A woman who delivered a stillborn baby after an emergency caesarean section was delayed by 30 minutes says Abbotsford Regional Hospital needs more funding and more obstetricians.
After six years of trying to conceive, Alisha Mankatala and her husband Ajay conceived in 2015 with the help of fertility treatments.
On Jan. 24, 2016, Alisha – by then overdue by a week – went to the hospital for an ultrasound. That afternoon, with Alisha starting to experience contractions, an ultrasound technician detected a decelerating heart rate. When a nurse received the information, the mood suddenly shifted.
“She screams at the top of her lungs, ‘I have a deceleration here!’ “
The next two hours were a blur of activity – and waiting.
Alisha had chosen to deliver at the hospital because of its ability to handle complications. But despite the urgency after her baby’s heart rate was found to be dropping, she said it took an unacceptably long time – some 70 minutes – to get the baby out. That included a 30-minute wait while an ongoing case was completed in an operating room.
When the baby – a boy who would be given the name Amari by his parents – did emerge, he wasn’t breathing, and doctors couldn’t revive him.
“It was just a complete shock,” Alisha told The News through tears. Alisha believes that if the C-section had been conducted quicker, Amari may have survived. The episode – including what Alisha felt to be a lack of transparency and help following the stillbirth – led her to file a formal complaint to the College of Physicians and Surgeons of B.C. That complaint found fault with one of her doctors, while absolving others who treated her.
Meanwhile, Fraser Health has launched its own review – which it says was planned independently of the event – to determine whether ARH needs more resources to deal with a dramatic increase in the number of births the facility has been handling in recent years.
Alisha was able to conceive again, and this spring headed back to ARH.
“I knew that the only thing that was going to heal me was another baby,” she said. This time, with their own doctor at the helm and a hospital staff that seemed to have been made aware of the Mankatalas’ past, a healthy girl named Ariella was born.
“We didn’t get to hear him cry, so when we heard her cry, it was all kinds of emotion.”
She remains upset with how her previous delivery was handled, including the decision to not call in another obstetrician, the monitoring of her son’s heart rate, the fact the obstetrician leading the caesarean section left her operating room to deliver two other babies, and her care after the incident.
The College of Physicians and Surgeons formally criticized radiologist Dr. Shivani Gupta for not immediately making a phone call to report the low fetal heart rate found in the ultrasound. In her report, Gupta said the event occurred at a very busy time and that she documented the heart rate in writing.
While the college said the finding should have been “urgently” communicated, it said the lack of a phone call “did not result in a significant delay” in the obstetrician receiving the results.
The college found the actions of the obstetrician, Dr. Jason Kim, to be appropriate throughout the delivery. The decision that Alisha’s caesarean section could be delayed 30 minutes was found to be reasonable because a “reassuring fetal heart” rate had since been detected. In addition, the college “agreed with his decision that, practically speaking, this was the fastest route” to get the caesarean section completed.
Dr. Peter Beresford, Fraser Health’s head of obstetrics and gynecology, couldn’t speak about the specifics of the case for privacy reasons, but said: “I deeply regret their loss and am very sorry for their loss.”
Beresford said such incidents are rare, but that it’s important for health officials to investigate them.
The number of births taking place at ARH – around 2,600 babies were delivered last year – is now 73 per cent higher than the amount delivered in the final years of the MSA Hospital (which ARH replaced). ARH is a Level 2 centre, and that comes with more resources than the Level 1 MSA Hospital, but Beresford said Fraser Health is reviewing whether more obstetrics resources are needed at the hospital.
He said that review was initiated independently of the Mankatalas’ stillbirth.
Whereas MSA hospital had four to five obstetricians, ARH currently has six full-time obstetricians on staff, along with two part-time. The review will also look at the demand on ARH’s six operating rooms.
Beresford said it will “really put a lens on the potential difficulties we face.”
As for the issues raised by Mankatala’s case, Beresford – speaking generally – said communication is one of the key areas of focus for those looking to reduce risks in hospitals. Encouraging the share of information between members of a health care team is key, he said. And patients too should feel comfortable in speaking out.
“It’s really important that patients and their partners feel in control of what’s going on around them.”
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Alisha, who has taken issue with how Fraser Health – and Beresford himself – responded to her complaints, thinks more support is needed for parents who lose a baby. She says staff didn’t seem to know how to respond following the stillbirth, and while a social worker was called to discuss her mental health, she says she needed more information about the medical effects, including the arrival of her milk.
“I really hope that they have trained their staff on how to deal with these tragic cases,” she said. “They didn’t know what to do with me.”
Alisha also wishes the hospital had told her that it used a “CuddleCot” to cool stillborn babies and give families more time to say goodbye. Alisha saw Amari three times on the date of the stillbirth, but rejected an offer to see him again the next day, not knowing the CuddleCot was slowing after-death processes.
“I could have had more time with him,” she said.
Her main hope, though, is for Fraser Health to add resources to its obstetrics division. While the college report suggested that her baby’s stillborn death might not have been avoidable, Alisha strongly disagrees. She believes the actions of her doctors were driven by the number of patients those treating her were responsible for.
“Dr. Kim delivered three babies in less than 10 minutes,” she said. “There needs to be more money put into the health care system, especially in Abbotsford, because people are dying, because Fraser Health either don’t want to spend the money or they don’t have the money.
“The doctors are doing the best with what they have but it’s not enough.”
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