The Desert Midwife

by Fiona McArthur

A few minutes later, Jill returned with the emergency birthing kit and an injection drawn up to give after the birth. Ava flashed her an appreciative smile. They certainly didn’t want a post-partum haemorrhage.

  ‘It’s coming,’ Jessamine gasped as the baby’s body gradually appeared with the help of gravity and the mother’s pushing.

  In slow slides, centimetre by centimetre, the baby’s hip descended. Denise’s eyes grew huge and even Jill looked incredulous. It became apparent that Jessamine’s dream about a new male in the family was right as a tiny scrotum swung into view. Her man would be pleased.

  ‘Let the legs come themselves,’ Ava murmured to Zac, even as she privately thought, It’s so hard not to flick those legs out! She was mindful of the words of her recent instructors and explained quietly to Zac, ‘While the legs are folded inside the mother, they’re stretching everything for the head. If the legs are flicked out too early, the birth canal misses out on the extra stretching that helps the rapid descent of the head.’

  He nodded. ‘Sensible.’

  As Zac hovered, and Jill scurried away and came back with a warmed towel to wrap around the baby, first one and then the other of the baby’s legs dropped down, all by themselves, so that the curve of the baby’s belly and a stretched part of the umbilical cord appeared.

  She spoke to Jessamine, but she was really talking to Zac. ‘Same for the cord. People used to ease that loop of cord out to save strain on it, but now we’re taught to leave it in case we cause a spasm in it.’

  ‘Got it,’ he said and they smiled at each other, both aware of how amazing the natural birth occurring in front of them was.

  They watched a section of the slippery rope tumble out of the birth canal. Ava chanted to herself, Wait. Wait. All she needed to do was wait.

  In fact, it all made beautiful sense to let the baby drive the birth. With progress this smooth, it would go well as long as she didn’t interfere and startle the baby into lifting his chin and interrupting the curve of his spine.

  Ava continued speaking softly to Zac. ‘See that dip between the baby’s nipples on the chest wall? See the space it makes for the cord to sit protected? Isn’t that wonderful.’ The little pale chest and legs hung between the mother’s buttocks, and slowly the tiny calves and thighs began to jiggle, as if the tiny human inside his mother had decided to slowly ride an invisible unicycle.

  ‘Will you look at that.’ Denise’s awed voice floated across in a whisper.

  Jessamine moaned.

  ‘He’s moving his legs to help him come down,’ Ava murmured to Jessamine. ‘That’s what you can feel. Soon he’ll be sitting on the ground under you, so let me know if you want to move.’

  ‘I ain’t goin’ nowhere,’ Jessamine ground out.

  With the baby doing his circus act, first one arm and shoulder appeared and then the other. Now there was only the head to come. The baby was sitting almost cross-legged under his mother, until suddenly his chin dipped forward and Ava had to lean over quickly to catch him before he fell face first onto the towel. ‘Spontaneous breech birth,’ she announced, wanting to laugh with the exhilaration of it all. Instead she asked, ‘Born at?’

  Zac made a noise. ‘Good catch,’ he said with an exultant note in his voice. He took the warmed towel from Jill and rubbed the baby firmly until the little boy screwed up his face and roared with disapproval.

  ‘Born three thirty-one,’ Jill intoned as if they were in a normal birthing suite, and they all sighed out at the same time. ‘Will I give the injection?’

  ‘Wait.’ Something wasn’t quite right, though Ava wasn’t sure exactly what it was. She hadn’t had a chance to feel Jessamine’s uterus and she knew the young mum hadn’t had a lot of obstetric care. This baby seemed too small for the size of his mother’s belly. While she thought about it, she allowed a minute for the extra blood from the placenta to flow into the baby. Anaemia could be a problem for some outback and especially Indigenous babies if the mother was anaemic, and the extra blood could mean a much healthier start to life. After a moment’s pause, she clamped and cut the cord to allow Zac to lift the baby away and around to the front of the mother.

  But Jessamine was busy again. Another gush of water, not blood, flowed from her, and another tiny buttock slid into view.

  ‘Second baby,’ Ava breathed.

  ‘Exciting times,’ Zac murmured.

  ‘I did wonder,’ Ava said, glancing quickly at Jessamine. ‘Jill, can you put a cannula in for Jessamine? I want Zac free for the babies. Then give that injection, IV. With twins, our PPH risk just went up.’

  The second baby was also a frank breech, and again two little buttocks presented and another little scrotum. Ava couldn’t help a tiny laugh as once more the procedure was accomplished easily. This baby’s trunk delivered quickly and Ava allowed the infant to rotate slightly to the left as the natural curves of the mother’s pelvis facilitated delivery of first one shoulder and arm and then pivoted the other way so that the other arm came free. Then there was a plop as the baby’s head eased out and he fell forward into Ava’s hands. Another baby who knew what to do.

  Ava waited again for an extra minute before she clamped and cut this cord, too. There was a small gush of bright blood and the cord lengthened suddenly as the placenta began to come.

  ‘Needle now,’ said Zac. Ava had no doubt he’d be thinking about the last post-partum haemorrhage they’d had in Alice Springs.

  Ava nodded. ‘Jessamine, I’m worried that you’ll bleed. So we have a needle here to give you. Is that okay?’

  Jessamine eyed the needle in Jill’s hand with trepidation. ‘Better be quick before I change my mind.’

  Ava marvelled at Jessamine’s fear of the needle when she’d just pushed out twin boys. She said soothingly, ‘Needles make people nervous, but Jill’s really good at it.’ At Jessamine’s nod, Ava said to the nurse with a smile, ‘Now would be good, Jill.’

  Jill tightened the tourniquet and inserted the cannula. Denise helped her strap it, and then Jill slowly inserted the uterotonic injection, then assembled an IV line. The look on Zac’s face was priceless – it was so full of amazement.

  ‘We’ve worked together before, you know,’ Denise told Zac. The whole procedure was completed quickly, before Jessamine could change her mind.

  Very soon after the injection Ava delivered the enormous placenta, and after a quick check down below, she encouraged Jessamine to roll over so she could massage the mother’s stomach. The idea was to reduce the placental site on her uterus and squeeze off any haemorrhage vessels. To Ava’s immense relief, everything settled with remarkably little fuss and they all breathed more easily for the moment.

  Zac made light work of helping Jessamine up to the day bed to lie down. Ava and Zac put the babies back against their mum’s skin, while Jill put a warmed blanket across the trio. Done.

  Ava laughed and stood back, stripping off her gloves. ‘Oh my. Now that’s an exciting event. Alice Springs maternity will be horrified, and jealous, that we had such a fabulous outcome here. Brilliant birthing, Jessamine.’ She couldn’t help thinking, That’s one way to keep off the labour-ward bed: a few kilometres of walking. ‘But don’t go starting a trend.’

  Both babies looked less than three kilograms, and to Ava’s surprise Jessamine didn’t seem perturbed that there were two. ‘Jim will be real pleased,’ she said quietly. ‘They’re both good, eh?’ she asked Zac. ‘They can stay on country?’

  Ava knew she couldn’t promise that. Everything might be fine, but they were too isolated. ‘I don’t think so. But we’ll wait for the team. You’ve done amazingly well, Jessamine. But twins! Your poor uterus is stretched and tired. I’m sorry. They’ll want you to go to hospital for at least a day or two so they can watch you don’t bleed, and these boys need to be putting on weight.’

  Jessamine’s face dropped. ‘I don’t want to go.’

  ‘We know.’ Zac crouched down. ‘But these little boys need their mum, and having two babies at once ma
kes your uterus risky. If something happened to you, their life would be sad. It’s best to go to the hospital and then you can come back in a day or two when everything is settled. You were amazing.’

  She sighed and there was a long pause. Ava held her breath. Finally Jessamine said, ‘At least they’re born here.’

  Zac nodded. ‘A big story they will hear from you when they grow up.’ Zac lifted his stethoscope. ‘Can I have a listen to them while you have a cuddle?’

  Good job, Zac, Ava wanted to say, but she glanced at the clock. Jessamine had been there for less than an hour and so much had happened. They were having a very big week.

  Chapter Twelve

  Zac

  Zac sat outside the clinic on the tiny verandah and waited for Ava to finish handing over Jessamine and her babies to the flight staff from the RFDS. Jessamine had wanted to breastfeed and he’d left them to it. Denise had collected a bottle of red soil for Jessamine to take with the boys as a symbol of country.

  Above him the sun had drawn closer to the horizon. Thinking of celestial movement made him feel remarkably blessed to have been present for Jessamine’s babies’ smooth arrival. The young mum had held it together so well, helped by Ava’s calm action and management, which kept him shaking his head. His girl had been like the conductor of nature’s incredible symphony of birth. How had he been so lucky to have been there to see it all?

  In Sydney he’d seen twins born by caesarean section but had never witnessed a natural twin birth. Although those times were special, the absolute amazement of seeing a first-time mother achieving what could have been a very complicated birth without any unnecessary hands interfering had truly blown him away. And made him rethink his medical-school risk-management ideas. His new motto was going to be: go natural birth until proven otherwise. The only vaginal breech birth he’d seen had been fraught with drama and declarations of what could go wrong, and he wondered now if that had been so dramatic because everyone had been hands-on when they should have been hands-off.

  It was a pivotal moment in his life, showing him that things could turn out well if he gave them a chance. He could see luck played a part. Ava had been here, obviously, and he had been backup in case the twins were compromised. But maybe you made your own luck.

  For some reason, the arrival of the twins au naturel reminded him that he should trust the arrival of Ava in his life. His Ava, who continued to astound and astonish him with her clarity of purpose, her intuitive skill and warmth when dealing with crises, and her unconditional generosity to allow him to enter her private world, dealing with his crisis, too.

  He could hear the dull murmur of voices from inside the little clinic, and he stood up and walked down the steps to the native gardens laid out like small green artworks of nature’s design all around the resort complex.

  Soon he would have Ava to himself. Someone in Alice Springs had suggested they attend the Sounds of Silence dinner between Kata Tjuta and Uluru, and he’d booked that for tomorrow night. Apparently, one of the local Aboriginal elders shared Dreamtime stories from the night sky while the attendees looked through telescopes. It would be marvellous to just sit out under the starlight with Ava and soak it all in with the stories. He decided he liked the sound of the traditional names more than ‘The Olgas’ and ‘Ayers Rock’, which had been given by the Europeans.

  But not tonight. Tonight he wanted Ava. Just Ava. Considering his plans for tonight, it was strange that tomorrow would be their first real date. He was just grateful for all they’d had up until now.

  The gratitude word had become his biggest lesson since meeting Ava May. To learn to be grateful for the blessings instead of bitter about the pills in life. It wasn’t new or groundbreaking, but he’d missed that basic truth in the rush and drama of his world away from here. Life before Ava.

  She’d gently suggested he shift towards being grateful for the good times, the friendship and early excitement with Roslyn, and that he’d had the time to say an extended goodbye, despite his ambivalence about her parents’ decision to continue life support. He certainly needed to be grateful that he’d been able to share the exhilaration of today.

  But now he’d like to have time with Ava to resolve their future, to put his feelings out there and be sure she felt the way he did, because if she didn’t then he needed to move on from here before he was so far in love with her he’d never recover.

  They needed to talk about whether they could both fit into each other’s lives, and that conversation required privacy for him to present his ring and ask to marry the woman he knew he was falling more and more in love with every day. He’d shifted the ring to the zipper compartment on the back of his wallet. He had no loose change and it couldn’t fall out, and he hadn’t wanted the bulky box to give away the surprise. He’d been hoping for a few hours before sunset, but they were running out of time.

  ‘You do draw drama.’ Ava’s voice came from behind him and he turned to look at her in the afternoon light. Her face was haloed by the sun, and every line and shadow seemed precious to him, making his chest ache with emotion.

  ‘Look at you in this light.’ It was an effort to keep his voice level. ‘I want to carry you away and learn your magic.’ He was very glad he’d made arrangements before he’d come to see her. ‘I don’t suppose I could invite you over to my hotel room for some contemplation of …’ he pretended to search for inspiration ‘… the afternoon view from our verandah?’

  She laughed. ‘It would be nice to have some alone time with you that didn’t include babies or medical emergencies.’

  He reached for her hand, and once they were joined he felt ridiculously complete to have her fingers in his. Hip brushing hip, they walked up the curved footpath towards the hotel. The sun cast long, thin shadows away from them and he waved his other hand back at the health centre. ‘All good on transfer?’

  ‘Amazing. Jessamine’s breastfed the boys twin fashion. She’s calm about the flight now. The pilot told her how many thousands of safe landings he’s had.’

  She squeezed his hand, her mind obviously on other things, but that was fine by him. He loved the way her mind roamed. In fact, he loved everything about her.

  ‘It’s five years away,’ she said musingly, ‘but when these babies go to school, I’ll talk to Jessamine about looking at a scholarship in health. She’d be an incredible nurse. Maybe even a midwife if it isn’t too far for her to travel for study.’

  Five years. She expected to be here? Of course she did. That was food for thought but not unexpected. Given his feelings, there was a big chance he’d be here too. For the moment, he only said, ‘You’re a midwife. From here. Nothing stopped you.’

  ‘No, it didn’t. But everyone is different. I do think she’d be such a great resource. We don’t have enough Indigenous midwives, and her inner strength shines. That’s where the change will come from. When Indigenous midwives can support Indigenous women in communities, we’ll see more outreach births. More babies born on country.’

  There was a long road to travel and a lot of red tape to cut through before that would be a reality, but if anyone could encourage it to happen, Ava and the friends she had here could. ‘No matter how good your set-up became, you’d not get twins booked to be born on country,’ he commented with a small laugh.

  ‘Yes. Except for today.’ They both smiled again at the thought. ‘Jessamine was brilliant with those babies coming out so well. Probably the long walk did it.’

  He’d thought about that. ‘She’s lucky she didn’t have them on the way.’

  Ava pretended to punch his arm. ‘Stop. I don’t want to think about it. Having you here helped a lot, too. If you hadn’t been here, I’d have been terrified the babies would need more than I could give them.’

  He laughed at that. Ava terrified? He seriously doubted that could happen. But at least he’d been useful. ‘Thank you.’

  Ava was still chewing over the problem. ‘I don’t know. I think she’d get a lot of help from Denise i
n finding support and assistance to study, too. She has a long-term goal for helping remote pregnant women, not just Jessamine. I’ve read about the Inuit women, where a system of local maternity support showed better outcomes for births at home, so I’m sure it could work here too.’

  He leaned in and kissed her. ‘Absolutely.’ Then he kissed her again and stepped back to re-tuck her hand into his arm.

  ‘I’m ranting again,’ she said with a sheepish smile.

  ‘You do it beautifully. If enough people feel the way you do, things will change. But I’m more selfish and wonder if I can entice the desert midwife to hurry a little faster across to my hotel room.’

  He felt the tension ease out of her and she touched his cheek. When their eyes met, her expression grew teasing.

  Tonight. I’ll tell her tonight, he thought. The declarations were threatening to burst from him.

  Chapter Thirteen

  Ava

  What an afternoon she’d had. And now this. She was mad. Intoxicated. The man just had to waggle his finger and she was there, ready to follow him to his bed and kiss him all over. She’d planned to drive him out to the viewing places to see the first sunset, but they’d never get out of his bed once they got to his room.

  As they turned left through the greenery and gravel paths between the buildings, she couldn’t wait to be wrapped securely in his arms. To know without a doubt that they were together again.

  He gestured for her to precede him up the stairs to the second floor. They would have the best views up here. My extravagant hero, she thought just a little smugly. Her heart pounded with the need to get him alone. Her heart also pounded because he’d walked her faster than her legs normally walked and she cast a sideways glance at his determined face. He was a man on a mission, apparently. Her mouth struggled to stay straight.

  He paused at the door with his key in his hand and turned to stare down at her with such an intense look. This was another face of Zac’s she had trouble reading. But she’d learn all of his expressions if she had the chance. Their gazes locked. Time seemed to stand still. Distantly, she heard a bird call out, and someone rumbled a suitcase over the path below. She could pick up the subtle scent of his aftershave, and the even more subtle scent that was Zac. Everything seemed more noticeable when she was with him.