The Bush Telegraph, page 24
Maddy smiled reassuringly. ‘They certainly will get stronger and closer together, but if you stay relaxed it will make them less painful. In a perfect world, they’d just niggle until after you land at least. Some women don’t begin proper contractions for days.’ She touched Belle’s shoulder. ‘When they start, try breathing out and in deeply and slowly. Slow, deep breathing will help lessen the tension in your body. Contractions don’t like to fight against a tense body, so if they’re more painful you need to relax more. Does that make sense?’
It was a little late for antenatal lessons, so the more basic they were, the better. ‘It’s a good theory,’ Belle said dubiously, not sounding convinced. And then she winced as the next one started.
‘Breathe,’ Maddy said calmly and showed her with her own deep inhalation. Which only slightly helped Maddy’s personal growing anxiety. This was going too fast.
Belle copied, and behind her she could hear Kyle doing the same.
By the next due tablet, exactly fifteen minutes later, at two-thirty, Belle’s labour had sped up and become regular. The contractions marched along just two minutes apart and were lasting over sixty seconds.
Maddy gave the second tablet and picked up the phone. Her friendly doctor answered immediately. ‘This is Madison Locke again from Spinifex, Doctor.’
‘I hear you, Madison, what’s happening?’
‘Belle’s labour is progressing rapidly. I need the flight nurse to ring me back, please, so I can arrange for her to come into town in case our premature baby decides to arrive before the aircraft or soon after.’
‘Roger. We can do that. Have we got someone going out there to meet them?’
‘Yes.’ She’d ask Alf. Or Connor. She wanted Kyle here with Belle.
‘Confirming you’re a midwife, Madison?’
‘Yes, with a neonatal certificate. But I only have two hands and no staff. I think the flight crew should come here first instead of us meeting them out at the airstrip.’
The phone rang shortly after she put it down, and Maddy arranged for the crew to come in, then quickly rang Connor on her mobile. She’d keep Alf in case something else happened.
‘What can I do for you, Maddy?’
That was the exact response she’d hoped for and the tension in her shoulders released a little. The man was reliable. ‘Can you meet the RFDS aircraft and bring the medical staff in, please? They arrive at two-fifty. Belle’s in labour and I want them to check her here first.’
‘Will do. I’ll be there five minutes early. The kids are back at Mrs Cook’s, picking lemons, so I’ll leave them with her.’
‘Thanks.’ She rang off.
After another set of observations and a listen to the baby’s heart rate, which thankfully seemed unperturbed about the progressing labour, Maddy still had too much to do in too little time. It was two forty-five.
‘Baby’s heart rhythm and rate are reassuring,’ she told the parents. ‘I even heard an acceleration at the start of a contraction, which means baby’s central nervous system is managing the rapid contractions well.’ She glanced at the clock and looked for her notes. She needed a scribe.
Kyle’s eyes were huge and Maddy steered him to the chair beside Belle and made him sit down. ‘I need you to be my note taker, and in between to hold Belle’s hand.’ She looked into his wide eyes. ‘It’s better if we write as I go instead of trying to remember the sequence and times of events later. That helps when Belle is transferred.’
Kyle took the clipboard with the pen on a string in one hand and Belle’s fingers in the other.
‘When I say something, just write the time, what I say, then start a new line to do it for the next thing I say. Okay?’
Kyle looked rattled, but he took a breath to settle himself and nodded.
‘Write,’ she glanced at the clock. ‘FHR one-fifty. Acceleration noted. Maternal BP one-twenty on eighty. Moderate contractions two over sixty and lasting sixty seconds.’ She looked at him. ‘Got that?’
Kyle nodded again.
‘Good.’
‘She’s not going to have the baby here, is she?’
Maddy didn’t answer that question immediately as she thought about the reaction she might get. Instead she said, ‘Write maternal pulse ninety-six.’
When he’d done that she said, gently, ‘She might.’ She smiled encouragingly at them both, which wasn’t as easy as she’d thought it would be. ‘If she does, we’ll manage.’ She gestured to the clipboard. ‘And if she does, those notes help the paediatric team a lot.’ She met Belle’s eyes. ‘I’m just leaving the room to get some warm blankets from the blanket warmer.’
She didn’t think she’d need to wrap the newborn that soon, but she could set up the space for the baby. Somewhere safe and out of drafts, and they could top up the heat with a new blanket later. Hopefully, they wouldn’t need it. But it was looking less likely they’d fly until after baby was born. And it was better to have a birth on the ground than in the air.
When she came back, Belle’s knuckles were white against Kyle’s hand as she ground his fingers together. He was grimacing. Maddy liked that part. She was mean like that.
Belle’s wide eyes searched Maddy’s face as if she could save her.
‘It’s okay.’ She lowered her voice to an almost hypnotic quiet and slowness. ‘Babies are tough. Fear is not your friend here, Belle. Nice and slow with your breathing. Nice and deep. Tell your baby everything is fine.’
She needed to get the gear ready in case they did have a birth, though. She reached up for the emergency pack from the top shelf. A small sterile pre-prepared bundle of very basic needs for a rapid birth. Two pairs of forceps for clamping the cord. A cord clamp for the baby’s end of the umbilical cord and disposable kidney dish for the placenta. A pack of disposable sponges for wiping away blood. A waterproof sheet and a towel. And she needed an injection for after the birth, because the last thing they wanted to deal with was a postpartum haemorrhage with no help.
And the next pill was due.
A cannula in Belle would be nice for just that reason – they had asked for that – so she’d try to fit that in before the flight crew arrived . . . or maybe they could do that if she didn’t get a chance. Now it was time for another tablet and more observations.
‘Write this down,’ she told Kyle. ‘Medication at fifteen hundred.’ Quickly, she checked the blood-pressure reading. ‘BP one-ten over seventy. Pulse one hundred.’ Maddy listened to the baby’s heart rate. ‘FHR one hundred and sixty-four.’
The flight nurse would be here soon, so she resumed assembling the equipment.
Once the labour set-up was done, she turned to her little blanket space on the bench. It was flat, close at hand, and a safe space with a warm blanket. She pulled the neonatal resuscitation bag and mask out of a drawer and assembled it, ready for if the worst happened and the baby didn’t breathe. Oxygen tubing was close, but she didn’t attach it. Air was best. Oxygen was a drug you saved for emergencies. And only if breathing problems persisted. This baby would be a breeze, Maddy reassured herself.
Belle was sure the baby was thirty-four weeks, so it wasn’t too small. A baby that gestation would tire and cool easily, but should be fine for the first half an hour to an hour. The flight nurse would be here by then and more hands would be available.
‘As soon as baby is breathing, I’ll pop him or her against your skin, so your body’s natural heating system keeps baby warm.’
On mum’s skin, the newborn’s breathing would regulate more quickly as well. That was the plan. Nice and simple. Tension coiled in Maddy’s stomach.
‘How long until the plane arrives?’ The catch in Kyle’s voice betrayed his concern.
Maddy looked up at the clock on the wall. She’d done that a lot. They should have landed now. ‘You can text Connor if there’s service out there and check if he’s picked them up yet.’
Chapter Forty
Maddy
Kyle phoned Connor while Maddy rechecked Belle’s blood pressure and the foetal heart rate. She also shook out the last tablet before the RFDS arrived, she hoped, not that they seemed to be doing any good at stopping this labour.
Sometimes this medication proved brilliant. Other times nothing worked. Which made her worry that something else might be going on. Maybe Belle’s baby needed to get out. Mother Nature was good like that.
By the time she finished, Kyle had picked up the clipboard again. ‘Fifteen fifteen,’ she said and gave him the observations to write down.
When they’d finished recording, she asked, ‘What did Connor say?’
‘They’ve landed and he’s waiting for them to turn off the engine.’
‘Great!’ Maddy felt the swell of relief and blew out a long breath. ‘They were quick. Sometimes it takes longer than that to get a response in a large hospital. Your RFDS’s organisation is amazing.’
She had five minutes spare and she’d done as much preparation as she could. She now had a moment of opportunity. ‘I’d like to put a cannula in,’ Maddy said, smiling apologetically. ‘I’ll use local anaesthetic, so apart from the first sting it shouldn’t hurt too much.’ She reached for the tray of cannulas she’d prepared earlier. ‘You okay with that, Belle?’
Belle nodded, but when Maddy glanced at Kyle she noted he’d gone deathly pale. She remembered that he’d left the room when she gave the last injection. ‘Take some deep breaths, Kyle. You okay with blood and injections?’
‘I won’t watch,’ he said quickly.
Maddy blessed all those years in the emergency department and the fact that she could site a cannula faster than almost anybody else. Done in seconds, she strapped down the cannula head securely and thought about running some fluids to keep Belle well hydrated. Just as quickly, she decided she’d wait for the crew to come and ask first. A full bladder in flight wasn’t fun.
It was time for more observations.
‘They should be here,’ said Kyle. Agitation had risen in his voice.
‘Won’t be long,’ Maddy reassured him. ‘Can you write this down, please, Kyle?’ So that was two good reasons to give him a job. The man was getting more and more distressed. She felt for him. It was horrid to be so helpless when someone you loved was in this situation. Maddy had seen this often in the emergency department in Sydney, but when she knew everybody who came into her clinic in a town like this, the fact became even starker.
Belle moaned this time with a hint of panic and Maddy knew they were getting close.
Come on, Connor, she urged silently, and then she heard a car pull up outside.
There were doors closing and footsteps on the verandah and the sound of the front door opening. ‘In here,’ Maddy called.
A young woman stepped through the doorway. She was different to the nurse who had picked up Tim and Mick. Tall, blonde, with calm eyes and a warm smile, she looked just the sort of person you needed at this moment. ‘I’m Lizzy. The doctor got called away so it’s us. You must be Maddy and you must be Belle.’ She projected all her attention to the woman on the bed.
Belle began to smile, but then her breath caught and there was an unmistakable groan followed by held breath as she grunted.
‘Just in time,’ said Maddy.
Lizzie glanced around.
Maddy pointed. ‘Handwash. Bag and mask. More baby blankets outside in the warmer. Cannula in, and post-birth injections drawn up. Delivery pack under that sterile sheet and gloves here.’
‘Well, go ahead,’ said Lizzie. ‘I’ll be a backup.’
Maddy met her eyes and then Belle’s. ‘Let’s see what’s happening, Belle,’ Maddy said gently, absolutely determined Belle would be mentally present and calm for this birth. ‘Despite the fact that your baby is six weeks early and this isn’t the place you chose to birth, your baby is a miracle.’
Maddy moved closer to the top of the bed and touched Belle’s shoulder. ‘There’s stress on you and Kyle, and there’ll be setbacks with prematurity, but your baby is determined and is going to arrive, no matter what we do.’
Belle nodded.
‘So, despite all that, this moment is special, and you will be amazing. Will you hate me if I say try to enjoy it?’
Belle almost smiled. ‘No.’
‘Then it’s time for me to check your dilation.’
Belle’s eyes widened as she looked up with a hint of panic. ‘Maybe you’d better. Something’s going on down there.’ Then she shook her head. ‘I think I need to go to the toilet first.’
Maddy smiled. ‘Sometimes when women need to go to the toilet, it means their baby is almost ready to be born.’ She glanced across at the flight nurse, standing with gloves on, checking the neonatal equipment. ‘Lizzie is here now. There’s nothing we can do to stop your baby making up its own mind. So just let everything happen.’
Maddy lifted the sheet discreetly and helped Belle shuffle out of her underwear. ‘Lizzie’s going to put the head of the bed down when I’m ready, so that you’re lying flat. That way I can reach to your baby’s head inside more easily. But first, I’ll check your tummy one more time.’
Maddy ran her hands surely over the shiny belly in a swift examination, and as she finished another contraction rolled through Belle. When it was over, Maddy and Lizzie both fixed their gazes on the clock as they counted the beats.
Lizzie nodded. ‘Baby sounds happy.’
Belle looked up at Kyle on her other side and he took her hand, but he looked away. Lizzie came around and pushed him down to sit in the chair beside the bed. ‘No fainting allowed,’ she said cheerfully.
Maddy washed her hands and pulled on her gloves. As soon as the next contraction finished, she began the examination. Oh, yes. ‘I can feel your baby’s head.’
She carefully checked for the thickened cervix at the circular opening of the womb, but it had pulled up and disappeared to become part of the uterus so that none remained that she could feel. ‘There’s nothing to stop baby coming through. Just give me a tiny push, Belle.’
Belle held her breath and grunted, and Maddy felt the head shift even with that small effort towards her fingers. ‘As we thought. If you do that next time the contraction comes, very soon, you will have your baby.’
Lizzie leaned over and listened with the ultrasound doppler again as Maddy stripped off her gloves and lifted the head of the bed.
‘Are you okay?’
Belle said in a strained voice, ‘Another one is coming.’
Maddy pulled on new gloves. ‘Sit up nice and high and put your hands behind your knees.’ They helped her get comfortable. ‘Okay, then. Drop your shoulders and let it all happen with the next contraction.’
Belle gasped again as the next contraction grew stronger and rolled over her with intensity. She blew a steady stream of breath out and dropped her shoulders. One lone tear slid down her cheek.
Kyle wiped it away and held her hand. ‘I’ve got you, baby.’
Maddy’s eyes widened at the rapid descent of the baby. She’d seen fast before, but this was ridiculous. With that first downward pressure, a sliver of head and one tiny curl of dark hair appeared between Belle’s legs. ‘If the contraction has gone then go limp, Belle. Rest. Baby is coming beautifully with your wonderful breathing.’
Lizzie swooped in and placed the doppler on Belle’s belly, low down near the pelvic bone now, and the steady gallop of the baby filled the room. Both midwives counted silently, lips moving, and smiled.
Maddy glanced at Kyle, but he was gazing with such awe at his wife she felt the tears sting. Maybe this would be the change Kyle needed. She hoped so.
Eyes shut, Belle drew in another noisy breath to signal the next contraction, then visibly forced her shoulders down to try to relax. Her hand whitened on Kyle’s fingers, but her breath expelled in a long, slow stream as if blowing out a hundred candles. Slow and calm. Strong and powerful with no held breath. Maddy wanted to hug her and shout, Exactly!
Kyle leaned over and his eyes widened as the crescent of baby’s head grew to almost a palm size, before the contraction ended and half of it disappeared again. He opened his mouth anxiously to ask something and then snapped it shut.
Maddy nodded at him in approval.
Lizzie leaned in and placed the doppler again.
Maddy said quietly in that slow, calm voice she kept for birthing, ‘Beautiful, Belle. Keep doing exactly what you’re doing. Nice and slow.’
With the next contraction the wrinkled forehead, tiny nose and bubble-filled mouth appeared until the whole head was out, the head turned, a white shoulder appeared, then another, and a long, limp, pale body and legs slipped from within in a flurry of expulsion. Belle’s baby uncoiled into Maddy’s waiting hands and Belle gasped at the sudden end of it all.
‘Fabulous, Belle. You and Kyle have a son,’ Maddy whispered as she gathered the baby close. ‘Congratulations.’
‘James,’ Kyle said.
‘Time of birth fifteen-thirty,’ Lizzie commented as the room zoomed into movement. Lizzie reached over to wipe the baby as it lay between Belle’s legs, Maddy reached for the injection to reduce the risk of postpartum haemorrhage, and Kyle fainted back into the chair.
Chapter Forty-one
Connor
Connor couldn’t believe he was an uncle.
Kyle hadn’t gone with Belle because there had already been a patient in the aircraft and Lizzie had been worried she’d need to move around the humidity crib and they’d need the space. He’d leave tomorrow morning because Belle had begged him not to drive in the dark.
Connor suspected that his brother staying behind with the emotions of the day to review was a bad idea. He’d even offered to go with Kyle to Brisbane and Mrs Cook could keep Jayden, but at his brother’s refusal there was nothing he could do about it.
After they’d watched the plane take off, Connor brought Kyle and Maddy back into town, to where Kyle had left his vehicle, but instead of going home to pack, his brother turned towards the pub. Fast. Connor’s heart sank. He feared his brother wouldn’t miss this opportunity for a celebration.
