Koovathur delivery: Poor state of medical services exposed

Despite suspecting an intrauterine death, a midwife and a nurse decided to perform a vaginal delivery.

The patient was not referred to the district headquarter hospital at Chengalpattu and the delivery was performed in the absence of an obstetrician, allege the relatives. The kin of the mother said that the PHC staff removed the head of the baby, while the torso was left stuck in the woman’s womb. After the torso could not be removed, the staff referred her to the Chengalpattu Medical College and Hospital, where the torso was surgically removed. Though the woman is out of danger now, her relatives are alleging medical negligence of medical staff at the PHC.

The family members alleged that the medical staff should have not performed the surgery in case they suspected complications. However, Kancheepuram District Health Department Joint Director Dr S Palani said that the cervix dilation had already started when the woman was brought to the PHC, therefore, delaying the process of delivery would have caused risk of life to both the mother and the child. Since the baby was 1.5kg, the vaginal delivery was not expected to be complicated, he said.

A five-member committee comprising of a National Health Mission consultant, officials from Directorate of Public Health, two paediatricians and an obstetrician conducted a primary level inquiry. The committee submitted a report stating that there is no trace of a gaseous shadow and suggests an intrauterine death few hours before being brought to the PHC. The committee members have monitored the labour room and analysed the post-mortem x-ray reports, added Dr Palani.

The incident has angered the public over the negligence in the case and highlighted the lack of medical staff and facilities at the PHCs. State Government Doctors Association had earlier submitted a recommendation to the former health secretary suggesting that deliveries should be done at the PHC only in the presence of pediatrician, anesthetist and an obstetrician, while all the PHCs should be equipped with a blood bank.

“Despite various representations and recommendations, the State Health Department has failed to ensure safe institutional deliveries at PHCs. Out of 1,600 PHCs, none, including the 24/7 PHCs have an obstetrician round the clock. While maternal mortality is a rising concern in the State, State Health Department is not taking effective measures to reduce the same,” said Dr G R Rabindranath, secretary, Doctors Association for Social Equality.

Medicos also question the qualification of the nurses and authorization to conduct a vaginal delivery in the absence of a doctor. Obstetrician and member of State Government Doctors Association Dr R Shanthi said that the government is forcing pregnant mothers for institutional deliveries to meet their target of maximum institutional deliveries, however, PHCs lack the staff and the equipment to perform the deliveries. “Various PHCs lack full-time staff and what can a pregnant woman do in case of labour pain during late night or early morning hours. The State should be responsible to ensure the presence of a pediatrician, an anesthetist and an obstetrician round the clock even in a PHC. There should be scanning facilities to monitor intrauterine deaths in PHCs,” said Dr Shanthi.

Though the State Health Department officials state that there was an intrauterine death, the body will undergo a post-mortem to investigate the cause of death through a muscle biopsy. Public Health Director Dr K Kolandaisamy said that the delivery was performed in an emergency state and the woman could not be referred to the GH. A preliminary investigation has been done in the case and the final report will be done after the post-mortem on Thursday.