The Consultant's Christmas Proposal. Kate Hardy
on the ward, so she did a quick round of the delivery floor.
‘Saskia, I’m glad you’re here. I could do with a second opinion.’
Saskia went straight onto red alert. Georgina Wilson was their senior midwife, and her instincts were always spot on. ‘What’s up?’
‘Clare Fellowes. First baby, due eleven days ago. We induced her yesterday morning with prostaglandins—two lots—and she was only just three centimetres dilated at a quarter to one this morning.’
Usually induction meant a fast labour—this one was unusually slow.
‘Larissa broke Clare’s waters at six this morning. It doesn’t seem to have speeded up her labour at all.’
‘OP?’ The best position in labour was when the baby faced the mother’s back. In OP, or occipitoposterior presentation, the baby faced the mother’s front, so the head didn’t press down as efficiently on the cervix, the baby’s head needed to rotate further and labour tended to take longer.
‘Yes. No sign of meconium.’ Meconium was the baby’s first bowel movement, a thick, greenish-black substance made up of bile, mucus and intestinal cells. If the baby passed it into the amniotic fluid, it generally indicated that the foetus was in distress—and sometimes the baby could inhale it when he started to breathe, when it would block his airways.
‘That’s good. What’s the baby’s heart trace doing?’
‘Slightly tachycardic, with late deceleration.’
This told Saskia that the baby’s heart rate was faster than normal, then dropping after the peak of Clare’s contractions—a sign that the baby wasn’t getting enough oxygen. ‘Have you taken a blood sample from the baby’s scalp?’
‘Just about to. I’ve put the mum on her left side and given her some oxygen.’
‘Well done. Let’s stop the oxytocin and do a blood sample.’ Saskia frowned. ‘If it’s not good, we’re looking at a section. Does it say anything in her birth plan?’
‘The usual. She wants a normal birth with minimal pain relief, hubby to cut the umbilical cord, and she’d rather not have an episiotomy if she can help it.’
Saskia winced. ‘Please, don’t tell me she’s been going through a labour this long on just gas and air or a TENS machine.’
Georgina shook her head. ‘When it was obvious she was in for the long haul, we talked over the idea of an epidural.’
‘I hope she went for it. Giving birth is a tough enough job—why add to it by struggling with pain when we can help?’
Georgina smiled. ‘You’re preaching to the converted.’
‘Yeah, I know.’ Saskia smiled back.
Saskia introduced herself to Clare and her partner, explained what she was about to do and that it wouldn’t hurt the baby at all, and took the blood sample. To her dismay, the pH value was 7.21, lower than it should be. Saskia examined Clare and realised immediately that the labour simply wasn’t progressing as it should have done.
‘Clare, you’ve done really well to get this far,’ she said gently. ‘You’ve had a tough first labour and you’ve been really heroic about it. But your baby’s starting to show signs of distress, and his blood’s slightly acidic. I’d recommend that you have a Caesarean section.’
‘But…we wanted a natural birth.’ A tear trickled down Clare’s face. ‘A normal one.’
‘Sometimes you need a bit of extra help. It’s your choice, but your labour’s very, very slow and you’re tired. The longer it goes on, the more the baby’s at risk of having problems. At the moment, I’m concerned he’s not getting enough oxygen.’
Clare swallowed. ‘Does it mean I’ll have to have a general anaesthetic?’
‘Not if you don’t want to. You’ve already got an epidural, so we’ll just top it up a bit for the operation. Your partner can still come in with you to hold your hand all the way.’ She smiled at Clare’s partner. ‘And you can still cut the cord, if that’s what you want to do.’
‘And the baby’s going to be all right?’ he asked.
‘If we deliver soon.’
Clare nodded. ‘All right.’
‘Thank you. I just need you to sign a consent form. And in about thirty minutes, you’ll be holding your baby.’ She smiled again, and signalled to Georgina that she wanted a word outside. ‘I’ll find an anaesthetist to top up the epidural for the section. Can you ring Paeds and ask them to send someone up, please?’
‘Sure.’
Once the anaesthetist was arranged, Saskia had another chat with Clare, explained what would happen in Theatre and answered Clare’s questions.
Just after she’d made the incision, a masked doctor in scrubs walked into Theatre. She recognised his outline immediately, and smiled to herself. The baby was going to be in good hands, then. Toby’s hands.
She worked swiftly but, as she’d dreaded, the baby had passed meconium. Inhaled some, too, by the green staining around his nose.
‘You have a lovely little boy,’ she told Clare. ‘The paediatrician’s just going to check him over, and then you’ll be able to have a cuddle.’
She concentrated on sewing up the wound she’d made, though every so often she glanced over towards Toby. He was good at his job—very good—but the more time passed, the more likely it was that the baby was in trouble.
Finally, to her relief, she heard what she’d been waiting for. A baby’s cry.
‘One perfect little boy.’ Toby brought the wrapped baby over to Clare. ‘He’s lovely. Well done.’
‘Is he all right?’
‘He’s going to be fine,’ Toby reassured her. ‘He did in hale a bit of meconium, but we’ve got rid of it and there won’t be any long-term damage. Congratulations.’
‘My little boy,’ Clare said, and burst into tears.
‘I love happy endings,’ Toby said a couple of hours later, as he unwrapped his sandwich. ‘I think we should have cases like that every day.’
‘Meconium inhalation isn’t my definition of a good day,’ Saskia said dryly. ‘How were the kids?’
‘Fine. They had the play-dough out at nursery, so Billy couldn’t wait to go and make something. You’re still OK to pick them up?’
‘Yep. Did you bring your diary?’
‘You’re such a slave-driver.’ He pulled a face at her. ‘How does your ward put up with you?’
‘They’ve learned how to be efficient,’ Saskia said sweetly.
He pulled his diary from his jacket pocket. ‘OK. I’ve got two days I can’t switch—meetings that can’t be moved—but otherwise I can be flexible.’
Saskia took a quick look at his schedule and compared it with hers on her organiser. ‘Actually, we won’t have to do that much switching. Say it’ll be two weeks until Lyd comes home. If you can change your late to an early on Friday, and I swap my Monday late for an early, we’re about there.’
‘Done. Now can I eat my sandwich in peace?’
‘We haven’t done the cooking rota yet. And, before you say it, no, we are not living on take-aways, Toby Barker.’
‘How about whoever’s home first cooks dinner, and whoever’s on a late has it heated up when they get in?’ he suggested.
‘Fine. I’ll be home first tonight, so I’ll cook.’ She handed him a key. ‘Here.’
‘What’s