‘What is your usual procedure with a page? Do you phone in?’
‘I would if I was at home, but we’re only minutes away now, so I’ll be there almost as soon as a phone call. The specialist on night duty must have his hands full for A and E to be paging me.’
They crossed the road and she led the way through a back entrance into the emergency department, lobbing her small backpack onto a shelf behind a manned desk by the door and grabbing a folded scrub suit to pull on over her clothing.
Then, as she thrust her arms into the sleeves, she turned towards him and smiled.
‘Well, get yourself ready. We’re on!’
Her smile wasn’t at all forthright. It was sweet, and slightly shy, as if unrelated to her confident manner and brisk words.
He glanced towards her, hoping she’d smile again, but she was talking to the nurse behind the desk, explaining about the page.
‘Oh, it must be the woman in the car they want you for,’ the nurse said. ‘Her husband’s driven into the laundry bay out the back. Let me check.’ She leafed through some notes on her desk then explained, ‘Full term, breech presentation, feet already out.’
‘At least someone had the sense not to try to move her,’ Marty replied, then she turned to Carlos. ‘Out this way. Have you delivered a breech? Normally it would have been picked up in prenatal care but a lot of women still don’t bother with it—or with much of it. When they present here in early labour and we realise it’s a breech, we’d do an ultrasound to work out foetal weight, a flat-plate abdomen X-ray to determine if the head is normally flexed or hyper-extended, and we’d do a clinical evaluation of the woman’s pelvis. Quite often, if there’s time, we can turn the baby. If the baby’s too big, or the pelvis is too small, or the head is in the wrong position, we’d consider a Caesar, but with the legs, and by now possibly the body, already delivered, we have to go ahead with a vaginal delivery.’
‘I remember the danger in a breech is in the delivery of the head, but you will do this in the car?’
She was snapping on a pair of gloves, but she smiled again, as if pleased he knew that much.
‘I imagine if you’re doing it back in Sudan it could be in far worse circumstances than the back of a car.’
‘Sometimes,’ he conceded, ‘although where I work there is now a hospital of sorts—the people themselves built it for me, with a thatched roof and mud brick walls, and the people are accepting it and coming if they need help.’
They reached the car and found a nurse kneeling at the open rear door, with a wheelchair, a gurney and several onlookers clustered nearby. The nurse stood up to make room for Marty.
‘FHR is strong, the feet showed then retracted but are well out now. I know theoretically about gentle traction on the feet, legs and pelvis in a breech delivery, but what’s gentle?’
She introduced Marty to the woman and her husband.
‘You’ve done just fine,’ Marty assured the nurse, squatting down so she could say hello to the woman and introduce Carlos, explaining who they both were and what she had to do, then taking hold of the protruding legs and body and slipping the forefinger of her left hand along the baby’s back so she could rotate his torso while his shoulders came free.
‘It’s a gentle pressure,’ she explained to Carlos. ‘We wait for a contraction, then use a finger to get the shoulder blades free. You’re doing really well,’ she added to the mother. ‘This isn’t your first?’
‘It’s her fifth,’ the father replied. ‘We had all the others at home but this was a new midwife and she felt the baby was in the wrong position and couldn’t turn it so told us to come to the hospital, then, while we were stopped at traffic lights, this happened. My wife had to push and I saw the feet!’
‘They’ll both be fine,’ Marty assured the man, who had obviously been prepared to deliver his child head first but had panicked at seeing feet. She was also reassured herself. After four children the woman’s pelvimetry should be flexible enough to expand to release the head. She turned her attention back to the labouring woman. ‘You’re the boss, so we’ll wait until you’re ready to push again then rotate him so his arms follow each other out.’
She turned to check the instrument tray, seeing the Piper forceps on it, should she need them to help deliver the head. She’d prefer not to, but if the baby’s head was hyper-extended, they’d definitely be needed.
‘Now,’ the woman gasped, while her husband, who was supporting her, leaned forward over her labouring body to see what was happening.
The arms came free and Marty continued with her instructions to Carlos who stood, bent almost double, beside her.
‘Now, with two hands, the left one underneath, you use your forefinger again, only this time you slip it into his mouth to keep his head flexed. Then with the next contraction, we pull down, then lift and pull at the same time. Wait for the push, then—bingo! One brave little boy comes backwards into the world.’
She held him while the nurse wiped his face and gently suctioned his nose and mouth, then handed the baby, who was squalling lustily, to the mother, took a soft towel from the nurse to cover him, then helped move mother and child to a wheelchair so she and the infant could be formally admitted to hospital.
‘You don’t do an Apgar score straight away?’ Carlos asked, and, still smiling about the successful delivery, she turned towards him.
‘He cried—that’s enough for me. As far as I’m concerned, it’s more important for his mother to hold him—to see for herself that he’s OK. We’ll still get the first Apgar done within a minute—or pretty close to it. Then another at five minutes, but, really, with healthy babies that’s stuff to put on charts.’
Their patient was wheeled into one of the trauma rooms in A and E to await the third stage of her labour, and for her new son to be checked out and his birth documented for posterity. But first things first. Marty clamped the cord in two places then handed a pair of surgical scissors to the father so he could cut the cord.
‘A son!’ the man said, touching the cheek of the baby who was held to his wife’s breast.
‘A son!’ Marty heard Carlos echo, and, turning, saw a look of wonder in his eyes, and although she experienced this same sense of miracle each and every time a new child was born, she had to wonder if he would have felt differently towards Emmaline if he’d been present at her birth.
Or if she’d been a boy?
‘Please, no drugs,’ the woman said, as Marty gently massaged her abdomen to encourage expulsion of the placenta.
‘Providing everything is OK, I’ll go along with that,’ Marty assured her. ‘But you’ve had a difficult labour and there could be damage to the uterine wall. I won’t make any promises at this stage.’
The woman seemed satisfied with this, though it was with reluctance she gave up the baby to be checked, weighed, cleaned and dressed.
‘A fine little boy,’ Carlos said, when the woman had been admitted—for observation only, Marty had assured her—and the two of them were having a cup of coffee in the staffroom.
The
