He suspected that the midwives didn’t need the visit but Reg clearly felt paternal in his concern for them. Finn thought it prudent not to share that insight with Catrina.
But what a gift of an excuse, he thought as he stepped through the automatic front door to Maternity and glanced around for her.
Instead, a nurse he’d met on his orientation round with Reg on Friday came in through the side door from the main hospital at a run and her relief at seeing him alerted his instincts faster than her voice. ‘Dr Foley—please follow me through to the birthing suite. Urgently!’
The smile slipped from Finn’s face and he nodded and followed.
When he entered, he saw Catrina standing over a neonatal resuscitation trolley, her fingers encircling the little chest with her thumb pressing cardiac massage over the baby’s sternum in a rhythmic count.
Another nurse held the tiny face mask over the baby’s face, inflating the chest with intermittent positive pressure ventilations after every third compression.
Finn stopped beside them, glanced at the seconds ticking past on the trolley clock that indicated time since birth. It showed ninety seconds.
Catrina looked up and the concentrated expression on her face faltered for the briefest moment and he saw the concern and the relief on her face. Then she looked at the clock as well. Her voice remained calm but crisp.
‘Rhiannon’s baby was born two minutes ago, short cord snapped during delivery so probable neonatal blood loss. Baby is just not getting the hang of this breathing business.’ Her voice came out remarkably steady and he filed that away to tell her later.
‘Heart rate less than sixty for the last thirty seconds so we added cardiac compression to the IPPV and it’s just come back to eighty.’ She loosened her fingers around the baby’s chest and turned down the oxygen to keep the levels similar to where a two-minute-old baby would normally be. Too much oxygen held as many risks as not enough oxygen for babies.
‘This is the paediatrician, Dr Foley, Rhiannon,’ she called across to the mum, who was holding the hand of an older woman, concern etched on their faces.
Finn lifted his hand and smiled reassuringly. Because the fact the baby had picked up his heartbeat was an excellent sign. ‘Give us a few minutes and I’ll come across and explain.’
He glanced at the pulse oximeter someone had strapped to the flaccid pale wrist. ‘You’re keeping the oxygen levels perfect. Umbilical catheter then,’ Finn said calmly. ‘I’ll top up the fluids and the rest should stabilise.’
‘The set-up is in the second drawer. There’s a diagram on the lid because we don’t use it often.’
He retrieved the transparent plastic box and put it on the nearby bench, squirted antiseptic on his hands and began to assemble the intravenous line that would be inserted a little way into the baby’s umbilical cord stump and give a ready-made large bore venous entry point to replace the fluids lost.
He glanced at Catrina. ‘Warmed fluids?’
‘Cupboard outside the door.’ The nurse he’d arrived with handed Catrina the clipboard she’d taken to jot observations on and slipped out to get the fluids. By the time he had all the syringes and tubing set she was back and they primed the line with the warmed fluids and set it aside.
Finn squirted the antiseptic on his hands again and donned the sterile gloves to wipe the baby’s belly around the cord with an antiseptic swab, and wiped the cord stump liberally with the solution.
After placing a towel on the baby’s belly to give himself a sterile field he could work from, he tied the soft sterile tape around the base of the finger-thick umbilical cord. The tape was a safety measure, so that when they removed the cord clamp Catrina had fastened at birth, he could pull the tape tight around the umbilical cord to control any further blood loss.
Once the tape was in place and fastened firmly, Catrina looked at Finn, who smiled reassuringly because he doubted it was something she did on a newly cut cord very often, and watched her remove the cord clamp with only a trace of anxiety.
Finn nodded to himself, satisfied—no bleeding—then sliced off the nerveless ragged edge of the snapped cord closer to the baby’s belly with a scalpel blade, the white tape preventing any further blood loss. Now he could easily see the vessels inside where he wanted to put the tubing.
Using fine artery forceps, he captured one edge of the cord and then offered the forceps to Catrina to hold to free up his other hand.
With the cord now pulled upright, Finn lifted the catheter and another pair of forceps to insert the end into the gaping vessel of the vein in the umbilical cord. He glimpsed the nurse from the main hospital looking wide-eyed and said quietly, ‘It’s easy to tell which is the vein, being the largest and softest vessel of the three in the cord. That’s the one that leads to the heart.’
Catrina asked, ‘Do you have to turn the catheter to insert it? Aren’t the vessels spiral?’
‘Yes, spiral so when the cord is pulled in utero there’s give and spring, the longer the cut cord the more spiral you have to traverse until you get to the bloodstream. That’s why I cut this fairly short. Not too short that you don’t leave yourself a back-up plan, though.’
The fine clear intravenous tubing disappeared just below the baby’s abdominal skin. A sudden swirl of blood mixed with the warmed fluid Finn had primed the tubing with.
‘And we’re in,’ Finn said with satisfaction. He adjusted the three-way tap on the line with one hand and slowly injected the warmed saline fluid with a fat syringe into the baby’s bloodstream. ‘Ten mils per kilo will do it, and I’d say this little tyke is about three kilos.’
He glanced at Catrina, who watched the monitor to see the baby’s heart rate slowly increasing. She nodded. He then glanced at her colleague, still calmly applying intermittent puffs of air into the baby’s lungs, and then watched as the tiny flaccid hand slowly clenched as tone returned to the baby’s body and he began to flex and twitch.
Finn looked over at the mum. ‘Not long now.’
‘Get ready to tighten the cord again, Catrina,’ he said softly and, once the full amount of fluid had been injected and Catrina was ready, he turned the tap on the infusion and removed the syringe.
‘We’ll just wait a few minutes before we remove it in case we need to give any drugs, but I think that will do the trick.’
CHAPTER FOURTEEN
Trina
TRINA’S GALLOPING PULSE slowed as the baby’s heart rate began to rise above eighty. Her hand loosened on the resuscitation trolley she seemed to have gripped as Finn did his thing. After what had seemed like forever the baby’s heart rate hit a hundred and ten and finally the baby blinked and struggled, grimaced against the mask and, in the most beautiful screech in the world, he began to cry. The tension in the room fluttered and fell like a diving bird and she watched Finn slowly withdraw the tubing from the vein. She tightened the cord as it came clear and then snapped on a new umbilical clamp close to the end of the stump. Done.
Baby threw his hands and kicked his feet and they pushed the resuscitation trolley closer to the mum’s bed so he could be handed across with the pulse oximeter still strapped to his wrist.
Trina considered removing it as he’d become so vigorous with the replacement of fluid but it would be easier to monitor instead of listening with a stethoscope so, despite the tangle of wires, she left him connected and pressed his bare skin to his mother’s naked breasts.
Once baby was settled on his mother, his breathing clear and unobstructed, she could relax a little more. A blanket covered them both, and she glanced at Finn, standing at the side of the trolley, his beautiful mouth soft as he watched the baby and mother finally together. His eyes shone with pleasure and he gave a little nod just before he saw Trina looking at him.
The smile he gave her, one of warmth and pride and appreciation, made her clutch her throat and heat surged into her cheek
s. She’d done nothing.
When she looked back at him he was watching the mum again, his eyes still soft as he spoke to her.
‘Hello there. Congratulations. As Trina said, I’m Dr Foley, the paediatrician, and your little boy looks great now. Snapped cords are fairly rare, but if a baby grows in utero with a short umbilical cord...’ he smiled that warm and reassuring smile that seemed to seep right down to the soles of Trina’s feet and he wasn’t even looking at her ‘...which he is perfectly entitled to do.’ He shrugged. ‘Not surprisingly, though it is always a surprise, they can run out of stretch at birth and the cord can pull too tight.’
Rhiannon nodded and her own mother sat back with relief to see her grandchild safely snuggled into Rhiannon’s arms.
Finn went on. ‘Babies don’t have a lot of blood to spare so some extra fluid through that intravenous line allowed his heart to get back into the faster rhythm it needs. As you saw, it’s usually a fairly dramatic improvement. We’ll do some blood tests and if we need to we’ll talk about a blood transfusion. But he looks good.’
‘Too much drama for me,’ Rhiannon said, as she cuddled her baby close to her chest. Trina could agree with that. Now that she had time to think about it, she had to admit that Finn’s appearance had been a miracle she’d very much needed. But there wasn’t time for that yet as she began to attend to all the things that needed doing in the immediate time after a baby had been born.
* * *
Two and a half hours later Trina had settled Rhiannon and baby Jackson into their room, and the myriad of paperwork, forms and data entry had been sorted. The nurse from the hospital had stayed to help Trina tidy the ward because Faith, the midwife from night duty, had already stayed later than normal. Trina glanced at the clock, just ten-thirty, so, on top of the tasks still waiting to be done, she did need a moment to sit back in the chair and consider the excitement of the morning.
It had been a little too exciting but thankfully Finn had appeared at exactly the right moment without needing to be called. An opportune thing.
Like he did at that moment. Striding through the doors from the main hospital as if he owned the place.
She felt a smile stretch her face. ‘I was just thinking about you.’
His laughing eyes made her belly flip-flop and caution flooded her. He had a wife. Somewhere.
‘Good things, I hope?’ he said.
She shook her head. Pretended to think about it. ‘How I didn’t need you this morning and you just pushed in.’ Teasing him.
His face froze for a second and she slid her hand over her mouth in horror, saying quickly, ‘Joke. A very mean joke. Especially when you were so good. I’m sorry.’ But she could feel the creases in her cheeks as she smiled because his shock had been palpable when the statement had been totally ridiculous. He must have known she’d needed him desperately. She had no idea why she’d said such a crazy thing except to startle him. Or maybe because she’d been trying to hide how absolutely thrilled she was that he’d come back to see her when she’d thought he would have been long gone from the hospital.
This man brought out very strange urges in her. At least she wasn’t giggling like a twit. She was saying bizarre things instead.
He laughed a little sheepishly. ‘I was worried for a minute there.’
She looked up at him. Seriously? ‘Don’t be. Sorry. I was never so glad to see anybody in my life. My pulse was about a hundred and sixty.’ And it wasn’t far from that now with him standing so close, which would not do.
He studied her. That didn’t help the galloping heart rate. ‘Well, you looked as cool as a cucumber.’
‘On the outside. Good to know.’ Hopefully she looked that way now as well—especially with her brain telling her to do stupid things in fight and flight mode. ‘But, seriously, you were very slick with inserting that umbi line. Most impressive.’
And she had no doubt her eyes were telling him a tad more than she was saying because he smiled back at her with a lot more warmth than she deserved after what she’d just done to him. He sat down beside her at the desk.
To hide the heat in her cheeks she looked past his shoulder towards Rhiannon’s room and murmured, ‘It would have been very tense to keep resuscitating a baby who didn’t improve as we expected. He really needed that fluid in his system to get him circulating properly.’
He didn’t say anything so she looked at him. He was studying her intently again and her face grew hotter. ‘What?’
‘We were lucky. That was all it was. I’m wondering if you could call me for the next couple of births through the day while Piper is in care, just so I can sneak in a refresher course on normal birth. It’s a long time since my term in Obstetrics working towards my OB Diploma and I want to be up to speed if an emergency occurs.’
His diffidence surprised her. ‘Of course, you’re welcome. I call in a nurse from the hospital as my second but I can easily call you instead if we have time. Or as well. I don’t mind. And I can run a simulation through the latest changes in post-partum haemorrhage and prem labour if you like.’
‘Excellent. I’ve been doing some reading but things aren’t always the same when you get to the different hospital sites.’
‘We’re a birth centre not a hospital, even though we’re joined by an external corridor. So all of our women are low risk.’ But things still happened. Not with the regularity you saw in a major hospital but they did deal with first line emergencies until a woman or her baby could be transferred to higher care.
He nodded. ‘Is that your first snapped cord?’
‘My first here.’ She shook her head, still a little shocked. ‘We’ve had them tear and bleed but to actually just break like that was a shock.’
‘It’s rare. Had probably torn already and when the last stretch happened at birth it broke—but you handled it well, getting the clamp on so quickly. I’ve seen some much worse situations.’
‘I kept expecting him to get better, like nearly all babies do when you give them a puff or two, but by the time you arrived I was getting worried.’
He nodded. ‘Hypovolemia will do that. How’s Mum?’
‘Taken it in her stride. Said her angels were looking after her and baby Jackson.’ She thought he’d laugh.
‘Useful things, angels.’ Then, in an aside, ‘My mother was a medium. I should have listened to her.’
He shrugged and Trina tried not to gape. His turn to say something off the wall, maybe, or he could be pulling her leg because he grinned at her surprise.
He changed the subject before she could ask. ‘Today Jackson also had the midwives and doctor.’ He grinned. ‘Shall I go down and see if she has any more questions now she’s had a chance to think about it?’
Trina stood up as well. Off balance by his throwaway comment about his mother...and his proximity. Moving to a new location sounded like a great idea, she thought, still mentally shaking her head to clear it. That had been the last thing she’d expected him to say. But she’d ask more later. This moment, here at work, wasn’t the time. Angel medium? Seriously, she was dying to find out.
‘Great idea. Thank you.’ She stood up and followed him. Finn was thoughtful, kind and darn slick as a paediatrician. Lighthouse Bay might just have to count its blessings to have another fabulous doctor in the wings when they needed him. Speaking of wings... Angels? Her head spun as she followed him down the hallway.
* * *
Over the next four days while Finn covered the hospital, he shared three births with Trina between breakfast and morning tea. It was almost as if the mothers were on a timetable of morning births to make it easy for him to be able to watch and even catch one.
She could tell he was enjoying himself. Basking in the magic that was birth. But the busyness meant she didn’t get a chance to ask about him. About his mother’s angels. About his childhood. About his marriage—not that she wou
ld! The woman who had given birth to Piper and what had happened to her.
Trina hoped they were at the stage of friendship where she could ask about at least some of those things soon. But then again, she hadn’t shared anything of her past either. Maybe they should just leave it all in the past and keep talking about Lighthouse Bay nineteen to the dozen like they had been. Share the past slowly because she was probably reading too much into his interest.
Lighthouse Bay Maternity must have decided to draw in the babies for Dr Finn, because they just kept coming. The overdue ones arrived, the early ones came early, and the more time they spent together with new babies and new families the more her curiosity about Finn’s world before he came here grew.
He left soon after each birth to continue his appointments at the surgery but returned at late lunchtime with his sandwiches to talk about the morning’s events.
On Thursday, his last hospital shift before Dr Southwell returned, Finn entered the birthing room quietly after the soft knock Trina had trained him in. She’d left a message with his secretary to say they were having a water birth, and even though he’d not long gone he’d been very keen to see the way water and birth ‘mixed’.
Trina had given him a scolding glance at his wording, but she had immense faith that once he’d seen the beauty of the way the bath environment welcomed babies into the world he’d be converted. She was glad he could make it.
Sara, the birthing mum, was having her second baby and had come in late in the labour. She’d phoned ahead to ensure the bath had been filled, mentioned she wanted lots of photos of her daughter’s birth because she had lots from her son’s birth.
They arrived almost ready for second stage and Trina had the bath prepared. At Finn’s knock her head lifted and Sara frowned at the sound.
Trina worried. Maybe things had changed. ‘Are you still okay if the doctor sits in on your birth, Sara?’
Healed by the Midwife's Kiss Page 9
