Today I learnt about another interesting aspect of Indian culture. There are strict rules on the interaction that can occur between a woman and her brother in laws. This is applicable to both the brothers of her husband and the husbands of her sisters. It is very important that she does not have her hair down when he is present. She should really cover it with a shawl or scarf if he is around. They cannot touch. Ever. Even a slight graze is forbidden. I discovered this was the case in clinic today. A woman came in having trouble conceiving. She had lost her first 2 pregnancies. During the first one her brother in law had touched or hit her abdomen. Somehow this put the paternity of the pregnany into question (I don't think sex education is well done here) and she was forced to take some herbal remedy to abort the baby. She sadly miscarried the second and is now very stressed about losing another baby. Firstly, I cannot understand why the brother in law would touch her (let alone hit her) if it is unacceptable. Also the person who has suffered most from this is the woman herself. It is just so tragic that a life was taken away for what seems so trivial to me. Men often don't have to suffer from the consequences of their actions.
This morning we were putting our management of newborn baby skills into action. When examining one of the babies, neil found him to have a slow heart rate. He was also a bit cold. He had an incredible level of body control especially for such a small baby (2.4kg). When you stand him upright he can almost stand by himself! Anyway, we took him through to the nursery amd got him under a heater. His oxygen levels were also pretty low so we gave him some oxyen. His heart rate was still low and we noticed that it was quite irregular. All these things were worrying us so we gave Shubhro a call and he said to get him warm and reassess. We got him warmed up but his levels and heart rate stayed much the same. He went back to his mum and got Shubhro to come and see him later. After some reading we think that it is because he quite a low birth weight which can cause a slower heart rate than you would expect. Neil had read that exercising the baby should increase the heart rate. The one time he needed the baby to cry it wouldn't. Instead he danced it around and the heart rate came up confirming his diagnosis.
After clinic, Elisabeth and I went up to the mat ward to deliver a baby. This mother had had a previous caesarean section so she would usually have had a scheduled one a few weeks before her due date. The women here don't often come up for this earlier operation, instead waiting until their waters break or the contractions start. This is dangerous because the scar from the previous operation means there is a weakness in the wall of the uterus so the uterus can rupture at this point. In the uk they try and encourage women to have a normal delivery after they have had a c section but here there is no blood bank and they don't want to have to deal with a uterine rupture. This mother delivered normally and she was fine. It was important that we delivered her quickly to prevent too much strain on the muscle. Just yesterday another post c section lady came in too late (3 weeks after her operation date). She ruptured her uterus during the c section operation. She is doing ok but it just highlights the problem of the women not coming in when they should. She is pretty much guaranteed to rupture again if she gets pregnant. Will she come in before labour starts? Probably not.
J x
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