Giving Birth In Bangladesh – Appalling Apollo Hospital, Dhaka

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Daily blog of an Englishwoman (married to a Bangladeshi) living in Dhaka, Bangladesh…

Our beautiful daughter – Nina Emily Fouzia Chowdhoury was born at Dhaka Apollo Hospital on the 3rd September 2013.  Whilst our little family is now doing very well and we could not be happier with our new addition my birth experience here in Dhaka was not ideal.  I deliberately decided to postpone blogging the details so I could give a more balanced view now that my baby is thriving.

Nina in Mummy’s tummy

The first part of my labour story I guess starts on the evening of the 1st September when I stopped feeling baby’s usual kicks.  The next morning we decided to check things out so we made an unscheduled appointment with our consultant Dr Mrinal.  He put on the ultrasound and did a quick scan. Our baby’s heartbeat was loud and clear on the sound system but the doctor, in a serious face, told us that he wanted me to be admitted to “see if the baby is still alive”.   My husband and I were very confused as obviously we had just heard a firm heartbeat but our instinct at the time was to go with what the doctors were telling us as we were now anxious that our baby could be in immediate danger.   Whilst I was taken to the maternity ward and placed on foetal monitoring my husband was directed to the billing counter to pay a deposit for my hospital stay.

After the initial 40 minute test my baby’s heartbeat was normal but I was still finding it difficult to pick up her movements.  I was then taken for a full ultrasound. The screening doctor there initially told us that the baby was moving and seemed fine.  She calculated that our baby’s weight was around 2.3 kg and explained that she still had a way to go and would gain more before delivery.   We explained that I had been sent for a full ultrasound as our consultant felt an emergency c-section might be necessary due to my baby’s reduced movement.  Instantaneously this Doctor then did a U-turn and distanced herself from own assessment!  She then said she wanted to recheck the size of the baby and increased the baby’s approximate weight to 3.3kg.  She reassured me that actually my baby was ready to be born now (a complete back track on her initial assessment) and confirmed that Nina would be “good size and perfectly healthy”.  Of course my husband and I really did not know what to believe at this point and we were nervous as we knew that Nina had still four more weeks to go.

I was then returned to the ward and placed in my own room.  Later that morning we were informed by the nursing staff that Dr Mrinal had made the decision to deliver my baby the following day by c-section.  Dr Mrinal did not consult us or even advise us about this himself – he took the decision unilaterally and told the nursing staff to book the operating theater.  Again we were confused as the nursing staff were only able to tell us that our baby had scored “highly on the foetal assessment” but that the baby still needed to be delivered then next day.  My husband and I discussed the possibility of getting a second opinion or transferring hospitals but we rationalised that this consultant knew us best and that handing over the care at this late stage might not be best.  At the time we were very vulnerable and did not have much time to decide what to do.

During the afternoon of the 2nd September 2013 I started to feel my baby move and her movements returned to normal.  My husband and I tried to consult with Dr Mrinal during ward round and the medical team throughout the afternoon and evening to see if we could postpone delivery but I was repeatedly advised that my baby was now ready to be born at 36 weeks.  Among the medical team there was a strict hierarchy where the junior doctors and nursing staff were literally frightened of the consultant.  They failed to address or escalate our anxieties about a premature delivery and could only reiterate that our baby was full term.  Sadly I felt that the duty doctors did not understand or want to listen to what we were saying.  My husband and I were deeply anxious about the decision that had been made and we felt steamrolled into undergoing the procedure – there were certainly a lot of tears before I went down for surgery.   With hindsight we should have sought a second opinion though at the time we were vulnerable and frightened of losing our baby after the panic that had been instilled.

At 4.10pm on the 3rd September my baby daughter was born.  She was 2.5 kg in weight. Due to her prematurity our daughter required immediate special care in the neonatal care unit.  Our baby required immediate resuscitation and showed signs of respiratory distress.  She required 18 hours of oxygen support.

My baby had to be placed on gastric feeding at 20 hours of age and I was only able to attempt to breastfeed when she was two days old. Without our knowledge, consultation or consent our baby was placed on antibiotics via cannula for septic screening.   We were advised by the pediatric team that our baby was actually premature by five weeks and that Nina was in fact only 35 weeks gestation!  We were then told that these sorts of complications were expected where babies that are delivered that early!

It immediately materialised that Nina was not ready to be born after all.  Cleverly as soon as delivery had taken place Dr Mrinal took no interest in our baby or her condition as his role was now limited to monitoring my c-section scar/post-op recovery.  He was not prepared to discuss Nina’s prematurity, her admission into special care or our anxieties that this would happen.  It soon materialised that at in Apollo’s private health care system the obstetrics and gynecology department are a completely separate limb from the pediatric team who looked after Nina.  These different departments do not work together to ensure a positive outcome and there was certainly no inter-departmental working to collectively weigh up the risks of a premature delivery.  Instead the pediatric team at Apollo welcomed the premature delivery of our daughter with open arms as conveniently her special care boosted our hospital bill.  WE HAVE SINCE BEEN ADVISED BY OTHER OBSTETRICS AND GYNECOLOGICAL CONSULTANTS THAT THE TREATMENT PROPOSED BY APOLLO WAS UNNECESSARY, INAPPROPRIATE AND UNETHICAL.  We have since been told that the sound and reasonable practice would have been to monitor and reassess the situation on a routine basis once Nina’s movements had resumed.  Had Nina’s condition been truly life threatening there would not have been a 30 hour delay in her delivery.

Seeing my baby in the special care unit was extremely traumatising and I don’t think it is something we will ever forget for all the wrong reasons.   At the time we had trusted Apollo as a place of  clinical excellence but sadly Apollo are only interested in the unethical practice of maximising hospital bills at the cost of the suffering of a little new born and her parents. We hear that even the public healthcare sector of Bangladesh, which is not as fancy as these private, foreign owned hospitals, has been performing better. Indeed Bangladesh has been getting high scores in reducing infant and mother mortality during child birth although this has nothing to do with these fancy operators.

Breastfeeding

Breastfeeding was a struggle for me as some physiological problems meant that my baby had difficulty latching. The hospital was not able to provide support with lactation or with feeding issues in general.  My pediatrician Dr Istiaque refused to discuss using formula despite Nina’s low birth weight and inability to take breast milk.  During a follow up appointment six days later my daughter’s birth weight had slumped to 2.3 kg (she had lost 15% in weight) and the doctor still refused to discuss alternative feeding options.  Our stress levels were in overdrive at this point.

Other Challenges

Whilst some of the nursing staff were very kind during my hospital stay many did not speak good English.  Fortunately my husband’s first language is Bengali so was able to translate.  Those who did speak English often responded in Bengali so I sometimes felt removed from the whole process.

We found that there was no consultation process like in the UK – the doctors give their opinion and you either accept it or go elsewhere.

Apollo do not give you access to your child’s medical/feeding records and we were not permitted to attend ward rounds when our baby was in special care.

On the Neonatal Intensive Care Unit the medical team was very awkward around me.  I was frequently stared at – I assume because I looked different and perhaps the language barriers made them feel embarrassed.   This was deeply frustrating at a time when I really needed some emotional support. This was totally unexpected given that foreigners do frequent the hospital when in need

Fortunately my bad experience at Apollo is now a distant memory as I now have a happy, healthy 4 month old.  My husband and I are pursuing a complaint following our experiences and we have been proactive in warning family and friends about what happened.

If we are lucky enough to have another baby in the future I would decide to return to the UK for the pregnancy and birth.  I would certainly never return to Apollo.  More than the delivery experience itself I think I missed out on the wider support network that exists in the UK with antenatal care and home visits from midwives to carry out care in the community.  I think that childbirth in Bangladesh is much more of a clinical process though in my experience more extensive community support is provided here by large family networks rather than healthcare professionals.

Needless to say I also really missed my own family during this life changing time and I would not choose to “go it alone” next time.  As for other foreigners I have met in Dhaka – one or two have delivered their babies naturally in different private hospitals in Bangladesh with mixed experiences.  Most have delivered their second babies in Bangladesh after delivering the first back in their own countries.  Many foreigners and wealthier Bangladeshis also choose to deliver children overseas with popular choices being India and Thailand.

Finally I thought I would finish this post with a few recent and happy pictures of our daughter Nina who is a complete

 

 

nina2….imag2796

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