Baby for the Midwife. Fiona McArthur
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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,