Australian Midwives

by Paula Heelan

  AUSTRALIAN

  MIDWIVES

  PAULA HEELAN

  www.harlequinbooks.com.au

  Paula Heelan grew up in Tasmania. In 1996, after graduating from The University of Queensland, she moved to live on a remote cattle station in the highlands of central Queensland with her husband Peter. From the start, Paula loved the outback – the extraordinary people, the extreme weather, the challenges, the beauty and even teaching her two children, Matt and Ali, through distance education. She writes and takes photos with a focus on rural and remote Australia for a range of state, national and international publications. Australian Midwives is Paula’s first book.

  For Peter

  CONTENTS

  1. Lane Johnson

  2. Catherine (Kate) Austin

  3. Chloe Coker

  4. Marg McDonald-Ashe

  5. Mark Holmes

  6. Joy Motter

  7. Lisa Peberdy

  8. Wendy Agars

  9. Gayle Donaldson

  10. Olivia Bigham

  11. Jo Hunter

  12. Pia Croft

  13. Genevieve Brideson

  Appendix: The midwives – brief profiles

  Acknowledgements

  CHAPTER

  1

  Lane Johnson

  Tasked with pilot Ben Ragg, known as Raggs, 26-year-old CareFlight nurse and midwife Lane Johnson was called out at three-thirty in the morning to pick up a woman on Groote Eylandt who had miscarried at 19 weeks pregnant. She was experiencing a postpartum haemorrhage (PPH) and had lost more than 800 millilitres of blood. Lane felt confident she could manage. ‘Health staff at the clinic had stopped the bleeding, but the mother still needed to come to Darwin,’ says Lane. She prepared for the flight and packed the drugs she thought might be needed as well as two units of blood. At 4 am Raggs lifted the King Air – an eight-person, two-stretcher, twin-engine turboprop aircraft – off the runway.

  CareFlight is an aeromedical charity that provides rapid-response critical care. Aircrew, medical teams and coordinators deliver the best care they can as soon as possible – essentially bringing the right team to the right patient at the right time. Flight doctors and nurses transport medicine and care for injured patients who need emergency treatment at the scene of the incident. They also transport seriously ill patients and expectant mothers who need to be moved between clinics and hospitals.

  With the very early morning start, Raggs and Lane were already tired. ‘Halfway into the flight, Raggs, who’s a very funny bloke, decided to keep me awake by telling me a joke,’ Lane says.

  ‘Have you heard the one about the goat? No? Well, there’s a bloke sitting in a bar …’

  Distracted by a strong odour, Lane interrupted him. ‘Raggs, can you smell that? I can smell smoke, a burning smell,’ she said. Her heart skipped a beat when suddenly she heard a cold, mechanical breathing sound coming through the radio, like someone speaking through a scuba mask with a microphone in the regulator. ‘I’m thinking, What the hell? I turned to see Raggs in the cockpit wearing a mask. He looked like Darth Vader out of Star Wars. I asked him if he was wearing an oxygen mask.’

  ‘Phhrssffhhh, yes,’ he breathed.

  ‘I thought, What? Where’s mine?’

  ‘Phhsssfhhh,’ came Darth’s reply again. ‘You don’t get one.’

  Lane looked wildly around to find Raggs hooked up to medical oxygen. Aware something was wrong, her heart was in her mouth. ‘He looked like someone out of Top Gun on his own little pilot mission,’ she says. ‘Raggs never panics – he’s as cool as a cucumber. But I could see he was clearly distressed by the burning smell. Later he told me he thought if we both became incapacitated it wouldn’t be good, so that’s why he put the giant oxygen mask on. I just didn’t get one down the back. I was terrified. Raggs figured out the heating element had burnt out and just needed to be switched off. Meanwhile, I’m down the back panicking away, thinking, We might explode any second. I’m going to die on this plane.’ Raggs turned off the heating and checked with Lane whether or not the smell had gone. ‘When I confirmed it had, he took his precious mask off.’

  At that point, Raggs and Lane had arrived at Groote Eylandt, Australia’s third-largest island with an archipelago that includes more than 40 smaller islands. On the western side of the Gulf of Carpentaria and about 640 kilometres south-east of Darwin, Groote Eylandt is the homeland of the Anindilyakwa people. The low-lying island measures about 50 kilometres from east to west and 60 kilometres north to south. A hilly island, it’s coloured by extensive red plains, a rugged sandstone plateau, sand plains and savanna woodland dominated by stringybark eucalypts and Darwin woolly butt. There are patches of monsoon vine forest, pandanus and citrus pine, and Casuarina trees and Banyan figs give shelter and shade near the beaches.

  They picked up the woman, who had been pregnant with her second baby. Raggs and Lane carefully placed her on board. She was still bleeding slightly, but her obs (observations) were fine and Lane didn’t think she needed to give her blood. When she noticed the woman was clutching a tiny container with her deceased baby inside, she felt wretched. ‘It was very impersonal and the sight of this poor woman holding it was very, very sad,’ Lane says. While Lane and Raggs were settling the young woman on the plane, Lane received another call asking if she could pick up a woman at Ramingining – a community on the edge of the Arafura Swamp in Arnhem Land with a population of about 800. ‘The woman had gone into early labour at 22 weeks. As we were the only aeromedical team flying in the Territory at that time, we didn’t have a lot of choice and we were only about an hour away.’ Lane checked with her patient, who was stable and okay, if she minded a small detour to pick up the Ramingining woman. After her own traumatic birth hours before, the woman said she just wanted to sleep. So Raggs and Lane flew into Ramingining, where they picked up the woman who was expecting her seventh child. She wasn’t contracting and had been given drugs to calm the labour. In the early-morning darkness, they quietly loaded her safely on board.

  With everyone secure and strapped in, Raggs took off. The plane was still climbing when suddenly the pregnant woman reached behind to where Lane was sitting and dug her nails into Lane’s arm. ‘I’m pushing!’ she screamed. Lane grabbed the microphone to tell Raggs what was happening and to ask when she could undo the seatbelt and get up. With the aircraft still in a 45-degree climb, Raggs asked her to wait 30 seconds. Gripped with anxiety, she waited and waited and held the woman’s hand, telling her she was doing well and to breathe, just breathe through it. When Raggs gave the okay to unbelt, Lane whipped up and knelt down beside her patient. As the small area at the back of the aircraft only takes two stretchers lying down - one on each side – there was very little room to move.

  ‘The woman had opened her legs and I could see a bulging sack of fluids discharging. I was down the back and too far from the two-way mic to be able to relay information to Raggs. I thought, Oh my God, this is not happening.’ She raced back up to the area behind the cockpit to grab her drug bag and neonatal bag valve mask (BVM), which is a hand-held device used to provide positive pressure ventilation to patients who are not breathing adequately. With only a small birthing bag kept on board for emergencies, Lane worried that she didn’t have any of the regular birthing equipment like a neonatal cot or even a simple hand-held neopuff automatic ventilator. The first patient’s baby had died and Lane hadn’t expected to have to deal with the actual birth of a baby. Frightened about what might unfold, her hands were shaking. She tapped Raggs firmly on his shoulder. He turned to her and took off his mic. Above the roar of the engines, she yelled, ‘I think we’re about to have a baby, you need to fly faster.’

  Lane returned to her patient and plugged in the oxygen. She had her neo
natal BVM and drew up the drugs in preparation for the mum. Within minutes the woman pushed out the baby. Being tiny, it was still enclosed in the gestational sack that hadn’t burst.

  Just seconds after the birth, the sack popped. And there, in front of her, was a beautiful little boy. Lane rested him in her hand. He reached from the tip of her fingers down to her wristwatch. She could see the baby was gasping for air and she needed to think level-headedly about what to do next. ‘His arms and legs were in a starfish position and he seemed to be trying to close his hands to cover himself. He was vigorous and very much alive. I clamped and cut the cord.’

  The plane was unusually cold because Raggs had had to turn off the heating system. Lane anxiously searched around for something warm to wrap the baby in. She found a plastic bag and swathed him in it. He was still gasping for air. So sitting cross-legged on the aircraft floor with the baby in her lap, Lane began ventilating him, giving him slight breaths. ‘His mum looked over lovingly and cooed at her baby,’ Lane recalls. ‘I explained to her that he was very, very tiny, but he was alive.’ Suddenly, the mother let Lane know she felt like pushing again. ‘I placed the baby, still in the plastic bag, carefully on her chest and said she could have a little cuddle while I just took care of her.’ The mother pushed out the placenta without any problems, and while very small, it looked complete.

  Lane now checked the baby. His breathing was distressed and his dark skin had turned pale blue. His arms, which had previously been stretched above his head, and his legs, which had been bent at angles with muscles tensed, were now lifeless. His pint-sized chest was heaving. With her own heart racing, Lane sat down again and tried to BVM him. ‘I started to ventilate him in my lap – by trying to force air into his alveoli in the lungs to inflate them. His chest became barrelled from using every single muscle, pronouncing his ribs with each chest movement. I gently squeezed a little orange bubble, no bigger than my fist, to blow air in from the BVM to his immature lungs using the pressure of two fingers. I had to get it exactly right: too small a squeeze and not enough air goes in, too much and you can over-inflate and burst a lung. I could see he was working hard to breathe.’

  The roar of the plane’s engine made using a stethoscope useless, so Lane balanced the baby on her lap and with two fingers still squeezing the BVM bulb, she slid her other hand into the plastic bag and placed two fingers over the apex of his chest and attempted to count the beats of his thumping heart. ‘My attempt to multi-task meant my ventilation was ineffective, so I stopped bagging him and focused on counting the heartbeats through his chest wall. Eighty beats per minute. He was okay. It wasn’t great, but it wasn’t the worst. Infants have ridiculously high heart rates. Anything below 100 requires you to breathe for them, anything below 60 beats per minute [BPM], which would be fine for an adult, requires CPR. When I thought another 30 seconds had passed I stopped to check his heart again. It wasn’t good, so I started CPR chest compressions. With two fingers again, straight down the centre of his chest I started the sequence. He wasn’t positioned on my lap firmly, so I sat flat on the floor and balanced him on one thigh with my two fingers on his sternum pounding into his miniscule chest. My other two fingers were back on the bulb of the BVM. Push, push, push, breathe; push, push, push, breathe. Over and over again.’

  Next thing, the mother told Lane she felt really faint. She was bleeding profusely. Lane remembered she hadn’t given her the intramuscular injection of Syntocinon she had prepared. This is a synthetic replication of the hormone oxytocin which should occur naturally to stimulate the uterus to contract shortly after the baby is born to prevent bleeding. Lane could see clearly the mother needed the synthetic dose. ‘I’d been so distracted by the baby, I hadn’t followed protocol.’ Running on adrenaline and dealing with each situation as it occurred as best she could, she turned her attention back to the mother. ‘I had nowhere to put the little baby. He still had a gigantic oxygen mask over his face, which was the smallest we had on board. He was still in the garbage bag, so I wrapped him again in the biggest blanket I could find and placed him on a bundle of rugs on the back seat with the oxygen mask lying over his face and just had to leave him there.’

  Lane injected the drug into the mother’s leg and rubbed her stomach to try to stimulate the uterus to begin clamping down. ‘But it wasn’t clamping and I couldn’t stop the blood from hosing out,’ says Lane. ‘I was at a total loss. I drew up some more Syntocinon, put it in a bag and started hanging it.’ She checked the mother’s blood pressure to find it was 42 over 38. Not good. Then she reached for the second blood unit she had brought on board for the first patient and gave it to the bleeding woman. After giving the blood and with the second dose of Syntocinon gone through the bag, the bleeding eventually slowed down. ‘Her blood started to trickle rather than pour,’ says Lane. ‘I got my bearings and had a quick look at my first patient. She was okay, still sleeping. The second patient was now looking a little bit better after receiving blood and fluid. Everything that could be done was done.’

  Lane reached for the baby, still lying on the back seat, and sat down on the floor next to the mother’s legs and began CPR again. Suddenly, she became aware of the seatbelt sign – Raggs was recycling the seatbelt sound alert to grab her attention. She climbed into the back seat, carefully holding onto the baby, and managed to buckle her belt. Then she resumed compressions on the infant. She looked across at the two women: one was sleeping and the baby’s mum was looking okay.

  With the plane on a tilt for the landing, Lane could see the runway straight ahead from where she was seated up the back. Feeling overwhelmed, she started to cry. ‘I thought, Oh my God, I haven’t called anyone and I haven’t got any help coming. I hadn’t called our logistics team to tell them our arrival time or asked for help, or for paramedics to meet us – nothing.’ It was 6 am when they landed and there was no one in sight. She was shattered. Raggs shut down the plane and all of a sudden the rumbling of the engines she had been constantly hearing fell silent.

  Then, from a corner of the airport, two ambulances sped over and the most senior CareFlight doctor and staff members emerged. For the entire flight, Raggs had been relaying on the satellite phone to CareFlight all he could see happening down the back of the aircraft.

  ‘I had completely forgotten to communicate with him,’ Lane recalls. ‘But he could see I was struggling. He knew I was performing CPR on the baby, giving blood, injecting Syntocinon – he was totally on the ball and had relayed everything. At six o’clock that morning, everyone I needed appeared. The staircase door dropped open and the doctor was standing there. Senior doctors rarely meet a plane.’ He looked at Lane with assurance and asked what he could do.

  ‘You need to take this,’ she managed to say and handed him the baby. The doctor carefully took the tiny bundle with the BVM from her arms.

  ‘Yep, no worries,’ he replied in a soothing voice. He whisked the baby away, accompanied by another nurse in the first ambulance. Before he left, he turned to Lane and asked if she would be okay with the two women. ‘Yes, I’m fine,’ she said, feeling the enormous weight lifting from her shoulders.

  Raggs opened the cargo door and together they carefully unloaded each of the women. As they pulled the stretchers out in the pale, early-morning light, they could see how much blood had been lost. It had splashed up the sides of the walls and all over the floor. ‘It had been so dark, I hadn’t seen it,’ Lane says. She had spent a large part of the flight sitting and working in a growing pool of blood. ‘We got the women into the ambulance and the paramedics, who were just beautiful, suggested I take a little breather. We’ll load them on and take care of the blood pressures, they said.’

  Raggs took the moment to approach Lane and wrap her in his arms, telling her what a great job she’d done. Standing there, bathed in soft, orange sunrise, he decided they should have a photo together to remember their good work – everyone had made it alive. ‘We have a beautiful photo of us from that horrendous morning that we’ll never
forget,’ Lane says through tears of deep emotion.

  The paramedic approached Lane and put a hand on her shoulder. It had just been radioed in that the first ambulance had had to pull over to try to intubate the premature baby boy on the way to the hospital. But the smallest tube they had to try to insert into the trachea to provide a definitive airway and maximise the effectiveness of resuscitation, was still too big. The baby was just too small. He had died. Lane was devastated.

  But it wasn’t yet over for Lane, and she had to work hard to hold herself together. She and the two paramedics moved the baby’s mum across to the ambulance. Then as they were bringing the first patient over, Lane noticed she had started to bleed again. ‘There was blood all over her,’ she recalls. ‘We started giving her the other remaining unit of blood.’ With dread Lane realised that had she bled significantly in flight, it could have gone unnoticed with all her attention on the birth, the bleeding mother and the struggling baby. Now the initial patient was haemorrhaging. The medical team stabilised her, then climbed into the ambulance and sped off to the hospital. ‘The mother didn’t know at that stage that her baby had passed away. We got the two women to the resuscitation area, and although they both needed a little time in the intensive care unit, both mums survived.’

  Though saving the mums was a wonderful outcome, the loss of the babies was something that would be felt by the whole community. When an Aboriginal family member passes away, the family belongs to everyone in the community and the sorrow is shared through kinship ties. Grief, known as ‘sorry business’, is shared by crying together, creating a communal sorrow and breaking the grief. On their return to their communities, each of the women and their families would receive lots of loving support led by the community’s senior women. When it comes to the loss of a premature baby, the grieving is done in a more private, close family way – unlike the way it is done for older people, where a large, community ceremony is held.