Fiona McArthur – Baby for the Midwife: The Midwife's Baby / Spanish Doctor, Pregnant Midwife / Countdown to Baby (страница 13)

If the placenta had sheared off from the uterine wall then it certainly wouldn’t have a pulse and Tim could cut the cord.

Georgia curved her fingers around the cord and gently squeezed the thick rope. ‘The cord has stopped pulsating, Mel. Is it OK for Tim to cut the cord now?’

Mel looked up. ‘Yes, that’s fine.’ She smiled at Georgia. ‘Isn’t our son beautiful?’

‘You are a very handsome man, Master Billy,’ she said to the baby, and then returned her attention to the job at hand.

‘I’m just sealing his umbilical cord with this little clamp and pinching another section a few inches down so Tim can cut between the two clamps.’ She looked up as she held out the scissors. ‘You ready, Tim?’

Tim nodded and took the scissors to saw away at the cord until it was severed. ‘Either the scissors are blunt or it’s pretty tough.’

They all laughed when the job was done and a few seconds later the third stage was complete.

‘No damage,’ Georgia said after a quick check down below, and she lifted out the disposable sheet from beneath Mel and tucked the warm blanket over her chest and the baby.

Max wandered over to the bench to start writing in the patient notes and Georgia checked Mel’s abdomen for a contracted uterus once more before pulling the blanket down and joining him.

Georgia frowned and checked again. Mel’s uterus was soft and spongy and not the hard ball she had expected. She lifted back the sheets and a sudden column of blood spread into a widening pool that seeped away underneath Mel onto the bed.

The blood didn’t just trickle, it flowed heavily in a serious postpartum haemorrhage that needed immediate treatment.

‘Max,’ Georgia said, and his head flicked up immediately at the tone of her voice. He crossed over to the bed and Georgia leant over and pressed the red button for help. Max already being there was a godsend, but they might need extra hands.

Georgia’s palm had gone straight to Mel’s abdomen again to rub the top of her uterus externally and make it clamp down on the bleeding. Max’s hand came in over hers.

‘I’ve got it.’ He rubbed Mel more firmly.

‘The uterus has no tone at all. Get me cannulas for IV access and I’ll slip them in.’

Georgia grabbed the tray from the bench and slid it onto the shelf beside the labour bed.

Max took one of Mel’s hands and slid the tourniquet Georgia handed him over her wrist. ‘Have to pop in a couple of needles so we can get a drip up. Sorry, sweetheart.’

Georgia picked up the injection tray she’d had prepared with the declined injection in it. ‘You get the needle now, Mel.’

Mel nodded. ‘I feel a little woozy.’

Georgia glanced at Max before speaking to Tim. ‘Gently pull two of her pillows out, Tim, so Mel can have her head lower.’ Tim moved the pillows and grew paler by the second as he watched the puddle of blood that filled the space on the bed below Mel’s waist.

‘Then can you rub Mel’s tummy here.’ Georgia took one of his hands and guided him to where the top of Mel’s uterus lay just above her umbilicus after the birth.

‘This feels like a squashy grapefruit and it should feel like a big hard lemon.’

She looked at Mel, who was clutching her baby with one hand as she tried to breathe calmly through her nose. ‘You won’t like Tim much for it but it is very important he rubs your tummy fairly firmly until the uterus contracts and stops the bleeding.’

She turned to Max. ‘OK if I give the first Syntocinon intramuscularly? I had it ready in case.’

‘Sure. Then check the placenta. Maybe there is a bit left behind that’s stopping her uterus from contracting properly.’ Max concentrated on finding Mel’s veins before she lost too much blood. Soon the lack of blood volume would make her veins collapse and it would be more difficult to find the blood vessel he needed.

Georgia explained to Tim, ‘I need to check the placenta to see there is none missing. Sometimes a small piece of placenta can stay behind and stop the uterus from fully clamping down on the rich blood vessel bed that it’s detached from.’

The nurses from the ward appeared and froze at the door, as if they didn’t want to come in. ‘I’m Flo,’ said one, and the other just stared worriedly at the blood.

Georgia smiled at them. ‘Come in, Flo. It’s OK. Maybe you could take over from Tim so he can help Mel hold the baby.’

Flo nodded and hurried to do as she’d been asked.

Georgia pointed at the tray and said to the second nurse, ‘Could you draw up four ampoules of the Syntocinon and put it into that flask for Doctor, please? That will help stop the bleeding. Then put another saline flask up to run as fast as it can through the other cannula to replace at least the volume of fluid Mel has lost.’

The nurse nodded and hastened to her tasks, obviously relieved that it was something she understood how to do.

Tim cradled his son and Georgia checked the placenta and then stripped off her gloves to check Mel’s observations. Max had the drip up as soon as it was loaded.

Still the haemorrhage continued and Max frowned as he looked across at Georgia. ‘Vital signs?’

Georgia didn’t like the persistence of this bleed and she was very glad Max had come when he had. ‘Her BP has fallen to eighty on forty and pulse rate is up to one thirty. I’ve some ergot here.’

‘Thanks. I’ll push it IV and see what we get.’

‘Mel?’ Tim’s voice startled them as he leaned over his wife. Mel’s face was ashen and her eyelids flickered but didn’t open when Tim called out.

Max had injected the drug and now he frowned as no immediate response was noted. ‘I’ll have to manually compress the uterus,’Max said. Thankfully, when he did bunch Mel’s uterus between his hands the bleeding slowed, though as soon as he removed his hand it started again.

‘Oxygen,’ Max said at the same time as Georgia passed him to reach the flip-down cupboards with the resuscitation equipment. She slipped the mask over Mel’s face and tilted the whole bed so that Mel’s feet were higher than her head.

‘I may need the Prostin F2 alpha,’ Max said quietly, and Georgia nodded and moved to prepare the syringe.

Not often used, the last drug was injected straight into the muscle of the uterus, which meant Max compressed Mel’s uterus against one hand and injected the medication with the other.

Within less than a minute the gushing blood slowed to a trickle and Georgia and Max looked at each other with ill-concealed relief.

‘Tricky,’ Max said.

‘Very, but that’s done it.’ Georgia breathed out with the reprieve and after checking Mel’s blood pressure even allowed herself a small smile.

Mel moaned and her eyes flickered open as Tim sagged with relief.

Max checked Mel’s abdomen again and her uterus finally remained well contracted. Max nodded and looked at Georgia. ‘Better.’

‘Thank you,’ he said to Flo, and he smiled to include the other nurse, who blushed and backed away. Then Max looked at his wife. ‘Well done, Georgia.’

He leant down and spoke to Mel’s abdomen. ‘Now, why did you do that?’

The tension lightened in the room and Mel roused enough to say in a weak voice, ‘What happened?’

Tim sighed with relief and then suddenly paled further, sighed and sagged sideways.

‘Grab the baby,’ Max called to Flo, who scooped Tim’s son from his arms as Tim fell back in a dead faint. Max caught the new dad easily under the arms before he hit the floor, and dragged him into a chair.

Max looked down at the ashen Tim. ‘Just to top it off, poor guy.’

‘Never a dull moment,’ Georgia said, as she carried a damp facecloth across to Tim, who stirred groggily as the blood returned to his brain.

By the time a sheepish Tim was sitting upright, Mel had recovered some of the colour in her face as well.

Max jotted down the sequence of events with times and then crossed the room to speak to Tim and Mel. ‘Unfortunately we probably will never know why your uterus decided not to contract after birth.’

‘Mel’s BP is back to ninety on fifty and her pulse is one twenty,’ Georgia said.

Max nodded and spoke to Tim. ‘Mel’s compensating for the lower volume of blood she has circulating now, but childbearing women have extra safeguards for the risk of bleeding after birth. We’ll check what her actual red cell levels are and think about blood transfusion or not and discuss it later.’

He smiled that smile Georgia really did love. ‘Everyone in the room has a pulse of one twenty at the moment but it’s all settling now. Mel’s uterus is firm and behaving itself and the bleeding has stopped.’

He spoke to Georgia. ‘We’ll run the drip over four hours to make sure it stays that way and keep her in this room for a while so we can keep an eye on her to ensure it doesn’t start again. But it shouldn’t.’

Mel spoke faintly from the bed. ‘So much for not having a needle. That was a bad choice.’

Max shook his head. ‘Not so. Don’t lay blame on anything in particular. Lots of people decline the needle after birth and though it statistically increases risk, it didn’t cause what happened.’

Max paused to let the words sink in. ‘Unless you have a history of bleeding! Now you have that history…’ he shrugged ruefully ‘… I think your choice is limited for the future.’

Bravo, Max. Georgia wished she could clap because she knew a lot of medical officers who would have ground Mel down for her choice. She would tell him so tonight. In fact, she couldn’t wait until dinner tonight and the chance for their first real discussion about a specialty of medicine they both obviously loved.