posted August 13, 2007 09:43 PM         

THE DOCTOR'S OFFICE: A country doctor asked for a miracle and got one. Ben Brewer on the smallest baby he's ever delivered.

By BENJAMIN BREWER, M.D.

An Unexpected Birth
Upends a Doctor's Day
August 14, 2007

Sometimes one phone call changes everything. In the midst of a routine morning of blood-pressure treatment, well-child care and ear aches, a pregnant patient started bleeding at home.

Sitting in her easy chair, she just started to bleed. It was enough to fill a bath towel and wasn't stopping. Thirty-two weeks into her second pregnancy, her baby's placenta was separating too soon. She was having a partial placental abruption, one of the most feared complications in pregnancy and an emergency that threatened the lives of mother and child.

I told her I'd meet her at the hospital. I pulled my partner out of the exam room in the middle of a patient visit, and we hopped in her car for the 20-mile trip. My partner kicked the car into passing gear, and we overtook a convoy of trucks speeding along the prairie two-lane. Traffic was heavier than usual for a weekday. We were both getting anxious.

Nine miles from the hospital I got the call. The nurses found the baby's heartbeat when the patient arrived, then they lost it. The surgery crew was getting her ready, but two experienced nurses couldn't find the baby's heartbeat. The mother was still bleeding, and the lab was preparing a blood transfusion. She was only a few centimeters dilated and would need a C-section.

My heart sank. I said a prayer for the mother and the baby. When a good nurse with more than 10 years experience in obstetrics can't find the heartbeat, I fear for the worst. In 10 minutes a lot can happen. A bleeding mother can die.

The nurses moved her to the operating room as we barreled down the highway.

We pulled up to the hospital and sprinted past the husband talking to his wife's family on the cellphone. When we arrived, the nurses had found the baby's heartbeat after a frantic two-minute search. Usually it takes less than 10 seconds, when things are going well.

The baby was still alive. The relief that poured over me was intense. The odds were long, but we still had a chance to help this baby.

A baby born at 32 weeks usually has difficulty breathing because of immature lungs. After the hemorrhage and weak heartbeat, this baby would likely need neonatal resuscitation and intensive care.

Our rural hospital doesn't have a neonatal intensive-care unit, neonatologist or pediatric intensive-care expert. We don't have an infant ventilator because the state doesn't license our hospital for that level of nursery care. Those specialists and the technology they use to help babies like ours are a helicopter ride away.

If only it were that simple. On this day the helicopter wasn't able to fly. We were on our own, but had no time to worry about that.

There was no meticulous five-minute hand scrub, just a quick smear of antibacterial hand gel. I got into the blue operating gown and sterile gloves in a blur. Our nurse anesthetist started the general anesthesia. My patient went to sleep not knowing if her baby could hang on long enough for the surgery or not. We didn't know either.

I drew a scalpel across the woman's lower abdomen, cutting through the skin and fat to the muscle underneath as quickly as I could. I pulled apart the strong, crimson abdominal muscles to open the thin, nearly transparent lining of the abdomen.

With the uterus in view, I made another incision in the front of the uterus to get to the baby. I widened the opening with my fingertips. The baby's tiny feet came first, followed by the twig-like legs and the hips. The tiny arms were stuck by the head, and I had to pull them down across the body to get the baby free. I gently flexed the head, smaller than a tennis ball, and the baby was delivered.

It was a boy. He was blue, pale and floppy like a rag. I unwound the umbilical cord from around his neck. He didn't cry, he wasn't breathing, and he looked more dead than alive.

I cut his cord and handed him to my partner.

"He has a heartbeat," she said.

My hopes rose.

"It's above 100." Even better.

She breathed for him with a bag and oxygen mask made for premature babies. He slowly turned pink and began to breathe on his own.

He let out a tentative little cry that got stronger with practice. He flexed his tiny arms and legs and started to wriggle.

At 2 lbs. 4 oz., he was the smallest baby I've ever delivered at this rural hospital.

In the two weeks since, he's put on weight and stayed off the ventilator. His mother has recovered and is in good health.

Nine miles north from Gibson City is a stretch of flat farm fields that extend to the horizon under the unbroken sky. A patch of prairie grass still grows along the old unkempt railroad line and black-eyed Susans wave in the breeze by the roadside.

There's nothing to mark the unlikely spot where a country doctor asked for a miracle and got one, but I know it's there.

posted August 13, 2007 10:22 PM         

Thank you!!

posted September 20, 2007 10:04 PM         

My daughter was born at just 28 weeks gestation.
She too was a miracle.
Emergency C-Section, blood transfusions, etc.

Aphrodite this truely was a "Beautiful story about a miracle".
Thank you so much for sharing.