* * *
Everything happened in the blink of an eye. One minute Viv was contemplating sitting down with her friend and finding out exactly how she could help him best.
The next second she was stripping off her comfortable PJs and yanking on a pair of the burgundy-coloured scrubs she kept in the top of her rucksack. She grabbed her matching soft shoes and ran across the grass, back towards the hospital.
Even though it was the middle of the night, every corridor was brightly lit. Vivienne followed the others. Lien was talking rapidly in Vietnamese and Duc was nodding. She tried to focus. She’d worked here a few times and had picked up a few phrases in Vietnamese. For a midwife they mainly comprised of ‘push’, ‘stop’ and ‘breathe’, but her brain was struggling to remember them right now.
Duc walked through to another room. Viv tried to keep track. She hadn’t familiarised herself completely with this place again. Between that, the jet-lag, and the overwhelming sweep of tiredness, she wasn’t firing on all cylinders. Thank goodness she’d had time to eat.
Her hands caught her hair and coiled it at the back of her neck, twisting it back on itself until it was anchored in place. Lien’s gaze caught hers. ‘Neat trick.’ She gave Viv an anxious smile.
Viv shrugged. ‘Years of people stealing my hair elastics. Had to improvise.’
The anxiousness of Lien’s smile made Viv’s stomach clench. Last time Viv had been here she’d been impressed by the relaxed nature of most of the deliveries at May Mắn Hospital. Hoa had very much believed in letting the woman take the lead for her labour—much like most of the midwife-led units back home—and Viv shared this philosophy. But right now? When there was a clinical emergency? Things were different. Now it was the job of the professionals to guide the woman and baby to the safest possible conclusion, and from the look on Lien’s face it was up to Viv to take the lead.
Duc pulled his T-shirt over his head, swapping it for a pale blue scrub top that he grabbed from the pile on a rack on the wall. Viv tried not to stare. But it had been a long time since she’d seen Duc in a state of semi-undress. His chiselled abs weren’t lost on her. She wasn’t blind. She pulled her eyes away just as Lien moved closer. ‘Do you want to come and meet our patient, Viv?’
Viv nodded. ‘Of course.’
Lien gave her a small smile as she pushed open a door. ‘I’ll introduce you.’
Lien gestured to the woman in the bed. There was another man with light brown hair by her bed. ‘This is Resta. She’s thirty-nine weeks, or thereabouts. Presented in labour with what appears to be shoulder dystocia. We have no prenatal history.’
Viv nodded. Because she’d worked here before with Duc she knew it wasn’t entirely unusual for women not to present for prenatal care.
Lien pointed to the other guy in the room. ‘My husband, Dr Joe Lennox.’
Joe was in position at the bottom of the bed, one hand cradling part of the baby’s head. He gave a quick glance up. ‘I hope you’re the cavalry,’ he said in a hushed voice, keeping his expression neutral, ‘because I’m no obstetrician and I’m out of options.’ His Glasgow accent was thick, and Viv immediately recognised the stress in his voice.
Viv drew in a breath. Shoulder dystocia. Every midwife and obstetrician’s nightmare. A baby whose shoulder got stuck and stopped the baby being delivered safely.
Viv looked around the room quickly, locating some gloves. ‘Would you like me to take a look?’
Joe nodded gratefully. ‘Please.’ Lien turned to the woman on the bed and spoke to her in Vietnamese, introducing Vivienne to her. There was no getting away from it, the woman looked exhausted and terrified. No wonder. Shoulder dystocia could rarely be predicted. Women typically got to the end of a long labour and once they’d delivered their baby’s head thought it was only a matter of minutes until it was all over.
Vivienne glanced around the room again, quickly taking note of the equipment available to her.
She took a deep breath. Lien and Joe were both doing their best to keep their faces neutral, but Joe had already told her this wasn’t his field. From what she’d gathered from Duc, this was nobody’s field right now at May Mắn Hospital.
Hoa was dead, and the other obstetrician who normally helped out was off sick, having just been diagnosed with breast cancer.
It looked like Vivienne was the total of midwifery and obstetric knowledge here.
She could see the baby’s head tight against the perineum. This wasn’t the first time she’d dealt with a shoulder dystocia. But usually a diagnosis was followed by hitting the emergency buzzer, with two other midwives, an anaesthetist and an obstetrician all rushing to assist.
Those people weren’t here now. It was her. It was just her.
Deep inside, part of her wanted to scream for this poor woman. She’d worked with Duc over the years, and she knew he was a good doctor. The absolute worst-case scenario here would be the Zavanelli manoeuvre, where they had to try and put the baby’s head back into the vagina and perform an emergency caesarean section. Duc was the only surgeon here. She doubted if he’d performed a caesarean section before but, if need be, she could talk him through it.
She pushed that thought away and tried not to think about it, taking a note of the time on the clock on the wall.
Viv moved automatically into midwife mode, reassuring her patient, even though she didn’t speak the language, and letting Lien or Duc take time to translate everything she said.
It was a stressful situation for everyone in the room. Joe and Lien were calm influences, moving smoothly and easily. They seemed to foresee each other’s actions. It was interesting to watch them work together.
Vivienne took charge. Assessing her patient. Directing her not to push. She attached a monitor to the baby that would alert her to any signs of distress.
‘Okay, folks,’ she said calmly. ‘We’re going to try a change of position. It’s called the McRoberts manoeuvre and it’s used in this condition to try and release the shoulder. What we really want to do is create some space in the pelvis, and we need to move mum and, sometimes, baby to do that.’
She gave Lien a nod, waiting for her to explain to Resta that they were going to help her to lie on her back and move her legs outwards and up towards her chest. As this was a delivery room there was no end on the bed and Vivienne could move easily to try and assist.
She kept her face completely neutral. ‘This entirely depends on the baby’s position. If it’s the anterior shoulder caught under the symphysis pubis, this tends to work.’
‘And if it’s not?’ Duc’s dark eyes met hers. He’d moved behind the patient, supporting her position.
Vivienne kept her voice calm and low. ‘If it’s both shoulders, they’ll be stuck under the pelvis brim and this won’t help. But this is where we start.’
She kept calm. Running through the mental checklist in her head. Waiting to see if the change of position would have any effect on the baby’s ability to be delivered. She was lucky. This baby wasn’t showing signs of distress. Yet.
After
