Management of patients with stillbirth

| Wednesday June 9, 2010 00:00

But the recent story in Mmegi newspaper dated 25th May 2010 alleging patient neglect at Princess Marina Hospital is grossly misleading and warrants our response.  Whereas the story makes specific reference to a patient, Princess Marina as a professional health care facility is constrained by patient-doctor confidentiality, so this response will only be in general terms. 

Please note the following:* There are many different causes of stillbirth such as high blood pressure,cord prolapsed,diabetes and bleeding;*There are several approaches to managing the condition including caesarean section;

*It is preferable to manage the condition medically before opting for an invasive procedure such as caesarean.

Following admission, the mother is given some gel vaginally or sometimes a catheter may be inserted into the vagina to induce labour. The gel will be repeated several times at regular intervals until she develops regular contractions strong enough to open the mouth of the womb. While the onset of labour is comparatively fast in a live pregnancy following induction of labour, it is painfully slow in a stillborn baby.  Unfortunately and expectedly, this is a source of conflict and misunderstanding between the mother and the health care workers whose best intentions may be interpreted as careless, inhumane or insensitivity toward the mother and her family. 

It can be extremely difficult to reassure both family and the mother in these circumstances, that the waiting is worthwhile.  It is not uncommon that induction of labour may fail.  When this happens, induction may be suspended, the mother and family reassured and the mother may be allowed to go home to rest for a week or so or may be retained in the hospital.  Induction of labour may then be recommenced about a week later provided everything else is well with the mother.  It is only when everything else fails that the option of a more invasive caesarean section is indicated.  It should be noted that for Clinicians, caesarean section is always the last option as it poses great challenges such as risk of infection, poor wound healing, risk of haemorrhage, prolonged patient care, scarring which may cause psychological effects.  Therefore, the public may appreciate that caesarean section is by no means a risk-free operation.

However, if the cause of death of a baby is known, it may be avoided in the mother's subsequent pregnancies.  If the cause was diabetes, high blood pressure or any correctable cause, then it will be stabilised before her next pregnancy.  Once pregnant, a scan would be required to date the pregnancy accurately and determine appropriate management of her pregnancy as dictated by the cause of the still birth and the point at which gestation happened.   We wish to advice patients to take time to understand their conditions and the management of those conditions. Medical conditions are complicated and it is important for patients to ask for professional advice.

Because of issues of ethics and confidentiality, the Ministry of Health and its medical facilities will not discuss medical conditions of patients with the media, but patients will be assisted if they raise their concerns with the respective department and the hospital management.   We also urge the media to report responsibly and avoid publishing stories that could mislead the public and affect compliance with medical treatment and recommendations. 

The Media is, however, always welcome to clarify issues with medical personnel. Please visit our website: www. moh.gov.bw Toll free line: 0800 600 740363 2754  - Principal Public Relations Officer363 2080  - Chief Public Relations Officer363 2500  - Switchboard

Editor's NoteIt is very regrettable when Public Relations Officers especially those within government fail to address properly formulated questions from the media on critical public issues and choose instead to engage in knee-jerk PR stunts after publication of the story. What exactly Ms Kagiso Motsumi's latest PR initiative is meant to achieve; we do not understand. We thought the reader would want to know what really transpired between us and Motsumi to warrant this diatribe from her. The point is that our reporter contacted Motsumi directly, and briefed her on the questions she wanted answered. Motsumi demanded a written questionnaire to be emailed to her official email address, which our reporter did.

There was no communication from Motsumi. When our reporter called back and managed to get her, Motsumi demanded that the same questionnaire be sent to her personal email address since she was having difficulties with her official email address.

Our reporter did that.  That was the last time our reporter heard from our esteemed PR professional. Our reporter attempted through various telephone calls to locate Motsumi who was said to be absent from office. This took a number of days, more than five days.

We made a decision to proceed and publish the story without Motsumi's input. As the private media, we are often averse to being held hostage by that specific species of government PR officers who seem to think that they are gatekeepers to what and how the public consumes issues of public concern. Our readers expect us to help them engage with each other. This is a mammoth task and we take it very seriously.

We have made a decision that we will give competent PR officers time to answer our questions but we won't be held hostage by the diversionary tactics of incompetent information officers within the civil service.

We gave Motsumi ample time to answer our questions. We called her back. We left messages. Motsumi never calls any reporter but waits for the reporter to catch her if he/she can which is somewhat a rarity.

We therefore take exception to Motsumi, in a desperate attempt to placate whoever, writing such a diatribe purportedly rejecting our story's validity. If Motsumi has such valuable information regarding the subject of the story, why didn't she offer it at the time we requested it? It would not have cost her anything to have just answered our questions. It would seem she prefers to react to our publication. We will grant Motsumi her preference, but she should not disparage us while she does so. As it stands, we have about three questionnaires with Motsumi which remain to be answered, some as old as a couple of months.  Motsumi you are a PR officer and we expect you to answer questions when they are posed. 

That is your job and it is not the last time we request answers from you. Unless you quit that position and hand it over to someone much more willing to do what the job entails.