19.05.2020 Difficult delivery: 3rd C-section in RSI

Today was a scheduled C-section for a patient that already had two before.  All preparations including a blood bag for eventual transfusion were arranged.  These cases with previous C-sections always have me worried a bit more because its a complete surprise on the inside.  I've seen the most atrocious anatomies on the inside since being here and every time I worry more and more about complications related to this.  This time difficulty started with anesthesia, the spinal did not work and we had to resort to rapid sequence induction which requires intubation and ideally a quick delivery. So the surgical team prepped and waited on the sign from anesthesia to begin. It takes a moderate time to get to the uterus as there are adhesions everywhere and what looks like the suturing together of the two rectus abdominis muscles.  Finally I'm in and feel the head of the baby, unfortunately the leading point deviates and extraction is not possible.  Increasing the size of the uterotomy to achieve more space does not work as the uterus is rigid (never felt this before) and multiple adhesions prevent this so I quickly apply a KIWI Vacuum to retrieve the leading point and squeeze my hand in just enough to deliver.  It felt like the longest 8 minutes.  8 Minutes of exposure to Propofol for this newborn who needed a little more stimulation after birth.  Amazingly no CPAP support was necessary, just some oxygen!

Baby Nehemia 2595g.  Poor guy slept for nearly an hour after birth, thankfully with stable parameters after a good dose of his very first anesthesia.  Still thankful that all went well despite the very difficult case.  The man is Andry our nurse anesthesia. He shares a birthday today with our little man! The other lovely ladies our part of our team of dedicated midwives. I'm so thankful for all the little miracles that happen here on a regular basis!