26 November 2009

Questions surround maimed baby

Doctors have raised eyebrows on this week’s horror story of a woman whose baby “came apart” during labour.

Doctors have raised eyebrows on this week’s horror story of a woman whose baby “came apart” during labour.

It was reported by the Beeld this week that the head and arms of a large baby boy were allegedly ripped off by doctors and nursing staff at the local hospital, while his mother spent hours in labour.

Baby Lemeel Booysen's head and arms were apparently stitched back onto the body before it was shown to his 29-year-old mother, Faiza. The "joins" are clearly visible on photos taken by her husband, Donovan.

However, Dr Anrich Burger, an expert consultant to Health24, said decomposition to the rate that a limb could detach would mean that the mother would already have been gravely ill.

Hospital on the defensive
The management of Klerksdorp hospital have however insisted that Lemeel was already dead when Faiza went into labour, and claim that this is why his head and arms came off while doctors and nursing staff were assisting with the delivery.

Yet Booysen believes her baby was still alive when she went into labour on Monday last week. She says that the nursing staff told her, among other things, to "push, because the baby's getting tired".

The hospital stated that the baby's death is not being investigated because, according to them, the foetus was no longer living when Booysen was admitted. The medical staff had apparently followed the "accepted obstetric procedure".

Caesarean should have been done
However, this is not an opinion shared by others.

Faiza, who has three other children, has reportedly had previous problems with diabetes during pregnancy and has already lost two other babies, at six and four months respectively.

The fact that she was diabetic, says Burger, may explain the baby’s size.

“Large babies are a common feature of diabetic pregnancy, and the attending doctor would need to do weekly follow-ups to monitor the status of both mother and baby.

“A basic pelvic examination would have determined that the baby was too large to be delivered naturally, and that an ultra-sound would have immediately alerted the delivery team as to whether the foetus had an active heart-rate.

“Taking the size of the baby into consideration, a Caesarean delivery would be the correct way to proceed,” he said.

However this does not explain the hospital’s claims that the baby had already decomposed, as he said that for decomposition to have reached the state where a limb could detach, by that stage the mother would have already been gravely ill from septicaemia, or deceased.

The right procedure may have gone wrong
According to gynaecologist Chantal Stewart, if a scan and a foetal heart monitor both showed that there was no heartbeat, then it would seem clear that the baby was dead. The size of the baby suggests the possibility of gestational diabetes which can cause sudden deaths in late pregnancy.

Decomposition or maceration of the body can occur after 24 hours though this depends on a number of factors. In this condition, parts of the baby can be detached during a difficult delivery, said Stewart.

Stewart adds that the issue around Caesarean section is not just about the emotional trauma for the mother at the time. Caesarean section is primarily done for the wellbeing of the foetus. It carries all the risks of surgery to the mother. In addition, there are longer term consequences such as adhesions and chronic pain. Also there is a risk of rupture of the uterus in subsequent pregnancies, though this risk is small. There is also a limit to how many pregnancies the woman can have after a ceasarean, and according to Stewart, this would be the rationale for preferring a vaginal delivery if the baby is dead.

Police investigating Booysen said the hospital never gave her an explanation in this much detail regarding what had happened, according to them.

Kebaakae Metsi, police spokesperson in North-West, said Lemeel's death is being investigated.

The hospital sent his body to Potchefstroom for a post-mortem. Booysen said they've been informed that it would be done on Wednesday. The family also want to bury Lemeel this week.

References: Dr Anrich Burger, Dr Chantal Stewart, Beeld

(Health24, November 2009)


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