Beth can’t stand up.
It hurts too much.
The warm bath helped her contractions, relaxed the ache in her back and fooled her into thinking things were calming down.
Her Mum’s on the landing with us, her kids downstairs in the living room – they waved Penfold and me down as we pulled into the street.
This is baby three, pregnancy three. She’s had no problems before, but her middle one was big and she ripped a little.
Other than that, the pregnancy’s been normal.
And still is.
When she contracts (which she’s doing every couple of minutes) I have a look at the business end. She’s on her hands and knees on the stairs which makes any kind of view tricky, though I’m confident it’s more comfortable for her. Beth is not a small lady and her size isn’t making my exam any more straightforward.
I make a little room with my hands and relax when I see that…nothing is happening. Nothing is stretching or bulging, everything is as it should be and where I’d expect it. The view isn’t great because we’re lit by a single dull bulb above us so I twist my torch on and balance it on a rolled up towel, pointing it where I need it.
“Right Beth, here’s what’s happening, ok? The baby’s not coming any time soon from what I can see, so we’re going to stand up and walk out to the ambulance. I’d sooner you were in the maternity suite than delivering here, right?
She nods, agrees and promises to do her best, but another contraction poleaxes her and has her face down on the stairs, crying. I encourage her to take more gas and air and rub her lower back while she moans, low and mournful. I’m reminded again of how very agricultural this whole delivery affair often is.
I give her a minute.
“After the next one, we’re moving, ok?”
She nods. Penfold picks up the gear and takes it out to the ambulance, main bag, paeds bag, maternity pack, oxygen, suction.
The contraction eases and I pull up Beth’s trackie bottoms, ready to help her to her feet when she screams and slumps back onto the steps.
“I know pet, c’mon, let’s go.”
She shakes her head, no.
“Nothing’s wrong, it’s just sore. Take the gas. We’ll go after this one.”
She sucks on gas greedily, stopping occasionally to cry. It’s hard to sob and inhale entonox at the same time.
“I need to go to the toilet…”
My heart sinks.
“A poo or a pee?”
This is never, ever good news for a patient to tell you. Heart attack patients often want a poo and, when they strain to pass the movement, their hearts stop. Women who are about to deliver their babies also feel the same pressure on their bowel. When the expectant mother shits herself? You shit yourself.
“Can you make it?”
She shakes her head and has an accident. Bizarrely, I don’t know what to do because of my training, but because I read “The SAS Survival Handbook” from cover to cover as a very strange and precocious 10 year old.
I grab some baby wipes from the bathroom behind us.
“I’ll just clean you up a bit, love, ok?”
“I’m sorry. That’s really embarassing.”
“This? THIS is embarassing? I’m currently pot-holing in your foof and the fact that you’ve done a poo is what’s embarassing you?”
I don’t say.
Instead I’m reassuring, pleasant, don’t worry love, it happens.
Empty platitudes because my head is shouting.
“She’s pooing! That’s a sign of imminent delivery!”
I take another look betyween her legs. Nothing.
“It’s coming…it’s coming,” she mutters at me.
I’m also remembering the “101 things paramedics have learned before you” jokes I’ve seen online. One of them included “When Mum says the baby is coming, you goddamn believe her.”
I’m an idiot.
“It’s not, Beth. Nothing’s happe……ohhhhhh!”
Because there, suddenly is a head of hair and a crumpled face. I stick my hands beneath the wee one’s shoulders as it delivers and support it down onto the floor.
I could weep.
The kid’s still in the membranes from the inside of the uterus and through the cloudy skin I see a pale, blue ghost of a face staring into the middle distance. At the same time the umbilical cord stretches, catches and rips. Not across itself but longitudinally, the rupture spinning down the length of the cord like an over stretched rope. Shining red arterial blood sprays in a mist from both ends.
Unresponsive baby in an airtight covering with an arterial bleed.
Who have I pissed off?
My left hand grabs the baby’s end of the split cord and I squeeze with my fist as tight as I can while the fingers on my right shred membrane and tissue away from…her…yes…her…congratulations, it’s a girl….away from her face. I grab a towel from the floor and rub her chest and belly with it.
She flexes her arms, opens her mouth and lets out her first utterance.
Her airway is plugged with fluid still, I can’t let go with one hand for fear she bleeds out through her cord.
He hares up the stairs behind me and takes in the scene.
“Oh shit! What do I do?”
I was wondering just that, pal.
“Open the pack and get me a cord clamp.”
He digs it open and snaps two plastic clips over the baby’s end of the cord.
“Now cut that, quick.”
He snips her away from her Mum with a stroke of scissors.
“Now get me the paeds resus bag. Go..GO!”
He legs it while I find an aspirator in the maternity pack and suck gunk and shite out of the back of the baby’s throat.
Rub rub rub.
She flexes, open her eyes and says.
Before flopping down again.
Penfold’s back and hooking an infant bag-valve-mask to an oxygen tank for me. I’m breathing for her in seconds, pushing harder than I normally would to force any excess fluid out of her lungs and into her blood stream.
“Why isn’t she crying?”
I’d completely forgotten about Mum.
“She’s not breathing very well, Beth. But we’ll deal with that.”
“You look after her, right?”
“Will do. Does she have a name yet?”
“Penfold – can you look after Beth? I’m going to take Emily into the next room.”
I want heat and light, I can’t resus a baby without the two of them but the house is dark and cool. Her heartbeat is audible through my stethofscope but muddled by the rattle of fluid in her lungs and airway.
This isn’t fair. I want her in a SCBU, not on the bedroom floor.
“Pen? Get us a second crew, at least one para, please.”
Because Beth is still my patient and there are all sorts of horrible complications that could still occur to her that would need attention.
Penfold, like a multitasking genius, handles making a call to control while catching a placenta in a yellow bucket. Meanwhile Emily has *almost* perked up, she’s still cold and pale on the edges, but at least she’s breathing for herself and when I flick her foot with my finger she grimaces and screams.
Beth at the bedroom door.
“How is she?”
“She’s ok…but she’s had a hard entrance to the world, ya know?”
“Can I hold her?”
“Of course you can, I’m going to keep this mask on her while you do?”
She reaches her arms out for her daughter and I tuck the two of them in together, unable to resist dropping an arm around Beth at the same time and giving her a squeeze.
She’s weeping, tears on Emily’s new face.
Voices and footsteps downstairs and the second crew arrive.
“Guys, this is Beth and Emily. Emily had some problems on arrival and I want to transport her now. I’m going to take her, can you sort Beth out and meet us at the hospital?”
Beth stares at me aghast.
“You’re taking her away?”
“I want her in hospital right now, honey.”
“Can I see her when we get there?”
“I’d hope so, yeah.”
She stares me down.
“You look after her.”
“Like she was my own, Beth, I swear it.”
Right now I feel like I’ve got a major stake in the wee girl anyway.
I snuggle Emily into my shirt where she wriggles once before shitting all over me. As we walk downstairs her brother, sister and granny kiss her in turn as we leave.
Penfold boots the vehicle down the motorway to the hospital while I sit in the back with the mask over Emily’s face, in turns singing to her and swearing at her.
“You made Kal shit himself, didn’t you? Now you just behave yourself, Madam, you hear that? I will be seriously pissed off with you if you try any more of your nonsense….”
It does nothing for her, but makes me feel better.
Half an hour later the four green suits are stood at the foot of the bed in the maternity suite, Beth and Emily cuddled up together.
Beth looks me in the eye.
I smile back and head off to the ambulance to exhale.