Concepcion came to Hospitalito at 8:30 AM. She had noticed onset of strong contractions at 4 AM but could not come to the hospital until she was able to get a ride from her village, Cerro de Oro (about 20 minutes from Hospitalito). When she arrived, at 8:30 AM, she was dilated to 5 cm and the baby was in a breech position. Concepcion also had a history of a previous Cesarean section in 2003. She was only 29 weeks pregnant and too early to deliver at Hospitalito.
Preparations were started to transfer to Guatemala City where there is a neonatal intensive care unit. She was given medicines to protect the babies brain, slow down the labor and help develop the babies lungs. After one hour she was 7 cm and it was felt it would be too risky to try to transport her for a 3 - 4 hour journey as she might deliver in the ambulance.
We then had to decide rather to proceed with a repeat cesarian or deliver vaginally. A cesarean would be the least traumatic to the baby but a 29 week newborn would probably not survive while a vaginal delivery would be the safest for mom. After consulting with a number of volunteer doctors and even a call to a good friend/obstetrician in the USA it was decided to proceed with a repeat Cesarean.
Brent performed the cesarean section with a visiting Obstetrician, Wayne Weber assisting and his son Nathan (an anesthesiologist) providing the spinal anesthesia. Baby Cecilia was delivered without difficulty with initial apgars of 3 and 6. Two other visiting doctors from Ventura, California, Drs. Lepore and Noah, helped to resuscitate Cecilia. Cecilia then began to have problems breathing and Dr. Nathan intubated and preparations were made to transfer to Guatemala City. Dr. Noah accompanied Cecelia for the 3 hour trip.
Cecelia returned to Hospitalito after 6 weeks on a ventilator and 2 months total in the Neonatal Intensive care unit in Guatemala City. She has a long ways to go but she already has come so far. She is gaining weight and developing well.