The Honourable Midwife

Emma knew that in a normal foetal heart, the ductus arteriosus was open. In a full-term baby, this vessel closed automatically at birth, as part of the heart’s almost miraculous shift from foetal circulation to the circulation pattern it sustains throughout its life. A premmie baby’s heart can’t always manage this shift on its own, however, and if the ductus remains open beyond early infancy, permanent heart damage could result. Fortunately, the condition could be monitored and treated if necessary.

‘If it’s that, and if the PDA doesn’t close on its own, there’s a drug we can use to encourage it,’ Nell agreed. ‘It doesn’t always work, and that’ll mean surgery.’

‘In Sydney.’

‘A few years ago, we’d have had no hope of handling a baby like this in Glenfallon at all, with or without the need for surgery. Even now, I wonder if we should be starting to look at arranging medivac transport.’

‘We’re a level two unit.’ Emma was a little defensive. ‘I’ve handled several thirty-four-weekers, and even a couple of younger ones whose mothers had their dates wrong, like this one did.’

‘Yes, I’m not kicking her out of here yet, am I, Alethea? There are no real danger signs, and it would be great if we could get her strong and well ourselves…but I still think Sydney’s on the cards.’

‘There’s no point in having the facilities to handle premmies here if we don’t use them to maximum potential,’ Emma said. ‘Thirty-four weeks is the cut-off, I know, but personally I’m trained to a higher level than that.’

‘True. And people get better at it if they practise. There are going to be a few of us practising on this baby.’

‘Don’t put it like that, Nell, as if she’s an anatomical model.’

‘Oh, I’m not. I’m not. You know I’m not. I’m just nervous. That thumb-pricking feeling that something’s not right, despite all the things that clearly are.’

‘The way you were worried about that little girl who was revived after she fell in her pool?’

‘She was Pete’s patient, too.’

‘This one was dropped into his lap,’ Emma pointed out, although why she felt this instinct to leap to Pete’s defence, she didn’t know. ‘He’d never seen her before.’

‘The man has trouble with the women in his life, doesn’t he?’ Nell commented lightly. ‘Whether they’re patients or family.’

Emma bit back a comment which she might regret. Was Nell implying Pete’s troubles were his fault? Again, she felt a need to protect him and to leap to his defence, which she didn’t understand. He was extremely competent and very intelligent. He worked hard, he cared and he had the right priorities. Just because he’d been living in her house, that didn’t mean he needed her nurturing. What was wrong with her today?

‘Let’s take this one across to the unit,’ Nell added.

It took them another hour to get the baby settled in Glenfallon’s tiny special care unit, which was simply a small, closed-off room with thick, almost soundproof windows opening onto the rest of the maternity unit. It was most often staffed by the midwives rostered for post-partum care.

Lucy was already there, in the care of Sue North now, but she’d probably go home with her mother in a few days’ time, if her condition continued to be this good and she began to feed properly. Alethea’s arrival would necessitate the juggling of staff so that Emma and a roster of two or three other experienced nurses could provide her with the acute care she’d need at first, round the clock.

In the meantime, Nell was staying.

‘I hope my department’s quiet,’ she said. ‘No doubt I’ll hear the yelling soon enough if it isn’t! We can let the dad come in and see Lucy now.’

Brian McNichol had been shepherded aside as soon as Patsy had been taken into the operating theatre. He’d probably been fed several gallons of tea by now. Emma had lost track of time. Where was Patsy? Still in Recovery? After her general anaesthesia and the extent of her bleeding, she’d probably be kept there for longer than usual. Had her husband been able to see her yet?

‘I’ll track him down,’ she said.

‘Rebecca Childer, too. She might need some encouragement. She seemed a little frightened about what to expect, and inclined to suggest it was all up to the nurses. Or her mother!’

‘We’ll work on that. I’ll hunt up some pamphlets on premmies, and talk to her and her mother as well, try and get her involved right from the beginning.’

Emma went back to the nurses’ station on the labour and delivery side of the unit, and found an unnatural level of quiet. No patients.

‘Just had a phone call from a first-timer in query early labour, but it sounded to me like a false alarm,’ Bronwyn summarised, lifting her head from the paperwork she was catching up on. ‘She’s not due for a couple of weeks. She wants to come in, but I expect we’ll be sending her home again. Pete Croft is chugging coffee in the kitchen if you want a progress report on Mrs McNichol.’

‘Oh, I do!’ Emma said. ‘And I’m hunting for the dad.’

‘I sent him off for breakfast. He was wandering around like a ghost.’

‘Dr Cassidy says Rebecca can see her baby now. Have you moved her to her room?’

‘Yes, half an hour ago,’ Bronwyn answered. ‘And her mother’s with her. I’ll take Brian McNichol round to Special Care as soon as he gets back from breakfast.’

As Bronwyn had said, Emma found Pete in the kitchen.

He’d evidently ‘chugged’ his coffee to good effect, and was holding his mug beneath the wall-mounted urn to fill it for a second time—or possibly a third—when Emma entered the room. He took a gulp of it black, then shuddered, grabbed the milk carton and splashed in a generous amount, before bringing the mug to his lips again.

Only then did he turn and see her standing there, and she had to quickly hide the awareness she suspected had been showing in her face. ‘Emma…’ he said, coming back to the present from what looked like a million miles away.

‘I was wondering…Mrs McNichol?’ she asked, before the beat of awkwardness could lengthen.

‘She lost a lot of blood,’ Pete answered. ‘Not enough to need a transfusion, but she’s on a fast drip and I’ll be watching her iron levels over the next few months. Thank goodness the baby started breathing when she did!’

‘What’s your sense about Alethea Childer?’ Emma asked.

‘I wanted to ask you that, actually, since you’ve been with her all the way through. How much did she weigh?’

‘Twelve-fifty grams.’

‘And we estimated thirty-three weeks gestation!’ He pressed his lips together, and she couldn’t help watching as they softened again when he continued to speak. ‘That’s small, even for the dates.’

‘I know.’ An average baby should have weighed several hundred grams more. ‘And Dr Cassidy doesn’t know why.’

‘Bothering her?’

‘Yes. She picked up a heart murmur as well, which she’s not sure about yet.’

‘Lucy McNichol has one, too.’

‘This time she thinks it may be more significant, but so far the heart is doing the job with no problems, so we’re hanging fire.’

‘Right.’ Pete shut his eyes for a moment, then opened them again. A tiny muscle twitched just above one cheekbone. ‘I guess I’m not all that surprised. Has the staffing been sorted?’

Emma nodded. ‘Yes, looks like it. Sue North knows what she’s doing. I’m in there, too, and they’ll juggled the roster. We’re all used to stretching when we have to.’

‘It may not be for long, if we end up sending Alethea Childer somewhere else.’

‘You don’t want to?’

‘Funny, but, no, I don’t.’ He gave an upside-down smile. His eyes had those creases around them again. ‘You’d think I might be keen to get this one off my hands. But she dropped on us out of the blue, and for some reason I don’t want to lose her again to another hospital just as quickly. Rebecca’s young. She has no confidence, and she’s not ready for this.’

‘She seems a little detached at this stage, like she might leave everything to us and just stay away.’