Parents, hospital wrangle
over cause of baby’s death
~ Incident underscores need for precise record keeping ~
By Judy H. Fitzpatrick
MARIGOT--The stillbirth of a baby at Louis-Constant Fleming Hospital last Saturday has sparked a dispute between the grieving parents and management as to what caused the death and whether it could have been prevented.
The incident has also highlighted the need for medical institutions to document and specify all unusual details pertaining to patient care and make these easily accessible to their patients.
The baby died last Saturday when an uncommon scar on the mother’s womb from a previous caesarean section ruptured minutes before she was wheeled into the operating theatre for an emergency C-section.
The parents claimed that the hospital’s procrastination in performing the surgery, three days after the nine-months-pregnant mother was first rushed to the emergency room bleeding and in excruciating pain, had resulted in the stillbirth.
But the head of the hospital’s Gynaecology Ward Dr. Louis Jeffry is adamant that the institution followed the “necessary protocols” governing its operations and did nothing wrong. However, he acknowledged during an interview with The Daily Herald on Tuesday that the death could have been prevented if the surgery had been performed earlier and if the doctor had been aware of the scar on the mother’s womb from her first C-section nine years ago.
In invited comments, Dutch St. Maarten-based gynaecologist Dr. Tjon-Kon-Fat and midwife Regina Janga said that while they were not aware of the incident in question, decisions on the childbirth process are based on the situation at hand, because the condition of the patient can change in the blink of an eye.
The loss of the baby has come at a time when efforts are being made globally to stem child mortality by two-thirds by 2015 as part of the Millennium Development Goals (MDGs), to which all United Nations member states, including France, are signatories.
Excruciating pain
Grief-stricken mother Avril Anderson and her reputed husband Texman Robinson said their troubles had begun on Thursday, May 1, when Anderson was rushed to Louis-Constant Fleming Hospital after she began experiencing an excruciating pain in her lower stomach and was “spotting” (bleeding lightly).
Anderson, who was scheduled to deliver today, Wednesday, said she had been examined and admitted that evening for observation and sent home the following day, Friday, around 3:00pm. However, she was still experiencing excruciating pain and still spotting and Robinson rushed her back to the hospital around 8:15pm.
Anderson was readmitted and taken to the delivery room around 9:15pm on Friday. She “was left there” until a decision was taken to perform a caesarean section on Saturday, around 9:15am.
Robinson said the series of events that had unfolded once Anderson was wheeled into the operating theatre had convinced him that something was amiss and that “someone” was probably “trying to cover up something.”
Robinson said he had been told that the delivery “was not going well” and that Anderson and the baby were “in trouble,” but that the health professionals were doing their utmost to “save” the mother. He later learnt that the baby had been delivered stillborn. He said too that it was only after persistent questioning that the reasons for the stillbirth had been explained to him.
Fighting back tears, the visibly upset Robinson said he believed his daughter had died because of negligence and procrastination. Had the doctor on duty been proactive and performed a C-section earlier, the baby would have been alive today, charged Robinson. “I was looking forward for the birth of my daughter for nine months and it hurt me to see this happen,” he said.
Robinson said Anderson had been left unattended for the major part of her time in the hospital. He said she had been told that her contractions were “not strong enough to push the baby out” and she wasn’t sufficiently dilated.
Anderson, who had delivered her first child by caesarean section in Jamaica, said she had been asking the medical professionals on duty since last Thursday, when she had first visited the hospital, whether a C-section couldn’t be performed, but had received negative responses.
Followed procedures
Decisions to perform caesarean sections aren’t made routinely, but are carefully planned based on the circumstances and based on the protocols governing the institution, said Jeffry when asked why a C-section hadn’t been considered earlier.
He acknowledged that the death could have been prevented had the surgery been performed earlier, but said the baby’s death was not the hospital’s fault. He said the baby apparently had died when the old C-section incision had ruptured as the mother was being wheeled from the ward to the operating theatre. The baby’s head was found between the edges of the old wound. Frantic efforts to revive it were futile.
He said the vertical cut on Anderson’s womb from her first surgery performed in Jamaica was rarely ever made these days and the medical practitioners hadn’t had any idea that this was the case. If they had known, Jeffry said, the surgery would have been done much earlier, as this type of cut is risky during second C-sections.
Although Anderson’s medical record showed that she had had a C-section, it did not indicate that the incision on her womb had not been made typically. While ample medical records are kept in the “French system,” this is not the case in some countries, said Jeffry.
Because of St. Martin’s diverse population of more than 100 nationalities, many immigrants don’t have any medical records when they show up at the hospital for medical procedures, and this complicates things for medical professionals.
In an invited comment Dr. Tjon-Kon-Fat, a practising gynaecologist in Dutch St. Maarten for the past 14 years, also underscored the importance of doctors indicating whether they have performed any unusual procedures on a patient and making this information easily accessible.
“If a patient had a C-section and it was not done the common way, you have to tell them,” he said, adding that gynaecologists at St. Maarten Medical Center, where he is based, usually informed a patient’s house doctor whenever an abnormal C-section was performed. These records are available for the patient if ever she has to relocate to another island.
Jeffry said Louis-Constant Fleming Hospital had each patient’s best interest at heart and tried to keep its infant mortality rate as minimal as possible. But even as the hospital is contending that it is doing its utmost to keep child mortality figures down, parents whose babies have died at the hospital during childbirth continue to complain.
T.P., a disgruntled Galisbay resident, said the number of infant deaths at the hospital including those of four of his children, including triplets, had left him with a sense of bitterness.
He said he had decided to send his pregnant wife to France for pre- and post-natal care and to deliver her baby after she had lost four babies, including triplets, at the hospital in French St. Martin over the past two years. P. said on both occasions his wife had been rushed to the hospital in excruciating pain and had been left unattended for lengthy periods.
Statistics obtained from the hospital show that 11 infants died in 2007 when there were 951 births and 15 died in 2006 when 971 births were recorded.
Jeffry said an average of 100 babies were born at the hospital monthly, but declined to say how many had died thus far this year. However, this newspaper understands that an estimated six corpses of newborns, including one that died yesterday, Tuesday, have been taken from Louis-Constant Fleming Hospital to the funeral home in French St. Martin for this year alone. This could not be confirmed.
In St. Maarten, the Dutch half of the 37-square-mile Dutch/French island, 29 babies died at St. Maarten Medical Center between 2003 and 2006 during which time 1,859 births were recorded.
In the meantime, as parents such as Robinson and P. continue to work towards reducing infant and child mortality rates, experts contend that many babies can be spared an early trip to the grave through timely intervention.
