Читать книгу Baby for the Midwife - Fiona McArthur - Страница 12

ALONE and in charge of a labour, Georgia thought wryly. It had been a while.

She had a quick look through the two inpatient records to check there were no medications due and why the women had chosen to have Caesarean births. Both had had babies in the breech position and their doctor had suggested they not attempt vaginal deliveries.

She reminded herself to ask Max what his stance on that question was.

She picked up Mel’s chart and quickly scanned her previous labour and antenatal history, before tucking the chart under her arm and heading back to the labouring woman.

‘Hi, guys. How are you going in here?’

Tim looked a little more stressed and Mel’s smile had slipped. ‘It’s getting tough now,’ Mel said through clenched teeth, and the next contraction cut off her sentence as she began to rock and moan with the force of the pains.

When the contraction had eased, Georgia quickly checked Mel’s blood pressure, temperature and pulse, and then listened to the baby’s heart rate through the next contraction. All observations were normal and she documented the progress in the nurse’s notes.

When she’d finished she crossed to the cupboard where the large blue exercise ball was kept. Georgia rolled it across the floor to show Mel and Tim. ‘Would you like to try sitting on the ball in the shower for a change, Mel?’

‘I might fall off.’ Mel gave it a quick glance and shook her head. ‘The ball wasn’t here last time.’

Georgia rolled it around in front of herself and sat down on it to show Mel. She tried to move it with her hands while sitting on it and the ball didn’t budge. ‘It sticks to the floor and won’t roll away when you are on it, Mel. Balls are very safe.’

Mel frowned and then nodded that she understood.

Georgia went on. ‘Your legs must be tired. Sitting here will straighten your back and encourage the contractions to work straight down with gravity and onto the cervical opening to make the contractions achieve as much as they can, just like the position you are in now.’

Georgia studied Mel’s strained face and her instincts told her Mel would get some relief sitting for a while. ‘The position you’re in now has been great but you may benefit from a change of position, even if for a few minutes. It’s getting tough.’

‘Too right it’s getting tough.’ Mel glared at her husband and Georgia restrained her smile. When a woman began to express irritation towards her partner, it often meant good progress in labour.

‘You could take the ball into the shower and while you sit you could direct the heat of the water onto the area giving the most pain. You can sway from side to side too—all those things will give good relief from the pain.’

Tim grinned. ‘What a salesperson. Do you have shares in the company that sells birth balls?’

‘Absolutely. Have a go, Tim, and tell Mel if it feels safe.’

Tim lowered himself gingerly onto the ball and never looked in danger of rolling away. ‘I see what you mean about it sticking to the floor. If you don’t want the ball, Mel, I might sit here to rub your back. Mine feels better already.’

That was too much for Mel. ‘Get off. My turn.’

She sat, sighed into it as her back straightened, and smiled. ‘Ok. Let’s try the shower with this thing, then.’

Georgia wished that Max had been here to see that. Pain relief wasn’t always something you had to prescribe. She went ahead and turned on the water to warm and placed the ball in the corner of the shower room.

Two rails on the wall gave Mel safe purchase as she lowered herself onto the ball and when the handheld shower was directed onto her lower abdomen where the contractions hurt most, she sighed blissfully. ‘Oh, my. That is good.’

The next pain began and she pushed the nozzle close to her stomach, streaming the hot water across her abdomen. Georgia could see she’d gained relief from the change.

Georgia pulled the shower chair up behind Mel and gestured to Tim. ‘If you sit behind her like this you won’t get too wet and can rub her back firmly with your massager when she gets pain. Your back will get a rest, too.’

Tim settled himself and soon they were back into a rhythm.

Georgia could see they were getting close to the end of the first stage of labour and she quietly went back into the main room to ensure what she needed was ready. She toyed with the idea of phoning Max but held off until she had everything ready because sometimes the arrival of the doctor put pressure on the woman.

The baby resuscitation trolley was in the corner and she checked the oxygen and suction were both functioning, even though she didn’t expect to need either.

A green-draped trolley held a kidney dish, clamps, scissors and some sponges, and she turned back the bed for Mel and her baby to lie on afterwards.

A tray rested on the bench in case Mel bled too much after the birth. It contained the IV line and infusion and drugs they might need. She glanced around and couldn’t think of anything else she should prepare.

She went back into the bathroom. ‘So where do you want to have your baby, Mel?’

‘Don’t I have to have it on the bed?’

‘Not if you don’t want to.’ It amazed Georgia when women did not realise they had choices in birth position. ‘You can use the birth stool or stand up or kneel down. It doesn’t matter. Whichever you find the most comfortable.’

Mel glanced at Tim. ‘How about I use the stool for the pushing and maybe move to the bed if I want to at the last minute? I remember last time and it would be good if I could just lie back with our baby after the birth.’

She looked at Tim again and remembered some-thing. ‘And I don’t want the needle afterwards because I want Tim to cut the cord when it stops pulsating.’

Georgia nodded. ‘That’s fine. If your placenta doesn’t come on its own after half an hour or you bleed heavily, you might need the needle, though.’

Mel checked with Tim and he nodded. ‘That sounds OK,’ he said to Mel encouragingly.

‘Fine,’ Mel said.

Georgia handed her a bottle of water and a straw to sip with. ‘I’ll have the stool ready when you want to get out of the shower.’

‘Do I have to get out?’

Georgia laughed. ‘Not if you don’t want to. When you get to the pushing stage, you can swap the ball for the stool in the shower.’

‘Won’t the doctor mind?’

‘No, the doctor won’t mind.’ Max’s voice came from behind the bathroom door and they all looked up. Georgia felt that warm pleasure she was beginning to associate with Max’s presence.

His voice came again. ‘Hi, Mel. I’m Max Beresford, the doctor on call. Sister can come out when she’s ready and fill me in. You keep doing what you’re doing.’

Georgia and Mel exchanged smiles and Georgia slipped out of the door.

Max watched her shut it behind her. ‘Hello, Sister,’ he said. In his mind he said, hello you gorgeous thing. His stomach dropped as she smiled up at him. She looked incredible.

Her eyes were shining with anticipation and yet her movements were calm and unhurried and she exuded an aura of confidence in the natural progression of events.

He fancied her badly. The tension on his side was building every minute that he was with her. Over the last few, amazingly wonderful weeks in Byron they had become closer than ever.

He knew she still needed recovery time, and he needed to give her that to have any chance for her to trust herself fully to a man again—and he wanted that more than anything.

She was way too vulnerable to make any physical demands on, he could tell by her body language if he even brushed against her, and no matter how much he ached to hold her and make her his, she had to be the one to initiate any change in that.

He had to protect himself too because all he could see on her side was appreciation of the safe harbour he provided and he was becoming more fascinated every day.

Even knowing she would be at work today was distracting but worth the opportunity to see her during the day. He hadn’t been able to stay away once he’d known that it was Georgia’s first morning back at work.

She was looking at him with that tiny frown he wanted to smooth away with his fingers, and he pulled himself back into the present. She expected him to say something, not stand there like a goose. ‘So here I am. Were you going to call me at all?’

She looked at him quizzically. ‘Yes, Doctor.’

Maybe she wasn’t sure if he was serious so he smiled to reassure her.

‘Mel sounds fine. I’m here before I go into the rooms for my day patients. I’ve read your notes and you’re obviously happy with her progress and condition. Do you want me to say hello to her or just leave it until later?’

‘Would you mind popping your head in to say hi now? I don’t think she’ll be long anyway, and it’s better than meeting when the baby is here.’

Before Max could even open the door they heard Mel’s voice. ‘Georgia-a-a.’

Georgia stepped back into the bathroom and rested her hand on Mel’s shoulder. ‘It’s OK. What’s happening?’

‘In the middle of that pain I wanted to push, but the feeling has gone now.’

‘That’s fine. Each pain will probably give you that feeling for a longer time and then it will come to the stage when you won’t be able to do anything but push.’

Mel nodded.

Georgia went on. ‘It’s all good.’

Mel chewed her lip. ‘I remember I hated this part last time.’

‘That’s OK. You might have been scared because your body is taking over. Don’t hate it. Work with it and listen to your body.’

‘I’m trying.’

‘You’re doing amazingly well.’ Max’s quiet voice came from the door.

‘You can come in,’ Mel said with half a smile in the pause between contractions. ‘I really don’t care if the world’s in here and at least you can help me if I need it.’

They could hear the smile in Max’s voice. ‘Which you won’t as Georgia is there and you’re all doing so well. I won’t come in unless you or Sister call me.’

The pains increased their intensity and soon Mel was pushing gently with each urge. The next minute she looked up at Tim and glared at him. ‘I want to move. Get me out of the bathroom.’

That was a good sign. Georgia smiled as Tim almost fell over in his hurry to do what Mel asked. They stood and she moved between pains towards the bed. Mel looked up once as she passed Max and nodded to him.

‘Hi, Doctor,’ she said briefly.

By the time she’d eased herself back on the bed her baby was almost ready to be born, and Tim had paled to an interesting shade of alabaster.

‘That’s the way to do it, nice and slow.’ Georgia helped Mel lean back onto the beanbag and slipped her gloves on.

Max stood back and watched Georgia. She had it all under control, brilliantly. He’d suspected she would be a great midwife and the last few minutes had proved that.

Mel’s next pain came and with her steady breathing, the baby’s head crowned and then extended, until only the shoulders remained to be born.

When the first shoulder came through, Georgia guided Tim’s hands down and encouraged him to lift his own baby up onto Mel’s chest as he was born.

Max stared at the sight of a loving father’s hands lifting his son onto his wife’s breasts, and the pain seared him unexpectedly, like a blow torch in his chest.

He would never do that for his own child. He would probably never share such a look as Mel and Tim shared at that moment.

‘Oh my goodness,’ Tim said, as he stared down at his baby. ‘It’s a boy. I’ve got another son! My Billy.’ He swooped down to kiss Mel. She laughed up at him and they both had their hands on their new son.

‘There you go. Eight thirty-one a.m.’ Georgia checked the clock and then she looked at Max.

He smiled back at her but there was such a wealth of sadness behind his eyes that her breath caught and she wanted to comfort him for something she didn’t understand.

Then the look was gone as if it had never been. Maybe she had been mistaken and he was just tired.

Max moved to the baby and placed his stethoscope on the baby’s back to listen to his chest as he lay against his mother. He stepped back and nodded.

‘Baby sounds great. Congratulations, Mel and Tim.’

Georgia watched his gentle handling of baby and realised she knew so little of this man who was legally her husband and here they were together at such a special event and yet she still didn’t know what he was thinking.

Georgia glanced down at the thick shiny umbilical cord and suddenly a tiny gush of blood indicated probable separation from the uterus. They were ready to complete the final stage of labour.

If the placenta had sheared off from the uterine wall then it certainly wouldn’t have a pulse and Tim could cut the cord.

Georgia curved her fingers around the cord and gently squeezed the thick rope. ‘The cord has stopped pulsating, Mel. Is it OK for Tim to cut the cord now?’

Mel looked up. ‘Yes, that’s fine.’ She smiled at Georgia. ‘Isn’t our son beautiful?’

‘You are a very handsome man, Master Billy,’ she said to the baby, and then returned her attention to the job at hand.

‘I’m just sealing his umbilical cord with this little clamp and pinching another section a few inches down so Tim can cut between the two clamps.’ She looked up as she held out the scissors. ‘You ready, Tim?’

Tim nodded and took the scissors to saw away at the cord until it was severed. ‘Either the scissors are blunt or it’s pretty tough.’

They all laughed when the job was done and a few seconds later the third stage was complete.

‘No damage,’ Georgia said after a quick check down below, and she lifted out the disposable sheet from beneath Mel and tucked the warm blanket over her chest and the baby.

Max wandered over to the bench to start writing in the patient notes and Georgia checked Mel’s abdomen for a contracted uterus once more before pulling the blanket down and joining him.

Georgia frowned and checked again. Mel’s uterus was soft and spongy and not the hard ball she had expected. She lifted back the sheets and a sudden column of blood spread into a widening pool that seeped away underneath Mel onto the bed.

The blood didn’t just trickle, it flowed heavily in a serious postpartum haemorrhage that needed immediate treatment.

‘Max,’ Georgia said, and his head flicked up immediately at the tone of her voice. He crossed over to the bed and Georgia leant over and pressed the red button for help. Max already being there was a godsend, but they might need extra hands.

Georgia’s palm had gone straight to Mel’s abdomen again to rub the top of her uterus externally and make it clamp down on the bleeding. Max’s hand came in over hers.

‘I’ve got it.’ He rubbed Mel more firmly.

‘The uterus has no tone at all. Get me cannulas for IV access and I’ll slip them in.’

Georgia grabbed the tray from the bench and slid it onto the shelf beside the labour bed.

Max took one of Mel’s hands and slid the tourniquet Georgia handed him over her wrist. ‘Have to pop in a couple of needles so we can get a drip up. Sorry, sweetheart.’

Georgia picked up the injection tray she’d had prepared with the declined injection in it. ‘You get the needle now, Mel.’

Mel nodded. ‘I feel a little woozy.’

Georgia glanced at Max before speaking to Tim. ‘Gently pull two of her pillows out, Tim, so Mel can have her head lower.’ Tim moved the pillows and grew paler by the second as he watched the puddle of blood that filled the space on the bed below Mel’s waist.

‘Then can you rub Mel’s tummy here.’ Georgia took one of his hands and guided him to where the top of Mel’s uterus lay just above her umbilicus after the birth.

‘This feels like a squashy grapefruit and it should feel like a big hard lemon.’

She looked at Mel, who was clutching her baby with one hand as she tried to breathe calmly through her nose. ‘You won’t like Tim much for it but it is very important he rubs your tummy fairly firmly until the uterus contracts and stops the bleeding.’

She turned to Max. ‘OK if I give the first Syntocinon intramuscularly? I had it ready in case.’

‘Sure. Then check the placenta. Maybe there is a bit left behind that’s stopping her uterus from contracting properly.’ Max concentrated on finding Mel’s veins before she lost too much blood. Soon the lack of blood volume would make her veins collapse and it would be more difficult to find the blood vessel he needed.

Georgia explained to Tim, ‘I need to check the placenta to see there is none missing. Sometimes a small piece of placenta can stay behind and stop the uterus from fully clamping down on the rich blood vessel bed that it’s detached from.’

The nurses from the ward appeared and froze at the door, as if they didn’t want to come in. ‘I’m Flo,’ said one, and the other just stared worriedly at the blood.

Georgia smiled at them. ‘Come in, Flo. It’s OK. Maybe you could take over from Tim so he can help Mel hold the baby.’

Flo nodded and hurried to do as she’d been asked.

Georgia pointed at the tray and said to the second nurse, ‘Could you draw up four ampoules of the Syntocinon and put it into that flask for Doctor, please? That will help stop the bleeding. Then put another saline flask up to run as fast as it can through the other cannula to replace at least the volume of fluid Mel has lost.’

The nurse nodded and hastened to her tasks, obviously relieved that it was something she understood how to do.

Tim cradled his son and Georgia checked the placenta and then stripped off her gloves to check Mel’s observations. Max had the drip up as soon as it was loaded.

Still the haemorrhage continued and Max frowned as he looked across at Georgia. ‘Vital signs?’

Georgia didn’t like the persistence of this bleed and she was very glad Max had come when he had. ‘Her BP has fallen to eighty on forty and pulse rate is up to one thirty. I’ve some ergot here.’

‘Thanks. I’ll push it IV and see what we get.’

‘Mel?’ Tim’s voice startled them as he leaned over his wife. Mel’s face was ashen and her eyelids flickered but didn’t open when Tim called out.

Max had injected the drug and now he frowned as no immediate response was noted. ‘I’ll have to manually compress the uterus,’Max said. Thankfully, when he did bunch Mel’s uterus between his hands the bleeding slowed, though as soon as he removed his hand it started again.

‘Oxygen,’ Max said at the same time as Georgia passed him to reach the flip-down cupboards with the resuscitation equipment. She slipped the mask over Mel’s face and tilted the whole bed so that Mel’s feet were higher than her head.

‘I may need the Prostin F2 alpha,’ Max said quietly, and Georgia nodded and moved to prepare the syringe.

Not often used, the last drug was injected straight into the muscle of the uterus, which meant Max compressed Mel’s uterus against one hand and injected the medication with the other.

Within less than a minute the gushing blood slowed to a trickle and Georgia and Max looked at each other with ill-concealed relief.

‘Tricky,’ Max said.

‘Very, but that’s done it.’ Georgia breathed out with the reprieve and after checking Mel’s blood pressure even allowed herself a small smile.

Mel moaned and her eyes flickered open as Tim sagged with relief.

Max checked Mel’s abdomen again and her uterus finally remained well contracted. Max nodded and looked at Georgia. ‘Better.’

‘Thank you,’ he said to Flo, and he smiled to include the other nurse, who blushed and backed away. Then Max looked at his wife. ‘Well done, Georgia.’

He leant down and spoke to Mel’s abdomen. ‘Now, why did you do that?’

The tension lightened in the room and Mel roused enough to say in a weak voice, ‘What happened?’

Tim sighed with relief and then suddenly paled further, sighed and sagged sideways.

‘Grab the baby,’ Max called to Flo, who scooped Tim’s son from his arms as Tim fell back in a dead faint. Max caught the new dad easily under the arms before he hit the floor, and dragged him into a chair.

Max looked down at the ashen Tim. ‘Just to top it off, poor guy.’

‘Never a dull moment,’ Georgia said, as she carried a damp facecloth across to Tim, who stirred groggily as the blood returned to his brain.

By the time a sheepish Tim was sitting upright, Mel had recovered some of the colour in her face as well.

Max jotted down the sequence of events with times and then crossed the room to speak to Tim and Mel. ‘Unfortunately we probably will never know why your uterus decided not to contract after birth.’

‘Mel’s BP is back to ninety on fifty and her pulse is one twenty,’ Georgia said.

Max nodded and spoke to Tim. ‘Mel’s compensating for the lower volume of blood she has circulating now, but childbearing women have extra safeguards for the risk of bleeding after birth. We’ll check what her actual red cell levels are and think about blood transfusion or not and discuss it later.’

He smiled that smile Georgia really did love. ‘Everyone in the room has a pulse of one twenty at the moment but it’s all settling now. Mel’s uterus is firm and behaving itself and the bleeding has stopped.’

He spoke to Georgia. ‘We’ll run the drip over four hours to make sure it stays that way and keep her in this room for a while so we can keep an eye on her to ensure it doesn’t start again. But it shouldn’t.’

Mel spoke faintly from the bed. ‘So much for not having a needle. That was a bad choice.’

Max shook his head. ‘Not so. Don’t lay blame on anything in particular. Lots of people decline the needle after birth and though it statistically increases risk, it didn’t cause what happened.’

Max paused to let the words sink in. ‘Unless you have a history of bleeding! Now you have that history…’ he shrugged ruefully ‘… I think your choice is limited for the future.’

Bravo, Max. Georgia wished she could clap because she knew a lot of medical officers who would have ground Mel down for her choice. She would tell him so tonight. In fact, she couldn’t wait until dinner tonight and the chance for their first real discussion about a specialty of medicine they both obviously loved.

Baby Billy nudged at his mother and Georgia smiled. ‘Would you like a hand to put your son to the breast? During breastfeeding more hormones are released, which will help prevent further bleeding as well.’

When Billy was settled at the breast, Georgia and Max left the new parents to enjoy their son in peace after the traumatic events following the birth.

Max slipped his arm briefly around Georgia’s shoulders and hugged her before he dropped his arm to his side again. ‘We’re a good team. That could have been much worse if the F2 alpha hadn’t worked or you hadn’t been prepared.’ Max smiled down at Georgia and she nodded.

‘I was glad you’d dropped in when the floodgates opened. It’s always tricky to do everything at once when things go only slightly unplanned, let alone a full-blown PPH. I wouldn’t have enjoyed the stress while I waited for you.’

Max’s eyes softened. ‘Is it still good to be back at work when you have occasions like that?’

Georgia looked at him and nodded without any doubt. ‘When it all turns out as well as that did then, yes, of course. And the birth was lovely.’

His face clouded again and she put her hand on his arm. ‘What’s wrong?’

He smiled and she wondered if it was forced. ‘Nothing. I was very proud of you, my wife, in there. But now I’ll have to go to work and crunch some numbers around until you call me again.’

He patted her shoulder and just before he moved off he said, ‘Do ring me. Any excuse to get out of the office is gratefully accepted.’

‘Perhaps you could come back at lunchtime and check on Mel and share my sandwiches.’

‘Sounds like a plan.’ He smiled and waved and she watched him go.

He’d been a pleasure to work with and as cool as ice in an emergency. But, then, she’d known that since Elsa’s birth.

She was trying to ignore the fact that her heart had given a jump when she’d first heard his voice, and just watching him talk to Mel had made her so proud to think that for the moment, at least, he was her man.

She gave herself a little mental shake. She needed to think more about her work and less about Max.

That night at dinner it seemed the floodgates of work discussion opened. They’d never really discussed much about Max’s work but it was as if he’d finally decided he could talk to Georgia and she would not only understand but be deeply interested and have much to offer him in response.

‘I had no idea how much I missed the face-to-face obstetrics that I grew away from in administration.’

‘How could you not notice you’d left a clinical role?’ Georgia listened with her chin on her hands and watched the play of emotions cross Max’s handsome face. How had she come to be with this man? His kindness to her seemed to have no limits.

‘I started teaching.’ He shrugged. ‘And that always moves you back a pace as you encourage students to gain skills and be safe. The only way to impart that knowledge is to let them do it—which meant I didn’t.

‘That access to students meant people were always asking about change and why things were done in a certain way. Soon I was the person advocating change and fighting against the old school of habit.’

She smiled. He would be a good teacher. ‘That must have been satisfying.’

‘In its way it was,’ he said with a twitch of his lips, ‘but that pushed me further away from the births and into the boardrooms and medical committee meetings. Before I knew it, funding had become the big issue.’

She wouldn’t like that herself. ‘You must have been good at creating change?’

‘Maybe, but it is paradoxical that the more I see of grass-roots obstetrics the more I want to be part of it again.’

She could listen to him all night. She’d never had this. As an only child she’d never had a sister or brother she’d been able to really relate to and she’d never been close to Tayla.

Her loving parents had died together when she had just left her teens—too young to have really understood her mother yet old enough to see that true love was a worthwhile goal.

Her marriage, after the initial honeymoon period, had never included an equal partnership so any conversations had been dominated and directed by Sol.

With Max she felt she could dispute, digress or downright disagree, and her contribution would be appreciated. He must have felt the same because he stood up and held out his hand.

‘Come and sit with me for a while on the veranda. We’ll look over the ocean and check out the stars. It is a beautiful night.’

She took his hand and the feel of his fingers around hers as he helped her up made her realise she had never felt so relaxed and cared for by a man who had no expectations of her.