Always the Midwife by Alison Roberts | eBook

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The blip of the foetal heart monitor had definitely slowed down. Her decision might be a no-brainer but Sophia knew it wasn't going to be popular.

'I'm sorry,' she told her patient, 'but I'm not happy with the way things are going. We need to get you to hospital.'

'No-o-o…' First-time mother Claire Robinson had her heart set on a home birth. 'You said I'm almost fully dilated. It can't be much longer.'

'You're exhausted, sweetheart. Every contraction is harder for you and things are slowing down.' She still had the hand-held Doppler against the distended abdomen of the pregnant woman. 'Can you hear that the baby's heartbeat has slowed down, too? It's a sign that baby is getting distressed.'

'What does that mean?' Claire's husband, Greg, was looking pale and anxious. 'Is the baby in danger? Is Claire in danger?'

'No.' Sophia hastened to reassure them both. 'But that's what I want to make sure isn't going to happen. The labour hasn't progressed quite the way we wanted and…' How could she tell these parents-to-be, without scaring them, that it was her instinct that something wasn't right that was making the transfer seem urgent? 'Let me make a call and see how far away an ambulance might be.'

The call was answered instantly.

'My name is Sophia Toulson,' Sophia said. 'I'm a midwife with the Melbourne Maternity Unit at the Victoria. I'm at a planned home birth…' She moved away from the young couple, lowering her voice as she gave the address details and then voiced her concerns.

'An ambulance is probably fifteen minutes away,' the dispatcher told her. 'But we do have a SPRINT guy in your locality.'

'SPRINT?'

'Single Paramedic Response and Intervention. An intensive care paramedic on a motorbike.'

'I think we just need the transport,' Sophia said. 'It's not an emergency…' But she could hear the note of doubt in her own voice. An exhausted first-time mother and a stalled labour. The potential for an emergency was there. Was that why alarm bells had started ringing?

'I'll change the plan,' Claire offered desperately, as Sophia ended the call. 'I'll have more pain relief than the gas. You can rupture the membranes. Whatever it takes…' She was sobbing now. 'We don't want to have our baby in a hospital.'

'I know.' Sophia smoothed damp strands of hair back from Claire's face. 'But you know what the really important thing here is?'

She didn't wait for a response. Greg was perched on the end of the bed, holding Claire in his arms as she lay back against him. She caught his gaze and then Claire's.

'My job is to keep both you and baby safe. At the end of the day, the only thing that matters is that you get to hold your healthy baby in your arms. I promise that where the delivery happens is not going to take away even the tiniest bit of joy that moment's going to give you.'

A joy that Sophia might never be able to experience herself but that didn't mean she couldn't share it happening for others. It was precisely why she'd chosen this profession. Why she loved it so much. And why she was so passionate about doing whatever it took to ensure a happy outcome.

'That's all I want,' Greg said, his voice cracking. 'For you both to be okay. We always said that we'd go to the hospital the minute we were worried about anything.'

'But I'm not worried. I'm just so tired… Oohhh…' Claire's face scrunched into lines of pain.

'Another contraction?' Sophia reached for the Entonox mouthpiece. 'Here you go. Deep breaths.'

The loud rap on the door made her jump. Surely the ambulance hadn't arrived this quickly?

'Shall I go?' Greg asked.

Claire spat out the mouthpiece. 'No—don't leave me… It's____Ahhh…'

Sophia wasn't going anywhere either. The contraction had produced a rush of fluid. Claire's membranes had finally broken. It was a sign that her labour was progressing again but Sophia wasn't feeling relieved. Quite the opposite.

The fluid soaking into the pad beneath Claire's hips had the stain of meconium that meant the baby could be in trouble. And.

Oh, dear Lord…yes…that was a loop of umbilical cord showing.

'G'day…' The rich, deep voice came from behind her. 'I let myself in. Hope that's okay.'

Sophia looked up. The man was wearing a high-vis heavy-duty jacket. He had a motorbike helmet on his head with the red, white and blue colours of Melbourne's ambulance service and the title 'Paramedic' emblazoned across the front. The chin-guard and visor were flipped up so that she could see his face but she barely registered what he looked like. There was relief to be felt now—that she had professional help in what had just become an obstetric emergency.

'Claire's waters just broke,' she said quietly. 'We've got a cord prolapse.'

'What's that?' Greg was leaning in, trying to see what was happening. 'What's going on? And who are you?'

The paramedic's helmet was off by the time he'd taken two steps closer. 'I'm Aiden Harrison,' he told Greg. 'Here to help.' He was right beside Sophia now. 'Modified Sims position?'

'Knees to chest, I think. Claire? We're going to get you to turn over, I want you on your knees with your bottom up in the air. Greg, can you help?'

'What? Why?' Claire was panting, recovering from the contraction. 'I don't want to move.'

'We've got a small problem, guys.' The paramedic had dropped his helmet and leather gloves, along with a rolled-up kit he'd been carrying. He didn't sound stressed. Rather, he made it sound as if whatever the problem was, it was going to be easily remedied. 'Your baby didn't read the rule book and part of the umbilical cord has come out first. We need to take any pressure off it, which is why we're going to let gravity give us a hand. Here…let me help.'

Somehow he managed to make it seem like nothing out of the ordinary to be getting a woman in labour to get into what seemed a very unnatural position, on her knees with her head lowered. Sophia was ready with the Doppler to check the baby's heart rate again.

Aiden listened, his gaze on his watch. 'Ninety-eight,' he said. 'What was the last recorded rate?'

'One-forty.' Sophia ripped open a packet of sterile gloves. In a blink of time, this had become a potential disaster. The baby's oxygen supply was being cut off. 'I'm going to try and ease the pressure.'

'Oh, my God…' Claire wailed. 'What's happening?'

'You're going to feel me inside,' Sophia warned her. 'I'm going to be pushing on baby's head to take the pressure off the cord.'

Greg's face was as white as a sheet. 'How are you going to take her to hospital if she has to stay in that position?' He glanced sideways to where the paramedic had discarded his bike helmet. 'You're not even driving an ambulance, are you?'

'No, mate. I ride a bike. Gets me where I'm needed faster.' Aiden reached for the radio clipped to his shoulder. 'SPRINT One to Base. How far away is our back-up?'

They could all hear the woman's voice on the other end. 'Should be with you in less than ten minutes.'

'Copy that. Make it a code one.' He nodded at Greg. 'Hang in there, mate. We're under control.'

'I'm getting another contraction,' Claire groaned. 'Ohhh… I want to push…'

'Don't push,' Sophia warned. 'Not yet.'

She looked up to find Aiden's gaze on her face. A steady gaze but she could see he knew exactly what she was trying to decide and the almost crushing responsibility for making the right choice here.

'The cord's pulsatile,' she told him. 'And Claire's fully dilated.'

Aiden nodded. If they were in hospital right now, an assisted delivery with forceps would be the fastest and safest way to get this baby out. With Sophia using two fingers to push on the baby's head, the cord was being protected and the blood and oxygen supply was still adequate. She knew what she was doing, this midwife. Intelligent-looking woman, in fact, which probably explained the anxiety he could see in her eyes. She had to know exactly how dangerous this situation was for the baby.

Her hand was probably already aching, although Aiden couldn't detect any signs of discomfort. Could she keep this up until they arrived at the hospital? The other option was not to slow down a natural delivery but to try and speed it up. To get the baby out fast enough to avoid potentially devastating complications from lack of oxygen. She was still looking at him and he got the feeling she was following his train of thought.

'She's also exhausted,' she added. 'Labour's been a bit protracted. That was why I called for an ambulance in the first place. I'm not sure…' Sophia bit her lip as her words trailed to an inaudible whisper. She hated feeling indecisive and it rarely happened, but a baby's life was at stake here and there was another option. But if they encouraged Claire to push and she was too tired to be effective, they would have to wait for another contraction and they could end up in a much worse position, with the baby's head cutting off any oxygen supply. The baby could end up with severe brain damage. Or it could die.

The weighing-up process was lightning fast but agonising. Sophia found she was holding the gaze of the paramedic. Light brown eyes, a part of her brain noted. Unusual. It was a calm gaze but it was intelligent. He knew what the issues were. It was also confident. Crinkles appeared near the corners, like a smile that didn't involve a mouth. There was a good chance they could pull this off.

It was Aiden who broke the eye contact. He crouched beside the bed so that he could look up at Claire who had her forehead resting on clenched fists.

'How tired are you, Claire?' he asked.

'She's stuffed, mate.' It was Greg who responded. 'We never thought it was going to be this hard, you know?'

But Aiden didn't seem to be listening. He was holding Claire's frightened gaze now.

'The best thing for your baby is going to be getting born as fast as possible,' he said. 'And we can help but you're going to have to do most of the work. Do you think you could do that?'

'I want to push,' Claire said with a sob. 'But I'm scared.'

'We're here with you. How 'bout we give it our best shot with the next contraction?' 'O-okay. I'll try.'

'Good girl.' He was smiling at Claire now and the mix of approval and confidence in his voice was compelling. Sophia could have felt defensive about having someone else make that decision for her, but instead she was as ready as Claire to put every effort into making this work. She believed it was the right decision. It would work.

Who was this knight in shining armour who'd ridden up on a motorbike instead of a horse just as things were turning to custard? This paramedic with his warm brown eyes and streaked, golden-blond hair that made him look like a surfer.

When the next contraction was due a couple of minutes later, they turned Claire onto her back again and Sophia released the pressure holding the baby's head away from the cervix and the cord. The clock was ticking from that moment on and the three of them, Aiden, Sophia and even Greg—who couldn't help but catch the urgency—coached Claire into giving everything she had. And then a bit more.

'You can do it,' Aiden told her firmly. 'Push, push, push. Keep going. Push'

'Crowning,' Sophia confirmed. 'Keep going, Claire.'

'You're doing great,' Aiden continued. 'But don't stop. We can't wait for another contraction. This is it. Push.'

'Can't…' The groan was agonised.

'Yes, you can. You are doing it. You're awesome. One more push, that's all we need.'

Good grief, this man had the most amazing voice. Sophia could feel her own abdominal muscles clenching. She wanted to push—how ridiculous was that?

'Oh, my God…' Greg's voice was choked. 'I can see him, Claire. Our baby.'

Sophia could see him, too. Could touch and help him into the world, but she'd lost track of how many minutes it had taken since the blood and oxygen supply had been cut off by the pressure of the baby's head and body on the prolapsed umbilical cord.

The baby was limp and blue. It looked lifeless.

Her heart sank like a stone. This had been the wrong decision, then, to let imminent labour progress instead of stalling it and trying to get Claire to hospital before she delivered. This was her patient and her responsibility. How could she have allowed this man she'd never even met before to come in and take charge the way he had? It would be unthinkable to lose a baby like this.

But the motorbike-riding paramedic was by her side, with a kit unrolled and resuscitation gear at the ready and she hadn't yet lost faith in the calm confidence he displayed.

A tiny bag mask to deliver oxygen. Fingers that looked so large against a fragile chest delivering compressions that were gentle but effective.

'Come on, little guy. You can do it. You're gonna be fine.'

The words sounded incongruously casual but Sophia could see the intense concentration in the paramedic's eyes. The fierce determination to save a tiny life.

And there was movement. A gasp as lungs expanded for the first time. A warbling cry. Skin colour that was changing from a deathly blue to a much healthier pink. Arms and legs beginning to stir.

'Hey…welcome back, little guy.' Aiden's hands cupped the baby to gently lift and place the newborn boy against his mother's skin. Both Claire and Greg had tears streaming down their faces. There was an overpowering sense of both relief and joy but fear hadn't been banished yet.

Sophia was watching anxiously. With the level of resuscitation needed, the baby would have still been under intense monitoring in a clinical setting, not being held and touched like this by his parents.

And then Aiden's gaze shifted away from the infant.

'Apgar score nine at five minutes,' he murmured. She could swear there was a ghost of a wink accompanying the report. He knew how anxious she was and he wanted her to know that he was still doing his job—that the baby was being carefully monitored. Sure enough, she could see him resting a finger lightly on the baby's upper arm, taking a brachial pulse. She could stop worrying and focus on Claire. She could deal with the delivery of the placenta and check for any tissue damage.

The emergency was over, almost as quickly as it had appeared.

The ambulance would be arriving within minutes and then they'd have the bustle of preparations to transfer the new family to the maternity unit, where Claire and the baby could both be checked by specialists, but this was a gift of time.

Private time in their own home—the place they had wanted to be in to welcome their first baby.

Aiden stepped back. He stripped off the gloves he'd put on to work on the baby and moved to one side of the room, where he propped an elbow on a tall chest of drawers. He was due to go off duty and he had his usual visit to make as soon as he was done but he wasn't going to leave until the backup arrived and he didn't want to crowd the young parents as they had their first minutes with their newborn.

Besides, he could watch the midwife as she dealt competently with the delivery of the placenta, transferring it to a bowl where she inspected it for any damage that could suggest part of it had been retained. She was tiny, he noticed. Only a bit over five feet tall. Funny that he hadn't noticed how small she was before. Maybe that was because she'd given off the impression of being confident. Good at her job and in control.

She hadn't felt so in control at one point, though, had she? He remembered that almost telepathic communication between them as they'd weighed up the option of whether to try and stall the labour or push it forward.

Her eyes were a rich brown, weren't they? A nice match for her hair, which had an auburn tinge to its dark colour. It was pinned up to her head to keep it out of the way and Aiden found himself wondering how long it would be if it was unpinned. How soft it might feel.

Good grief… Okay, she was pretty cute but there was no need to get carried away.

But then she looked up from her work and her smile told him there was nothing to worry about.

He could feel that smile as much as he could see it. Gorgeous was the only word for it.

Sophia hadn't noticed the paramedic moving to the other side of the room. Had he apparently read the vibes in the room in the same way he'd seemed to ever since he'd walked in the door?

Always the Midwife

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