Medical emergencies: childbirth, and a traffic accident

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aruna

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Once again, friends, I need some advice.
In my current novel I run into two medical emergencies.

In one, a single mother is giving birth in a remote area of Guyana. She lives with grandparents in a house only accessible by boat, no electricity or running water. She can make it to a local hospital in the nearest town, which is about 40 minutes away, but that too is pretty remote; it does have an airfield connecting it to the capital Georgetown, but of course flights are irregular and it's small 6-seater planes. So a doctor could fly in if there's an emergency. The outcome is that I want the woman to die but the baby to survive. There would be a midwife or two at the hosptital and of course doctors but something goes wrong -- perhaps a "black-out" (power failure) and the generator (they would definitely have one) fails, or else it's just one of those things that the birth team is not up to, a bad position, too much bleeding and no blood -- or something, just as long as it's plausible and the (very young) mother dies.


The second emergency is a traffic accident in town involving a very young child, 3 years old. The child runs into traffic and is hit by a car. It's hit and miss for a few days, whether she'll live or not. She lives, but has permanent damage of some kind -- an ankle that never recovers, crushed limbs that can't be fixed, a permanent limp. Anything. Use your imagination! She goes to a private hospital and has good care, but nothing can correct it, not even sending her abroad. (She could possibly get good free treatment in Cuba). I just want the result to be something permanent, but not horrendously crippling. (Just enough to make someone feel guilty for life for not watching the child better!)

Hope one of you experts can help! I always enjoy your suggestions.
 

Maryn

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I'm sure the medical people will chime in with more accurate information than I have, but I know two women who suffered strokes during delivery--and strokes untreated can lead to death. There's some drug that, if administered within a few hours, minimizes the permanent damage, but would a rural hospital have it? Or maybe she dies of her stroke or hemorrhage during the boat trip to the hospital but the baby is still alive and they get her out in time.

Again, no direct medical knowledge, but I understand crush-type injuries may not be repairable in the best of circumstances. Maybe she has a useless arm or walks with a limp and cannot run, something like that.

Maryn, not sure what best serves your story
 

talktidy

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I have no medical training whatsoever, but I remember watching a history documentary on the telly. I can't quite remember which royal it was now -- Princess Charlotte, maybe? -- anyway the point is that there was a massive haemorrhage during her labour, and the 21st century obstetrician, wheeled out for comment, pointed out that even in our modern era, a bleed like that could be touch and go for the mother.

Don't know if that would work for you, because the poor woman's baby died as well and I have not the knowledge to understand whether the baby could have been saved.
 
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lonestarlibrarian

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Is your single mother on her first birth? Or is the current birth her first birth? Is she a city girl with no clue about life, or is she indigenous? Why are her grandparents not a factor in helping her? Or whatever community exists in their remote area? In most cultures, there's a certain amount of... custom? community? support? ...that springs up around both birth and death, and so having someone be isolated and cut off from assistance with their birth is going to be very jarring if there isn't an underlying reason.

If she's been down this road before, she should have a basic idea of what to do. If she has a support network of friends and family, this is what they come together to handle. If she has no clue about what to do, you need to explain why she hasn't gone to the city a week or two before her EDD and stayed at a hotel so that she can check herself into the hospital when contractions start. But in some countries to this day, it's normal for a woman to get up, go to work in the fields, pause long enough to give birth, and then get back to work, la dee da, another day.

It's okay to kill off your mom, but anyone who's ever had a child is going to have a frame of reference for how they approached childbirth, and judge your character against it. If she has an easy pregnancy, they're going to wonder why she had nine months to prepare for childbirth and somehow made a slew of poor decisions. If she had a difficult pregnancy, they're going to wonder why she had nine months to prepare for childbirth and somehow made a slew of poor decisions. Rather than distracting your readers with "My gracious, has she no brains???!" it would be helpful to keep in mind that childbearing is a normal part of life, and people have managed it for thousands of years (and still continue to manage it!) without all the latest and greatest.

If you look back to, say, Victorian times, a lot of maternal mortality came after the birth itself, rather than during it. You can look up "puerperal fever", aka postpartum sepsis, which is an infection that's contracted during childbearing, but nowadays is most often associated with C-sections. There can be hemorrhage (C-sections are also an increased risk factor). There can be eclampsia (aka high blood pressure/organ damage). There can be obstructed labor, although that often results in the death of the baby as well.

But rather than approaching things from the "medical disaster, and the limited technology of that poor remote area was just not enough to save her!!!" direction, I'd be more likely to enjoy a book where it's, "oh, it's just one of those sad things that happens sometimes, and there was nothing anyone could do" kind of approach. I'd probably pick the postpartum hemorrhage--- you get the normal pregnancy, you get the normal childbirth, you think everything's okay, but oh no...
 

aruna

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Thanks all, and I think I'll go with the hemorrhage.
Lonestar: She's a rural girl and it's her first birth. I don't think there would be any negligence or blame involved, as it would be normal for such a girl to act as she does -- there is no reason to expect complications. Yes, her grandparents do support her. They would take childbirth as just a normal part of life, as you say. Rural people in Guyana tend to be very laid back about such natural processes! Home births would be common, with just a midwife attending, but in this case the hospital is necessary.
 

aruna

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Thanks all, and I think I'll go with the hemorrhage.<br>Lonestar: She's a rural girl and it's her first birth. I don't think there would be any negligence or blame involved, as it would be normal for such a girl to act as she does -- there is no reason to expect complications. Yes, her grandparents do support her. They would take childbirth as just a normal part of life, as you say. Rural people in Guyana tend to be very laid back about such natural processes! Home births would be common, with just a midwife attending, but in this case the hospital is necessary.
 

aruna

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Thanks all, and I think I'll go with the hemorrhage.

Is your single mother on her first birth? Why are her grandparents not a factor in helping her?

Yes, her first birth, and her grandparents are a factor -- they bring her by boat to the town!

Or whatever community exists in their remote area? In most cultures, there's a certain amount of... custom?

Normal in this area might be a midwife, and home births.

community? support?

No community. They live by themselves on the river.

.that springs up around both birth and death, and so having someone be isolated and cut off from assistance with their birth is going to be very jarring if there isn't an underlying reason.

If she's been down this road before, she should have a basic idea of what to do. If she has a support network of friends and family, this is what they come together to handle. If she has no clue about what to do, you need to explain why she hasn't gone to the city a week or two before her EDD and stayed at a hotel so that she can check herself into the hospital when contractions start.

All of this is explained in the novel (There isn't a city)



It's okay to kill off your mom, but anyone who's ever had a child is going to have a frame of reference for how they approached childbirth, and judge your character against it. If she has an easy pregnancy, they're going to wonder why she had nine months to prepare for childbirth and somehow made a slew of poor decisions. If she had a difficult pregnancy, they're going to wonder why she had nine months to prepare for childbirth and somehow made a slew of poor decisions. Rather than distracting your readers with "My gracious, has she no brains???!" it would be helpful to keep in mind that childbearing is a normal part of life, and people have managed it for thousands of years (and still continue to manage it!) with

Indeed! I have had two children without much fanfare or anesthetic, including a home birthl


But rather than approaching things from the "medical disaster, and the limited technology of that poor remote area was just not enough to save her!!!" direction, I'd be more likely to enjoy a book where it's, "oh, it's just one of those sad things that happens sometimes, and there was nothing anyone could do" kind of approach. I'd probably pick the postpartum hemorrhage--- you get the normal pregnancy, you get the normal childbirth, you think everything's okay, but oh no...

Yes -- it's just one of those things. It's just that she has to die for plot purposes.
Thanks for your input!
 

lonestarlibrarian

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(heart) Cool beans! I'm sorry if I came off as harsh... but I definitely noticed I started reading those sorts of medical-emergency-pregnancy scenarios a lot more critically after I had kids, than before, and many books were (figuratively) thrown across the room. :)

re: permanent damage, perhaps she needs something amputated, or she ends up with disfiguring scars that she never grows out of. A head injury/brain injury might incapacitate her ability to think clearly/sharply, and she might be always a bit slower than everyone else... and picked on because of it. Or she might end up with permanently slurred speech.
 

LarsonFan

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Once again, friends, I need some advice.
In my current novel I run into two medical emergencies.

In one, a single mother is giving birth in a remote area of Guyana. She lives with grandparents in a house only accessible by boat, no electricity or running water. She can make it to a local hospital in the nearest town, which is about 40 minutes away, but that too is pretty remote; it does have an airfield connecting it to the capital Georgetown, but of course flights are irregular and it's small 6-seater planes. So a doctor could fly in if there's an emergency. The outcome is that I want the woman to die but the baby to survive. There would be a midwife or two at the hosptital and of course doctors but something goes wrong -- perhaps a "black-out" (power failure) and the generator (they would definitely have one) fails, or else it's just one of those things that the birth team is not up to, a bad position, too much bleeding and no blood -- or something, just as long as it's plausible and the (very young) mother dies.


Unfortunately maternal mortality rates are high enough that there doesn't have to be anything dramatic for a woman die as a result of child birth. A very common cause of death is eclampsia and preeclampsia, which is a rapid rise in blood pressure that can cause cerebral blleding, seizures along with clotting problems that can cause strokes, as well as pulmonary edema. This isn't my area of expertise, but my understanding is that delivery of the child is treated as the cure for preeclampsia, but sometimes it doesn't happen fast enough. This isn't my specialty, but far too many women die in child birth.


T
he second emergency is a traffic accident in town involving a very young child, 3 years old. The child runs into traffic and is hit by a car. It's hit and miss for a few days, whether she'll live or not. She lives, but has permanent damage of some kind -- an ankle that never recovers, crushed limbs that can't be fixed, a permanent limp. Anything. Use your imagination! She goes to a private hospital and has good care, but nothing can correct it, not even sending her abroad. (She could possibly get good free treatment in Cuba). I just want the result to be something permanent, but not horrendously crippling. (Just enough to make someone feel guilty for life for not watching the child better!)

Hope one of you experts can help! I always enjoy your suggestions.

Okay, this is closer to my expertise, I don't work with kids but I do currently work in trauma at a regional trauma center. My suggestion would be some sort of spinal cord injury, with that sort of thing rehab can maximize your mobility, but there's not a lot to be done other than fixing the bone. There's such a range of injuries that the life long side effects could be anything from walking with a slight limp to needing a cane, wheelchair or ventilation for the rest of your life.
 

aruna

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Sorry for the multiple posts! AW was getting sticky and not freezing so I posted and reposted and then -- this happened!
Thanks to all your contributions, very helpful.
 
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