An Unexpected Delivery in Gabon

by Andrew Benc

An extra passenger arrives during a flight over the Gabonese jungle.

We took off with just me, the woman in labor, and the pilot in the small, hot, noisy helicopter. We had been flying for less than ten minutes when she became increasingly restless and started to grunt and strain. I examined her again, and my heart sank. This time, a tiny foot could be felt descending the birth canal. It meant that the baby’s position had changed and was now about to be born body first in what is known as a breech delivery. Even in a well-equipped and fully staffed labor ward, a breech delivery can be a risky business. Having to deal with such a case alone in a cramped, noisy aircraft a couple of hundred feet over the Gabonese rainforest was orders of magnitude more hazardous.

The legs and torso appeared soon after, and I prayed that the whole baby would then quickly follow. It didn’t. Time was now critical, as the baby’s head was trapped in the mother’s pelvis, and his brain was being starved of oxygen with every passing second. I tried to remember the maneuver taught in my past obstetric jobs to deliver a baby’s head in a breech presentation.  Was it applicable to a patient thrashing around in the back of a tiny helicopter? In desperation, the mother raised herself to a crouching position, stumbling over the medical bags, and grabbed a rail on either side of the cabin ceiling with each hand. The pilot kept glancing around anxiously at the increasingly chaotic scene unfolding behind him. Eventually, with an ear-splitting scream, the woman gave a titanic push, and the baby was delivered into my shaking hands.

He was completely limp and as gray as slate. I felt sure he was dead but went through the process of resuscitation anyway just in case a glimmer of life was still there, and to avoid catching the mother’s eye. She had collapsed back onto the stretcher, utterly spent by her efforts, and looked anxiously at her newborn son. As I intubated the lungs of the baby with the little red endotracheal tube grabbed as an afterthought as we were leaving the clinic, I reflected wryly that I had left General Practice in the UK a few days before to seek more interesting and challenging work in Africa. My wish had been rapidly and emphatically granted.

Three weeks earlier, my job as a doctor in Gabon had at last been agreed, and all the countless permits and visas obtained. The final hurdle was a medical examination and a health certificate signed to confirm that I was, to use the exact wording, “Sound in mind and in body and not suffering from Leprosy, Trachoma, Insanity, Acute Epilepsy, Dysentery or any other disease likely to endanger public health.”  Fortunately, the examining doctor in London dryly confirmed that I was indeed free from all these exotic diseases, and a certificate was duly issued to this effect. So, on a wet windy morning in January, I left England to start a new life in Africa. 

The remoteness of our clinic in the south of Gabon meant that the doctors had a huge amount of autonomy when providing health care, but this brought with it some scary moments when we were presented with acutely ill cases. Soon after I started my job, a pregnant woman arrived in the back of a pick-up truck that screeched to a halt outside the emergency room. She was evidently in labor and was groaning in distress. Her clothes were drenched in sweat and stuck to her clammy skin as she moaned and looked at us imploringly. She had been in this state since the previous day, yet the baby had shown no sign of arriving.

I examined her internally but had no idea what my gloved fingers were touching. In a normal labor, the smooth, slippery surface of the baby’s head coming down the birth canal should be felt, but in this case it could not. A colleague examined her.

“That’s the baby’s spine I can feel, so it’s a transverse lie. This woman needs a C-section.”

A transverse lie meant that the baby was lying sideways across the pelvis and would most probably need to be delivered by Caesarian Section. This meant transporting her to a larger hospital in Port Gentil further up the coast. For this emergency, a road trip was too long and out of the question, but on the nearby airstrip was a helicopter that had been carrying out some jungle survey work. It was available to take her on the 40-minute flight, and the pilot agreed to fly us there immediately.

When the helicopter landed at the hospital helipad in Port Gentil, the pilot turned off the engine. The baby was starting to make some efforts at breathing, and with the clatter of the rotor blades replaced by blissful silence, it was finally possible to listen to his chest with my stethoscope. To my delight, a heartbeat could be heard. We took the baby to the neonatal ward and handed him over to the staff. The pediatrician was clearly upset that he had not been forewarned of this admission to his unit. 

“Mon Dieu. Que se passe-t-il?”

As I stood there with my shirt soaked in sweat and liberally spattered with blood, amniotic fluid, and baby poo, I explained that I too would have preferred to take the woman to the maternity ward while still in labor. Unfortunately, things had progressed faster than expected.

Having completed the handover of the mother and baby, I wearily climbed back into the helicopter and returned home. It was a relief that the infant had survived the delivery, but my concern was that his brain had been damaged by the lack of oxygen during the prolonged labor. I dreaded witnessing his increasing disability over the coming months and years.

However, my concerns were unjustified because after he was discharged from the hospital and returned home, his mother brought him to see me regularly. With every medical assessment, I became increasingly optimistic as he reached each of his developmental milestones on time. By his fourth birthday, he had grown into a healthy and happy little boy.

His mom, who clearly had a sense of humor, had called him Helico.

Cover photo credit

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