‘Thanks,’ said Georgia. ‘That all seems pretty standard to any of the small hospitals I’ve worked at.’
Karissa picked up her bag. ‘I have a feeling Max would like to be here but if you ring him don’t let him push you out of the way for the birth. We can’t have him begin bad habits and we catch our own babies here. But he’ll let you know when he does his morning round.’
Georgia savoured the thought of having Max there for their first professional birth together. It would be lovely to share such a moment with him and until she knew what sort of back-up the general ward nurses wanted to be, the idea seemed sensible.
Karissa went on. ‘It works for us. On paper, it’s sad our only OB GP has retired, but in fact he rarely came for deliveries and high-risk women were shipped out anyway. If we stick to low-risk labours, I can’t see why we couldn’t do what we’ve always done and keep training midwives to be autonomous and the unit open. Fifty miles away from her family to the base hospital is a long way to send a woman to have a normal delivery.’
‘I agree. It’s crazy that it all depends on some number-cruncher in a distant city.’
‘Don’t start me on that. That way is madness, girl.’ Karissa had obviously been there. ‘We’re just dots on the big picture.’ She shrugged and yawned. ‘But I’ve been up all night and what I vote for at the moment is going home to bed. Good luck and happy birthing.’
She pulled the drug keys from her pocket with a wry smile and handed them over. ‘I’m so glad I didn’t accidentally go home with the keys and have to come back.’ She yawned again. ‘Bye.’
CHAPTER FIVE
ALONE and in charge of a labour, Georgia thought wryly. It had been a while.
She had a quick look through the two inpatient records to check there were no medications due and why the women had chosen to have Caesarean births. Both had had babies in the breech position and their doctor had suggested they not attempt vaginal deliveries.
She reminded herself to ask Max what his stance on that question was.
She picked up Mel’s chart and quickly scanned her previous labour and antenatal history, before tucking the chart under her arm and heading back to the labouring woman.
‘Hi, guys. How are you going in here?’
Tim looked a little more stressed and Mel’s smile had slipped. ‘It’s getting tough now,’ Mel said through clenched teeth, and the next contraction cut off her sentence as she began to rock and moan with the force of the pains.
When the contraction had eased, Georgia quickly checked Mel’s blood pressure, temperature and pulse, and then listened to the baby’s heart rate through the next contraction. All observations were normal and she documented the progress in the nurse’s notes.
When she’d finished she crossed to the cupboard where the large blue exercise ball was kept. Georgia rolled it across the floor to show Mel and Tim. ‘Would you like to try sitting on the ball in the shower for a change, Mel?’
‘I might fall off.’ Mel gave it a quick glance and shook her head. ‘The ball wasn’t here last time.’
Georgia rolled it around in front of herself and sat down on it to show Mel. She tried to move it with her hands while sitting on it and the ball didn’t budge. ‘It sticks to the floor and won’t roll away when you are on it, Mel. Balls are very safe.’
Mel frowned and then nodded that she understood.
Georgia went on. ‘Your legs must be tired. Sitting here will straighten your back and encourage the contractions to work straight down with gravity and onto the cervical opening to make the contractions achieve as much as they can, just like the position you are in now.’
Georgia studied Mel’s strained face and her instincts told her Mel would get some relief sitting for a while. ‘The position you’re in now has been great but you may benefit from a change of position, even if for a few minutes. It’s getting tough.’
‘Too right it’s getting tough.’ Mel glared at her husband and Georgia restrained her smile. When a woman began to express irritation towards her partner, it often meant good progress in labour.
‘You could take the ball into the shower and while you sit you could direct the heat of the water onto the area giving the most pain. You can sway from side to side too—all those things will give good relief from the pain.’
Tim grinned. ‘What a salesperson. Do you have shares in the company that sells birth balls?’
‘Absolutely. Have a go, Tim, and tell Mel if it feels safe.’
Tim lowered himself gingerly onto the ball and never looked in danger of rolling away. ‘I see what you mean about it sticking to the floor. If you don’t want the ball, Mel, I might sit here to rub your back. Mine feels better already.’
That was too much for Mel. ‘Get off. My turn.’
She sat, sighed into it as her back straightened, and smiled. ‘Ok. Let’s try the shower with this thing, then.’
Georgia wished that Max had been here to see that. Pain relief wasn’t always something you had to prescribe. She went ahead and turned on the water to warm and placed the ball in the corner of the shower room.
Two rails on the wall gave Mel safe purchase as she lowered herself onto the ball and when the handheld shower was directed onto her lower abdomen where the contractions hurt most, she sighed blissfully. ‘Oh, my. That is good.’
The next pain began and she pushed the nozzle close to her stomach, streaming the hot water across her abdomen. Georgia could see she’d gained relief from the change.
Georgia pulled the shower chair up behind Mel and gestured to Tim. ‘If you sit behind her like this you won’t get too wet and can rub her back firmly with your massager when she gets pain. Your back will get a rest, too.’
Tim settled himself and soon they were back into a rhythm.
Georgia could see they were getting close to the end of the first stage of labour and she quietly went back into the main room to ensure what she needed was ready. She toyed with the idea of phoning Max but held off until she had everything ready because sometimes the arrival of the doctor put pressure on the woman.
The baby resuscitation trolley was in the corner and she checked the oxygen and suction were both functioning, even though she didn’t expect to need either.
A green-draped trolley held a kidney dish, clamps, scissors and some sponges, and she turned back the bed for Mel and her baby to lie on afterwards.
A tray rested on the bench in case Mel bled too much after the birth. It contained the IV line and infusion and drugs they might need. She glanced around and couldn’t think of anything else she should prepare.
She went back into the bathroom. ‘So where do you want to have your baby, Mel?’
‘Don’t I have to have it on the bed?’
‘Not if you don’t want to.’ It amazed Georgia when women did not realise they had choices in birth position. ‘You can use the birth stool or stand up or kneel down. It doesn’t matter. Whichever you find the most comfortable.’
Mel glanced at Tim. ‘How about I use the stool for the pushing and maybe move to the bed if I want to at the last minute? I remember last time and it would be good if I could just lie back with our baby after the birth.’
She looked at Tim again and remembered something. ‘And I don’t want the needle afterwards because I want Tim to cut the cord when it stops pulsating.’
Georgia nodded. ‘That’s fine. If your placenta doesn’t come on its own after half an hour or you bleed heavily, you might need the needle, though.’
Mel checked with Tim and he nodded. ‘That sounds OK,’ he said to Mel encouragingly.
‘Fine,’ Mel said.
Georgia handed her a bottle of water and a straw to sip with. ‘I’ll have the stool ready when you want to get out of the shower.’
‘Do I have to get out?’
Georgia laughed. ‘Not if you don’t want to. When you get to the pushing stage, you can swap the ball for the stool in the shower.’
‘Won’t the doctor mind?’
His voice came again. ‘Hi, Mel. I’m Max Beresford, the doctor on call. Sister can come out when she’s ready and fill me in. You keep doing what you’re doing.’
Georgia and Mel exchanged smiles and Georgia slipped out of the door.
Max watched her shut it behind her. ‘Hello, Sister,’ he said. In his mind he said, hello you gorgeous thing. His stomach dropped as she smiled up at him. She looked incredible.
Her eyes were shining with anticipation and yet her movements were calm and unhurried and she exuded an aura of confidence in the natural progression of events.
He fancied her badly. The tension on his side was building every minute that he was with her. Over the last few, amazingly wonderful weeks in Byron they had become closer than ever.
He knew she still needed recovery time, and he needed to give her that to have any chance for her to trust herself fully to a man again—and he wanted that more than anything.
She was way too vulnerable to make any physical demands on, he could tell by her body language if he even brushed against her, and no matter how much he ached to hold her and make her his, she had to be the one to initiate any change in that.
He had to protect himself too because all he could see on her side was appreciation of the safe harbour he provided and he was becoming more fascinated every day.
Even knowing she would be at work today was distracting but worth the opportunity to see her during the day. He hadn’t been able to stay away once he’d known that it was Georgia’s first morning back at work.
She was looking at him with that tiny frown he wanted to smooth away with his fingers, and he pulled himself back into the present. She expected him to say something, not stand there like a goose. ‘So here I am. Were you going to call me at all?’
She looked at him quizzically. ‘Yes, Doctor.’
Maybe she wasn’t sure if he was serious so he smiled to reassure her.
‘Mel sounds fine. I’m here before I go into the rooms for my day patients. I’ve read your notes and you’re obviously happy with her progress and condition. Do you want me to say hello to her or just leave it until later?’
‘Would you mind popping your head in to say hi now? I don’t think she’ll be long anyway, and it’s better than meeting when the baby is here.’
Before Max could even open the door they heard Mel’s voice. ‘Georgia-a-a.’
Georgia stepped back into the bathroom and rested her hand on Mel’s shoulder. ‘It’s OK. What’s happening?’
‘In the middle of that pain I wanted to push, but the feeling has gone now.’
‘That’s fine. Each pain will probably give you that feeling for a longer time and then it will come to the stage when you won’t be able to do anything but push.’
Mel nodded.
Georgia went on. ‘It’s all good.’
Mel chewed her lip. ‘I remember I hated this part last time.’
‘That’s OK. You might have been scared because your body is taking over. Don’t hate it. Work with it and listen to your body.’
‘I’m trying.’
‘You’re doing amazingly well.’ Max’s quiet voice came from the door.
‘You can come in,’ Mel said with half a smile in the pause between contractions. ‘I really don’t care if the world’s in here and at least you can help me if I need it.’
They could hear the smile in Max’s voice. ‘Which you won’t as Georgia is there and you’re all doing so well. I won’t come in unless you or Sister call me.’
The pains increased their intensity and soon Mel was pushing gently with each urge. The next minute she looked up at Tim and glared at him. ‘I want to move. Get me out of the bathroom.’
That was a good sign. Georgia smiled as Tim almost fell over in his hurry to do what Mel asked. They stood and she moved between pains towards the bed. Mel looked up once as she passed Max and nodded to him.
‘Hi, Doctor,’ she said briefly.
By the time she’d eased herself back on the bed her baby was almost ready to be born, and Tim had paled to an interesting shade of alabaster.
‘That’s the way to do it, nice and slow.’ Georgia helped Mel lean back onto the beanbag and slipped her gloves on.
Max stood back and watched Georgia. She had it all under control, brilliantly. He’d suspected she would be a great midwife and the last few minutes had proved that.
Mel’s next pain came and with her steady breathing, the baby’s head crowned and then extended, until only the shoulders remained to be born.
When the first shoulder came through, Georgia guided Tim’s hands down and encouraged him to lift his own baby up onto Mel’s chest as he was born.
Max stared at the sight of a loving father’s hands lifting his son onto his wife’s breasts, and the pain seared him unexpectedly, like a blow torch in his chest.
He would never do that for his own child. He would probably never share such a look as Mel and Tim shared at that moment.
‘Oh my goodness,’ Tim said, as he stared down at his baby. ‘It’s a boy. I’ve got another son! My Billy.’ He swooped down to kiss Mel. She laughed up at him and they both had their hands on their new son.
‘There you go. Eight thirty-one a.m.’ Georgia checked the clock and then she looked at Max.
He smiled back at her but there was such a wealth of sadness behind his eyes that her breath caught and she wanted to comfort him for something she didn’t understand.
Then the look was gone as if it had never been. Maybe she had been mistaken and he was just tired.
Max moved to the baby and placed his stethoscope on the baby’s back to listen to his chest as he lay against his mother. He stepped back and nodded.
‘Baby sounds great. Congratulations, Mel and Tim.’
Georgia watched his gentle handling of baby and realised she knew so little of this man who was legally her husband and here they were together at such a special event and yet she still didn’t know what he was thinking.
Georgia glanced down at the thick shiny umbilical cord and suddenly a tiny gush of blood indicated probable separation from the uterus. They were ready to complete the final stage of labour.
If the placenta had sheared off from the uterine wall then it certainly wouldn’t have a pulse and Tim could cut the cord.
Georgia curved her fingers around the cord and gently squeezed the thick rope. ‘The cord has stopped pulsating, Mel. Is it OK for Tim to cut the cord now?’
Mel looked up. ‘Yes, that’s fine.’ She smiled at Georgia. ‘Isn’t our son beautiful?’
‘You are a very handsome man, Master Billy,’ she said to the baby, and then returned her attention to the job at hand.
‘I’m just sealing his umbilical cord with this little clamp and pinching another section a few inches down so Tim can cut between the two clamps.’ She looked up as she held out the scissors. ‘You ready, Tim?’
Tim nodded and took the scissors to saw away at the cord until it was severed. ‘Either the scissors are blunt or it’s pretty tough.’
They all laughed when the job was done and a few seconds later the third stage was complete.
‘No damage,’ Georgia said after a quick check down below, and she lifted out the disposable sheet from beneath Mel and tucked the warm blanket over her chest and the baby.
Max wandered over to the bench to start writing in the patient notes and Georgia checked Mel’s abdomen for a contracted uterus once more before pulling the blanket down and joining him.
Georgia frowned and checked again. Mel’s uterus was soft and spongy and not the hard ball she had expected. She lifted back the sheets and a sudden column of blood spread into a widening pool that seeped away underneath Mel onto the bed.
The blood didn’t just trickle, it flowed heavily in a serious postpartum hae
morrhage that needed immediate treatment.
‘Max,’ Georgia said, and his head flicked up immediately at the tone of her voice. He crossed over to the bed and Georgia leant over and pressed the red button for help. Max already being there was a godsend, but they might need extra hands.
Georgia’s palm had gone straight to Mel’s abdomen again to rub the top of her uterus externally and make it clamp down on the bleeding. Max’s hand came in over hers.
‘I’ve got it.’ He rubbed Mel more firmly.
‘The uterus has no tone at all. Get me cannulas for IV access and I’ll slip them in.’
Georgia grabbed the tray from the bench and slid it onto the shelf beside the labour bed.
Max took one of Mel’s hands and slid the tourniquet Georgia handed him over her wrist. ‘Have to pop in a couple of needles so we can get a drip up. Sorry, sweetheart.’
Georgia picked up the injection tray she’d had prepared with the declined injection in it. ‘You get the needle now, Mel.’
Mel nodded. ‘I feel a little woozy.’
Georgia glanced at Max before speaking to Tim. ‘Gently pull two of her pillows out, Tim, so Mel can have her head lower.’ Tim moved the pillows and grew paler by the second as he watched the puddle of blood that filled the space on the bed below Mel’s waist.
‘Then can you rub Mel’s tummy here.’ Georgia took one of his hands and guided him to where the top of Mel’s uterus lay just above her umbilicus after the birth.
‘This feels like a squashy grapefruit and it should feel like a big hard lemon.’
She looked at Mel, who was clutching her baby with one hand as she tried to breathe calmly through her nose. ‘You won’t like Tim much for it but it is very important he rubs your tummy fairly firmly until the uterus contracts and stops the bleeding.’
She turned to Max. ‘OK if I give the first Syntocinon intramuscularly? I had it ready in case.’
The Midwife's Baby Page 6