Australian Midwives

by Paula Heelan

  Saving the two women depended as much on pilot Ben Ragg as it did on Lane. Ben began flying gliders in 1997 when he was only fifteen, and moved to powered aircraft in 2000. Set on a career as a pilot, he worked determinedly for several years to save the $100,000 needed for a pilot’s licence, with qualifications to fly a commercial plane in bad weather. In the lead-up to full-time work as a commercial pilot, he towed gliders, flew skydivers and spent twelve months with Broome Air Services in Western Australia flying people around the Kimberley and Pilbara regions.

  Ben soon landed a job with Chartair in Darwin and, based on his bush experience, was sent on his own with an aircraft to Ngukurr, a remote Aboriginal community on the banks of the Roper River in southern Arnhem Land, to start up a new base to fly patients to Katherine for medical appointments. Then, after several years with Hardy Aviation flying tradies, teachers, politicians, mining staff, medical crew, supermarket staff – anyone with a need to travel, to anywhere they needed to be – Ben started working for CareFlight in 2011. After two and a half years he was promoted to a supervising role to mentor new pilots for the first few months before they fly solo. ‘All our flying is usually done with a single pilot,’ he says. ‘The training and mentoring was a strong area of interest for me, having lost two acquaintances and two work colleagues to preventable plane crashes.’

  When Ben and Lane were tasked to the second patient, CareFlight base crew wanted to ensure Lane was happy with the first patient before loading her up with a second. ‘A miscarriage at 22 weeks is a terrible thing for any parent to have to go through and it’s also hard on the medical crew – they’re just sad flights to be on,’ Ben says. ‘And it’s certainly not the sort of job you want to be on when they ask if you can go to another 22-week pregnancy with a strong potential of miscarriage. Because we weren’t leaving for the second patient from a larger centre, we didn’t have a doctor or the extra equipment we’d normally take to a high-risk pregnancy. But Lane and I were the only crew that could get to the patient within the next five hours and likely to have her in a hospital within two.’

  The fumes event happened when Ben and Lane were on their way to retrieve the first patient. ‘Lane had asked me if I could make the cabin warmer than normal for her patient. Ninety-nine per cent of the time nothing goes wrong with the plane, and while we’re busy, there’s plenty of opportunity to chat – yes, we can do two things at once!’ He laughs. ‘But that all changes if we get a red light on the annunciator panel or someone tells us something isn’t right – and that’s what happened that night.’

  ‘Smoke’ is one of those words that will capture a pilot’s full attention – and is treated as a real emergency. ‘Much like the medical crew uses DRSABCD [which stands for Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillator] and recognises that danger to themselves is initially more important than trying to help the patient’s airway, breathing, circulation and so on, we have an aviation equivalent. Pilots need to make sure they are safe before attempting to fix the problem. Passing out from the smoke or fumes does nobody any good. Pilots have died trying to fix a simple problem – leaving nobody flying the plane to keep them or anyone else safe on board. From there we need to work out whether the smoke is electrical and smells like bacon, or from the environmental system, which is usually oil burning and smells like a cross between dirty socks and vomit. Either way, our world just got busy and we don’t have time to chat.

  ‘Electrical smoke gives me thirty things to do, environmental smoke only fifteen,’ Ben continues. ‘Neither involves dropping the passenger oxygen masks. Where there’s smoke, there’s fire and adding a lot of oxygen to fire is not a good thing. The passenger masks aren’t anything like the pilot masks – they don’t provide enough oxygen to overcome the fumes, so we don’t deploy them. If they deploy automatically, it’s actually the one time we tell people not to use them.’ High above Groote Eylandt and aware he had just turned up the heater, Ben ran through the environmental checklist. ‘I was also working out the nearest place I could get the aircraft on the ground – not all our day strips are useable at night,’ he says. ‘But before too much more had happened Lane mentioned the smell had gone – and suddenly we were back to a normal, uneventful flight and able to land at our planned destination.’

  When Ben and Lane landed Ben thought the condition of the patient wasn’t as serious as Lane had described. ‘At 22 weeks the baby bump is barely showing and Indigenous women tend to be very quiet in labour. From the similar jobs I’d had in the past, I wrongly assumed this would be a quiet, uneventful flight back to Darwin. I should have realised no flights with Lane are uneventful,’ he quips.

  When Lane asked Ben if she could unbuckle her seatbelt after take-off and he asked her to wait 30 seconds, he didn’t think she was too panicked at that stage. ‘It’s not unusual for the nurses to want to get back to work as soon as it’s safe,’ he says. ‘I didn’t realise that that would be the last time she’d put her headset on for the entire flight. We normally set up our planes so the more critical patient is on the front stretcher and the relatively well patient is on the rear stretcher. The exception to this is the midwifery jobs – nurses usually prefer to have pregnant women on the rear stretcher where there’s more room in case there’s a birth. Because that’s not a very common situation, the nurses don’t normally have their headsets plugged in when they’re down the back.’

  Immediately after departure, pilots are very busy and it wasn’t until Lane tapped Ben on the shoulder and said I think we’re about to have a baby that he comprehended something was going on. ‘The nurses are ordinarily very good at keeping us in the loop. When they’re not, it’s usually not very good. I shouted back and asked if she wanted me to let anyone in Darwin know – I don’t think she heard me and she didn’t talk to me again,’ he says.

  Ben thought it was better to be safe than sorry and called the logistics team on the sat phone and suggested they wake up everyone. ‘Even as a pilot, we know a pregnancy less than 24 weeks is very rarely viable, but the medical crew does everything it can until the woman reaches the hospital.

  ‘About half an hour into the flight the woman birthed the baby – worst possible scenario. There’s very little we can really do except get to a hospital as quickly as we can. I know that first half hour is a trial of life for the baby – the more medical help it receives at that point, the more likely it is to make it. I made another sat-phone call to keep logistics (and doctors on the ground) in the loop – the information can change whether they bring a second ambulance to the airport or not. I also called Air Traffic Control to let them know we’d gained an extra passenger in flight as they need to know if there’s an accident – and it’s good to confuse controllers at five in the morning as to how we picked up someone in flight,’ Ben says with a laugh.

  About twenty minutes out from Darwin Ben noticed things weren’t fine. ‘Lane was in a pool of blood on the floor of the aircraft performing CPR on the baby – while paying a lot of attention to his mum at the same time. I twigged something was wrong there as well so I gave logistics another call. The consultants, which are the most senior doctors, are pretty good at interpreting pilot-speak to work out what’s going on – they also tend to go straight for the worst-case scenario. We had the former medical director on that night and it was the first time I’d heard him say, I’m driving in now – I’ll meet you at the plane. This was from a pilot’s description of events only – almost always they ask to be put on to the nurse or registrar.’

  At two minutes to land, Ben could see Lane was still sitting in a pool of blood. ‘We’re required to have passengers wear a seatbelt and I’d given up shouting long ago. I cycled the seatbelt sign a couple of times, which sounds like a chime – it was enough to get Lane’s attention and I pointed to the runway. We can keep flying if the nurses need more time, but the look on Lane’s face at seeing the runway and jumping back into the escort’s seat told me she was ready for this to be over – and time for
me to get the plane on the ground.’

  After the ordeal hospital staff surrounded Lane. ‘They were literally patting me on the back, telling me what a good job I had done,’ she says with surprise. ‘Everyone was really amazing. They kept bringing me cups of tea and asking if I was hungry. The senior doctors came in to chat and to ask what had happened and what I’d done. They told me I’d done an amazing job.’ But despite the unremitting praise, Lane was overwhelmed with concern. Was it the best she could have done? ‘If I’d given the drugs straightaway, maybe the mother wouldn’t have bled? And then I would’ve had more time with the baby. I had to accept that it was just one of those things that can happen when there are so few resources to work with.’

  With everyone showing great concern and care for her, this somehow made it worse for Lane that morning. The experience of that disastrous night had definitely upset her. She went home to her apartment. It wasn’t until she walked through her front door that she noticed she was covered in blood. She stripped off her blood-soaked uniform and dumped it in the outside bin.

  She crawled into bed and fell into a deep sleep. ‘I had had a big cry at the hospital and was exhausted,’ she says. ‘When I woke up at home, my arms were cradled. I thought I was still holding the baby. It was so vivid. It was horrific to wake up that afternoon thinking he was still in my arms and then to remember that he’d died.’

  Lane rolled over and reached for her phone, which sat on the side table. There was a message from Raggs. It read: So about that goat, and he finished the joke. ‘It made me feel so much better. It just capped off that long, traumatic morning that had started with the stupid fire scare on board,’ she says. ‘At the hospital they refer to that day as the disaster night and use it as an example of what can go wrong when teaching student nurses. I was very lucky to have had such a supportive team and Raggs was just spectacular. That’s the only way to describe him. The senior doctor racing out and taking the baby from my arms, the support from paramedics and hospital staff - everyone was just at the top of their game. It was incredible.’

  Having to cope with that kind of catastrophic, extreme incident by yourself in the middle of the night on a small plane doesn’t happen often. ‘Usually, we get a heads-up about what we’re going to do and can decide what equipment we need and how many hands to take. We can take a doctor or a specialist with us if we think it’s necessary.’

  Lane had thought one woman bleeding was totally within her manageable scope of practice. ‘I would have taken a doctor, a neonatal cot and a heating chamber and some extra bits and pieces had I known what was going to unfold. You can’t predict these things. I went back into work that afternoon to debrief. Everyone came in after their night shift in their own time to talk and find out what had happened. When we went through it, I was very open about the fact that I had felt I’d failed to give the drug soon enough and that this may have led to the catastrophic haemorrhage. People were very sweet and understood I had just been caught up with a little baby boy that had pulled at my heartstrings – he was a massive distraction in the course of my work. They talk about this in emergency work – it’s known as “scene distraction”. In the end, you just do the best you can.’

  After the debrief Lane felt better. Everyone echoed again what a professional job she had done, and while some may have taken different steps, they might not have been able to do as much. ‘I crammed a lot into the relatively short flight of one hour and ten minutes from Ramingining to when I saw that runway in Darwin. It felt like ten minutes.’

  Lane turned up to the CareFlight office for work the next day without realising how shaken she still was. She was sent home and after a good night’s rest, she felt better and was back on the job the following day. But two years later, she still thinks about that night. ‘This is the first time I’ve cried about it since then,’ she says. ‘You can be a little blasé when it comes to protecting yourself. I haven’t gone into so much detail about it since it happened. I guess that’s the self-preservation strategy at work. If you burst into tears every time you talk about a difficult experience, you’ll crack. And it wasn’t my journey – it was the journey of the women in my care and their babies. I was just there to help.’

  Lane grew up on Sydney’s north shore with her parents and two younger brothers. In 2008, armed with a Bachelor of Nursing, she began working at Sydney’s Hornsby Ku-ring-gai Hospital in the emergency department where she had trained. She also completed her postgraduate training in critical care. ‘My training covered everything, but I really just loved the blood and guts,’ she admits. ‘I had always known I would. Growing up I loved playing doctors and nurses with my brothers. Charming children that we were – often caught running around with kitchen knives and scissors, playing operations.’

  Lane gathered and built skills in resuscitation, triage (prioritising injured people when limited medical resources are available in an emergency), ordering her own bloods and X-rays. ‘Working in emergency is great for gaining knowledge because there’s constantly something new coming through. It’s one of those places where the more you learn, the more you realise how little you know. I was completely under the wings of senior nurses until I moved to the Manly Hospital’s emergency department in 2011. Going in with a fresh slate at Manly was really nice. At last I wasn’t known as the baby nurse in training. Instead, I went in as one of the more senior staff.’

  At Manly, Lane provided continuity of care for pregnant women. She did the antenatal appointments and was on call to attend the births of the babies of the women in her care. She also followed through with the postnatal care. ‘As a student it helps to follow the woman’s journey and it’s helpful for the woman to form a bond and trust in her midwife. It’s a model that’s been proven to reduce maternal stress and can lead to a better birthing experience emotionally.’

  Lane was following a patient named Katherine at Manly. Along the way it had been a normal, uneventful pregnancy with a scheduled caesarian. ‘Everything was going to plan and a beautiful, term baby girl, named Laura, was born,’ Lane says. ‘While Katherine was still on the operating table we gave the baby a little wash and brought her to her proud parents for cuddles. Two minutes later Katherine said, Lane, I don’t think she’s breathing. Sure enough the baby had dropped like a sack of potatoes. I grabbed her and raced her back to the Resuscitaire [the neonatal resuscitation station]. Her heart was beating but she wasn’t breathing. My supervisor, Karen, swiftly gave positive pressure ventilation with the neopuff. Thirty seconds later we checked again and found there was no heartbeat. I started CPR and before we knew it we were a team in high action. A surgeon helped and after quite the emergency, Laura was revived and well. I nicknamed her Spud because she had dropped like a sack of potatoes without warning. She had scared us half to death – not least her mother. The family put a lovely thankyou letter in the local paper, which I kept.’

  Three years later, Lane was visiting Sydney – for only the third time since she’d left for Darwin. ‘I was walking along a main road with a girlfriend when next minute, a car pulled up beside us – completely stopping the traffic. A woman yelled out – Hey, are you a midwife? It was Katherine – she had circled the block three times checking to see if it was me. She was screaming out the car window – still holding up the traffic – and in front of all the onlookers called out, You did CPR on my baby – you’re my angel. I’ve got Spud in the back seat! I knew it was you, Lane – I’d never forget that smile. She pulled up and we had a great chat and I got to meet three-year-old Spud. It was one of the most humbling moments of my life.’

  Lane had longed to become a flight nurse since she saw a Royal Flying Doctor Service (RFDS) stand at the Sydney Royal Easter Show. That was it. That was her dream. After two years at Manly in the emergency department, she decided to study midwifery to increase her chances of becoming an aeromedical flight nurse. ‘I hated it at first,’ she admits. ‘I found it hard because it was so women-centred. There are a lot of very strong personalitie
s in midwifery and everyone has their own style, agenda and beliefs. Some believe in pain relief, some don’t, some love bouncy balls, others water births. I found spending long hours with women who really need you while they are in labour, intensive. I was just there for the skills I needed to become a flight nurse, not so much the midwifery.’

  When Lane got the job as CareFlight nurse and midwife in 2012, she packed her bags and flew out of Sydney. She arrived in Darwin with very little idea about what lay ahead. ‘With a population of 127,000 the city is quite small and there are no department stores like David Jones or Myer,’ she says. ‘There are no four seasons – it just has a wet season and a dry season and you just get used to the year-round tropical humidity. It’s a great outdoors place with plenty of fishing, walking and swimming and there’s a great mix of people – it’s very multicultural.’

  While Lane was over the moon about the job, it was a very steep learning curve because she had never worked as a sole practitioner before. ‘When you fly up here, it’s usually just you and a pilot. I found it nerve-racking at first and was pretty much overwhelmed with it all. But the pilots are extremely professional and astute and try their best to assist new crew. They pick up quickly on things and assist whenever they can.’

  During her first two weeks in Darwin, despite her anxieties, Lane embraced all things new with fierce determination. The first day she stepped onto a King Air plane she was on a ‘buddy flight’ with the nurse on duty. This is a training flight for new nurses under the supervision of an experienced, senior nurse. They had been assigned to retrieve an ill patient and Lane was terrified. ‘At that stage I was just along for the ride to watch how the nurse interacted with clinic staff and patients.’

  Not long after she started working on her own, she stepped off the plane into the red dust of the remote community of Wadeye (pronounced wod-air-yer) and was driven from the airstrip into the middle of the settlement. As the four-wheel-drive-cum-outback-ambulance hurtled along, Lane noticed countless camp dogs and idle young men sheltering under trees and doorways from the searing sun. The vehicle pulled into a secure steel structure next to the clinic. The bumper sticker read, No Humbugging, meaning ‘don’t annoy the clinic staff – no free rides’.