by Stuart Gray
Before we left, I got her some inco pads so she could put them on her bed sheets. I walked back into the house and found her crying quietly to herself. I held her hand and said, ‘I’m so sorry.’ I didn’t know what else to say or do.
We left her to do what she thought was right and I pondered the emotional horror that miscarriage can be for women. It’s hard for a man to imagine the pain they must feel, I think.
* * * * *
My first encounter with a traumatic complication of childbirth came without warning. We received a call by radio for a 25-year-old pregnant female who was giving birth in the back of a car on a residential street. After all the details were taken, the single most important piece of information was added. The baby was a breech; it was being born feet first. Any breech birth is dangerous for the baby, because it’s coming out feet first and that means that the shoulders and arms will get stuck in the birth canal. If this happens, the baby will asphyxiate as it lodges in the canal. It’s ready to take its first breath, but when it does so it finds its mouth is surrounded by blood, birth fluid and meconium (baby faeces, basically). It ingests that combination and drowns. And this case was the worst kind of breech: this baby was ‘front up’ and was hanging out of its mother by its neck.
As we approached the street, I saw the car parked with its hazard lights flashing and both rear doors open wide. A man was walking around from one door to the other - there was no real sense of urgency. He didn’t look at us. I don’t know if he even noticed us there.
I got out of the ambulance as soon as we parked up and went to the rear of the car. I saw a woman crouching on her hands and knees in the back seat. She was completely naked from the waist down and she was crying in pain. There was a small, grey baby literally hanging out of her, suspended by its neck, the body facing forward. It was a little boy. His head was still fully inside his mum’s vagina. The scene was bloody and noisy.
I supported the baby’s body so that the weight was off its neck and, with the help of the man, who was her husband, tried to get the head released by stretching the vaginal opening. I told the woman to push but she could not understand English and was very frightened. I asked her husband to go to the other side of the car and talk her through what I was doing and what I wanted her to do for me.
My crewmate was gathering the equipment I would need and a second ambulance arrived. The paramedic from this crew assisted me with my efforts to get the baby’s head out of the birth canal, but it was proving difficult and the woman was losing the energy to push. Every time she tried the head would begin to appear but then she would give up, exhausted, and it would disappear back inside her. This was very frustrating for all concerned.
At one point, I felt the baby take a breath inside his mother. He moved his limbs and struggled feebly as he tried to escape for air. A flood of mucus and meconium escaped and I knew the baby was in serious danger. I used suction to clear as much of the fluid away from inside the vagina as possible, but it was an uphill battle.
I continued to struggle to release him. The mother was screaming in pain and providing very little effort to the push he needed. I couldn’t just rip him from her and I considered what to do. A midwife was needed urgently; the woman would probably need to have incisions made to widen the opening for her baby but there was a delay in getting one to scene, so I had to think about the problem with my colleagues.
As we tried to plan what to do, I felt the baby breathe deeply again, struggle for a few seconds and then go limp in my hands. I didn’t feel him move again after that.
The midwife arrived and began to help us with the delivery. It took a further few minutes but she applied as much pulling force as she dared, and with an extra hard push from the mother the baby was free. It had been trapped for over fifteen minutes and he was lifeless in my arms.
We rushed him to the ambulance, continuing our resuscitation attempts. He looked like a tiny rubber doll: every time I pushed down on his chest, his wee arms sprang up. I knew that what I was doing was pointless; I remember thinking, Why am I doing this? Why don’t I leave this poor little thing alone, instead of standing here compressing his ribs and abusing his body even more?
I kept going all the way to hospital but I was looking down at a lost cause. Newborn babies’ eyelids are always closed when they die - this is not always the case with adults, their eyes are usually open or half-open - and they look like they are sad. That’s my abiding memory of this little boy: he looked as though he knew he’d nearly made it and was sad that he hadn’t.
They lifted him onto a trolley covered in a crisp white sheet and they wheeled him away, a tiny dot of extinguished life that had never seen the outside world.
I felt deeply saddened for his mother. She’d endured a long, agonising experience, and had lost her son at the end of it.
I brought that home with me and I sat and I welled up. I was on my own and I sat there for hours, thinking about that baby. He had been alive when I got there. I’d felt him take his last breath. If we had been able to get him out, he would have lived. He died because we couldn’t get him out. He had drowned inside his mother as I held him.
I wrote it all down in my diary, as a way of exorcising it. And for ages afterwards, every call we got for a maternity job, I didn’t want to go to it. Sod’s law, it just seemed that everyone in north London was having a baby at around that time. No kidding, there was one a day. If I was on the FRU, I’d absolutely dread the message coming up on my screen - especially if it read, ‘Complicated birth’. I would start worrying: What do I do if this goes wrong, or that happens? I just didn’t want that responsibility, and I found myself driving to the calls dreading knocking on the door, hoping that the ambulance would get there ahead of me, or with me so that I could have back-up.
PAY: I love my job, despite the occasional moments of heartbreak. But our rates of pay aren’t great. A trained paramedic like me earns around £20,000 a year basic (about £1,000 a year more than an EMT), though there are additional earnings for London weighting and unsocial hours etc, that mean you can boost this to around £30k (gross).
Eventually, the score was evened out for me.
I was working with a female friend and colleague on a night shift when we received a call to a 23-year-old pregnant female, ‘delivery imminent’.
Butterflies. Panicky feeling. At least I wasn’t alone.
A first responder was on scene when we arrived. He told us that the woman’s waters had broken and she was lying on the floor awaiting the birth. The woman’s family were around but they didn’t know what to do, so it was going to be up to us to help her. We gave her entonox for the pain and prepared to move her to the ambulance, but she began to push and when I asked if she felt like bearing down she said she did, so I knew we had run out of time. She was wearing shorts so I told her husband to remove them. As soon as they were off we could see the baby’s head.
We positioned ourselves for an imminent delivery. It took no more than three good pushes for the baby to come out. I checked his colour, airway and breathing (although he was crying now, good and strong) and confirmed his sex. I wrote down the time of delivery and then we got with drying him and clamping the cord.
My colleague had never cut a cord before, so she was given the honour. (Umbilical cord is very tough, so it took a few attempts to cut through it properly.) Once that was done, all that remained was the delivery of the placenta, which had yet to materialise after 15 minutes. The placenta is attached to the wall of the womb and it should come out naturally with secondary contractions. If it doesn’t, that dead tissue is going to cause problems for the mother. There can also be massive bleeding if it comes away before it’s ready, because it will tear away the wall of the womb. That happens a lot, and we can administer drugs to help with it. This was proving less straightforward than the birth itself. The first responder left to attend another call and my colleague and I waited for the midwife to arrive. It actually took two hours for the placenta to show up - two
hours of real concern, during which I had a running discussion with the hospital about whether we should bring her straight in and I tried to get the woman to pant and push to discharge it.
After a lot of coaxing and pushing by the woman on the floor, her secondary contractions started and a couple of minutes later the afterbirth was out. The bleeding was controlled and the woman was in good shape, even after the prolonged finale.
She was happy, too; her baby was yowling at the top of his lungs, sounding very healthy indeed.
The midwife arrived ten minutes later. She checked both baby and mother, pronouncing them well. Then I assisted with the last job on scene, stitching up the woman’s perineum, which had torn during the birth.
I was happy with this call; it helped give me closure after my horrendous ordeal with the breech a while earlier. I still have a photo, taken by my colleague with the woman’s permission, of the little group involved at that birth: me, my colleague, the mum and her baby. It’s a happy, smiley memory.
Sometimes even the short distance between a home address and the hospital maternity unit can be too much for an expectant mother. My first Born Before Arrival (BBA) happened so quickly that I barely had a chance to take it all in. I was working with a crew who had just driven a few yards from the patient’s home when she suddenly had the urge to bear down. Her waters had broken earlier and we had been called because she felt the birth was imminent. How right she was.
She lay on the trolley bed and my colleague inspected her. The baby was ‘crowning’, so the top of its head was visible. The woman was moaning in pain and biting hard on the entonox mouthpiece. There was going to be no time for a midwife or another ambulance, so I got the maternity kit and prepared to assist with the delivery.
My colleague coached the woman to breathe and the baby was delivered within two minutes of the appearance of its head. It came out along with a gush of blood and fluid - a lot of fluid. The ambulance floor was awash with it.
The woman screamed in pain as the baby came and then the baby joined in. We were parked up on a residential street close to her home, so the neighbours must have thought we were murdering her. Hopefully the sound of a baby crying helped put their minds at ease.
After the cord was cut and the afterbirth delivered we took them both to the maternity unit. We used our lights and sirens and got to the hospital in a few minutes, much sooner than waiting for additional help.
I ran into the unit with the newborn and the mother followed on the trolley bed. She was weak and exhausted. It took us an hour to clean the ambulance up after that delivery. She wasn’t a particularly large woman but she’d held an awful lot of fluid.
A more traumatic BBA was described on my mobile data terminal (MDT) as ‘Baby down toilet’. As unambiguous as the call descriptor was, I was still activated on my own for this job with a request to ‘report on arrival’. You’d have thought the mother and baby needed more support than just one paramedic, and you’d have been right.
When I got on scene I had to find the address among the myriad identical apartments (not unusual) and then take the lift to the top floor (not unusual either) to the flat in question. I knocked and a man appeared at the door. I was hurried inside and I could smell the location of the problem before I saw it. In a little bathroom a woman was sitting on the toilet, wailing in pain. The man went in, spoke to her (she spoke no English) and then pointed to the floor on the other side of the toilet.
‘Is that the baby?’ I asked.
‘Yes.’
‘Is it breathing?’
‘I think so.’
God, I hope so, I thought.
He moved out of the room and swept his two little sons aside. They had been hanging around the doorway watching this mishap unfold but they seemed completely unfazed. I went in, reassured the lady (with no effect) and then looked down at the floor where the man had pointed. There was a new-born baby lying on its back, umbilical attached, grey as hell - but moving.
It was a girl, and as I watched she seemed to go limp. Quickly, I checked her airway and stimulated her to move and prove that she was breathing. She was: so far, so good. I opened my maternity pack and as I did so a colleague walked through the door. I was very happy to see him.
With his help, I covered the baby and cut the cord - only then could we deal with mum’s problem, whatever that was. The FRU desk decided to call me just then (they often seem to do so at the most delicate moments) to ask if I needed any other support. I requested another ambulance in case mum and the baby needed to be taken to hospital separately.
The situation was smelly, messy and noisy but not life-threatening. As far as I could see. The woman had gone to the toilet when she felt the urge to push down. She opened her bowels and, simultaneously, gave birth. The baby fell into the toilet head first. The new-born girl was left in the water of the toilet bowl, covered in faeces until her father had plucked her out and put her on the floor, minutes before I arrived. The woman had made no attempt to do this. The umbilical must have been pulled violently as a result of all of this, and she was now in pain and possibly bleeding behind the placenta, which had yet to appear.
When I wrapped the baby up and handed her to the mother she rejected her immediately. She wouldn’t even look at her. She just sat there and wailed. Neither would she let me inspect her, so I asked my female colleague on scene to do it for me. I left the bathroom and went to check on the baby again.
Another ambulance crew arrived and I requested a midwife, too. The woman was going nowhere until the extent of her injuries could be ascertained. My female colleague had confirmed that there was no obvious bleeding, but that didn’t rule it out and I had a drug available if needed to stop any serious haemorrhage. But you feel a lot more comfortable with a midwife taking charge, so I left the two crews on scene and drove to the maternity wing of the receiving hospital to pick up the on-call midwife. I rushed her back to the scene and she went to work - job done.
I was able to leave the flat with a sense of having done some good. The woman had been given Entonox for her pain and the baby had begun to colour up nicely. She had ten fingers and ten toes and they all moved, so I was quite happy.
I’ve delivered or helped to deliver a number of babies in my career, and I’m fine with that. It’s the complicated calls I don’t like - the responsibility of safely delivering a new life is much more wearing than trying to save an old one.
SUICIDAL TENDENCIES
MY COLLEAGUES AND I get close-up to emotional crises. We all get to see the raw edge of life in this job and suicides, successful or not, are one aspect that none of us relishes dealing with.
My first experience with a suicidal adult came whilst I was still working my way through my degree. I was on the road whenever I had the time to do some paid work with the ambulance service and had started a run of nights when a call for a ‘suicidal male’ came in.
He was standing on an eighth floor ledge outside the bedroom window of a hotel room, threatening to jump. It was four o’clock in the morning and this was one of London’s poshest hotels. If he jumped, the publicity would be extensive and it would not be good.
I stood far below him in the inner quadrant of the building; rooms in this part of the hotel faced each other around a large square and there were plenty of wide-awake guests peering from behind curtains and leaning out for a closer look. At any moment, I expected to hear someone in a room near to the suicidal man open their window and yell, ‘For God’s sake, jump and let us all get some sleep!’
Until now, the shift had been slow and relatively routine; drunk after drunk until the early hours and then medical emergencies at a steady pace. A call like this could go either way and it was too early in the morning for lucid thought, so I hoped he would see sense and go back into his room.
The London Fire Brigade was already on scene and a couple of police officers were in his room attempting to talk him back to terra firma. He wasn’t budging, and I noticed that he was standing on a thin ledge
which pitched down at something like a 45 degree angle. He was dressed in light clothes, but his feet were bare and probably a little sweaty owing to the grip required for such a precarious position. It wouldn’t take much for him to slip and go over accidentally, never mind to leap off.
I looked below him. If he went, he was going to land on the angled glass and metal roof of the restaurant below. Which would be messy. I thought about what I’d do if he fell. There was next to no chance of him surviving - he was 100 feet up. I wasn’t worried about having to go down and deal with the aftermath, but I was concerned about having to witness it. That sort of thing makes my skin crawl.
My crewmate had wandered off, and now he came back.
‘Apparently he’s very well-off,’ he said, rather stating the obvious. Rooms here were hundreds of pounds a night, even 15 years ago. ‘He’s fallen in love with a business colleague, but when he told him the colleague rejected his advances.’
The rich man hadn’t taken this at all well, and had climbed straight out of the window. The colleague had immediately called 999, and here we were.
I looked up again at the man, far above, teetering on that acutely-angled, narrow ledge, alternately crying and shouting. He was edging away from the window and then back again, almost casually, as though he was on the ground. It seemed to me that his mind wasn’t quite made up - I suppose he’d have gone by now if it had been - but it was clear that he was very likely to fall and die accidentally if he kept this up. His screams of despair and anguish grew louder, and soon every guest in the vicinity was awake. More lights shone out of bedroom windows, illuminating the spectacle. The police officers were still trying to coax him back into his room; one of them was leaning out of the window and I could hear the conversation to-ing and fro-ing between him and the potential suicide. It really looked and sounded hopeless and I waited for the inevitable fall that would result in the instant and grisly death of a man right in front of my eyes. Light butterflies of anticipation fluttered in my stomach; I was nervous about what I was possibly about to see.
