The Honourable Midwife

‘How are you feeling, Patsy?’ Pete asked at once.

‘The contractions are getting stronger. There’s one coming now…’

From Patsy’s reaction, the pain was quite intense. She couldn’t move or speak during its peak, and had to press a thick pad between her legs to deal with the blood. Pete wasn’t happy about how much was still flowing. He abandoned any thought of getting her moved to Canberra or Sydney.

This didn’t mean he was relaxed about the idea of delivering her here. They could be in for some problems after the birth, and dealing with a post-partum haemorrhage could be a nightmare. Thank goodness there were a couple of good doctors he could call on.

‘Let’s get you on your left side with your feet up on a pillow,’ he told his patient, masking the extent of his concern.

She looked pale and drawn. Tired, as if she hadn’t been sleeping well in weeks, which was probably the case. Bed rest wasn’t fun. No physical activity to promote a healthy fatigue at the end of the day, too much time to think and worry. And she was huge, the size due to her fibroids, not the baby.

Pete palpated the uterus, gave her an internal examination and found that the cervix was ripe, already fully effaced and dilated to six centimetres. The baby’s position wasn’t good. Feet and bottom down low, and head lying next to her mother’s heart. The heartbeat was fine, no sign of distress, and that was a plus. But he really didn’t like the bleeding, or his rough impression of the baby’s size. He’d been monitoring this for several weeks, and there’d been steady growth, but the baby was still smaller than it should be for this stage of pregnancy.

‘I’ll be back in a minute,’ he promised Patsy, when he’d finished.

Heading for the phone at the nurses’ station, he almost cannoned into Emma Burns, who had just arrived, and whom he hadn’t seen in the three months he’d been renting her house. She was like a breath of cool, fresh air, scented with spring. She was like her home—bright and pretty and calming.

They smiled at each other.

‘Hi,’ he said. ‘Welcome back.’

‘Thanks.’

A beat of uncomfortable silence hung in the air, and neither of them knew what to say. Pete felt there ought to be something better than what he’d come out with thus far. Something witty or meaningful. Something a little private and personal that encompassed all the complex flavours of the e-mails they’d exchanged.

As if he had time to think about it now!

She’d done something to herself while she’d been away, he noted vaguely. Something good. Hair was different. Eyes. Lips. How she’d done it, he didn’t know. He didn’t even know quite what she’d done, he only knew that it was good.

Straight, dark, glossy tresses, arched brows, glowing brown eyes, soft, happy mouth. And yet he didn’t even have time to say, Wow! You look great, Emma! Although he definitely wanted to.

‘Can you make sure the ob. theatre is fired up and ready to go?’ he said. ‘No one else in there, is there?’

‘No, we’re quiet.’

‘I’m phoning Gian Di Luzio and Nell Cassidy. I’ve a got a patient in there…’ he gestured at Room One with a backward jab of his thumb over his shoulder ‘…who’s making me nervous.’

‘Fill me in,’ she said. She had a lovely voice, clear and steady. ‘I’m not officially on yet, but I’m obviously going to be in on the surgery, right? I think we’ve got another labouring mum coming in, but Bronwyn’s going to handle her.’

‘Yes, I want you in Theatre,’ he answered. ‘And I expect you’ll be moving over to Special Care to look after this baby, if we keep her.’

Emma had spent two years in Sydney, a few years ago, acquiring specialised neonatal nursing qualifications, and staffing was usually juggled to enable her to care for any babies who needed extra attention and skills after birth. There were a couple of other well-qualified nurses to share the load as well.

‘Might we not keep her?’ she asked.

‘I hope we can.’ He hadn’t quite answered her question with the words, but went on to do so in his description of the patient’s history.

Emma’s appearance might have changed in three months—what was it? Her eyes glowed! But he doubted whether her capabilities had. She’d always been good. A team player and able to handle all the different types of people she had to deal with, from nervous new fathers to overworked GPs. She was level-headed, thorough and adept at anticipating problems. He sketched out what she needed to know, using a barrage of medical shorthand which had her nodding and frowning at once.

‘Yes, I see what you mean,’ she said. ‘I can see why you’d want Dr Di Luzio and Dr Cassidy.’

Gian Di Luzio was Glenfallon’s one obstetrician and gynaecologist, and a woman would have to go quite a distance to find another one. Like most parts of rural Australia, Glenfallon was chronically in need of specialists. As a result, there were several GPs in the area who’d obtained extra credentials in various fields to meet demand.

Pete was one of them. He’d returned to Glenfallon at the beginning of the year after two years spent in Sydney, and he was now better qualified than anyone but Gian in delivering babies and dealing with associated areas, but he was by no means too proud to reach out and grab a fully fledged specialist’s extra experience when he needed it. With the twin risks of post-partum haemorrhage and a delicate baby, this was one of those times.

Nell Cassidy was no slouch when it came to extra experience either. She ran the hospital’s accident and emergency department with an iron hand, and no velvet gloves involved. She also oversaw the hospital’s acute-care patients—adults, children and infants. She was extremely bright, unflappable in a crisis and always the very last person to accept that a patient couldn’t be saved.

She’d revived one of Pete’s patients last year—a four-year-old girl, the same age as his daughters now were—after a near-drowning, and she’d kept vigilant when everyone else had been ready to celebrate and relax.

Two days after the incident in the back-yard pool, when Amber Szabo had already started smiling and talking and her parents and hospital staff were talking about her discharge, Dr Cassidy had headed off a major organ shutdown, battled death once again and saved the child.

Now, as far as Pete was concerned, the A and E staff could saddle the woman with any unflattering nickname they liked, but he would defend her with spirit all the way.

They had a full team assembled by seven-twenty. They had type A-positive blood waiting for Patsy, and a neonatal resus trolley equipped and waiting for her baby. They had oxygen and intubation equipment, monitors for heart rate, respiratory rate and blood oxygen saturation, and a barrage of drugs on hand.

They had overhead lights switched on, trays of shiny, sterile equipment lined up, and their patient ready to be wheeled in. The pace had picked up in Labour and Delivery, too. The recently delivered mum had been moved across to the post-partum ward, but they had a new admission to take her place—a young woman of nineteen, who’d had only sporadic prenatal care and no second-trimester sonogram, and was uncertain of her dates. Around eight, eight and a half months gone, she thought.

Thirty-six or thirty-seven weeks? Apparently Bronwyn Jackson wasn’t convinced of this after a manual examination.

‘She feels too small,’ the midwife reported to Pete. ‘By the height of the fundus, I’d say thirty-five weeks, maybe even thirty-four.’

‘Can we try to stop the labour?’ Pete asked.

‘No chance. Fully effaced, half-dilated, contractions every few minutes. This baby’s coming today, and we’ve got the resus trolley on hand.’

‘I’ll get there for the delivery if I can.’

‘The joint is jumping all of a sudden.’

‘Better phone Alison Cairns and tell her she might be needed, too.’ Dr Cairns was good with fragile babies.

The new admission, Rebecca Childer, had been put down as Pete’s patient, although her family was fairly new to Glenfallon, and he’d only ever seen her mother, Susan, for a couple of routine things. He didn’t like having this new, questionable labour hanging over his head when Patsy and her baby were uppermost in his mind.

The baby obviously didn’t want to stay in Patsy’s tumour-filled uterus any longer. He only hoped the little girl would be safe out of there, and in their hands. Should he have sent Patsy to a bigger facility before this? She’d argued against the idea very strongly, but he could have presented it in starker terms.

If we lose this baby, came the insistent thought, how much will I question my own decisions? And where’s Rebecca Childer going to be up to in her labour when I get out of Theatre?

‘Dr Croft looks terrible,’ Emma said quietly to Nell Cassidy.

Although Emma was over a year younger than the A and E specialist, she and Nell had been friends since their school days. More specifically, since the Glenfallon Ladies’ College Senior A netball team’s memorable trip to Sydney about seventeen years ago, for a round of competitions.

Teenage giggles and confessions during the long bus ride had gradually evolved into the more considered honesty and support of adult friendship, and had survived divergent career paths and life experiences, long periods of living in different places and even some significant criticisms of each other’s choices.

Nell knew that Emma considered her too cool and too uncompromising in her approach to her work. Emma knew that Nell would have ‘thrown that parasitical stepmother of yours out months ago’, instead of putting up with the situation until Beryl had left in a huff to go and live with her own daughter earlier that year.

Somehow, however, these differences of opinion didn’t matter. This same honesty now made it possible for the two of them to have a serious, if snatched conversation on an unrelated subject while they waited for their own role in safeguarding the McNichol baby’s first minutes of life.

‘Terrible is a bit harsh,’ Nell said in response to Emma’s comment. ‘He looks tired, definitely. And stressed.’