maternal death

We had our first maternal death in close to two years in the hospital
yesterday, a fact which is remarkable in itself, although we did have a
second case about three months ago of a woman who died en route to the
hospital. Most hospitals in Zambia have maternal deaths approximately
every 2-3 months, so a stretch of 24 months is really exceptional and a
testament to good medical care over the past two years by our maternity
staff. Our case yesterday was a difficult one where the woman came in
talking and in labor; Dr. John was discussing tubal ligation with her,
turned away for a few minutes, and when he came back she was not
breathing and had no pulse. I got a call while working in the theater
that they needed a laryngoscope and someone to help, so I grabbed the
equipment to find John doing CPR on a blue patient in the dim light of a
60 watt bulb with about a dozen of the nursing students and nursing
staff standing around looking frightened and unsure of themselves. I
tried to intubate her without suction and was unable to see the cords, I
asked for a scalpel and after a couple of minutes was brought one; a
minute later we delivered the baby but it was dead as well. We managed
to get the suction working and intubated her and continued CPR for a few
minutes, but didn't manage to bring her back. I stitched up her wounds
while John went to talk to the family and the nursing staff helped to
clean up the mess of blood on the bed.
Today John and I had a discussion about doing the peri-mortem C-section
on the patient; it's one of the heroic measures that I've been taught in
emergency medicine but I had to admit that I had the thought about
whether it was the right thing to do -- possibly deliver the ninth baby
to a father without a mother, little funds for infant formula, probably
limited family support, and so forth. But I just couldn't be that
utilitarian in the situation without more information.
The father is a local elder in a nearby church; he was remarkably
phlegmatic about his wife and child's death. We will have a lot of
processing to do as a hospital staff about how we feel and if we could
have done anything differently.