Warning! This story is not for the faint of heart.
According to a story in The Independent:
A doctor caused an unborn baby to be accidentally decapitated inside her mother’s womb while performing a delivery, a medical tribunal has heard…
The obstetrician at Ninewells Hospital in Dundee is accused of wrongly going ahead with a vaginal labour in spite of several complications that meant a Caesarean delivery would have been safer because the premature infant was in a breech position.
The 30-year-old patient’s baby boy died during childbirth. Dr Laxman was suspended by NHS Tayside in the wake of the incident in March 2014.
How could something so hideous have happened? It appears that in the midst of an life threatening emergency, the obstetrician resorted to a last ditch procedure appropriate in a low resource setting instead of an immediate C-section.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The baby deserved every reasonable attempt to save its life; instead it was dismembered. [/pullquote]
The woman’s waters had broken early at 25 weeks and upon examination her unborn baby was found to have a prolapsed cord, was in a breech position while the mother’s cervix was around 2-3cm dilated. It can be 10cm when fully dilated.
The prolapsed cord posed an immediate threat of death to the baby. That’s because the umbilical cord goes into spasm in room temperature air, cutting off blood supply and therefore oxygen to the baby. The baby must be delivered immediately by C-section to save his life. Although the mother was in labor, the cervix was not dilated enough for the baby to pass through. Furthermore, premature babies in the breech position are at even higher risk of injury from a vaginal birth than term babies. That’s why C-section is almost always recommended for premature breech babies.
But what if you’re in a setting where you don’t have access to a C-section and the baby is dying? In that case, you might use Durhssen’s incisions to cut open the cervix and allow the baby’s trapped head to come through.
What are Durhssen’s incisions?
Three surgical incisions of an incompletely dilated cervix, corresponding roughly to positions at 2-, 6-, and 10o’clock,used as a means of effecting immediate delivery of the fetus when there is an entrapped head during a breech delivery.
The use of Durhssen’s incisions carries serious risks for the mother including hemorrhage, injury to the urinary tract and the possibility of incompetent cervix leading to second trimester miscarriage in subsequent pregnancies. That’s why they’re reserved for situations in which an immediate C-section cannot be performed.
In contrast, this situation was a hideous case of malpractice. According to the mother:
I remember them saying I was two to three centimetres dilated and I was told to push. Nobody said I was not having a c-section and doing something else instead. Whilst this was going on I was in pain.
… I had the doctors putting their hands inside me and I had them pushing on my stomach and then pulling me down.
I tried to get off the bed but they pulled me back three times and just said they had to get the baby out. They twice tried to cut my cervix and nobody told me they were going to do it. There was no anaesthetic. I said to them ‘it doesn’t feel right, stop it, what’s going on, I don’t want to do it’ but nobody responded to me in any way.
Apparently the obstetrician pulled on the baby’s legs until the baby’s head detached inside the uterus. The details are nearly beyond belief:
They tried to coerce the birth through traction as the baby was coming feet first followed by the lower abdomen, upper abdomen and head,” lawyer for the General Medical Council Charles Garside QC said.
“However, there was an obstruction during the birth which proved to be fatal. Dr Laxman allegedly delivered the legs, torso and arms successfully but whilst trying to deliver the head, it got stuck in the cervix.
“The attempt to manipulate the baby’s head to come out of the cervix failed because the cervix has clamped onto the baby’s head and despite effort made to assist, these efforts failed. Dr Laxman made three attempts to cut the cervix with scissors but Baby B’s head was separated from his body and his head was stuck inside Patient A’s body.
“The doctors had to arrange for the head to be removed. A Caesarean was then carried out – not by Dr Laxman who had become overcome by events – but by Dr C and Dr D, and his head was removed in that way.
“As a matter of compassion the head was reattached so the appearance of the baby was not too extreme. The baby was shown to his mother so she had the consolation of seeing him.
I cannot image what the obstetrician was thinking. I wonder if she is mentally ill because I can’t find a remotely logical explanation for this entirely preventable tragedy. That’s does not mean that the baby would necessarily have lived. Cord prolapse is often fatal, and extremely premature infants face monumental risks. But the baby deserved every reasonable attempt to save its life; instead it was dismembered. And that doesn’t even count the horror that this mother had to endure and cope with for the rest of her life.
If the facts are as presented in the newspaper accounts, this doctor should never practice again.
