The Honourable Midwife

‘OK, placenta’s coming away,’ Gian said. ‘Most of it. Getting a big bleed now.’ His voice was calm, almost lazy, but no one was fooled. ‘Cautery, Mary Ellen. Good. Thanks. Let’s get this closed off.’

There was a hiss, and the acrid smell of burning.

‘Good girl, what a lovely pink colour now! What great breathing!’ Nell said, as if it was the baby’s own success, not hers, and perhaps she was right. She leaned closer, listened once more just to check. ‘You good, darling girl! Now we’ve got it all happening,’ she crooned at the tiny baby, still working quickly as she spoke.

She taped a pulse oximeter to the baby’s hand, checked the fluctuating numbers that appeared on the screen. Climbing. Pink had now begun to radiate outwards from torso to extremities. Emma blinked back tears of relief. Blue was just the wrong colour for a baby, frightening and wrong. Pink was like the sun coming out on a cold, cloudy day, lifting spirits at once.

‘Thank God!’ she whispered.

She saw Pete’s glance cut across in her direction from the table. His face looked frozen for a moment, stark. He was thirty-six, she knew, but he looked forty today. A very masculine, competent, good-looking but stressed-out forty. Her fingers suddenly itched to smooth the lines on his face, to trace the shape of his mouth until it softened beneath her touch.

Then he blinked those tired brown eyes with their creased lids, grinned at her and nodded, wordlessly sharing her prayer of relief. She grinned back, and felt a rush of warmth and happiness. Gian’s running commentary suggested he had the bleeding in hand. Most importantly, the baby girl was breathing.

Emma wasn’t, as she smiled at Pete.

She seemed to be floating a good three inches above the ground, and she wasn’t breathing at all.

But at the moment breathing didn’t seem remotely important.

CHAPTER TWO (#u9e6b5cac-0ea8-5f7a-8e3b-f369aba0e074)

‘DR CROFT, we’ve got Rebecca in transition and almost ready to push,’ said Bronwyn. She was an efficient, thin and rather cool brunette, married with a school-aged son and daughter.

‘Right.’

Pete took a deep breath, switched his focus quickly. Little Lucy McNichol was looking good now, better than he’d dared to hope. She was small, just over three pounds on the old scale, but after that initial, frightening hitch with her breathing, she seemed reasonably strong, and she’d even taken the breast.

Nell had said she thought the gestational age might be closer to thirty-five or thirty-six weeks, not the thirty-three he’d been working on. Patsy might have mistaken bleeding at the beginning of the pregnancy for a period, and he’d dated the baby on that basis. With the spread and position of the fibroids retarding growth, the ultrasound scan at seventeen weeks hadn’t contradicted those dates.

But now here was Rebecca Childer about to give birth, and Bronwyn thought her dates might be wrong in the other direction. With no accurate date of LMP—last menstrual period—and no ultrasound measurements, they were working purely on the measurement from pelvic bone to top of uterus.

‘Don’t be surprised if you get called back up here,’ he told Nell, as she stripped off gloves and mask and prepared to head back down to A and E. ‘We have another iffy pregnancy on hand.’

‘I’ll be back up here anyway as soon as I can, just to make sure Lucy’s doing as well as we think,’ she said. ‘I did hear a faint murmur over her heart, did I tell you? But, of course, that’s very common. I’ll let it go as long as her stats are good.’

‘It’s your call. She looked good to me, too.’

‘See you in a while.’ Nell went towards the lift.

‘Rebecca, how are you doing here?’ Pete asked his new patient, as he entered Delivery Room Two.

She didn’t answer, just gave him a hostile look which he shrugged off. If he hadn’t asked about her state, the look would have been just as grim. In the grip of a powerful contraction, she wasn’t enjoying herself at the moment.

As soon as the contraction was over, he gave her a manual exam. It wasn’t routine policy to do so in this department, but Rebecca wanted a progress report. He listened to the baby. Heartbeat was fine. Dilatation was almost complete. The head was nice and low, but small. He agreed with Bronwyn. This wasn’t a thirty-seven-weeker.

‘Have we got extra staff?’ he muttered to her.

‘Vanessa Gunn is coming in,’ Bronwyn answered. ‘Emma will go into Special Care, with back-up from Sue North in post-partum. We’ll juggle it.’

Rebecca moaned. ‘I’m not ready for this. Nobody said it would be this bad.’

‘You’re doing really well, Rebecca,’ Bronwyn told her.

‘Don’t give me that garbage…’

Pete listened to the heart again, and found that the rate was perceptibly slower. ‘Get Dr Cassidy up here again,’ he told Bronwyn. ‘We might not need her, but if we do, I don’t want to wait.’

‘What about Emma?’

‘Her, too, as long as the post-partum staff have got Lucy’s care covered.’

Rebecca groaned, half sat up and opened her legs. The head was already crowning, propelled forward by the action of the uterus. Contractions were coming without a pause in between. Rebecca strained again. They’d have a baby very soon…

‘OK,’ Nell said. ‘She’s stable. She’s good.’

Like Patsy, Rebecca had delivered a tiny girl, whom she’d named Alethea. It was an old-fashioned name, but it was pretty, Emma thought. She clung to this thought—that the baby’s name was pretty, that the baby was pretty—because the little creature had problems at the moment.

She’d needed intubation and she was on a respirator. It had taken Nell, Emma and Pete an hour to get her stabilised enough to move her to Special Care, and Nell, who’d actually thought that was ‘nice and fast’ under the circumstances, was still working over her with a severe frown on her face.

Pete had left to check on Patsy McNichol.

‘Oxygen saturation’s gone up,’ Nell said. ‘I like her heart rate. I like how quickly we got this done. I like most things.’

‘That’s good.’

‘For the moment. And I’m hoping we’ll get her off the respirator within the next couple of days.’

‘What’s worrying you, Nell?’ Emma said. She knew her friend well enough to realise there was something.

‘I don’t know.’ She shook her head, as if to clear swimming-pool water from her ears. ‘I think I’m hearing a murmur again.’

‘Lucy had one, too.’

‘I know. They’re so common in babies, especially early babies, and mostly they mean nothing. With Lucy, I wasn’t so concerned. Her dates were better, even though she was almost as small. A small baby delivered within a few weeks of term is almost always better off than a larger one delivered earlier.’

‘And this one wasn’t large, in any case.’

‘I know. Which worries me, too, because I don’t know why.’ Nell listened to the heartbeat again. ‘I don’t know whether to be concerned about this baby’s murmur either,’ she said. ‘Certainly want to get the rest of her stronger before we start worrying about her heart. Hey, Alethea? Do you support that plan, darling? You don’t want a whole lot more mucking around, do you?’

Her voice was soft and cooing as she addressed the motionless baby. Then she straightened and spoke to Emma again.

‘All indications are that the heart is working fine at the moment,’ she said. ‘If it wasn’t, her numbers wouldn’t look so good. If I keep hearing this, though, or if it changes, I’m going to do a couple of tests. Let me know if there are any indications that her heart isn’t doing its job.’

‘She’s premature…’ Emma said.

‘I’m guessing thirty-three or thirty-four weeks.’

‘So…Patent ductus arteriosus is a fairly common condition in premmies, isn’t it? Treatable, too.’