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Bonnie swallowed anxiously. Jacob still had the foetal monitor on Holly’s swollen abdomen. She could see the contraction clearly. As an experienced midwife she knew Holly wasn’t in the early stages of labour, even though she was upside down. A thought flicked through her mind—had Holly already been in labour and on her way to the hospital before the crash? Or was this a trauma-induced labour brought on by the crash? One thing was for sure: as soon as they got Holly into the ambulance, they’d better be prepared for a delivery.
As the seat belt was cut and Holly slid onto the backboard Bonnie glanced around. ‘Does anyone know about next of kin?’ she shouted. They were just about to take Holly away from the accident site. There hadn’t been a chance to get all the information they needed.
One of the policemen appeared at her elbow. ‘We’ve sent someone to contact her husband. Are you taking her to CRMU?’
Bonnie nodded. ‘Can you give me her husband’s name and contact details?’
He nodded and scribbled in his notebook, ripping out the page and handing it to her. By the time she turned around Holly was already being loaded onto the ambulance.
Jacob was ruthlessly efficient. The other trauma doctor secured Holly’s head and neck, checking her airway before he left. He was part of the general team from Cambridge Royal. ‘I have to accompany another patient back with a flail chest. I’ll send an orthopod around to the maternity unit.’ Jacob gave him the briefest nod as he attached the monitoring equipment. Bonnie barely got inside as the doors slammed shut and the ambulance started off at breakneck speed.
‘There’s another contraction coming,’ she said as she finished attaching the BP cuff and heart monitor. She helped him slide off Holly’s underwear and covered her abdomen with a blanket.
Jacob’s frown deepened. ‘She’s crowning. This baby is coming out any minute.’
Bonnie turned towards the portable incubator, struggling to stay on her feet as the ambulance rocked from side to side. There had to be rules about this. She was sure they were supposed to be strapped in. But this baby wasn’t waiting for anyone, and what use would two health professionals be at her head or at her side, while a baby slipped out?
She was doing rapid calculations in her head. ‘She’s thirty-four weeks. That’s not too early. Hopefully the baby won’t have any breathing difficulties.’ She switched on the monitoring equipment in the incubator, ensuring it was warm and the oxygen was ready.
It was difficult to take up position in the swaying ambulance. She could only try and lift Holly’s nearest leg, holding it in position to allow Jacob easier access to the presenting head.
She gulped. ‘She’s missing out on the birth of her baby.’ She blinked back tears. ‘I hope she doesn’t miss out on anything else.’
This was awful. Her first delivery for CRMU with a mother that she didn’t even know would wake up. Why was she still unconscious? The trauma doctor had only given her a quick once-over. There hadn’t been time for anything else. A Glasgow Coma Scale chart dangled from a clipboard. As each contraction gripped there were facial twinges—as if she were reacting to some element of the labour pain. Reaction to pain was a crucial part of the head injury assessment. And she was breathing spontaneously. Bonnie tried to focus on the positives. She would hate to think this mother would never get to hold her new baby.
As another contraction gripped Holly’s stomach the head delivered. Jacob had a quick check around the baby’s neck for any sign of a cord. He glanced quickly in Bonnie’s direction. ‘No cord. Presentation is good.’ He gave an audible sigh of relief. ‘Thank goodness.’
One minute later the baby slid into his hands and he quickly handed it over to Bonnie.
A little girl. Just like Freya. A fist squeezed around her heart. She’d heard Freya’s first cries, felt her first little breaths against her chest. Holly was missing all of this.
She quickly gave the pale little baby a rub, stimulating her first noisy breath, followed by some sharp cries. She gave Jacob a quick smile before wrapping the baby in the warming blanket and doing a quick assessment. ‘APGAR six,’ she said as she finished.
It was a little low, but would likely come up before the second check in five minutes. It was certainly better than she’d initially hoped for.
She looked up; they were pulling up in front of the emergency entrance at the maternity unit. Three other staff were waiting for them.
Jacob moved into position as the doors opened and helped lift the incubator down. ‘Take her to the nursery and get a paed doc to check her over.’
Bonnie gave a brief nod and headed down the corridor with one of the nursery midwives by her side. The handover was quick. The little girl was pinking up now and was letting everyone know she wasn’t entirely happy with her entrance to the world.
By the time Bonnie got back to the labour suite, Jacob was consulting with the orthopaedic doctor who’d come over from the main hospital. Holly’s notes had appeared at the desk. Thankfully, she had no significant medical history and her pregnancy seemed to have gone well. Bonnie could see from the whiteboard that Miriam, the senior midwife, was with her.
‘Has she woken up yet?’ She was having trouble getting her head around the fact that Holly had delivered a baby without being conscious. ‘In ten years of midwifery I’ve never seen a woman labour while unconscious.’ She blinked back the tears that threatened to spill over. ‘Does she have some kind of head injury?’
The orthopaedic doctor glanced at Jacob, then leaned over and touched Bonnie’s arm. ‘It actually might not be as bad as first thought. She almost certainly has a head injury but her Glasgow Coma Scale responses are improving. I suspect Holly’s in spinal shock from injuries sustained in the crash. She wouldn’t have felt the intensity of the labour pains even though her body naturally delivered. Jacob and I were just discussing the fact that we think she might actually have been in labour prior to the accident. We’ve checked the ward call log. She hadn’t called into the labour suite and she didn’t have any bags in her car. We’re wondering if she was going home to collect her things.’
Bonnie nodded. She could only remember a few things about spinal shock from her general nurse training. It was usually temporary but could cause loss of sensation and feeling. It certainly sounded better than some of the things she’d been imagining.
Jacob’s voice cut across her thoughts. ‘I take it the little girl is okay?’ He was glaring and it took her a couple of seconds to realise it wasn’t at her—well, not entirely. His eyes were fixed on the orthopaedic doctor’s hand, which was still on Bonnie’s arm.
Was Jacob this territorial around all his staff?
She gave a nod to the orthopod and walked behind the desk to pick up some paper notes. ‘Baby Burns is doing fine. APGAR was eight at five minutes. The paediatrician was checking her as I left.’ She waved the not
es at Jacob. ‘I’m just going to write up some midwifery notes for what happened out there. I’ll get the clerk to put Holly and baby Burns into the hospital admission system.’
There was a bang at the bottom of the corridor as the doors were flung open. Both Bonnie and Jacob jumped to their feet. It wasn’t entirely unusual for people to enter the labour suite in a rush. This time, though, there was no pregnant woman—just an extremely anxious man.
‘My wife, Holly, is she here? They said there was a car accident. What happened? Is she okay? Is the baby okay?’
Jacob and the orthopaedic doctor exchanged glances. Jacob gestured towards his office. ‘Mr Burns, why don’t you come into my office and I’ll let you know what has happened?’
The man’s face paled even more and he wobbled. ‘Are they dead?’
Jacob quickly reassured him. ‘No, no, they’re not dead. And you can see them both. Let’s just have a chat first.’ He turned to the orthopaedic doctor. ‘Dr Connelly, will you join us, please?’
But the man’s feet were welded to the floor. His eyes widened. ‘Both? The baby is here?’
Bonnie walked over, putting her hand on his arm. ‘You have a lovely daughter. I’ll take you to see her once you’ve spoken to the doctors.’ She helped usher him into the office and, once he was inside, closed the door behind him and left them to it.
‘Debbie’ The labour suite domestic was working in the kitchen. ‘Would you mind taking a pot of tea into Dr Layton’s office? I think the man he’s talking to will need some.’
Debbie gave a little laugh. ‘Tea, for Jacob? You’ve got to be joking. The guy drinks his coffee with three spoonfuls.’ She shook her head. ‘You’ll soon learn he usually has a cup from the café across the street welded to his hand. Don’t worry. I’ll sort it out.’
For the rest of the day Bonnie’s feet barely touched the ground. She finished her notes, took over from Miriam for a while, then took Mr Burns along to see his new daughter.
Holly had gradually started to come round. Things were complicated. Midwives really shouldn’t be dealing with a patient with a head injury. But Holly had a few other complications with the delivery of her placenta. She really wasn’t suitable to be on a general ward either. After some careful calls and juggling, Bonnie finally managed to make sure that either a midwife who was also trained as a general nurse was looking after her, or that an extra nurse be called over from the brief intervention unit. After the first twenty-four hours she’d need to be reassessed and other arrangements made.
