Teresa Lalltoo, a mother who lost a baby after medical personnel at the West Demerara Regional Hospital (WDRH) chose to artificially rupture her amniotic sac, is claiming that the absence of theatre staff at the institution led to her child being stillborn.
Doctors at the institution have told Stabroek News that they cannot confirm Lalltoo’s claim, since they are not familiar with the details of her case. They have, however, confirmed that the hospital has been operating with a staff shortage in the theatre for the last two years—a situation which has resulted in the theatre not being operational on Sundays.
On Saturday, Lalltoo told Stabroek News that she was taken to WDRH at about 7:30 on the evening of the previous Saturday, April 18th. After being made to wait for about 30 minutes, during which time she was accused by a nurse of trying to “put on a show,” Lalltoo was examined and admitted with a cervical dilation of 3 cm.
It was estimated that she would reach optimal dilation of 10 cm by 2AM the next day. However, after 6:30AM on Sunday, April 19th, Lalltoo had still not progressed from a 3cm dilation and workers at the institution, according to her family, chose to induce labour by intravenously administering oxytocin. After an initial dose failed to augment Lalltoo’s labour, a second higher dose was administered to the mother.
Lalltoo told Stabroek News that at this point she heard one of the attending physicians say he would be attempting “an experiment” as he had never encountered a mother who did not progress after oxytocin induction. The increased dosage of oxytocin saw the expectant mother dilate to 6cm. At 1:30 PM, a decision was made to artificially rupture Lalltoo’s amniotic sac, since her “water didn’t break.”
It was at this point Lalltoo said that a portion of the umbilical cord was pushed forward but became lodged in the vagina—a condition known as cord prolapse. A cord prolapse, according to medical professionals, constitutes an obstetric emergency; while attempts may be made to put the cord back into place, there is no longer an option for natural delivery. At this point, a caesarean section (C-Section) must be performed.
The absence of a functioning theatre, however, led to Lalltoo being referred to the Georgetown Public Hospital Corporation (GPHC) the same afternoon.
Upon her arrival at the GPHC, Lalltoo was told that there was no foetal heartbeat. At 2:15 AM on Monday, April 20th, she delivered a perfectly formed 3.2 kg female child in the presence of nurses and midwives at GPHC.
‘My baby didn’t have to die’
As a result of her ordeal, a distraught Lalltoo, who could barely speak of her experience without bursting into tears, is calling for action to be taken against three members of the WDRH staff. These members are the nurse who accused her of trying to “put on a show” and later accompanied her in the ambulance to GPHC, the nurse who ruptured her “water bag” and Dr Ravi Persaud, who she said was her personal doctor and who was absent during her labour and delivery despite promising to assist or oversee the delivery.
“My baby didn’t have to die,” she wept.
‘Can happen to any woman’
Stabroek News spoke with the doctor, who said that he was not Lalltoo’s personal doctor and neither was he attending her delivery or on call on the day of her delivery.
“There are no personal doctors in the public health system. I’m often on call in the gynaecology department and examine the expecting mothers. So everyone says doctor Ravi is their doctor,” Dr Persaud explained.
He further noted that a decision can be taken to artificially rupture an amnion if the “foetal head is at suitable position and other indications concur.” These indications include a mother who is in active labour (4cm dilation or more) and a pregnancy which is at term.
Lalltoo, from her own admission, fit these criteria. He expressed sympathy for what Lalltoo is now going through, while noting that he understood her pain and confusion.
Asked if a decision could’ve been made to call in the theatre staff to attend Lalltoo in this emergency, he said, “It would’ve taken less time to transfer to the Georgetown Public Hospital Corporation than to attempt to call in theatre staff to perform a C-section.”
The Medical Superintendent of WDRH Dr Shawn Bancroft, speaking with Stabroek News said that while Lalltoo’s experience was not common, it was something that could unfortunately happen to any expectant mother as obstetric complications do sometimes have unfavourable outcomes. It “can happen to any woman,” he said.
He expressed disappointment that the family approached media before even informing the hospital that the child had died.
“We refer numerous cases to the GPHC and we don’t know what happens until someone tells us, and no one told us this had happened,” he lamented.
On Tuesday last, Stabroek News had contacted Chief Medical Officer Dr Shamdeo Persaud about the case of Lalltoo. At that time, he said that an investigation had been launched into the death of Lalltoo’s child.
Up to Tuesday, however, medical personnel at the WDRH were unaware of any such investigation. No one from the Ministry of Health had approached the hospital for Lalltoo’s medical records nor had even informed the hospital that Lalltoo’s child had died.
Medical sources contacted by Stabroek News expressed the opinion that Lalltoo’s experience can be considered the result of administrative negligence. “Doctors on the ward shouldn’t have to worry about a theatre being operational; a labour ward should not exist without an operating theatre that has staff always available,” one source said, while noting that “there should be no labour ward without functioning theatre not even for normal deliveries, if there is no theatre close down the ward.”
Noting that the doctors will probably be used as scapegoats, the source stressed that they should not be blamed since “as a matter of principle, you shouldn’t have women labouring in a place where you can’t rescue them and their child if necessary and that responsibility rests with the people chiefly in charge.”
