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Sally was lying quietly, holding tightly to her husband’s hand as she listened to Luca.
‘You have an epidural in place,’ Luca told her, ‘because I don’t want you to push at the wrong time.’
Tia knew that it also meant that he could use forceps if he needed to.
‘I’m never, ever having another baby,’ Sally wailed, gripping her husband so hard that her knuckles turned white.
He looked at Luca in desperation and Luca gave him a reassuring smile.
‘Everything is fine, I promise you.’ He examined Sally carefully and then glanced at Dr Ford. ‘This is an extended breech—so that the presenting part is the buttocks. It is the most common type of breech presentation and much safer than a footling breech.’ He gave Sally a smile. ‘Sometimes they come out feet first and that gives us more of a headache.’
Sally gave him a wavering smile, her trust in him clear to see. ‘What if he gets stuck?’
Luca shook his head. ‘He won’t get stuck.’ He was totally sure of himself. ‘We know the size of the baby from the scan that you had, and we know the size of your pelvis from the X-rays.’
Dr Ford stepped closer, her arm brushing Luca’s. ‘Did she have lateral pelvimetry?’
Luca nodded. ‘It shows the shape of the sacrum and gives accurate measurements of the anteroposterior diameters of the pelvic brim, cavity and outlet.’ He looked at Sally and gave a sexy, lopsided smile. ‘This baby will fit, Sally. Trust me.’
He glanced at the CTG machine and placed a hand on Sally’s abdomen. ‘You have another contraction coming— I want you to push when I say.’ His eyes flickered to Tia. ‘Can you chase the paediatrician for me, please?’
Tia slipped out of the room and called Switchboard, knowing that the delivery wasn’t far away. She knew that lots of obstetricians chose to deliver all breech presentations by Caesarean section because they were afraid of litigation. It was typical of Luca that he’d allowed Sally to have the delivery that she wanted. His experience and instincts had told him that a vaginal delivery should be safe and he wasn’t going to let other people’s opinions dent his self-confidence.
She spoke quickly to the paediatrician who assured her that he was on his way, and then returned to the room to find that Luca had delivered the baby’s buttocks and legs.
Luca gently pulled down a loop of cord. ‘It’s important to avoid traction on the umbilicus or the cord might tear,’ he murmured to Dr Ford, ‘but it is also important not to manipulate or stretch the cord because it can cause spasm.’
Dr Ford leaned closer to Luca. ‘What happens now?’
‘The uterine contractions and the width of the buttocks will bring the shoulders down onto the pelvic floor,’ Luca told her, ‘and then they’ll rotate.’
He glanced up and smiled at Sally. ‘You’re doing brilliantly. Nearly there.’
Tia watched as he grasped the baby by the iliac crests and tilted it to free the shoulder.
‘I need a towel.’
Tia had warmed one in readiness and she handed it to him quickly.
Luca wrapped it around the baby’s hips, improving his grip and also helping to keep it warm.
As the anterior shoulder appeared he placed two fingers over the clavicle and swept them round to release the arm and then grasped the an
kles to free the posterior arm.
‘Just the head to go, Sally,’ Luca said quietly, infinitely patient as he waited, refusing to hurry nature. ‘I wait a couple of minutes and the weight of the body will bring the head onto the pelvic floor.’
Dr Ford looked at him with open admiration. ‘How will you deliver the head? Will you use forceps?’
‘No.’ Luca didn’t take his eyes off the patient. ‘It doesn’t really matter how you deliver the head as long as it’s slow and controlled. That’s the vital thing to remember. Tia, are you ready to clear the airway?’
‘Yes.’ Tia got ready with the suction and held her breath while he grasped the baby’s feet and, with gentle traction, swept them in an arc over Sally’s abdomen, allowing the lower half of the baby’s head to slip out.
She quickly aspirated the nose and mouth, making sure that the air passages were cleared.
‘All right, Sally,’ Luca’s voice was deep and controlled, ‘I want you to take regular breaths while I deliver the rest of the head.’
He took another three minutes to deliver the baby, allowing the slow release of pressures and tensions on the skull before finally placing the bawling child in the arms of his mother.
