When you practice medicine in a rural setting you never know what is going to show up. With limited equipment and resources we sometimes have to get very creative and always be ready for a change of plans. A few months ago we got a call from the ambulance around one o’clock in the morning. They were in route to our hospital with a thirty five year old female with abdominal pain; they said they were about fifteen minuets away. It was early spring and we were in the middle of a big storm with snow, wind, icy roads and bad driving conditions.
Ten minuets latter they called to report they were very close to the hospital and the cause of the abdominal pain had been discovered; she was pregnant and her water had just broken.
Apparently the woman was from Guatemala and spoke an unusual dialect, she spoke very little Spanish and no English so there were some challenges with communication. The town they were coming from lies about half way between our little hospital and a bigger hospital down the road, had they know she was pregnant they would have gone to the other hospital where all of the deliveries in the region are done. Now a few minuets out in the middle of a blizzard it was too late to turn around.
Our hospital does very few deliveries, in fact the only deliveries in the past few years have been unplanned emergent. We have limited equipment and supplies when it comes to obstetrics. I am trained to do C-sections but at this remote location I have no anesthesiologist available in the middle of the night. I was the only doctor in the hospital. We had no choice but to begin setting up a make shift labor and delivery room, an upside down bed pan to lift the pelvis, extra sheets to support the mothers legs. In a very remote rural setting with no back up you try to plan for the worst and hope for the best. I knew the mother had not had any prenatal care, and she had numerous risk factors for complications including postpartum hemorrhage, diabetes, large baby and dystocia. Our biggest concern was we had no incubator for the new born. So a clean cardboard box was found, lined with blankets and exam lights were placed over the box to help warm the area, a spontaneous rural incubator was created. A stocking net used for casting was cut and formed into a little hat for the new born.
As we were setting up the ambulance called in to say they were pulling into our parking lot and “the baby was coming out. “ I ran outside through the snow and jumped in the back of the ambulance just as the infant was emerging. One of the female ambulance attendants had a good handle of the infant as he quickly emerged from the birth canal. We clamped and cut the cord and quickly brought him into our ready made cardboard incubator, when I was sure the baby was doing well, breathing and stable I returned to the ambulance to deliver the placenta, repair a couple of vaginal lacerations and stop any bleeding.
Dr. Still the founder of osteopathy writes quite a bit about the care of obstetrical patients from and osteopathic perspective. He describes how the physician should use his hands to help the pelvis soften and widen. He sais if the physician follows osteopathic principles only 1 in 1,000 deliveries will result in any type of vaginal lacerations. He goes on to say that the 1 tear out of a 1,000 is still the physician’s fault, in other words it could have been avoided using osteopathic principles.
We have seen that woman who are treated with osteopathy through their prenatal course have less back pain, and generally have a faster easier delivery, requiring less medications. There are osteopathic principles and techniques for verting breach babies with very little force, and for inducing labor when a woman is post dates. There are very important osteopathic treatments for neonates to help with growth and development and to help overcome problems that are often associated with the birthing process such as poor feeding and suck reflex and colic which can often be related to vagus nerve entrapment at the cranial base which can occur during the birthing process.
Our Guatemalan patient and her new born both did very well, had no complications and are enjoying a normal postpartum course.
