Healed by the Midwife's Kiss

by Fiona McArthur

  He could feel the scowl on his face. Tried to smooth it out. To listen with empathy as if she were a tiresome patient who refused to take necessary advice. But she wasn’t. She was his wife who had abandoned them. Remember his oath to treat the ill to the best of his ability. He’d always known she wasn’t one hundred per cent well. It didn’t help a lot. ‘You’re a year late.’

  ‘I’m sorry.’

  Well, that didn’t cut it, but he hadn’t heard the reasons yet. He fought the panic that engulfed him. His brain had seized. His chest felt tight. And he had to keep from squeezing Piper too tightly against him. How could she be here? And—the most frightening of all—was he even glad?

  He stood again. Turned his back on his wife and moved across to put Piper down in her playpen, but she clung to him. He kissed the top of her head and reached for the fruit sticks he kept in a jar in the fridge.

  ‘Here you go, sweetheart. A bit cold but you don’t mind, do you?’ Then he put her in the playpen and she sat quietly with her big eyes watching him as she began to chew the fruity sticks.

  He heard Clancy’s soft voice. ‘You’re very good with her.’

  He stamped down the anger. ‘We are family. Plus...’ he looked at her steadily ‘...someone had to be.’

  She flushed. ‘I made a mistake.’

  Really? he thought. Just one? But didn’t say it. And it took a year for you to tell us that? Instead he tried to make his voice neutral and said, ‘I don’t understand why you would drop out of nowhere like this. What are you hoping to get out of this?’

  ‘Just to talk. At first.’

  He winced at ‘at first’.

  She went on hesitantly. ‘See what happens. If what happens is good then maybe—’ she drew a long breath and squared her shoulders for a second ‘—I’m hoping that we could start again.’

  Finn sucked in a breath, stunned she could even contemplate that, but then he was in shock. His thought processes were not good. He needed to be calm.

  Her shoulders drooped again. ‘I could learn to be a mother.’ She looked up at him and her eyes were shiny with tears. ‘Maybe even a wife.’

  CHAPTER TWENTY-TWO

  Trina

  TRINA PUSHED OPEN the door to Maternity and from down the hallway she could hear quiet moans from the closed doors of the birthing units. Someone sounded very close to having a baby.

  In the other birthing room it sounded as if someone else was also very close to having a baby. It happened sometimes. Not often, but when it did at change of shift a third midwife was needed. Technically she didn’t start her Sunday call until after eight a.m. but the other midwife had plans for today and Trina was pathetically grateful to be doing something.

  She tucked her bag into her locker and washed her hands. The fine tremor of distress was barely noticeable but still she glared at her quivering digits. Stop it. She liked and trusted Finn. She would just have to leave it there, parked, until she finished work.

  But, deep inside, a crack of loss began to tear and rip and widen. Too soon for loss. She should have stayed safe from pain for a lot longer. Healed more solidly before ripping at the wound.

  The woman down the hall moaned louder and Trina drew a deep breath and shut the world outside the doors far away. This was her world. Inside this unit. This was where she needed to concentrate.

  The called-in midwife appeared beside her and spoke very quietly. ‘I’m in room one with Bonnie. She won’t be long. All going well and I have a nurse with me. Jill has Jemma. It’s been a long hard labour and slow second stage. Will you take her?’

  Catrina was one hundred per cent there. ‘Absolutely.’

  She turned and knocked gently and pushed open the door.

  Jill, the midwife on night shift, looked up with wordless relief. ‘Here’s Trina, come in to help,’ she said to the woman with a brightness that didn’t quite ring true. ‘You know Jemma and Pierce, don’t you, Trina?’

  ‘Yes, I do. Hello there, Jemma.’ She nodded to the usually jolly Pierce as well, but his face had strained into taut lines. Some dynamic wasn’t working or there was a problem. ‘You both look to be doing an amazing job here.’

  Then she looked back to Jill as she reached for the handheld Doppler to check the baby’s heart rate. ‘I always like to say good morning to babies too, so is it okay if I have a listen to yours, please, Jemma?’

  ‘Sure,’ Jemma sighed as the last of the contraction ebbed away, and Trina put the dome-shaped Doppler on Jemma’s large rounded stomach. Instantly the clop-clop of the foetal heart-rate filled the room. The contraction ended and no slowing of beats indicated the baby had become tired or stressed, and the rate sat jauntily around one-forty. There was even a small acceleration of rate as baby shifted under Trina’s pressure, which told her that baby still had reserves of energy, despite what she guessed had been a long labour.

  She stared at the large shiny belly and guessed the baby’s size to be larger than average. Acknowledged that position for birth would be important to optimise pelvic size.

  ‘He/she sounds great,’ she said after a minute of staring at the clock. ‘Magnificent belly there, Jemma.’ The tension in the room eased another fraction.

  ‘Can I check the position, please?’ Jemma nodded and Trina ran her hands quickly over Jemma’s abdomen. Confirmed the baby was in a good position and head too far down to palpate. That was good. ‘So, catch me up on Jemma’s progress, Jill?’

  Jill glanced at the couple and smiled wearily. ‘It’s been a long night and they’ve been amazing. Jemma’s due tomorrow; this is her first baby and her waters broke about four p.m. yesterday. The contractions started pretty much straight away and they came in here about five p.m.’

  She glanced at the clock that now pointed to almost seven a.m. ‘The contractions have been strong and regular since six p.m. so she’s been working all night to get to this point. Her observations have stayed normal, and she’s been in the shower and the bath, has tried the gas but didn’t like it much. We’ve walked a fair way and at five she felt the urge to push. I checked and she’d reached that stage already.’

  Two hours of pushing and head well down. Good, not great, Trina thought. ‘Wow, that’s a hard and long labour,’ she said gently and Pierce nodded worriedly.

  ‘So,’ Jill went on, ‘Jemma’s been pushing for just under two hours now; she’s tired and we almost have head on view but it hasn’t been easy for the last few pushes. We’ve been in the bathroom for most of that time, but she wanted to lie down so she’s just come back to the bed.’

  Trina looked at the night midwife and nodded. In bed on her back was the last place any midwife wanted Jemma if she had a big baby on board. Jill wasn’t happy with the progress which, on the surface, seemed timely and acceptable so there must be more.

  Jemma moaned as the next wave of contraction began to build and Trina tuned to see why Jill would be worried as the team went to work to support Jemma in the expulsive stage.

  Tantalisingly close, the baby’s head seemed to be hovering but not advancing that last little bit to birth and Trina kept the smile on her face as she suspected Jill’s concern.

  Trina moved in with the Doppler again to listen to the baby after each contraction. ‘How about you give the doctor a ring and he can be here at the birth? Then he can do his round early and leave early. He’ll like that. I’ll stay with Jemma and Pierce for this last little bit. You can write up your handover notes here in the room, and that way you’ll be ready to go as soon as we have this determined little passenger in his mother’s arms.’

  Gratefully, Jill nodded and they changed places. When Jill had finished the phone call, she settled herself on the stool in the corner at the side desk and they all rested as they waited for the next contraction.

  Trina looked into Jemma’s tired face. ‘After this next one, I’d like you to think about changing position.
’

  Jemma sighed and Trina smiled. ‘I know.’

  Jemma grumbled, ‘I just want this over.’

  Trina nodded and glanced at Pierce. ‘I’m thinking Pierce wants to see this baby snuggled up between you both too. Your baby probably has his father’s shoulders, so I’m suggesting turning around and kneeling on the bed or even down on the floor, because that position gives you an extra centimetre of room in your pelvis. That tiny amount can make all the difference at this stage when it feels hard to budge.’ She smiled at them both. ‘It’s a good position for making even more room if we need it after baby’s head is born.’

  ‘Is there a problem?’ Pierce had straightened and looked down at his wife.

  ‘No. But sometimes when second stage slows this much it means there might be less room than expected. We have set body positions a mum can go into that create extra space in her pelvis. I’d rather have Jemma ready to do that, even if we don’t need it, than try to awkwardly scramble into position if we have a more urgent need.’

  Pierce nodded. ‘What do you think, Jem?’

  ‘I think I’d do anything to get this baby here.’

  After the next long contraction a weary Jemma rolled over in the bed onto her knees and rested her head on her forearms on the high pillows that had been behind her. Trina settled the thin top sheet over her and gently rubbed the small of her back. Pierce offered her a sip of water from the straw at Trina’s silent prompting.

  In the new position baby made progress and the first of the head began to appear on view. There was a soft noise at the door and, instead of old Dr Southwell, it was his son, Sam, and Trina could have kissed him.

  Reg was good, but there was nothing like an obstetrician when you needed one. ‘This is Dr Southwell, Jemma. Pierce, this is Sam.’

  The men shook hands quickly as Trina went on. ‘We’ve some second stage progress since Jill spoke to you, after moving to all fours. There’s better descent with the last contraction.’

  She moved her hand and placed the ultrasound Doppler awkwardly upwards against Jemma’s now hanging belly. It wasn’t as clear as before in this position but they could hear the steady clopping from the baby on board.

  Sam nodded at the sound. ‘Baby sounds good. I’m here as extra hands if position changes are needed.’ He went to the sink, washed and put gloves on.

  Pierce looked at him. He glanced at his wife and seemed to change his mind about asking more. The next contraction rolled over Jemma and she groaned and strained and very slowly the baby’s forehead, eyes and nose birthed. But that was all.

  ‘Keep pushing through,’ Trina said with a touch of urgency and Sam nodded. But no further descent of baby occurred. Trina found the foetal heart again with the Doppler and it was marginally slower but still okay.

  ‘We’ll try putting your head down. Move the pillows, Trina,’ Sam said quietly. Jill appeared at their side and Sam said, ‘Phone Finn. Tell him I want him up here to stand by.’

  Trina looked up as Jill disappeared and her heart sank. Sam must think it was going to be more difficult than expected.

  She removed the pillows and encouraged Jemma to put her head on the bed and stretch her knees up towards her chest with her bottom in the air. It would straighten out her sacrum and, hopefully, give them a tiny bit more room in her pelvis.

  The head came down another centimetre and the face cleared the birth canal but then the chin seemed to squeeze back inside like a frightened turtle’s head against his shell.

  Trina listened to the heart rate again and this time they all heard the difference in rate. Much slower. The cord must be squeezed up between the body and the mother’s pelvis. That would dramatically reduce the oxygen the baby was getting.

  ‘It looks like your little one has jammed his anterior shoulder against your pubic bone, Jemma. Not letting his body come down, even though his head is out. I’m going to have to try to sweep baby’s arm out so the shoulder collapses to make room.’

  ‘Do it,’ Jemma panted.

  ‘Try not to push as I slide my hand in.’ From where she stood, Trina saw Pierce fall back in his chair and put his hand over his face.

  Jemma stared at the ceiling and breathed slowly, striving for the calm that was so important, and Trina felt her eyes prickle with admiration for the mother in crisis as she squeezed her shoulder and spoke reassuring words in Jemma’s ear.

  She watched Sam’s eyes narrow as mentally he followed his hand past the baby’s head and reached deeply to slide along the upper arm to the elbow. Trina saw the moment he found the baby’s elbow and swept it slowly past the baby’s chest and face; she saw the relief and determination and wished Ellie was here to see her amazing husband, saw the muscles on Sam’s arm contract and watched the slow easing of the limp arm out of the jammed space and suddenly there was movement.

  The arm was out, the head shifted. ‘Push, Jemma,’ Trina urged, and then the baby’s flaccid body slid slowly into Sam’s hands.

  ‘I’ll take him,’ a voice said behind Sam and Trina looked up to see Finn there. The relief that swamped her was so great she didn’t care that his wife had arrived. Didn’t care her heart was broken. No space for that. She wanted this baby with the best paediatric care and she didn’t doubt that was Finn.

  Sam cut the cord quickly. Trina saw Jill’s worried eyes and knew she’d be better at the resus than Jill without sleep.

  ‘Swap, Jill.’

  Jill looked up, relief clear on her face. She nodded and hurried over to change places with Trina beside the mother.

  CHAPTER TWENTY-THREE

  Finn

  FINN HEARD CATRINA say, ‘Swap, Jill...’ as he carried the silent and limp baby to the resuscitation trolley that Jill had set up. The lights and heater were on and Finn rubbed the wet baby firmly. Catrina handed him the next warmed dry towel and he did it again.

  She spun the dial on the air and handed the tiny mask to Finn, who started the intermittent positive pressure breaths while she placed the pulse oximeter lead on the lifeless white wrist.

  After thirty seconds, the heart rate was still too slow. ‘Cardiac massage.’ Finn said briefly.

  Catrina circled the baby’s chest and Finn wondered if this had happened twice in a fortnight before for her. It was unusual. For a low-risk unit this was too much.

  He watched as she began compressing the baby’s chest by a third in depth. He intoned, ‘One, two, three, breathe. One, two, three, breathe.’ For another thirty seconds.

  Catrina said, very calmly—too calmly, ‘Still heart rate below sixty.’

  He glanced at her face and saw the fear she held back. ‘Thinking about adrenaline after the next thirty seconds,’ Finn said quietly, and then Sam appeared.

  ‘I’ll take over the cardiac massage, Trina.’ He’d be thinking that, as the midwife, she could find their equipment faster.

  Trina nodded and Sam slipped in with barely a pause in the rhythm. She reached down and pulled open the drawer, removed the umbilical catheter set he recognised and pulled out the adrenaline. Once you needed adrenaline things didn’t look so good.

  Good idea about the umbi catheter. He prayed it wouldn’t get to that. Finn hoped this baby would breathe before then. Then the big adrenaline ampoule appeared in his vision; the sound of her snapping off the glass top was reassuring. She was slick and he heard her muttering as she began to draw it up. ‘The new guidelines say point five of a mil standard; is that what you want, Finn?’

  ‘Yes, thanks. ARC Guidelines.’

  He glanced at the clock. ‘Next thirty seconds. Heart rate still fifty. Slightly better. Keep going.’ He looked at Catrina and nodded at the box.

  Thirty seconds later and Catrina had dashed out for the warmed fluid for the umbilical catheter box.

  ‘Seventy.’ He saw her sag with relief. He felt a bit that way himself. Thank goodness. No adren
aline needed. No umbi catheter needed. If the heart rate kept going up.

  Sam stopped compression and Finn continued on with the breathing. The baby wasn’t white any more. Streaks of pinkish blue were coming. The blue on the face stayed but that would be compression of the head causing congestion and that might take hours to go. The body was pink. Excellent.

  He heard Trina breathe out as the baby’s hands flexed, as did his little blue feet. Then the neonate struggled and gasped. And cried. Finn sighed and let the mask lift off his face for a second to see what he did. The baby roared.

  He glanced at Trina, saw the tears she was trying to hold back. He didn’t blame her. That had been a little too close.

  ‘Good job,’ Sam said quietly and Finn looked at him. All in all, it had been an emotional day.

  ‘You too.’

  Catrina had gone. Over to the mother to explain her baby was coming over soon. Reassure, like she always did. Being the midwife. To help Jill with settling the woman more comfortably when her baby came across. The baby that was crying vigorously now. Finn felt the muscles in his shoulders release.

  Sam said, ‘It was in good condition before the cord was occluded by the body. So he had some reserves.’

  ‘They’ll have to keep an eye on his blood sugars after that resus.’

  ‘Does he need transfer?’

  ‘See what the glucometer says. Not if his sugars stay good.’

  They both knew it wasn’t good if a baby had no reserves and got into that kind of bother. Shoulder dystocia was a mongrel. Not common, but fifty per cent of the time there were no risk factors when it happened. At least this baby had been strong enough to come back with a little help.

  Sam had lived up to the glowing praise he’d heard. Catrina had been amazing again. They all were. He could grow to be a part of this team.

  Then the real world crashed in. If his wife went away and left him to it. And he still hadn’t told Catrina that Clancy had arrived.

  He stepped back as Catrina lifted the baby to take across to the mum.