The Honourable Midwife. Lilian Darcy
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Pete took a deep breath, switched his focus quickly. Little Lucy McNichol was looking good now, better than he’d dared to hope. She was small, just over three pounds on the old scale, but after that initial, frightening hitch with her breathing, she seemed reasonably strong, and she’d even taken the breast.
Nell had said she thought the gestational age might be closer to thirty-five or thirty-six weeks, not the thirty-three he’d been working on. Patsy might have mistaken bleeding at the beginning of the pregnancy for a period, and he’d dated the baby on that basis. With the spread and position of the fibroids retarding growth, the ultrasound scan at seventeen weeks hadn’t contradicted those dates.
But now here was Rebecca Childer about to give birth, and Bronwyn thought her dates might be wrong in the other direction. With no accurate date of LMP—last menstrual period—and no ultrasound measurements, they were working purely on the measurement from pelvic bone to top of uterus.
‘Don’t be surprised if you get called back up here,’ he told Nell, as she stripped off gloves and mask and prepared to head back down to A and E. ‘We have another iffy pregnancy on hand.’
‘I’ll be back up here anyway as soon as I can, just to make sure Lucy’s doing as well as we think,’ she said. ‘I did hear a faint murmur over her heart, did I tell you? But, of course, that’s very common. I’ll let it go as long as her stats are good.’
‘It’s your call. She looked good to me, too.’
‘See you in a while.’ Nell went towards the lift.
‘Rebecca, how are you doing here?’ Pete asked his new patient, as he entered Delivery Room Two.
She didn’t answer, just gave him a hostile look which he shrugged off. If he hadn’t asked about her state, the look would have been just as grim. In the grip of a powerful contraction, she wasn’t enjoying herself at the moment.
As soon as the contraction was over, he gave her a manual exam. It wasn’t routine policy to do so in this department, but Rebecca wanted a progress report. He listened to the baby. Heartbeat was fine. Dilatation was almost complete. The head was nice and low, but small. He agreed with Bronwyn. This wasn’t a thirty-seven-weeker.
‘Have we got extra staff?’ he muttered to her.
‘Vanessa Gunn is coming in,’ Bronwyn answered. ‘Emma will go into Special Care, with back-up from Sue North in post-partum. We’ll juggle it.’
Rebecca moaned. ‘I’m not ready for this. Nobody said it would be this bad.’
‘You’re doing really well, Rebecca,’ Bronwyn told her.
‘Don’t give me that garbage…’
Pete listened to the heart again, and found that the rate was perceptibly slower. ‘Get Dr Cassidy up here again,’ he told Bronwyn. ‘We might not need her, but if we do, I don’t want to wait.’
‘What about Emma?’
‘Her, too, as long as the post-partum staff have got Lucy’s care covered.’
Rebecca groaned, half sat up and opened her legs. The head was already crowning, propelled forward by the action of the uterus. Contractions were coming without a pause in between. Rebecca strained again. They’d have a baby very soon…
‘OK,’ Nell said. ‘She’s stable. She’s good.’
Like Patsy, Rebecca had delivered a tiny girl, whom she’d named Alethea. It was an old-fashioned name, but it was pretty, Emma thought. She clung to this thought—that the baby’s name was pretty, that the baby was pretty—because the little creature had problems at the moment.
She’d needed intubation and she was on a respirator. It had taken Nell, Emma and Pete an hour to get her stabilised enough to move her to Special Care, and Nell, who’d actually thought that was ‘nice and fast’ under the circumstances, was still working over her with a severe frown on her face.
Pete had left to check on Patsy McNichol.
‘Oxygen saturation’s gone up,’ Nell said. ‘I like her heart rate. I like how quickly we got this done. I like most things.’
‘That’s good.’
‘For the moment. And I’m hoping we’ll get her off the respirator within the next couple of days.’
‘What’s worrying you, Nell?’ Emma said. She knew her friend well enough to realise there was something.
‘I don’t know.’ She shook her head, as if to clear swimming-pool water from her ears. ‘I think I’m hearing a murmur again.’
‘Lucy had one, too.’
‘I know. They’re so common in babies, especially early babies, and mostly they mean nothing. With Lucy, I wasn’t so concerned. Her dates were better, even though she was almost as small. A small baby delivered within a few weeks of term is almost always better off than a larger one delivered earlier.’
‘And this one wasn’t large, in any case.’
‘I know. Which worries me, too, because I don’t know why.’ Nell listened to the heartbeat again. ‘I don’t know whether to be concerned about this baby’s murmur either,’ she said. ‘Certainly want to get the rest of her stronger before we start worrying about her heart. Hey, Alethea? Do you support that plan, darling? You don’t want a whole lot more mucking around, do you?’
Her voice was soft and cooing as she addressed the motionless baby. Then she straightened and spoke to Emma again.
‘All indications are that the heart is working fine at the moment,’ she said. ‘If it wasn’t, her numbers wouldn’t look so good. If I keep hearing this, though, or if it changes, I’m going to do a couple of tests. Let me know if there are any indications that her heart isn’t doing its job.’
‘She’s premature…’ Emma said.
‘I’m guessing thirty-three or thirty-four weeks.’
‘So…Patent ductus arteriosus is a fairly common condition in premmies, isn’t it? Treatable, too.’
Emma knew that in a normal foetal heart, the ductus arteriosus was open. In a full-term baby, this vessel closed automatically at birth, as part of the heart’s almost miraculous shift from foetal circulation to the circulation pattern it sustains throughout its life. A premmie baby’s heart can’t always manage this shift on its own, however, and if the ductus remains open beyond early infancy, permanent heart damage could result. Fortunately, the condition could be monitored and treated if necessary.
‘If it’s that, and if the PDA doesn’t close on its own, there’s a drug we can use to encourage it,’ Nell agreed. ‘It doesn’t always work, and that’ll mean surgery.’
‘In Sydney.’
‘A few years ago, we’d have had no hope of handling a baby like this in Glenfallon at all, with or without the need for surgery. Even now, I wonder if we should be starting to look at arranging medivac transport.’
‘We’re a level two unit.’ Emma was a little defensive. ‘I’ve handled several thirty-four-weekers, and even a couple of younger ones whose mothers had their dates wrong, like this one did.’
‘Yes, I’m not kicking her out of here yet, am I, Alethea? There are no real danger signs, and it would be great if we could get her strong and well ourselves…but I still think Sydney’s on the cards.’
‘There’s no point in having the facilities to handle premmies here if we don’t use them to maximum potential,’ Emma said. ‘Thirty-four weeks is the cut-off, I know, but personally I’m trained to a higher level than that.’
‘True. And people get better at it if they practise. There are going to be a few of us practising on this baby.’
‘Don’t put it