Angels with broken smile

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Tuesday, June 10, 2014

ENDURING a labor pain that is beyond comprehension, Melissa, 22 years of age, is agonizingly positioned on a cold delivery room table with legs spread apart and placed on stirrups.

Hours prior this, her bag-of-water had ruptured.

The painful feeling is described as insurmountable that ever grinds so slow considering that only a woman who is about to give birth could relate to this highly sensory experience.


Occasionally, she gets brief periods of rest from these painful episodes.
But most of the time, Melissa’s hideous facial expressions tell us of her tormenting tale.

With the obstetrician facing her stark naked womanhood; a midwife to assist in catching the baby; and nurses to monitor her vital signs, this may well be a typical scene in a delivery room.

Her obstetric history reveals that this is her fourth pregnancy. This is considerably high for a woman in her 22.

As her labor continued to advance, her pain was heightened as well. It was then the time that she started manifesting great agitation, increased restlessness and began crying her heart out like most laboring women do.

In a little while, the head of the baby was already bulging at her perineum. In obstetrics, we call this stage “crowning.”

As the head continue its way out, the midwife, with use of a clean piece of cloth, pressed over Melissa’s perineum to prevent laceration as much as possible.

A few more minutes and then the baby’s head was out facing down. In a swift, the obstetrician gently pulled the head downwards and then the rest of the baby’s body followed like a gel flowing out of a jar.

“Baby boy out, 11:20 p.m.,” called out the obstetrician. At the same time, the midwife cried out, “aguy, nay problema, doc” [Oh my, something’s wrong, doc].

It was then everybody realized that the baby had cleft lip and cleft palate.

“Bungi” [boo-ngi] in the vernacular, but cleft lip and cleft palate are two separate conditions that may coexist.

According to the ‘Nelson Textbook of Pediatrics,’ there are a variety of theories that explain cleft lip and cleft palate that all point out to one general truth: cleft lip results in failure of the middle nasal and maxillary processes to join and cleft palate represents a failure of the palate to fuse.

Furthermore, the incidence is one in every 750 births; more common among males and Asians; and most importantly, it is due to inherited genes.

As a matter of fact, it maintains that there is a 50 percent possibility of inheriting the genes that cause the cleft if either of the parents has it in the family.

Other sources claim that maternal drug exposure and a ‘syndrome- malformation complex’ are some possible causes.

Overall, this is considered a congenital deformity.

In a matter of seconds, the dilemma was now how to break this heart-wrecking news to the mother who took notice of the commotion among the medical staff.

By the time the obstetrician satisfied the curiosity of Melissa, the latter was in heart-breaking tears as she hugged her newborn, who was then placed near her breasts to foster early skin-to-skin contact and ideally, to initiate early breastfeeding.

It was as though the whole world has fallen apart.

Likewise, right there and then, she verbalized that most likely the cleft lip and cleft palate that her baby manifested was caused by her bad fall during her second trimester of pregnancy.

According to Melissa, during such a fall, she fell on her buttocks. But this is a gross misconception, which may be the mother’s attempt of rationalizing the deplorable experience as stated earlier in this column, genetic predispositions determine which baby acquires cleft lip and cleft palate.

As we probed further, we found out that she had a cousin who gave birth to a child with cleft and lip palate.

One source shares that a cleft lip can be detected by sonogram during fetal life.

In terms of management, surgery promises repair.

Some experts inform that earlier repair helps infant experience sucking, which is a necessity when feeding.

However, some medical experts are divided as to the right time of scheduling the surgical repair.

Some suggest delaying it in order to condition the newborn for the surgical experience.

Others promote immediate surgical intervention so that the newborn do not experience significant delays in his or her development.

In sum, the following are the complications of cleft lip and cleft palate: feeding problems; ear disease; socialization problems.
In the old days, German Doctor’s Hospital offered free surgical assistance.

Unfortunately, according to the nurse I have spoken with who used to work at German Hospital, the latter’s operating rooms and wards had shut down.
Fortunately, Northern Mindanao Medical Center continues to offer charitable services to children with broken smile.

Sources: Nelson Textbook of Pediatrics; Maternal & Child Health Nursing

Published in the Sun.Star Cagayan de Oro newspaper on June 10, 2014.


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