Dear Dr Brayley

We are contacting you once again regarding the increasingly urgent situation on
Nauru involving Dima Habboub, the 35+ weeks pregnant 37-year-old
primiparous woman who has a breech presentation on a background of at least
two miscarriages, at least one of which was on Nauru.
As you know, until recently pregnant women offshore were brought to deliver in
Australia, as was previously determined to be the safest option. However this lady
is told she should expect to deliver on Nauru, where the neonatal mortality rate is
30/1000 and that either or both a Caesarean section and External Cephalic
Version (ECV) are being considered. ECV in an Australian hospital would be
accompanied by the immediate (within five minutes) ability to proceed to
emergency Caesarean section, as in a significant percentage of cases there will be
an outcome which could necessitate Caesarean section.
We have discussed this case with Australian obstetric specialists who all agree
that she should definitely come to Australia for the delivery, cautioning that
elective breech vaginal deliveries have recently had some quite adverse outcomes
in Australia and that any ECV attempt should only be done by experienced
obstetricians in the presence of an operating theatre and team ready to proceed
to immediate Caesarean section and with appropriate neonatal expertise and
facilities on hand.
Compounding this already high-risk situation, Dima appears to be treated with
citalopram, without her knowledge or consent to the risk this presents to
the baby. As we have previously noted, citalopram is a Pregnancy Category C
medication. Possible effects on the newborn include persistent pulmonary
hypertension, respiratory distress, cyanosis, apnoea, seizures, temperature
instability, feeding difficulty, vomiting, hypoglycaemia, hypotonia, hypertonia,
hyperreflexia and tremor among others, indicating that her newborn would also
need to be immediately assessed by an experienced neonatologist.
We urge you as the CMO of DIBP and in your profession as a doctor to comply
with the RANZCOG standards and take urgent steps to ensure this woman is
brought to Australia immediately and receive the care she needs.
Time is obviously pressing in this situation, so we are grateful for your earliest
intervention.
I am available by email or phone today and over the weekend.
With thanks and kind regards,
Barri Phatarfod
Dr Barri Phatarfod
President
Doctors for Refugees