealand. He is the author of Anaesthesia: A Very Short Introduction, published by Oxford University Press
Work and life
patient safety and clinical risk
consent to treatment
refusal to treatment
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