In the wake of the worst humanitarian disaster in years, post-earthquake Haiti could be one of the most hostile places on earth to give birth.
On Sunday morning, ABC News senior health and medical editor Dr. Richard Besser found himself faced with a woman in labor. She was 25 years old and a first-time mother, and she was going into labor in a park. Even in the best of circumstances, the relative lack of medical infrastructure in the tent city where Besser attended to the woman made dealing with such a case a challenge.
This, however, was not the best of circumstances. The baby appeared to be in what is known as a transverse position – one in which the baby is oriented with its back or shoulder toward the cervix instead of the head. A foul smelling, brown discharge had already emanated from the mother. And no movement or heartbeat could be immediately detected from the baby.
At 11:26 AM, using his BlackBerry, Besser contacted several obstetricians for advice in dealing with the problematic case. Dr. Jacques Moritz, director of gynecology at St. Luke's-Roosevelt Hospital in New York, was one of these experts. Moritz, who was in upstate New York for the weekend, responded to the call. And as Besser's texts revealed more and more information, Moritz said the situation quickly appeared to go from bad to worse.
"My fingers were kind of trembling on the BlackBerry," said Moritz, who in the past has provided medical services in Haiti. "Even if I had been there myself, it would have been a bad situation."
The foul-smelling discharge, Moritz said, indicated than an infection was possible, even likely. But more troubling was the reported orientation of the baby.
"In the transverse position, it is impossible to deliver vaginally," he said, adding that the only option would be to perform a c-section. "Without the medical ability to do a c-section... the baby would die in labor, and soon enough the mother would die."
The only hope would be to get to a hospital. And time was running short.
Haiti Dangerous for Mothers, Babies
Even before Tuesday's massive earthquake, statistics had shown that Haiti is a dangerous place to give birth. According to the United Nations Children's Fund (UNICEF), Haiti has the highest rate of infant, under-five and maternal mortality in the Western hemisphere.
Out of every 1,000 children born alive, 57 die before their first birthdays in Haiti. By comparison, in the United States the rate is 7 per 1,000. And according to the UNICEF's 2005 statistics, the maternal death rate stood at 670 deaths per 100,000 births -- a rate that puts it closer to countries in Sub-Saharan Africa than neighbors in the Americas. Just across the border in the Dominican Republic, only 150 women per 100,000 births die.
Other statistics are equally grim. A woman in Haiti has a 1 in 44 chance of dying from childbirth in her lifetime, according to the World Health Organization. The comparable statistic for the United States is 1 in 4,800.
Part of the problem may be that even in the best of times, medical resources may not be accessible to many Haitians.
"About 80 percent of the population delivers outside of the hospital on a good day [in Haiti]," Moritz said.
Past bouts with hurricanes and other crises have revealed that in times of crisis, these odds can get even worse. And even if a baby and mother survive childbirth, the odds can be stacked against infants. UNICEF has found that one in four babies in Haiti are born underweight, and only about half are fully immunized against diseases such as measles, polio, and whooping cough.
Dr. Ligia Peralta, associate professor of pediatrics at the University of Maryland School of Medicine in Baltimore, said that for most Haitian women who are delivering babies in the aftermath of this disaster, the prognosis is grim.
"Number one is the problem if premature delivery based on trauma," said Peralta, who herself has provided medical services in Haiti in the past. She added that these mothers may, in cases of natural disasters, already be injured. "Number two is going to be infection, which is very likely in this case."
And then there is the problem of maternal hemorrhage and bleeding in the course of delivery. With the Red Cross reporting shortages of medical supplies and equipment in the wake of the disaster, doctors on the ground may not have immediate access to even basic needs like sutures, sterile equipment and antibiotics.
Basic Medical Supply Shortage in Haiti Poses Problems
In the case of massive bleeding during childbirth, Peralta said, the mothers "should have some sutures; if that's not available, doctors will be unable to stop the bleeding mechanically.
"Also, if blood supplies are not available, it will be very difficult to deal with these situations," Peralta said. "You can have the best and most skilled, well-trained physicians, but without the necessary tools and antibiotics to prevent infection, it will be very difficult to have the best outcome."
Hope Amid a Disastrous Situation
By Sunday afternoon, Moritz received the first few hopeful e-mail messages from Besser of the day. He and the 25-year-old woman were in an ambulance, en route to an Israeli field hospital that was set up in a Port-au-Prince soccer field near the airport on Friday evening. There they met the team of Israeli doctors, nurses and paramedics who had at their disposal a pharmacy, a children's ward, a radiology department, an intensive care unit, an emergency room, two operating rooms, a surgical department, an internal department -- and most importantly, a maternity ward.
Even better news followed -- an ultrasound suggested that the baby was not only still alive, but oriented head-first, suggesting a likelihood of a normal, non-surgical delivery.
And shortly after 6:00 p.m. on Sunday evening, the baby -- a girl -- was born. She was born premature, at only 32 weeks gestation, and weighed only 3 pounds, 15 ounces.
And even though the greatest threats to her health may now have passed, she still faces an uphill battle; aside from having experienced slow growth in the womb, she was born with a leg problem.
But doctors expect the leg problems to heal. The mother is doing well, despite having experienced preeclampsia, a leading killer of pregant women in Haiti, shortly before giving birth. And when Besser spoke with the doctor who delivered the baby, he said that the earthquake, ironically, likely saved the lives of both baby and mother.
"He said that had she delivered at home, both the mother and baby would have died," Besser said.
Another baby was delivered at the same Israeli field hospital, which Besser said is "phenomenal" and has been up and running since Saturday. That grateful mother named her child Israel.