Island Nurses

by Howie, Leonie; Robertson, Adele;

  Sure enough, a very short time later, with the bag of saline, the giving set and the IV needle still in their sterile packaging beside the bed, Phaedra rolls on to all fours and, with two massive pushes, the baby is birthed. Again, Leonie finds herself amazed to be seeing a pink, healthily breathing baby, rather than the limp, lifeless bundle she had imagined they might receive. She had been primed to begin resuscitation, but now she experiences a wash of pure relief as the baby wrinkles its face and cries lustily.

  Phaedra lifts her baby girl on to her chest where the baby enthusiastically searches for her nipple. Phaedra looks as shocked at the speed of the labour and delivery as Leonie is at the happy outcome. Leonie forces herself back into action, and finds there is now practically no blood loss. Phaedra is shivering. Leonie drapes blankets over her and checks her blood pressure and pulse.

  ‘Phaedra, your recordings are good,’ she reports. ‘I don’t know if we need to replace your blood loss. What do you think?’ she asks Ivan.

  Ivan agrees to hold off. We wait.

  Adele arrives, her face showing the fear she must have been feeling the whole way as she drove, the fear at what she was likely to find when she arrived. But this changes when Leonie tells her with a smile, ‘Mother and baby are doing well and we’re just waiting for the third stage now.’

  Adele is offering her congratulations to Phaedra on her second successful birth when suddenly the lights go out. Everyone is sitting in total darkness. Ivan tells a joke. The genny is out of fuel.

  We light up our trusty torches. Leonie’s wrist is illuminated as she checks her watch. ‘Fifty minutes since the birth,’ she says. ‘No placenta. But no more bleeding, either.’

  Phaedra makes a small noise, and our torch beams swing to where the placenta is just now emerging. She gives a small push, and it plops into the basin, apparently intact, and with no further blood loss of note. So much for the ‘abruption’ theory. The birthing is now complete.

  Adele remains while Leonie and Ivan drift off home to catch up on some sleep before starting their day’s clinic in a few hours.

  Phaedra recovers her energy quickly. She phones her family off-island to give them the good news.

  Adele is happy with her recovery. ‘Drink lots of fluid,’ she says. ‘And, above all, take it easy. You have lost a lot of blood and you may get tired easily. You will need the energy to care for your two girls.’

  Phaedra nods.

  But, soon after Adele has gone, Phaedra suddenly realises that the plane is due in a short couple of hours, and the place needs to be cleaned up. She sweeps the floor, spends time with her elder girl before she leaves for school, and deflates the birth pool.

  ‘Fat lot of good you were,’ she tells it ruefully.

  Oh no! The genny!

  Phaedra carefully straps her brand-new daughter into a car seat and straps the car seat into the car. The garage is just up the road. She is hoisting a jerry can out of the boot as the attendant approaches.

  ‘Phaedra!’ he says. ‘You look like you’re just about ready to drop!’

  ‘Already have.’ She smiles.

  ‘No way,’ he replies, but she points to the back window of the car. He leans to look. There is no arguing with what he sees.

  ‘Oh my God!’ he says, but what he really means is: ‘Welcome, baby girl. Welcome to Aotea.’

  ________

  * Not her real name.

  Chapter 6

  GROWING TOGETHER

  As you would expect, our lives soon became intertwined. We were in the same profession and we had the same island as a workplace, but before long it ran deeper than that. These days, it runs deeper still, because we have shared experiences, and not just of the places and people we have in common. We have shared some of the triumphs and tragedies of one another’s lives. We are colleagues and friends, and we are more than both of these things.

  There are phrases bandied about in nursing and midwifery—boundaries, partnership, professional relationships. Things are supposed be tidy and clearly defined. But we have found that, on Aotea, boundaries shift like the tides, and all it takes is something unexpected to occur and we must react and readjust—a kind of rethinking on our feet. Nursing and midwifery are administered by separate professional bodies and have their own individual requirements of practice. In our situation they are not easily teased apart, and nor are professional relationships with one another and with our ‘clients’, and none of it can be entirely separated from friendships. But, in saying this, we have found that objective decision making cannot be distorted by our personal emotions. Once we place our figurative professional hats on, our other roles in someone’s life become eclipsed for their sake—to keep them safe. Some episodes bring this home to you more than others.

  Adele wakes in the early hours of the morning in the late eighties to the sound of quiet but insistent knocking on her door. She already has a fair idea who she will find when she opens it. Sure enough, after she has tugged on some clothes, she opens it to find Garth, the Okiwi telephone operator standing there.

  ‘Sorry to wake you, Adele,’ he says. ‘Ivan just called. There’s a woman in labour down in Tryphena.’

  ‘I’ll be on my way,’ Adele says.

  ‘Right,’ Garth says, and returns to his car to drive back over the hill to Okiwi. As occasionally happens, Ivan could not raise the Port FitzRoy operator, so he turned to Okiwi. Garth was quite happy to make the eight-kilometre dash over the hill.

  Adele is wide awake by now, the adrenaline pumping in her system. This is only her ninth home birth and, while there has been nothing to indicate problems, she is nervous.

  It is 37 kilometres from Port FitzRoy to Tryphena, where Cathy lives. The road is rough, unsealed, very narrow, winding and—although it is a beautiful, clear night—very dark. At some points, there are steep drop-offs and there is no shoulder. But one good thing about driving on the island at night is that the wash of headlights alerts you to oncoming traffic. You do not have to crawl around the bends the way you do during the day. Adele is able to make good time, despite the awful surface.

  All the same, she is an hour away, and her mind keeps tracking over and over the possible scenarios. A few days previously, she took the precaution of leaving a birth pack with Cathy in case the labour is fast: there is a chance she will arrive to find the baby has already been born. But there are other possibilities. What if she got the presentation wrong and the baby is breech—bottom first instead of head first? She runs through breech birth manoeuvres in her mind.

  The schoolhouse and the airstrip at Okiwi pass by dimly. Somewhere, well off the main road, Garth is doubtless already tucked up in bed again.

  What if the baby becomes distressed? Hospital assistance is at least 90 minutes away by helicopter. Adele goes through neonatal resuscitation procedures.

  The farmland around Okiwi gives way to dense native bush, and Adele is half watching the trees on the bends for headlights, and half working on her contingency planning. What if there is a bleed after the baby is born? She rehearses in her mind the drugs and manoeuvres for post-partum haemorrhage.

  The road enters the Awana Valley, another farming area. The black cattle here are escape artists, and Adele has to keep an eye out for them. At the southern end of the valley, she sees the cold blue gleam of surf along Awana Bay. Still no oncoming traffic.

  Over the hill, the black expanse of the Pacific Ocean extends to the horizon as she leaves Aotea Road to wind along the roads named after the settler families. At Claris, briefly illuminated by the headlights, the small shopping centre and the main airport slide by along with the road to Ivan and Leonie’s house. One of the roads is Walter Blackwell Road, and Adele is aware that Cathy is right now labouring in one of the old Blackwell family homesteads. Beyond Medlands Beach, the bush closes in beside the road again. Adele begins relaxation breathing and wills herself to keep her speed down on the corners. The bush eventually thins and then is replaced abruptly by housing, and she is passing
through the outskirts of Tryphena. At the end of Medland Road, she indicates to turn left—unnecessarily, as there is nobody else on the road, and she has not seen another car since leaving Port FitzRoy. A short drive along Shoal Bay Road, another left into Blackwell Drive and she is there.

  Dennis answers the door. He seems calm. He shows Adele through to the warm room in which Cathy is sitting on a mattress with Leonie, all smiles. Cathy is confident and prepared to welcome her new baby. Her contractions have been a bit erratic, and she asks if it is worth trying a mix of homeopathic remedies—caulophyllum, pulsatilla, hypericum and arnica. Adele has no objection to that, and they seem to do the trick. Before long, the contractions are strong and regular and everything is back on track again.

  There are noises from somewhere else in the building. Adele is focused on Cathy and Dennis, but registers the sound. Someone, somewhere is in pain.

  Earlier in the night, Leonie starts awake, aware that she has been woken by a noise, but unable at first to identify it. It is merged with a dream she has been having, so she is disorientated. She is drifting back to sleep when it comes again. It is a gentle tapping.

  ‘Ivan.’ She shakes Ivan.

  He is awake in an instant, well used by now to waking at all hours of the night for some emergency or another.

  ‘There is a weird noise,’ Leonie begins, but the tapping comes again and Ivan is out of bed in a flash, grabbing a dressing-gown and thumping downstairs to the front door. Leonie listens.

  ‘Sorry to bother you, Ivan,’ a woman’s voice says. ‘It’s Cathy. The baby’s coming.’

  Leonie is already out of bed and dressing when Ivan returns. He, too, starts throwing on clothes by the light of the 12-volt fluorescent tube running off a car battery. Leonie is wide awake by now. As she dresses, she clutches the bulge of her belly where her own baby—30 weeks along—is kicking ferociously, obviously none too pleased at the rude awakening.

  Attending any birth is special, but there are new layers of meaning for Leonie in each of the births she has attended since discovering she was pregnant herself. Cathy is reaching the end of the journey of her pregnancy, and Leonie’s awareness of the significance of the approaching moment is heightened by the fact that she is walking the same path. Cathy has asked Leonie to be her supporter. As she dresses, she feels again what she felt when Cathy first asked her: honoured, and a bit excited. It is funny, she has attended plenty of births before, both on the mainland and on Aotea, but she has always been there in her professional capacity as a midwife. But on Aotea she has observed at close quarters the role of supporter, and seen for herself how important it is to the labouring mother. Often it has been another woman who has walked the path before—a mother, a sister, a friend who has birthed before—and Leonie has been struck by the instinctual, almost spiritual connection between supporter and labouring woman, the way they seem to be able to communicate with one another without words, the way the supporter has seemed to be able to divine the needs of the mother-to-be without having to ask. You do not necessarily experience this when you are a professional, when your training is to remain detached and alert so that you can monitor mother and baby. Leonie hopes that she can turn off her midwife brain and be all that she needs to be for Cathy’s sake.

  She knows Cathy is prepared and focused, as have been all of the Aotea women whose births she has attended. Making the decision to have a baby on the Barrier is not done lightly, because when you do it you are aware that the nearest secondary-care facility is far enough away to be of little use in a real emergency. You are confident in your own body’s ability to give birth safely. You are prepared to rely upon your own physical and emotional resources. ‘Safe passage’ is a term used in midwifery texts to describe how women prepare psychologically for pregnancy and birth—the mother’s inward focus on the baby. This is apt, as it is a bit like putting to sea in a boat. On the island, we are further out to sea than most, quite literally. For this reason, it is only those who have developed the resilience to manage this emotional vulnerability who choose an Aotea birth.

  The sound of Cathy’s neighbour’s car recedes into the night. Once dressed, Leonie fetches the ‘birth-day’ cake—a celebratory fruit cake—that she has baked and squirrelled away for the arrival of this baby. She pauses over the bottle of champagne she was planning to produce for the support team when it was all over. It is not good for breast-feeding mothers—or for pregnant women, for that matter.

  Drat, she thinks, smoothing her hands over her belly.

  They are dressed and about ready to go.

  ‘We need to let Adele know,’ Leonie says. ‘Should we get Garth to drive over? He is such a light sleeper.’

  ‘Probably the best idea,’ Ivan agrees.

  He loads his obstetric bag, his emergency bag and his medical bag into the Holden HQ as Leonie climbs in the passenger side, the vinyl of the bench seat smooth and cold against the backs of her legs. She feels the excitement tight in her belly.

  They drive to Claris, where they stop at the public phone box outside the telephone exchange. Ivan gives the crank handle an expert twirl and, after a short pause, the international operator comes on in the almost imperceptible hiss of wire noise.

  ‘New Zealand here.’

  ‘It’s the doctor on Great Barrier Island here,’ Ivan explains. ‘Will you put me through to Okiwi, please?’

  ‘Certainly,’ the operator says, and the quality of the silence on the line changes as Ivan is put on hold. Then the operator is back. ‘Through now,’ she says.

  ‘Garth, it’s Ivan. We need to get hold of Adele. Would you mind heading over the hill and waking her to tell her that the woman in Tryphena is having her baby?’

  ‘Yes, sure. I can do that,’ Garth replies sleepily. ‘I’ll leave right away.’

  ‘Adele is alerted,’ Ivan says as he climbs back in the car.

  They leave Claris behind and wind over the hill towards Tryphena. Leonie has time to notice the sky—it is clear and ablaze with stars.

  The shape of a car looms in the headlights, the bonnet up and steam seething out of the engine bay. Cathy’s neighbour straightens up from where she is inspecting the engine. Leonie winds down her window as Ivan pulls up.

  ‘Are you OK?’ Leonie calls.

  ‘Yes,’ the neighbour replies cheerfully. ‘Minor problem here. I’ll be on my way soon.’

  Ivan and Leonie press on, and just before four in the morning, they are pulling up outside Pōhutukawa Lodge, the old Blackwell homestead, which the Sages are running as a guesthouse. Dennis is at the door as they get out of the car.

  ‘How is Cathy?’ Ivan asks.

  ‘Fine,’ Dennis replies. ‘We’re all good.’

  He shows them through to the sitting room, where there is a large mattress on the floor surrounded by all the necessaries—the birth pack, plastic floor protection, pillows, towels, a drink, newborn baby clothes and nappies.

  ‘Hi, Cathy. I see you’re all prepared,’ Leonie says.

  Cathy grins back. She looks happy and excited.

  Dennis is on porridge duty when there is a loud knocking on the front door of the lodge.

  Dennis opens it to find a worried-looking man standing there. There is the quite audible sound of moaning coming from a car across the road.

  ‘Is Ivan there?’ the man asks. ‘That’s his car, isn’t it?’

  ‘Yes, he’s here,’ Dennis replies. Ivan has already quietly slipped out from Cathy and come to see what is going on. The man looks tremendously relieved to see him.

  ‘My wife’s got stomach pains,’ he says. ‘Really awful ones. She keeps throwing up.’

  Ivan accompanies him across the road, but soon they’re back, both supporting the woman between them. She is in serious pain. Dennis has offered them a back room where Ivan can assess her.

  Another car pulls up. It is Adele.

  We compare notes with Cathy—everything is going well—and then Ivan calls Leonie out to help with his new patient. She pas
ses from one dimly lit room to another and in the same instant goes from being maternity supporter to nurse.

  ‘Rae has woken up with acute upper abdominal pain,’ Ivan briefs her. ‘It has been accompanied by vomiting.’

  As if on cue, Rae leans over and is painfully sick into a bowl.

  ‘I have discussed a plan with Rae to alleviate her pain and vomiting. Would you check these ampoules for the intravenous analgesia? How is our other patient?’

  ‘She’s good. Adele has everything under control.’

  ‘Let’s get a line in and try to get Rae stable.’

  Leonie can tell Ivan is worried. He fires further instructions at her so fast she struggles to keep up. He then disappears quietly back into Cathy’s room.

  An hour later Rae is still writhing in pain, moaning and occasionally shrieking loudly. Despite the anti-emetic drug that Leonie has administered, she is still retching. Ivan frowns. The analgesia is also having little effect. Adjustments to the medication plan need to be made.

  They are both conscious of the lack of communication with the outside world. They can’t reach the Tryphena exchange. There is no VHF or CB radio handy. Dennis and Cathy’s neighbour is clearly still tinkering with her car, because she has not returned.

  Eventually there seems to be a bit of a let-up in Rae’s symptoms. Leonie leaves and goes in to see how Cathy is faring. The contractions are close together, and everything is progressing well. After a few words of encouragement, Leonie puts her figurative nurse’s hat on again.

  So it goes for the next hour or so—Ivan and Leonie relaying each other in the two rooms. Towards six in the morning, as the dawn is brightening the windows, Rae appears to be more comfortable. Her vital signs are stabilising, and the drugs seem to have got the pain and nausea under control. Ivan feels she is stable enough to put her on the helicopter, just as soon as we can call it out from the mainland, to get her to Auckland Hospital for specialist surgical review.

  Adele appears in the doorway. ‘It’s time,’ she says.