by Sarah Morgan
Ruth stepped forward with a smile. ‘I’ll show you where we keep the machine, Miranda.’
Jake watched Miranda, wondering why she had her back to him. Then she slowly turned round and the reason became immediately clear. His eyes dropped to her waist and he inhaled sharply.
‘Stop looking so shocked,’ Ruth laughed, punching him on the arm in a teasing gesture. ‘Midwives are allowed to be pregnant too, you know. In fact, the mothers love it. Shows we’re capable of understanding what they’re going through. Miranda is six months now. More than capable of doing a good day’s work still.’
Miranda didn’t look at him and Jake’s mouth tightened.
She was pregnant.
How could she be pregnant? And how the hell had he not noticed?
He was an obstetrician, for goodness’ sake. He dealt with pregnant women on a daily basis. And he’d had a woman who was six months pregnant in his house and he hadn’t even noticed.
Well done, Jake. Good going. He closed his eyes briefly. The signs had all been there. The fact that she ate so much, her extreme tiredness, the fact that she burst into tears for apparently no reason…
But what had she been doing on her own in the mountains on Christmas Day? And what had she been doing kissing him when she was six months pregnant with another man’s baby?
Angry with himself and even more angry with her, his jaw clenched and his eyes hardened.
He’d thought she was interesting and beautiful and appealing. It turned out she was duplicitous and lacking in morals. No wonder she’d made cynical comments about families. Clearly she had no sense of responsibility.
‘Never known you speechless before, Jake,’ Ruth teased, walking Miranda to the door. ‘We’ll just go and get the ultrasound machine while you pull yourself together.’
‘Do you think the baby will be all right, Mr Blackwell?’
Aware that Lucy was looking at him expectantly, Jake pulled himself together and stood up.
‘We’re going to check everything, Lucy,’ he assured her, managing a smile despite the turmoil inside him, ‘and we’re going to keep a very close eye on you. Leave the worrying to me if you can. It’s what they pay me for. But I’m afraid you’re spending the rest of Boxing Day in here with us.’
‘I’d be too scared to go home anyway,’ she confessed ruefully.
Miranda came back with the ultrasound machine and Jake resisted the temptation to drag her back into the corridor and demand an immediate explanation for her behaviour. That was going to have to wait until they were alone. But they would be alone, he promised himself, and they were going to talk, whether she liked it or not.
Where had the father of her baby been when she’d been spending Christmas Day at his house? Had they had a row? The guy must have been worrying himself sick. He knew he would have done if his wife or girlfriend had vanished without any warning.
His eyes slid to her neat little bump and he asked himself again how he could possibly not have noticed that she was six months pregnant. She was so slight.
But when he’d first seen her she’d been wearing a bulky waterproof jacket and then she’d changed straight into his jumper, which had been at least six sizes too large. Large enough to conceal a pregnancy.
Why? Why would she want to hide something like that?
Forcing himself to concentrate on his patient, Jake slid the transducer across Lucy’s rounded abdomen and studied the picture on the screen. Later, he vowed, he’d get her on her own and find out what was going on.
‘OK, everything looks fine with the baby, Lucy, but I want you to stay in for now, if that’s all right with you.’
‘Whatever you think.’
‘I think that if your waters have broken, I want you where I can see you for the rest of the day,’ Jake said calmly, reaching for some paper towels and wiping the jelly from her abdomen.
‘That’s fine by me. I don’t want you to go off duty.’ Lucy gave a worried smile. ‘I want you to sleep here in the room with me tonight!’
Ruth smiled. ‘Oh, don’t worry about that—the work I’ve got for him, he’ll still be here at New Year, but he certainly won’t be sleeping.’
Jake gently covered Lucy with a blanket and stood up. ‘Stop worrying,’ he said softly, and then turned to Miranda. ‘I want her kept on the monitor for the time being and let me know if there’s any changes. I’ll be back to check on her when I’ve seen the other lady.’
Miranda nodded and he turned to Ruth. ‘Where is she?’
‘Room 2.’
Jake could see from the look on Ruth’s face that she was expecting the consultation to be difficult, and the moment he walked into the room he knew that she was right. The couple didn’t appear to be speaking but the atmosphere crackled with tension.
The husband was hovering helplessly in the background and the woman, Gail, was leaning over a beanbag and her face was pale and sweaty. The moment she saw Jake, her features tensed.
‘I need to tell you straight away that I don’t want to be here and I certainly don’t want any intervention.’
‘Of course you don’t.’ Jake’s voice was calm as he walked across to her and pulled up a chair. ‘I’m Jake Blackwell, one of the obstetric consultants. I gather you were hoping for a home birth so being in here must be rather a shock for you.’
‘I’ve had three at home and one in hospital.’ She glared at him and then winced as another pain gripped her. ‘And I don’t want to repeat the experience. It’s all monitors and machines that beep at you. That isn’t what nature intended.’
‘I completely agree.’
She stared at him. ‘You do?’
‘Absolutely. My belief is that nature should be allowed the upper hand, unless she appears to be getting things wrong which, I’m afraid, she sometimes does.’ He turned to look at Ruth, his gaze questioning. ‘Notes?’
‘I’ve requested them from her hospital,’ Ruth murmured. ‘I’m going to get someone else to take Lucy to the ward and ask Miranda to come in here. I think she’d be helpful.’ She slid out of the room, leaving Jake alone with the couple.
He looked at the CTG trace that Ruth had handed him and studied the pattern. Then he put the trace down on the table and concentrated his attention on Gail, knowing that he was going to have to handle her carefully.
‘All right. I think honesty is the best way forward so I’m going to be straight with you.’
She tensed and glared at him with blatant hostility. ‘You want to induce me so that you can have this room for the next poor woman—’
‘I’m not given to inducing women unless the health of the baby is threatened,’ Jake said smoothly, aware that Miranda had just entered the room. ‘I’ve certainly never induced a woman to satisfy a staffing or bed need and I don’t intend to start now.’
‘I had three babies at home with no problems.’ Her voice rose and her husband put a hand on her arm to calm her. ‘And then with number four my placenta was low-lying so they had to take me in and I had a Caesarean section. And they were all totally useless! I had an infection and was really ill—’
‘Oh, you poor thing.’ Miranda hurried across the room. ‘I can quite see why you wouldn’t want to be here. You must be terribly anxious about it all.’
Jake looked at her and felt a flicker of admiration. She’d seen through the stroppy, angry exterior and seen the anxiety, just as he had.
‘You obviously had a less than perfect experience last time,’ he said quietly, turning his attention back to Gail, ‘and for that I’m sorry. It’s always disappointing when childbirth doesn’t go as nature intended.’
‘It was a nightmare. I shouldn’t be here.’ Gail glared at her husband. ‘And I wouldn’t be if your mother hadn’t forced the issue.’
‘She didn’t want you having a baby in her kitchen on Boxing Day, love,’ her husband said awkwardly, running a finger around the neck of his jumper as if it was suddenly too tight. Gail tried to struggle to her feet.
‘
Well, I’m sorry if I’m inconveniencing everybody, but I just want to go home now!’
Miranda slipped an arm around her shoulders. ‘Please, Gail, just stay and listen to Mr Blackwell. He’ll take a look at you and make some suggestions. We’re asking you to listen, that’s all. No one’s forcing anything on you.’
‘I had three babies at home with no problems whatsoever.’ Gail’s voice rose as she looked at Jake. ‘Give me one good reason why I shouldn’t have this one at home.’
‘Because having had a Caesarean section last time, you’ll be at slight risk of the scar opening up,’ he said frankly. ‘And with your fifth baby you’re more likely to have other problems, so it’s safer for both of you if you’re in an environment where we’re geared up to help if necessary.’
‘Intervene, you mean.’
Jake picked up the trace and leaned towards Gail. ‘Look at this.’ He ran his finger over the line on the paper. ‘This tells me that your baby’s heart rate was a bit slow here—and again here. I want to keep an eye on that.’
‘There are always variations in heart rate,’ Gail said immediately, her gaze challenging. ‘At home they don’t monitor it constantly so you don’t know about it and you don’t worry. And the baby is still fine when it’s born.’
‘Sometimes that’s true.’ Jake’s voice was quiet. ‘But are you willing to take that chance? What I’d like to do, with your permission, is ask Miranda to monitor you for a while so that I can get a better look at what’s happening during each contraction.’
‘You’re just going to drag me into Theatre at the first opportunity and cut me open!’
Jake shook his head. ‘If you want to check my records, I have a very low Caesarean section rate compared to the national average,’ he said calmly, ‘but I’m not willing to sacrifice a baby to keep that rate low. I can’t promise you that I won’t perform a Caesarean section if I think it’s necessary, but I can promise you that we’ll make the decision together. If everything goes well, there’s no reason why you can’t just quietly deliver your baby here. It’s not home, that’s true, but it’s a comfortable room and we do our best to make it as relaxing as possible.’
Gail stared at him and then at her husband, who looked exhausted, stressed and totally out of his depth.
‘Oh, hell, I don’t know,’ she muttered under her breath, and then her eyes slid to the trace again and she put a protective hand on her abdomen. ‘You really think that the baby might be in trouble?’
‘I don’t know. We need to do some more tests.’
Gail hesitated and then gave a reluctant nod. ‘All right. I suppose I’ll stay. For now. But I don’t want a stream of staff through here, staring at me or practising on me.’
‘There won’t be a stream of staff. Just me. I’m going to be staying with you,’ Miranda assured her, and Gail gave a wan smile.
‘I’ve heard that before. We both know that if my labour happens to run past the end of your shift I’ll get someone else,’ she said bitterly. ‘I had three midwives in total last time I had the misfortune to deliver in hospital.’
‘Well, that isn’t going to happen this time,’ Miranda said softly, putting a hand on her shoulder. ‘I can promise you that, whatever happens, I will stay until you’ve had this baby.’
Gail looked at her and gave a disbelieving laugh. ‘It’s Boxing Day. You’re pregnant yourself and you’ve got a family waiting for you. I should think it’s bad enough working, let alone running into overtime.’
Miranda’s gaze didn’t flicker. ‘I’m staying until you’ve had the baby. Now, if it’s all right with you, I want to put you on the monitor and see what’s happening.’
Something in the stiff set of her slim shoulders drew Jake’s gaze but there was nothing in her face to reveal what she was thinking. Who was her family? Where was the father of her baby? Suddenly he wished Gail had chosen to be more direct in her questioning. He might have received answers to some of the questions buzzing around his head.
‘I’ll be on the unit if you need me.’ He stood up and went back to his office to catch up on some paperwork, but every time he thought he was making headway he was interrupted.
He saw another patient for Ruth and then called the ward to check on Lucy.
When he looked up Miranda was standing in the doorway. Her gaze was wary and it was obvious that she would have preferred not to seek his help. ‘Gail’s progressing slowly. I presume you don’t want to accelerate labour with oxytocin?’
Jake shook his head. ‘There’s some evidence that it increases the risk of rupture. How’s the foetal heart?’
‘Showing variable decelerations.’ Miranda handed him a trace. ‘Gail’s complaining of pains, which might just be normal labour pain, of course, but I have a bad feeling about her.’
Never one to dismiss the instincts of a midwife, Jake looked at her. ‘She had a lower transverse incision, which makes a uterine rupture less likely. And she’s only had one previous Caesarean section.’
Miranda nodded. ‘That’s all true, I know, but her labour is slowing down and the baby’s heart rate isn’t as I would like it to be. And there’s something about this pain she’s complaining of that worries me. It just doesn’t sound like labour pain.’
Jake dragged his eyes away from the smooth skin of her cheeks and concentrated his attention on the trace. Instantly he saw the problem. ‘I’ll take another look at her but it certainly isn’t going to be easy to persuade her to allow us to intervene in any shape or form. Is she still as defensive as ever?’
‘I don’t think she means to be defensive. She’s just very frightened.’
‘There’s often more to a person than meets the eye, isn’t that right, Miranda?’
She had the grace to blush. ‘Perhaps.’
‘You and I are going to talk,’ he said softly, and she straightened her shoulders.
‘There’s nothing to talk about.’
‘There’s plenty to talk about, but it will keep for now. We need to see to Gail.’
CHAPTER FOUR
WHY was it, Miranda wondered as they walked through the labour ward towards Gail’s room, that every time she lowered her guard, it backfired?
When she’d made the impulsive decision to go back to Jake’s house the day before, it hadn’t occurred to her for even a moment that she’d ever see him again, let alone find herself working side by side with him.
And now he’d seen that she was pregnant and had jumped to all the wrong conclusions.
She gave a sigh as she pushed open the door to Gail’s room. Well, she could hardly blame him for that, could she? He didn’t know anything about her circumstances because she hadn’t shared them with him. And she had no intention of sharing them with him.
It had been a mistake to go back to his house with him the day before. A luxury she should never have allowed herself. She’d been naive to think that she could just enjoy the moment and walk away.
She pulled herself back to the present and concentrated on supporting Gail, who was listening to Jake.
‘I’m not happy with what I’m seeing,’ he said gently. ‘The baby’s heart rate is slow and I’m worried about your scar.’
Gail stared at him defensively, a sheen of sweat on her brow and her eyes blank with pain. ‘The scar will be fine. I’ve read enough to know that the chances of a uterine rupture are minimal and I’m not having another Caesarean section. I’d rather take the risk.’
‘It’s true that it isn’t common for the uterus to rupture,’ Jake agreed, ‘but in certain circumstances it can happen. And the risk isn’t just to your life, it’s to the baby’s life.’
Her fear and frustration barely contained, Gail’s eyes filled and she looked away from him. ‘I should have stayed at home,’ she muttered, her voice clogged by the threat of tears. ‘I should never have let them bully me into coming in. Everything would have been fine, then.’
‘No, Gail. It wouldn’t have been fine.’ Determined to add her voice to Jake
’s, Miranda stepped forward and slid an arm round the woman’s shoulders. ‘I’m a huge advocate of home birth, but this is one baby that never should have been born at home. And I think, deep down, you know that.’
Gail sniffed. ‘Where are you going to have your baby?’
‘Oh…’ Aware of Jake’s glance in her direction, Miranda’s face flamed. ‘I don’t know. I’ve only just moved into the area and I haven’t had time to give it much thought yet.’
And she couldn’t talk about it in front of Jake. It was too personal. Too intimate.
Before she could question her further, Gail pulled a face and placed a hand on her abdomen. ‘Ouch! That hurt.’
‘Another contraction?’
‘It didn’t feel like it.’ The woman’s face was pale and she grimaced again. ‘Oh…’
‘It could be the scar.’ Jake stepped forward. ‘I know it’s the last thing you want, but I want to take you into Theatre, Gail. Just to be on the safe side.’
Miranda caught his gaze and knew instinctively that he was starting to share her bad feeling. ‘She’s only three centimetres dilated,’ she reminded him in a soft voice, and he nodded.
‘I know. I want her in Theatre.’
‘All right.’
Gail stared at him. ‘I really don’t know—’
‘Gail.’ His voice was urgent as he sat down on the edge of the bed. ‘My job is to deliver a healthy baby from a healthy mother. You’re not letting me do that job. I know it’s hard for you but I’m asking you to trust me.’
‘Well, it’s just that I don’t—’ Gail broke off and gasped, one hand on her abdomen. ‘Oh—what is that pain?’