Tuesday, June 21, 2005

 

How not to have your first child

My wife has had a very good pregnancy up until today. This morning she woke up and noticed blood and that she was experiencing cramps. She was scheduled to see a doctor today to discuss where she wanted to have her baby. We had gone to see doctors at the local Russian hospital here in Moscow and the American Medical Center. She is registered to live in the town of Saratov so she is supposed to give birth there, however, like everything else in Russia-Rules are for the poor. Her one trip to the hospital in Saratov with its peeling, water damaged walls and nurses incapable of placing an I.V. without hacking up her arm convinced my wife that giving birth in Moscow was the best choice. From the other expats in Moscow I had learned that all the private clinics send their patients to the same hospital so it really did not matter which clinic you went to for prenatal care. I have told my wife to go to the AMC but she had a friend who recommended another clinic. I made my preference known and then shut up. I figured that she and her mother knew Russia much better than I and that they would look to find the best care they could.

I received a call from my wife almost 2 hours after they had left. She had had an emergency C-section, she and the baby were ok and my mother-in-law (MIL) was coming to get me. She sounded very tired so I just confirmed that she was ok and told her I loved her and to go to sleep. I did not know what to do so I went on the internet and read everything I could about premature babies. I discovered that under 37 weeks is considered premature and under 24 weeks is considered a micropreemie. At 32 weeks our daughter will need a respirator for as long as 3 weeks. The cut off for the respirator is around 36 weeks. The biggest difficulties revolve around immature lungs. Preemies over 30 weeks have a 95% chance of survival. (I need to hear the stats in order to make it tangible to me)

I am in an information blackout right now. They are not in the hospital that I had hoped. My MIL told me that my wife is ok but my daughters condition is a mystery. I learned from an expat friend that irresponsive doctors and no visiting hours are typical of a Russian hospitals. Of course, the first few days are critical. So a little info would be nice. Russian hospitals and doctors are not big on service or bedside manner. I am glad I sent my MIL off with a couple hundred dollars which she offered to the surgeon. He did not accept, they are not so crass as to demand payment at the door of the operating room. But bribery is crucial in the care of a Russian patient. If the doctors know that they are going to get paid this assures better service. I would like a it much better if the doctors were motivated by the Hippocratic oath but greed is all we have in Russia. Let's hope greed is good enough.

I promise more information when I get it. I am going to go to the hospital with a fistful of rubles. Please keep us in your thoughts and prayers.

Update:

Through an expat friend, Sam, I got the phone number of a nurse who has a friend who works at the hospital my wife and baby are at. Whew! The nurse said that the baby is stable but the next few days are critical. Tomorrow we go to the hospital to talk to the doctors about getting what the baby needs. The reason for this is that they are not likely to have large supplies of medicine on hand so we will get a shopping list of preemie meds. Having a friendly nurse who gives the hospital her approval makes me feel much better. We need to go and make friends with the doctors and nurses (wink, wink) so that they know my girls should get top notch care. More tomorrow.

Wednesday, June 22nd: My MIL and I visited the hospital. They would not let us into see the baby or my wife. We spoke on the phone and she is walking around, gingerly, and feels better. She said they might let her see the baby and she would call when she did. The hospital is not in the best shape. It is called Imanya Baumanya #29 (Baumann Estate); a.k.a. #29. It is made up of five or six of the rectangular tenements common in Russia. We arrived by taxi and started wondering around trying to find the correct building. The first building we stopped at was the place where my wife and baby are kept. We were allowed to drop off clothes, food, flowers and various things she might be needing at a desk manned by a nice lady with two rotary dial phones and a spreadsheet with the patients names. There were three video phones in this lobby to allow relatives a chance to talk. They didn't work.

The second building we visited was the delivery ward. MIL had made friends with the guard in her three hour stay the day before so he helped us watch over our packages while we waited to talk to the doctor who delivered our baby. (The one hundred rubles didn't hurt either) The doctor said that my wife had Placenta Previa and detachment. She was angry because she has had three other women with the same problem who had had their prenatal treatment at the American Medical Center. Placental Previa is something that should be seen in a sonagram of which we had two at the center. Inna did receive a sonagram early in her pregnancy in Saratov and another, the most recent, at a hospital near us. Two or three sonagrams are normal in a pregnancy that appears normal. Placental Previa is a matter of degree. The placenta does not attach to the top of the uterus likfe normal. Thus it attaches to the side of the uterus and can completely cover the cervix or only partially. Placental detachment seems to be a problem that can occur at any time. Just as it sounds it is when the placenta detaches from the uterine wall. Inna never had a lot of bleeding before yesterday so I doubt that was an ongoing problem. Both Previa and detachment carry the risk of denying oxygen to the baby. Given this it is very understandable why Inna was given the caesarian section, ASAP.

I have a phone call, actually several, into the doctor Inna had seen at the American Medical Center. She got through to me once but her cellphone cut out and she never returned the call despite my calls to the clinic. Her name is Serine Kazaryan. Although we went to the clinic twice Inna only had seen this doctor once. The first time she saw a French man who left between our visit at 12 weeks into the pregnancy and 23 weeks. Inna was not thrilled with Dr Kazaryan so she sought out another doctor for the delivery. If Dr. Kazaryan does not feel my wife is her patient, I can't argue. She didn't want to be. But I think she could at least return a phone call. All I really want is to ask some questions about the extent of the Placental Previa and detachment. The percentages of both will give me an idea of the extent of any damage to Sofia. Not knowing is the worst feeling in the world.

After we spoke with the doctor in charge of delivery we returned to the first building to speak with the doctor who was watching over Sofia. She said that she is critical but stable and that the doctor has decided to move her to a better facility tomorrow morning. Again, the next few days are critical. Again, I could not ask any questions because my Russian is horrible. This whole process is a struggle for information. It took me an hour to translate and find out that the reason for the c-section was Placental Previa and detachment. That is why I need to talk to a doctor who speaks English. Paging Dr. Kazaryan...

Thursday morning: Sofia is being moved this morning to another hospital, Kolomenskii Proezd, which has a more advanced neonatal intensive care unit (NICU). I stayed away because there was not much I could do but get in the way. I am glad to know they think the baby is stable enough to move. I am grasping at any good news, or perception of good news, at this point. My friend John O's mother put me in touch with a friend of hers who is a certified nurse/midwife, her name is Mary and she is a godsend. She answered many of my questions and greatly reassured me. I spent a most of yesterday afternoon and evening reading about placenta previa and detachment (abruption). Mary helped me fill in the gaps. For one, the abruption, or placental detachment from the uterine wall, could be upto 25% and still supply the baby with enough oxygen to survive for the three hours between the time we first noticed my wife's bleeding and the caesarian section. It is not likely that the abruption was this much because there was not a great deal of blood. My MIL is as strong as a rock but I could tell she is very nervous. She told me something last night which had me very worried. The baby was not born breathing. She needed resuscitation. At 31 weeks this is normal because the babies lungs are not fully developed. Mary assured me that this is not a problem as long as the baby was put on a ventilator which she was. Also, preemies that are born via emergency c-section will be listless. They were perfectly happy to stay in the womb for another 7+ weeks so it is not surprising that they are not excited about leaving early. MIL is still worried after I told her this but less so.

This morning while I slept much better than the night before, MIL went to the first hospital to hand out the-how should I put this-tips that are necessary to insure the medical staffs attention. I cannot say for sure that our baby would not get the best care without a stipend but I am not willing to take that chance. Given the Russian proclivity to stick their hands out at every opportunity, I was not shocked to learn that this would be true at a hospital. In their defense, they are paid very little by the state.

My wife is doing well and I have encouraged her not to worry and not to move. There is the very real risk of hemorrage as a complication to the abruption. She did see the baby and she has blond hair! Inna also said she was crying a lot. I took that as a good sign. She has some energy. From my readings, preemies are prone to over stimulation. Preemie bodies and minds are not developed to the point where they can process all the information and stimulae. They are very quick to cry and their cries are at a higher pitch than a full term infant. It is important not to overstimulate them because this can cause an accelerated heartbeat. The natural regulation of bodily processes need time to develop. More later.

Thursday night: I found out when my MIL returned home that the doctors decided not to move Sofia because she it was too dangerous at this time. Also, my MIL received a call from the babies doctor saying that the baby had had severe lack of oxygen and that brain damage was most likely going to result. I decided at this point I really must speak to the doctors because I had many questions. Nate, a good and true friend, took time off work to come and translate. We waited a little and then went into speak with the Sofia's doctor and with, I believe, the head of obstetrics. I did get most of my questions answered but I got the impression they were not particularly happy about answering them when the head of obstetrics asked me why I wanted to know the answer to a particular question. I think they had expected to give general answers and not be asked what was the percentage of previa (100%) and abruption (unknown but acute, over 50%). Also her heart rate before the c-section was 90 beats/minute and my wife had lost 800 ml. of blood. Then I found out that the baby had experienced hemorrhaging in her lungs which had start overnight. Because of this and the lack of oxygen due to hemorrhaging before birth they did not expect the baby to survive. There was really nothing more I could say after this. It was a very sad moment for all of us.

We left and I sent Nathan back to work while my MIL and I went and visited my wife. She seems to have come to terms with this much better than I have. We did not talk about the future because I can't, I know we will survive I made sure she knew that no matter what we would have each other. I have not given up hope and I believe that from the information I was given that Sofia did not have a severe lack of oxygen. What I have done is realized that there is not much good I can do by interfering with the work that the doctors are doing in that hospital. If there is a obstetrician who can help please let me know. I am very angry with the people at the American Medical Clinic. The doctors at Imenya Baumanya #29 seem to think that the care that my wife received was very poor. I don't know what will come of this and I don't care. I just want my daughter to live.

Friday morning: We found out last night around 10 pm that Sofia had passed away. I want to thank all of you for your support and prayers. I have insisted that an autopsy be performed and we are contacting a friend of my wife's family who is a lawyer in Moscow. There were some mistakes made especially with not correctly diagnosing that my wife had placenta previa. If this had been flagged by any one of the doctors she had seen or during the 4 sonagrams we would have known to watch out for problems and to keep my wife inactive. I will keep you up to date regarding any investigation. We have decided to have Sofia cremated so that we can have her with us. Some day she will be buried close to us. Because of the caesarian section my wife was told that she should not get pregnant for two years. She is young and I am extremely grateful that she came out of this ok. She could have died if the hemorrhaging had not been caught on time. We plan on having many children. Kind love, Bill.

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