asked in a scandalised whisper. ‘As in our Assistant Head of Obstetrics?’
Ella winced. Was it so unlikely? ‘Yes.’
‘But... When?’
‘The night of the charity ball. We danced together. A lot. He drove me home. And we...’ She shrugged. ‘Well...’
‘I had no idea you even liked him.’
‘I’ve liked him since the moment I met him,’ Ella admitted. ‘But I never said anything because I always thought he was way out of my league.’
Annabelle scoffed. ‘You’re lovely, and anyone who says otherwise has me to answer to.’
‘But you know what the hospital gossip’s like. They say he only dates people a couple of times—and they’re usually tall, willowy women who look like models or movie stars. As in the opposite of me.’
‘You’re beautiful,’ Annabelle said loyally.
‘Thank you, but we both know I’m not Oliver’s type. I’m too short and too round. And he... Well.’ Ella had absolutely no idea how Oliver felt about her. He was being overprotective, but was that because of the baby?
‘So what are you going to do?’ Annabelle asked.
‘I’m still working that out,’ Ella admitted.
‘Is he going to support you?’
‘He’s pretty much driven me crazy—presenting me with a box of folic acid, telling me to cut back on my shifts...’
‘Ah. The protective male instinct coming out. And you sent him away with a flea in his ear?’
Ella nodded. ‘You know how hard I worked to get through my exams. I’m not going to give all that up now.’
‘So what do you want him to do?’
‘Be part of the baby’s life,’ Ella said promptly. ‘And not boss me about. Except I want him to be there because he wants to be there, not just because he thinks he ought to be there.’
‘What does he say?’ Annabelle asked.
‘It’s—’ But Ella didn’t get the chance to finish the conversation, because one of their colleagues came in, needing Annabelle to come and see a patient.
‘We’ll talk later,’ Annabelle promised, on her way out of the door. Except Ella had a busy shift, starting with a normal delivery and then one that turned complicated, so she didn’t have time to catch up with Annabelle.
Everything was fine in her second delivery; there were no signs of complications and no signs of distress as she monitored the baby.
But, as the mum started to push, Ella realised that she was having difficulty delivering the baby’s face and head. The classic sign of the baby having a ‘turtle neck’ told her exactly what the problem was: shoulder dystocia, meaning that the baby’s shoulder was stuck behind the mum’s pubic bone. And in the meantime it meant that the umbilical cord was squashed, so the baby had less oxygenated blood reaching her.
‘Sophie, I need you to stop pushing,’ Ella said calmly. She turned to the trainee midwife who was working with her. ‘Jennie, please can you go and find Charlie? Tell him we have a baby with shoulder dystocia, then get hold of whichever anaesthetist and neonatal specialist is on call and ask them to come here.’
‘What’s happening?’ Sophie asked, looking anxious.
‘Usually, after the baby’s head is born, the head and body turns sideways so the baby’s shoulders pass comfortably through your pelvis. But sometimes that doesn’t happen because the baby’s shoulder gets stuck behind your pubic bone,’ Ella explained. ‘That’s what’s happened here. So we need a bit of extra help to get the baby out safely, and that’s why I’ve asked our obstetrician to come in. There will be a few people coming into the room and it’ll seem crowded and a bit scary, but please try not to worry. We’re just being super-cautious and making sure that someone’s there immediately if we need them, though with any luck we won’t need any of them.’
‘Does this happen very often?’ Sophie asked, clearly in distress.
‘Maybe one in a hundred and fifty to one in two hundred births,’ Ella said. ‘Try not to worry, Sophie. I’ve seen this happen a few times before, and we can still deliver the baby normally—but right now I’m going to have to ask you to stop pushing and change your position a bit so we can get the baby’s shoulder unstuck and deliver her safely.’
‘Anything you say,’ Sophie said. ‘I just want my baby here safely.’ A tear trickled down her face.
‘I know.’ Ella squeezed her hand. ‘I promise you, it’s all going to be fine. Now, I want you to lie on your back, then wriggle down so your bum’s right at the very edge of the bed. Can you do that for me?’
‘I think so.’ Sophie panted a bit, clearly trying to hold back on pushing, and then moved down the bed according to Ella’s directions.
Charlie came in with Jennie, followed by the anaesthetist and neonatal specialist. Ella introduced everyone to Sophie. ‘Charlie, I want to try the McRoberts manoeuvre first,’ she said quietly. It was the most effective method of getting a baby’s shoulder unstuck, and would hopefully avoid Sophie having to have an emergency section.
‘That’s a sound decision,’ Charlie said as he quickly assessed the situation. ‘I’ve got another delivery, so if you’re confident with this I’ll leave you and the team. I’ll be in the birthing suite next door—my patient’s waters have just broken.
‘I’m good, Charlie,’ Ella said, then turned her attention back to Sophie as Charlie departed, leaving her to manage the birth.
‘Sophie, I’d like you to bend your knees and pull your legs back towards your tummy,’ Ella said. ‘Jennie’s here to help you. What that does is to change the angle of your spine and your pelvis and that gives the baby a little bit more room, and then hopefully we’ll be able to get her shoulder out a lot more easily. You’ll feel me pushing on your tummy—it shouldn’t hurt, just feel like pressure, so tell me straight away if it starts to hurt, OK?’
‘All right,’ Sophie said.
While Jennie helped move Sophie’s legs into position, Ella pressed on Sophie’s abdomen just above her pubic bone. It wasn’t quite enough to release the baby’s stuck shoulder, and she sighed inwardly. ‘Sophie, I’m afraid her shoulder’s still stuck. I’m going to need to give you an episiotomy to help me get the baby out.’
‘I don’t care,’ Sophie said, ‘as long as my baby’s all right.’
Which was what Ella was worried about. There was a risk of Sophie tearing and having a postpartum haemorrhage—but more worrying still was that the brachial plexus, a bundle of nerves in the baby’s shoulder and arm, could be stretched too much during the birth and be damaged.
‘OK. You’ll feel a sharp scratch as I give you some local anaesthetic,’ Ella said as she worked. ‘And you won’t feel the episiotomy at all.’ Swiftly, she made the incision and then finally managed to deliver the baby’s head.
