Dear Dr BrayleyWe are contacting you once again regarding the increasingly urgent situation on Nauru involving Dima Habboub, the 35+ weeks’ regnant 3!"year"old rimiarous woman who has a breech resentation on a background o# at least two miscarriages, at least one o# which was on Nauru$%s you know, until recently regnant women o##shore were brought to deliver in %ustralia, as was reviously determined to be the sa#est otion$ However this ladyis told she should e&ect to deliver on Nauru, where the neonatal mortality rate is3'()''' and that either or both a *aesarean section and &ternal *ehalic ersion -*. are being considered$ * in an %ustralian hosital would be accomanied by the immediate -within #ive minutes. ability to roceed to emergency *aesarean section, as in a signi#icant ercentage o# cases there will bean outcome which could necessitate *aesarean section$We have discussed this case with %ustralian obstetric secialists who all agree that she should de#initely come to %ustralia #or the delivery, cautioning that elective breech vaginal deliveries have recently had some /uite adverse outcomesin %ustralia and that any * attemt should only be done by e&erienced obstetricians in the resence o# an oerating theatre and team ready to roceed to immediate *aesarean section and with aroriate neonatal e&ertise and #acilities on hand$*omounding this already high"risk situation, Dima aears to be treated with citaloram,
without her knowledge or consent to the risk this presents to the baby.
%s we have reviously noted, citaloram is a 0regnancy *ategory * medication$ 0ossible e##ects on the newborn include ersistent ulmonary hyertension, resiratory distress, cyanosis, anoea, sei1ures, temerature instability, #eeding di##iculty, vomiting, hyoglycaemia, hyotonia, hyertonia, hyerre#le&ia and tremor among others, indicating that her newborn would also need to be immediately assessed by an e&erienced neonatologist
.
We urge you as the *2 o# D4B0 and in your ro#ession as a doctor to comly with the %N6*7 standards and take urgent stes to ensure this woman is brought to %ustralia immediately and receive the care she needs$ 8ime is obviously ressing in this situation, so we are grate#ul #or your earliest intervention$4 am available by email or hone today and over the weekend$With thanks and kind regards, Barri 0hatar#od
Dr Barri PhatarfodPresidentDoctors for Refugees
