please don’t blame yourself. You’ve given it your best shot and that’s more than good enough.’
‘OK.’ But Mrs Harris still looked close to tears.
Ruby hugged her. ‘Hang on in there,’ she said. ‘It’s going to be fine.’
MRS HARRIS CAME in with her husband the next day for another attempt at the ECV. ‘I’ve been feeling a bit off, all day,’ she said. ‘I woke up in the middle of the night with a bit of a tummy-ache. Obviously I must’ve eaten something that didn’t agree with me last night.’
Or maybe, Ruby thought, it was something else causing that tummy-ache. She had a funny feeling about this—and her funny feelings were usually right.
‘Come and lie down, and I’ll examine you before we try the ECV again,’ she said.
Mrs Harris had just settled back against the bed when she grimaced. ‘Sorry. That was another twinge.’
Ruby examined her gently. ‘Has anyone mentioned Braxton-Hicks to you?’
‘The practice contractions, you mean?’
‘They’re the ones,’ Ruby said.
‘Yes—but I don’t think I’ve had any.’ Mrs Harris’s eyes widened. ‘Hang on—is that what the twinges mean? I’m having a practice contraction?’
‘Given that you’re three centimetres dilated,’ Ruby said, ‘then, actually, I think this is the real thing.’
‘But I’m only thirty-seven weeks! It’s too soon for the baby to be born.’ Mrs Harris bit her lip. ‘Do you think it was that ECV thing yesterday that’s caused this?’
‘Possibly. Or it could be that your baby’s just decided that his birthday’s going to be today,’ Ruby said with a smile. ‘Don’t worry about him being thirty-seven weeks. Not that many babies are born on their official due date—some are a couple of weeks before, and some are ten days or so late. By this stage your baby’s lungs are definitely mature enough to cope with being born.’
‘So will I have to have a section?’
‘Hopefully not,’ Ruby said cheerfully. ‘I’m just going to get someone to call Dr Webster for me. And I need to give you a scan to see exactly how the baby’s lying.’
‘Cold gel again?’ Mrs Harris asked ruefully.
‘I’m afraid so,’ Ruby said.
She came out of the cubicle and asked one of the auxiliary staff to find Ellis for her, then went back to see the Harrises and do the scan. She turned the screen so that the Harrises could see it. ‘And here we can see one baby getting ready to be born. His head’s tucked forward, just as I’d want it to be, and he’s in what we call the frank breech position—that’s the least complicated one, with his legs straight up in front of him.’
‘So I can try for a normal birth?’ Mrs Harris asked.
Ellis arrived in time to hear the question. ‘I examined you yesterday and I’m happy that your pelvis is big enough to cope with having the baby. He’s not too small, so there’s a lower risk of having problems with the cord; and he’s not too big, so he’s not going to get stuck. I’m happy with the position he’s in, with his head nicely tucked forward—so, yes, we can do this.’ He smiled. ‘As I said yesterday, I believe in keeping things natural as far as possible, so I’m not immediately going to say you’ll have to have an episiotomy and forceps to help you deliver. It might end up that way, but we’ll do our best to help you have the birth you want. Though I do want to remind you that if your labour doesn’t progress, any delays mean that the baby’s likely to be in distress and you’ll need to have a section. No heroics, OK?’
‘Agreed,’ Ian Harris said firmly.
‘Agreed,’ Mrs Harris said, though she didn’t sound quite so sure.
Ellis smiled at Ruby. ‘Dilation?’
‘Three centimetres.’
‘OK. It’s going to be a while yet before your baby arrives, so I’d suggest walking about a bit—the gravity will help him move down,’ Ellis said.
‘Would you mind very much if Coral—the trainee midwife you met yesterday—and one of the junior doctors came in to observe?’ Ruby asked.
‘No, that’s fine,’ Mrs Harris said. She squeezed her husband’s hand. ‘We’re going to have our baby today, Ian. I can’t believe it.’
It was a couple more hours before Mrs Harris was ready to start delivering the baby. Coral, the trainee midwife, and Lance, the new first-year doctor, came in to observe and Ruby introduced them both to the Harrises.
‘Being on your elbows and knees will be the most comfortable position for you, as well as being the most effective position for delivering the baby, because you can move about a bit,’ Ruby said. ‘And resting on your elbows rather than your hands will protect your wrists.’
‘Unless you really want an epidural, I’d recommend having either gas and air or pethidine as pain relief,’ Ellis added, ‘because an epidural will slow everything down.’
‘I don’t want a section,’ Mrs Harris said, ‘so I’ll manage with gas and air.’
‘Good on you,’ Ellis said.
‘The main thing to remember about a breech birth,’ Ruby explained to Coral and Lance, ‘is that you keep your hands off and be patient—you don’t want the mum clenching her muscles if you touch her.’
‘You intervene only if it’s clear that the baby needs help,’ Ellis said. ‘Which is why we’re using a foetal monitor to keep an eye on his heart rate.’
Ruby encouraged Mrs Harris to breathe through the contractions.
‘I can see the baby now,’ she said at last. ‘When you have the next contraction, I want you to give a nice big push for me.’
The baby’s buttocks arrived first, and then with the next contraction and the next push the back and shoulders were visible.
Ruby glanced at Ellis. As always when she delivered a baby with him, she noticed that he was almost misty-eyed. Ruby was, too; the moment a new life came into the world was so very special, and it was such a privilege to share it.
And Ellis was a particularly good doctor to work with; he was supportive, he listened to both the mum and the midwifery team, and he didn’t try to rush any of the mums straight to Theatre at the first sign of a complication.
At the next push, the baby’s legs came down.
‘Well done,’ Ruby said. ‘You’re doing just great. His legs are down, now. Keep breathing for me.’
The baby’s shoulders and arms came out next, and then Ruby glanced again at Ellis. At his nod, she moved into position, ready to catch the baby.
