by Lucy Clark
‘Is that a hand?’
‘Yes,’ Arthur answered. ‘Sometimes babies are born with an arm above their head and given there are two babies in there, things may have been getting a little cramped.’
‘Who are you?’ Sean demanded.
‘Shut up, Sean,’ Jenna yelled between breaths.
‘That’s it. The head’s almost out…now pant, Jenna. Pant. I just need to check that the cord isn’t around the baby’s neck.’ Maybelle’s tone was calm and controlled, as were her actions as she confirmed the tiny little neck was clear of the cord. ‘Arthur?’
‘Ready,’ he told her.
‘OK, Jenna. With the next contraction, I want you to focus all your energy on pushing down. That’s it. Good. Good. Grit your teeth and… That’s it! Baby girl number one is out.’
Maybelle expertly handled the tiny twenty-eight-week-old baby and held her out so Arthur could wrap her in a towel. The fluffy new towel almost engulfed the baby, which Maybelle guessed to be less than one kilogram in weight.
Arthur was rubbing the baby with the towel, trying to stimulate blood flow and breathing. Maybelle grabbed the box of paper straws Arthur had brought in and pulled one out, sucking the mucus and gunk from the baby’s mouth then nose, spitting the contents onto the sheet surrounding the area.
‘Why isn’t she crying?’ Jenna’s voice was tremulous, worried and extremely concerned.
‘They’re working on it,’ Sean soothed, as he watched what was going on. Once Maybelle had finished sucking out the nose, the little one dragged in a fighting breath, gasping a little as Arthur continued to rub the vernix off and stimulate blood flow.
‘New towel,’ he stated, and Maybelle reached for another one and accepted the baby from him.
‘Nostrils are flaring a bit and there’s sternal recession.’
‘Wh-what does that mean?’ Jenna’s tone was almost hysterical and with good reason.
‘Baby’s having a bit of trouble breathing,’ Maybelle told the new parents. ‘But she’s a fighter.’ Maybelle was about to pass Arthur two of the bag clamps so they could clamp off and then cut the umbilical cord when Jenna’s body tensed with another contraction and she started to yell once more from the pain.
‘Give me the one-minute Apgar,’ Maybelle told him as she returned her attention to delivering the next baby. Arthur was more than capable of clamping and cutting the cord. Ordinarily, they’d get the father to do it but right now there was no time for formalities. These little girls needed expert attention and it was up to them to provide it. ‘All right, Jenna. Here we go again.’
‘Isn’t the ambulance here yet?’ she panted as she tried to breathe her way through the pain racking her body.
‘One-minute Apgar is six and a half,’ Arthur stated and Maybelle nodded.
‘You’re doing great, Jenna. Let’s just focus on what’s going on here. I can see the baby’s head. It’s bigger than the other twin.’ She paused and checked, feeling around. ‘Quite a bit bigger.’ Maybelle glanced over at Arthur, her look indicating that something wasn’t completely right with this whole situation. It would be wonderful if they had a baby heart monitor, or a stethoscope or even an old Pinard horn so she could check the other baby’s heart rate because what she was thinking meant that the baby who was still to be born wasn’t about to have an easy ride.
‘When was your last check-up?’ she asked Jenna as the contraction eased. Jenna closed her eyes and rested her head against her husband’s shoulder. ‘Sean?’ Jenna needed to rest and if she didn’t feel up to answering questions then her husband could do it for her. ‘When was the last check-up?’
‘Last week. Our obstetrician wanted Jenna to have a scan on Monday because she had some concerns.’
‘Did she happen to say what those concerns might be?’
‘She told us one baby was bigger than the other but that it should settle down. She wanted it monitored closely, though. Why? What’s wrong? Is there something wrong with our little girls?’
‘Sean!’ Jenna growled at him. ‘You’re freaking me out. Just let me get through this delivery.’
‘This next baby is quite a bit bigger than the other.’ Maybelle spoke softly to ensure Jenna remained calm and focused.
‘That’s OK, right? Our doctor said that neither of the twins were the same size as a normal baby…you know…if we weren’t having twins.’
‘Yes, that’s right, but one big twin and one small twin can sometimes mean one has been greedier than the other in the womb.’
‘Fighting already?’ Jenna groaned, before gritting her teeth as another contraction began. Once more, Maybelle looked at Arthur and he nodded as though he received the silent message she was sending.
‘Are the babies identical?’ Arthur asked as he continued to care for the tiny baby rugged up in the fresh towel.
‘Yes. They share a placenta.’ Sean answered immediately, proud that he knew and understood that much.
‘Oh. Did your doctor talk to you about the possibility of twin-to-twin transfusion?’
‘She said a lot of things,’ Sean answered when Jenna seemed more focused on getting the job done, rather than answering questions. As Jenna started to push, Maybelle focused her attention on delivering the baby’s head and while this one was bigger than the first twin, it was still quite tiny compared to a baby carried to full gestation. ‘Just checking there is no cord around the neck…and we’re good. Excellent panting, Jenna. Almost there. Almost there now.’
The store manager opened the door for a moment and announced that the ambulances were pulling into the car park.
‘There you go. Good news. Keep pushing, keep pushing,’ Maybelle encouraged as Jenna continued to deliver her second daughter. Arthur announced the five-minute Apgar for the first baby to be eight.
‘Good,’ was Maybelle’s reply.
‘Sean. I need you to come and hold your daughter,’ Arthur told him, and beckoned him over. ‘Open your shirt and we’ll put her on your chest.’
‘My chest?’ Sean’s eyes were already wide at what was happening but they grew even wider at this.
‘Body heat. It’s the best way to keep her warm.’
The bemused Sean opened his shirt and Arthur placed the baby on his chest. ‘Hold her firmly and watch her in the mirror—that way you can report any breathing difficulties or change of colour. It’s imperative we keep her warm. See how she’s breathing a bit better than she was before? Now you need to keep her in this position. We need to be able to see her breathing. See her sternal area?’ Arthur indicated the area where the baby’s chest was rising and falling as she breathed. ‘Keep her at this angle because it helps get air into her lungs. We also need to make sure we support her head and not move her around too much.’
‘Are you sure I should be holding her?’ Sean asked, clearly freaked out by holding his extremely tiny baby girl.
‘Yes. I need to help with your other daughter and, as you’re her father, who better qualified?’
‘Father!’ Sean’s eyes suddenly registered the truth of the word.
Arthur smiled but left the tiny baby girl in her father’s more than capable arms before preparing to accept the second daughter from Maybelle. Towels at the ready, it wasn’t long before the little girl was out of the womb and into his waiting hands.
He wrapped her up and started to stimulate the blood flow, the poor little thing grunting for air. Maybelle used the straws once again to suck out as much mucus and gunk as she could from the mouth then the nose, in order to clear the airways, but still the baby grunted, the breaths shallow.
‘What’s happening?’ Jenna asked as she lay back, eyes closed, but the concern in her tone was evident.
‘This one’s having difficulty breathing.’
‘But she’s really red and a good colour,’ Sean interjected.
‘She’s too red,’ Maybelle said as she readied another towel after Arthur had finished wiping all the vernix off. ‘What are you going to call the girls?’
She pressed her fingers to the baby’s umbilical cord in order to take a pulse.
‘The first one is Poppie and the other one is Lillie,’ Jenna said, trying to open her eyes to see what was going on, but exhaustion was kicking in and they still had to deliver the placenta.
‘Well, Lillie is red because she has too many blood cells. It appears that although the girls were sharing a placenta, they weren’t getting equal shares of the nutrients.’
‘One-minute Apgar for Lillie is four.’ Arthur continued to stimulate blood flow but they really needed to get her into the hospital and sort her out sooner rather than later.
‘Is that bad?’ Sean asked. ‘Poppie’s score was six and a half and—’
Before he could finish his sentence, the door to the restroom burst open and the paramedics came in, carrying their medical bags.
‘Good timing,’ Arthur said as they finished clamping and cutting Lillie’s cord. ‘Twin-to-twin transfer. Placenta still to be delivered,’ he stated, as the paramedics knelt down to assist them. ‘Maybelle, you and I need to get the girls to the hospital, stat.’
‘The ambulance with the incubator is in the parking lot.’
‘Excellent.’
‘We’ll take care of the mother,’ the other paramedic told them as Maybelle and Arthur wrapped Lillie in another towel to keep her body temperature up. ‘Oh, and by the way, the media’s here. TV crew pulled up just after us.’
‘Media!’ Maybelle was the one who reacted and she quickly shook her head repeatedly. Not the media. She just couldn’t deal with that. Not now. She’d already been emotionally exhausted from dealing with the crowds, fighting her attraction to Arthur and having to deliver sick babies! She’d been raised to keep herself hidden, to never appear on any sort of media, most of all on television.
‘The store manager must have called them,’ she heard someone say, but their words seemed far away, echoing around her. All she was conscious of was fear and panic beginning to grip her. The media…cameras…reporters…everything she’d been avoiding for years was right outside those doors. Her mouth went dry and her breathing increased as she tried to figure out a way she could escape without being photographed by any cameras.
‘Someone clearly did,’ Arthur replied as he handed Lillie to Maybelle, before retrieving Poppie from Sean. ‘We’ll take good care of your girls.’ As she accepted the baby from him, she briefly met his gaze and tried to swallow over the dryness in her throat. Arthur’s eyes widened imperceptibly as he recognised the panic in hers.
‘Dr Maybelle here is going to give Lillie her undivided attention.’ His words were pointed and Maybelle acknowledged them with a slight nod of her head. Yes. She had to concentrate on Lillie, on ensuring the little girl could breathe properly. Then Arthur picked up her baseball cap and placed it on her head, pulling it down so it obscured a lot of her face from the view of prying cameras. The action was so considerate, so nice, so thoughtful.
‘They couldn’t be in better hands,’ the paramedic agreed, trying to fill both Jenna and Sean with confidence as their newborn twins were being taken away from them.
‘Focus on the babies.’ Arthur’s words were warm and caring. He was standing just behind her, his warmth seeming to encompass her, calming her previously frazzled nerves. How was it possible that one reassuring look from him could instantly settle the anxiety she’d spent years trying to control?
‘Because he’s Arthur!’ she whispered to Lillie as together they walked out of the store.
CHAPTER TEN
AS THEY ENTERED the ambulance, Arthur and Maybelle were solely focused on the babies.
‘That wasn’t so bad, was it?’ Arthur asked softly as they placed the babies in a shared incubator. The paramedics shut the door, stopping the prying eyes of the media from watching them any further. As they’d exited the women’s restroom and walked through the store, the media cameras had been rolling, reporters trying to ask them questions as they’d carried the babies through to the waiting ambulances. The store manager had been trying to clear a path for them, as well as getting himself in every photograph being taken, either by the media or others in the store.
Maybelle had kept her head down, focusing on Lillie’s breathing, still stimulating blood flow, hoping it wouldn’t take too long to settle down, but poor Lillie was still grunting and gasping for air.
‘It went as well as could be expected,’ Maybelle replied, as they made sure the babies were on their backs, their heads up. Thankfully, this ambulance was equipped for treating small babies and children. She found the smallest-sized mouth and nose mask in one of the drawers and attached it to the Laerdal bag before assisting Lillie with her breathing.
‘Five-minute Apgar is around seven, which is a definite improvement,’ Arthur added a moment later after he’d attached an oximeter to Lillie. ‘How’s Poppie?’
‘Oh, she’s a fighter. Look at her colour. Nice and pink.’
They continued on to the hospital, their attention solely on the girls, and when they arrived, finally able to get some tests started for both girls, Maybelle checked Lillie’s umbilical pulse and was pleased to find it improved.
They were met at the doors to the emergency department by one of the ED nurses and one of the neonate nurses.
‘Twenty-eight weeks gestation monochorionic twins: Poppie and Lillie,’ Maybelle stated, giving the staff the information they needed. ‘Twin-to-twin transfusion with Lillie being the recipient, as you can see. Lillie’s Apgar scores were four, then seven; Poppie’s were six and a half, then eight.’
‘Chest X-ray, cranial ultrasound, full blood count, blood gas and electrolyte levels,’ Arthur added as they finished transferring the girls to their individual incubators. The nurses performed their observations and reported their findings.
‘So tiny.’ Maybelle checked Poppie’s blood pressure reading, which was being monitored via the umbilical arterial line. She put her sterilised hand into the crib through the arm porthole and gently placed her hand on the girl’s chest.
‘Just as well we were out shopping.’ Arthur’s words were quiet as he visually assessed Lillie, the cardiac monitor letting them know her beats per minute had progressed to one hundred and ten. She was under the lights, the jaundice starting to appear.
Gemma came over to let them know that both Jenna and Sean were at the desk, wanting to see their girls. When Maybelle walked over to greet them, pleased that Jenna was in a wheelchair as she would be exhausted after her ordeal, she was astonished when Jenna grabbed her hands and pulled her down for a fierce hug.
‘Thank you, thank you, thank you.’ There were tears in the new mother’s eyes. ‘I hated it when you took my babies away but I knew you had to.’
Maybelle managed to murmur all the right responses as she slowly pulled back from the anxious woman.
‘You saved my girls. You saved me. So many things could have gone wrong and yet—’
‘We’re not going to think about that,’ Sean interjected as he placed both hands on the wheelchair handles and started to edge the chair forward.
‘I was only in the maternity ward for a matter of minutes before they said it was OK to come and see our girls,’ Jenna continued, as though Sean hadn’t spoken, her desperation for her daughters mounting with each passing second. ‘Can we see them? Can we?’
‘Of course. They’ve both stabilised and we’re getting ready to transfer them to the NICU.’
‘What’s that?’ Sean asked, concern in his tone, and Maybelle smiled.
‘Neonatal Intensive Care Unit. Let me introduce you to Iris. She’s one of the NICU nurses.’ Maybelle headed over to where Lillie and Poppie were lying, so tiny but so very much alive.
‘Can we hold them?’ Jenna’s eyes greedily drank in the sight of her baby girls.
‘Not for a few days but you can definitely touch them. No stroking, just putting your hand through to touch them.’ Maybelle waited while they washed their hands, then took them over to their babies, the twins
lying side by side in their incubators.
‘What’s wrong with Lillie?’ Jenna shook her head as she looked at her daughter hooked up to tubes and monitors. ‘She’s so much bigger than Poppie, but I thought Poppie would have been the one who was struggling.’
‘In a twin-to-twin transfer, which is what’s been happening here with your girls,’ Arthur explained as he finished adjusting one of Lillie’s monitors, ‘Lillie’s been getting the lion’s share of the nutrients provided by their shared placenta. This means that Poppie has always been used to fighting.’
‘You mentioned something like that when Lillie was born,’ Sean added as he stared in wonder at his girls.
‘Lillie, on the other hand,’ Arthur continued, ‘isn’t used to fighting and hence why she’s the one now needing more attention, but she’s picking up. Her breathing has settled, her oxygen saturations are much better and her blood gases are improving.’
‘They’re improving.’ Jenna sighed as she spoke, relief in her tone. Arthur and Maybelle stayed with Jenna and Sean until after the babies had been transferred to the NICU and once their obligations were done, they headed out of the hospital.
‘That wasn’t how I thought the day would go,’ Maybelle commented as they walked towards the car park.
‘Part and parcel of the job, eh?’ he asked rhetorically.
‘They’re just so…tiny…so innocent. They have no idea how bad this world can be.’
‘Or how good,’ Arthur countered.
Maybelle glanced at him. ‘There’s more bad in this world than good, Arthur.’
‘I beg to differ.’
‘That’s because all you’ve seen are the good bits. You got the good parents, the stable life, living in one house, doing the things that every normal person does.’
‘And you got the bad,’ Arthur stated. ‘Not living in one house, seeing the dark side of life and learning how to live in it, but, Maybelle…’ He placed a hand on her arm to stop her movements and when she turned to face him, he spoke earnestly. ‘You survived. You conquered. With everything that’s been thrown at you, everything you’ve gone through, you won, honey. You won!’
