by Paula Heelan
Not wanting to go back to shift work, Lisa applied for a position with Cell Care, Australia’s largest private cord-blood-bank company based in Melbourne. Now, at 47, Lisa is the state manager in Queensland. She has also undertaken a PhD looking into cord-blood stem-cell therapy, and patients’, obstetricians’ and midwives’ understanding of it. She’s focusing on cell volume, cord clamping time and health professionals’ knowledge of stem cells and placental transfusion. It’s a new and exciting area in Australia. ‘Umbilical cord blood and tissue are rich in powerful stem cells that can only be collected at birth for potential future use,’ Lisa says. ‘Stem cells have the ability to create and regenerate the organs, blood, tissue and immune system that make up our bodies. There’s only one chance to collect and store a baby’s cord blood and tissue stem cells and that’s at birth.’ A trained Cell Care collector, obstetrician or midwife performs the cell collection process, which is quick and painless for both mother and baby.
Late one afternoon Lisa received a call from an obstetrician asking if she had a spare cord-blood collection kit. She was just about to take a woman with a baby in trouble to theatre at Brisbane’s Wesley Hospital and wanted to collect the cord blood. Lisa told her she was fifteen minutes away. ‘My phone rang when I got in the car and the woman asked if I had two kits. There were twins and they wanted to collect from both to help the baby in trouble. I ran back upstairs and got the second kit. But on the way I got held up in peak-hour traffic. The receptionist rang: Where are you? They’re in theatre and they’re waiting for the kits.
‘I’m stuck in the traffic, I told her. Can you ask them to leave the cord clamps on the cords and I’ll get there as soon as I can. The traffic was moving slowly. I told her I was three sets of lights away and asked if she could meet me at the front door and take my car away – no time to find a park. When I arrived I jumped out of the car, grabbed the kits and rushed into the theatre. I’m here to do cord-blood collection on the twins, I said.’
Lisa changed, scrubbed and rushed in. The obstetrician looked up at her.
‘Thank God you’re here,’ was her welcome.
‘Where are the placentas?’ Lisa asked.
‘Still inside the uterus.’
‘What time were the babies born?’
‘Twenty-five minutes ago.’
‘Usually, after this amount of time the placentas have been delivered and I collect the blood afterwards,’ Lisa says. ‘The obstetrician said, Well, Lisa you’ve always told me the best collections are the ones you collect when the placenta is still inside. So I held them there for you.
‘That’s never happened in a caesarian situation before,’ Lisa says. ‘The doctor had kept the uterus open with the placentas attached waiting for the cord blood to be collected. It was quite a big thing and an exciting time. It all went well for the two little boys and we collected good blood volumes.’
Most people think once the baby is born the cord is clamped immediately in order to collect the cord blood for storage, but Lisa says that’s not so. ‘In order to collect an adequate volume of cells as well as allowing the baby to get as much blood as possible, we need to clamp the cord at one minute post-birth. By this stage the baby has already received approximately 75 percent of the blood that was left in the placenta. Then we collect the remaining amount.’
The baby or the family can use the cells if needed later in life. The newborn’s umbilical cord stem cells are a perfect match for the child and, more than likely, any siblings and family members. That’s why it’s known as family cord banking.
Never did Lisa think she’d end up working in Brisbane again. ‘I often talk to nursing and midwifery students about the possibilities after graduation and tell them working in rural and remote areas is the best experience personally and professionally. You can’t beat it. You meet some great characters along the way and you learn to appreciate the important things in life. When city people I know get stressed about small issues, I usually say to them, Did someone die as a result? No? Well that’s not a drama, sit down and let me tell you a story.’
But Lisa’s life now is back in the city. Five years ago, at 42, she met Mark Fairbairne. ‘I never planned not to marry. I was just used to being on my own and able to do what I wanted, when I wanted. But when I met this lovely man, a Kiwi, everything changed.’ He is the manager of Queensland’s largest drug and alcohol centre in Brisbane – so he’s also a health worker. ‘He’s very urbane with little outback experience,’ Lisa says with a laugh. They married five years ago and Lisa is now the proud stepmother of Dea.
CHAPTER
8
Wendy Agars
It was three in the morning when the Northern Territory Aerial Medical Service (NTAMS) pilot made an instrument approach into a remote community in the Gulf of Carpentaria, Northern Territory. With poor visibility due to low cloud and lack of moonlight, he set the aircraft down on what’s known as a ‘black hole’ night. It was the mid-1990s during the wet season, and midwife Wendy Agars was on board, tasked to pick up a man with a respiratory problem.
As Wendy emerged from the plane the heady mix of kerosene, aviation fuel and dust was hard-hitting. In the distance, a vehicle’s beaming headlights ignited the black night. Wendy trod carefully towards the light until she could see a troopy packed with people. A pregnant woman was sitting in the front seat between the remote-area nurse and a locum doctor. The patient with the respiratory problem was in the back seat with members of his family. The sound of low, hushed voices suggested quite a few women were waiting in another vehicle nearby.
The nurse asked Wendy if she could fly out the pregnant woman as well as the man she had flown in for. There hadn’t been time for a proper examination, but she was concerned that at an estimated 35 weeks pregnant, the woman might have a urinary tract infection. Wendy worried it may not be safe to take her on the plane in a nurse-only situation. ‘There hadn’t been any consultation with the medical officer [MO] or acceptance at the hospital,’ Wendy says. ‘I wondered whether both patients were stable. I thought, Maybe a doctor is needed? We’ll have to go back to the clinic and call the MO to decide.’
She leaned into the vehicle to greet both patients and check their condition. She knew she’d have to find out exactly what was happening with the pregnant woman. She made a mental checklist: Is she contracting? Is she sure of her dates? Has she ruptured her membranes? What number baby is this for her? Has there been a premature birth before? ‘I needed to examine her to see if she was dilating and find out if the baby was cephalic [head first] and find out how low in the pelvis the baby was. I knew I’d have to establish all this and more before we made the decision to evacuate her. The golden rule is if a baby is close to being born and there’s a risk of an inflight birth, then stay put. Go back to the clinic where the environment is safer.’
Wendy took a closer look. The woman was sitting quietly and still. Wendy could see she was frightened. ‘I noticed a few beads of sweat on her nose and I thought, Uh-oh something is going on with you. Then suddenly she gave a big, involuntary push. And with that, all hell broke loose. The men in the troopy realised a birth was imminent and with lightning speed scrambled out and took flight.’
In low light Wendy and the doctor carefully helped the woman to lie along the front seat. Her mother cradled her head from the driver’s side and comforted her. ‘Then the expectant mum called out, The baby is coming,’ Wendy says. ‘I removed her undergarments and to our surprise and alarm we could see a tiny foot, followed by another. I thought, Oh my God, here we are in this very remote location, in the dead of night on the side of an airstrip with a patient I wasn’t expecting. She’s about to give birth, the baby is breech and there’s not enough time to get back to the health centre.’ Wendy clicked into overdrive. She asked the pilot to grab the delivery pack from the plane. He had done some ambulance work in the past and it was showing. He raced back to the plane and grabbed further oxygen and a spare suction unit, the drug box and bunny rugs. ‘He
was an amazing assistant and I thought, Yep, you’ve been in situations like this before.’
The expectant mother’s women relatives were chatting excitedly and ready to pitch in. The troopy was running to keep the internal light and her grandmother resourcefully warmed the bunny rug and towels by draping them on the warm bonnet. The bewildered locum doctor had only just arrived from Sydney and the bush experience was brand new. ‘I felt for him,’ says Wendy. ‘He was only in the community for three weeks and hadn’t seen an aeromedical evacuation. He really only came down to the airstrip out of curiosity. He stood near the passenger’s door ready to assist in the birth.’ With trembling hands, Wendy set up the oxygen, suction, and bag valve mask and drew up an injection of Syntocinon. ‘Here we were delivering a baby with barely any light, very few resources and no back-up.’
Despite the breech presentation, the labour process was smooth and steady with the cervix dilating for the baby to descend. ‘There can be a lot of concern around birthing a breech baby, but I’ve seen quite a few and I hoped this birth would not be a problem despite our less-than-ideal location,’ Wendy says. ‘I remembered the other golden rule – hands off the breech. I thought, Please let her be fully dilated so the head isn’t trapped. We needed to keep the baby warm, to wait until the nape of the neck and the hairline were visible before doing any manoeuvring – if at all. If we had to touch the baby, we needed to handle it gently by the pelvic girdle, not around its little abdomen, to avoid injury.’ Wendy’s primary focus was to assist the mum to breathe out the baby’s head – gently and slowly.
‘As the baby emerged I was putting my two bobs’ worth in to the doctor about safely birthing a breech,’ Wendy says, laughing. ‘I wasn’t sure he had done one before. I hovered behind him and the nurse, peeping in between their waists to see what was happening. I knew things could go awfully wrong and if they did, we would all have to deal with the situation at hand using the resources we had.’
Everyone had a job to do and they worked together. Thankfully, the baby’s arms and shoulders emerged without too much handling and then her head appeared. ‘To our delight she gave a hearty cry. We placed her on her mum’s tummy and cleaned her with the towel. I don’t think there was a dry eye among us.’
Everyone’s joy was palpable. Wendy could see the big relief and thrill on the faces of the grandmother, aunty and mother. ‘Aunty cut the cord and the nurse gave the mum some Syntocinon to help deliver the placenta. It came away uneventfully and without excessive bleeding. We inserted an IV cannula just in case, but everything went really well. This night strengthened my faith that leaving things well enough alone is often the best.’
With the mother’s bleeding settled, Wendy’s thoughts turned to the original patient she had come to collect. She shone her Dolphin torch over by the plane and there he was, propped against the aircraft wheel. ‘He didn’t want to be near the women’s business either,’ Wendy says. ‘So the other men had picked him up and moved him. They had seated him upright to make his breathing easier and his family was looking after him. The pilot and I loaded him onto the aircraft stretcher and made our way back to our base hospital.’ The mother and baby were taken back to the health centre for further stabilisation. It was safer for the two to stay in the clinic overnight rather than flying on a plane so soon after the birth. The day crew flew in the next morning to retrieve them. ‘It was lovely to catch up with the mother and baby in the hospital the next day and to talk over the amazing birth,’ Wendy says.
Born in Adelaide in 1961, Wendy began her university-based nursing training at the Sturt College of Advanced Education straight from school in 1979 and finished in 1981. She had done well on the maternity module and thought she would carry on with what she enjoyed and came easily. ‘I knew midwifery would broaden my career opportunities,’ she says. Wendy had heard Scotland was a well-thought-of place to train. It sounded exciting, so in 1984 at 23 years of age she left home and flew to Edinburgh. ‘As soon as the Qantas jumbo was hurtling along the runway, I thought, Oh my God what am I getting into? I’m leaving family, friends and home.’ But this decision marked the beginning of Wendy’s interminable sense of adventure, desire to travel and extraordinary midwifery career.
In Edinburgh Wendy lived in the Florence Nightingale nurses’ home. One of walls had a brick that was from Florence’s original home. ‘It was very old-fashioned training, but a great place to learn,’ Wendy says.
Wendy loved community placement during her training. The midwives zipped around the streets of Edinburgh in little Mini Minors – the home-visiting cars of the community-midwife fleet. They wore a cape and beret and carried their gear in little suitcases. ‘We used Pinard stethoscopes [a little wooden tool used by midwives to listen to heart rates] – there was no such thing as a Doppler foetal heart monitor back then,’ Wendy says. ‘I attended a couple of homebirths during that time and I just knew midwifery was for me.’
There were about a dozen midwives in training with Wendy – girls from around the world. ‘Our bedrooms in the quarters were small with great big baths and the bathrooms had heated towel rails – totally foreign to me. Sometimes our food went missing from the shared kitchen so we decided to start hanging it in bags out on the window ledge to keep an eye on it. But it would often freeze overnight. A stop was put to that to protect the pedestrians below.’
After graduation and with only a week left on her visa, Wendy had to leave the United Kingdom. ‘I travelled around Europe and the Greek islands and Ireland with another midwife and then after eight months, I felt homesick.’ She returned to Adelaide, but before long she was keen to travel again. ‘I applied to hospitals in Darwin and New Zealand for work and they suggested I gain my postgraduate certificate in midwifery first. So I did that at Flinders Medical Centre and it was indeed a great experience and year of confidence building.’
On landing a job at Royal Darwin Hospital, Wendy arrived in the Northern Territory with very little idea of what lay ahead. Until then she hadn’t thought for one minute she would work in the bush – but she was ready. ‘It was 1988 and Darwin was a wild old place at that time,’ she says. ‘But the minute I stepped off the plane onto that shimmering tarmac and into the heat, I thought, This isn’t the dry and dusty frontier I thought it was. It was lush, green and tropical, with a lingering scent of frangipanis in the air and countless palm trees. I loved it instantly. I asked the taxi driver how best to cope with the heat and humidity and he said, Let it be mind over matter. I’ve heeded his advice ever since.’
When Wendy called in to the Darwin Hospital’s nursing office to hand in her paperwork, she was shocked to be greeted by a barefooted staff member wearing jeans and a T-shirt. It was clear life in the Territory was going to be very laidback. ‘And little did I know, it would be my home for the next eighteen years,’ she says.
At the hospital Wendy experienced her first contact with Indigenous women and embraced the opportunity to learn all she could about Aboriginal culture and a different way of life. ‘My plan was to work in midwifery in Darwin for twelve months and then decide where next,’ she says. ‘But before the end of the year there was a call for midwives to work in Nhulunbuy, a town on the Gove Peninsula, East Arnhem Land.’ Nhulunbuy was established in the late sixties with a bauxite mine and deep-water port nearby. The 4000-strong population included predominantly traditional owners (the Yolgnu people), miners and people working in support services to the mine.
A whole new world opened up. ‘I was very green and had a lot to learn,’ Wendy admits. ‘It was a 30-bed hospital with a ten-bed, low-risk maternity unit that also served surrounding communities. On any given maternity shift there was one midwife and a mothercraft nurse. Women came in for sit-down at 36 weeks, leaving behind their family and often other children, which was very difficult for them. Looking after both Indigenous and non-Indigenous women in a low-risk unit broadened my perspective as a midwife in so many ways. I soaked up skills from other incredibly passionate and knowledgeable midw
ives,’ she says. ‘I learned the value of active labour and became more attuned to the nuances of when things were going okay to when they started to veer from the course of normal. I learned when to intervene and call for medical help and when to sit on my hands. I learned about normal labour and how to keep it that way and to have faith in women’s ability to birth their babies with minimal intervention. And essentially, I learned to trust my own instincts.’
Women from the community of Yirrkala came into Nhulunbuy in large groups to help their young women in labour. They surrounded them with love and stroked their bellies, encouraging the babies to come. The pregnant women usually preferred to be in a room together and after the birth of their babies they would often be found outside contentedly breastfeeding under shady trees in the hospital grounds.
Wendy’s friend and nursing colleague Roxy Dale recalls her time at Nhulunbuy with Wendy. ‘She was a beautiful and caring midwife,’ Roxy says. ‘If any of the nurses at the hospital were pregnant they wanted Wendy as their midwife – and she helped birth quite a few of their babies,’ she says.
Wendy stayed at Nhulunbuy for eighteen months before heading down the coast to Numbulwar, a community with around 600 people on the Gulf of Carpentaria. Someone was needed to relieve a nurse for three months. ‘I very gingerly put my hand up for the job because I didn’t have a big background in emergency nursing or in Indigenous health – apart from midwifery. But I’d heard great things about remote-area nursing – so off I went.’ There were no telephones and all outside communication was by radio. Wendy’s contact person for patient consultations was the doctor on Groote Eylandt. He came in to Numbulwar once a week to conduct a clinic with the assistance of the NTAMS nurses and allied health staff from Nhulunbuy.