S Bolton - Sacrifice

At that moment, my beeper sounded. I excused myself and went out into the hallway to make a call. One of my patients was nearing the end of the second stage of labour and the baby was showing signs of distress. The midwife thought an emergency Caesar might be needed. I went back in and explained.

'I'll give you a hand,' said Gifford. 'Catch up with you later, Andy'

Andy Dunn opened his mouth, but Gifford was too fast for him. He had the doors open and me out of there before anyone had time to object. I caught Dana's eye; she looked surprised and not entirely happy and I couldn't help feeling that we were being deliberately separated.

Once outside, Gifford strode ahead and I followed as best I could. It was difficult to keep up as we crossed the car park and walked up the flagged path that led to the main door of the hospital, so I walked faster than I really had the energy for and wondered when he was going to open his mouth and ball me out for the trouble I'd caused.

I had so many words bubbling inside me I didn't trust myself to get them out in the right order once I'd begun. I wanted to accuse him, to demand an explanation, to vindicate myself. At the same time, I was determined not to let myself down by incoherent babbling. It was up to him to speak first, to offer some sort of explanation and I was determined he was going to do it.

He still hadn't said a word as we entered the hospital, turned left past A &E and carried on towards the maternity unit. At the stairs he turned and started to climb.

'I thought you were coming to give me a hand?' I said, realizing I sounded like a nagging wife but not caring. I had the moral high ground now and I wasn't budging.

He was on the fourth step up but he stopped and turned. The light from the staircase window shone brightly behind him and I couldn't see his expression.

'Do you need help?' he asked.

Instantly I felt stupid. Of course I didn't need help. But I wasn't about to be ignored either. Two nurses and a porter were coming along the corridor. Their conversation faded as they took in the obvious tension between us. 'You said you were coming with me,' I said, not bothering to lower my voice.

Kenn had noticed the others too. 'I needed to get away,' he said. 'There are things I have to do.' He turned and continued up the stairs. I stayed where I was, watching him. 'You're needed in maternity, Miss Hamilton,' he said firmly. 'Come and see me when you're done.'

The three staff members passed me and followed him up. One of them, a nurse I knew slightly, didn't even bother to hide the curious look and the half-smile she shot in my direction. She thought I was in trouble and wasn't in the least bit sorry.

I could hardly follow Gifford up the stairs, demanding an explanation in front of half the hospital. And he was right, I was needed in maternity. I turned, continued on down the corridor and, stopping only to scrub my hands and tie back my hair, strode into the delivery room.

There were two midwives in attendance; one a middle-aged, local woman who'd been doing the job for twenty years and had made no secret of the fact that she thought me superfluous. The other was a student, a young girl in her mid twenties. I couldn't remember her name.

The mother-to-be was Maura Lennon, thirty-five years old and about to produce her first child. She lay back on the bed, eyes huge, face pale and shiny with sweat. She was shivering violently, which I didn't like. Her husband sat by her side, nervously glancing towards the machine that was monitoring his baby's heartbeat. As I approached, Maura moaned and Jenny, the older of the two midwives, raised her up.

'Come on now, Maura, push as hard as you can.'

Maura's face screwed up and she pushed as I took Jenny's place at the foot of the bed. The baby's head was visible but didn't look as though it was coming out in the next few minutes. Which was what it needed to do. Maura was exhausted and the pain had become too much for her. She pushed, but it was a feeble attempt and as the contraction died away she fell back, whimpering. I glanced at the monitor. The baby's heartbeat slowed noticeably.

'How long has it been doing that?' I asked.

'About ten minutes,' replied Jenny. 'Maura's had no pain relief apart from gas and air, she won't let me cut her, she doesn't want forceps and she doesn't want a Caesarean.'

I glanced at the desk. Maura's birth plan, bound in red card, lay on it. I picked it up and flicked through. About four pages, closely typed. I wondered if anyone but the mother-to-be had actually read it. I certainly wasn't about to.

I stood by the bed and then reached out and stroked away the damp hair that had fallen across Maura's forehead. It was the first time I had ever touched a patient in that way.

'How are you feeling, Maura?'

She moaned and looked away. Daft question. I took her hand.

'How long have you been in labour?'

'Fifteen hours,' replied Jenny, on Maura's behalf. 'She was induced last night. At forty-two weeks.' The last sounded slightly accusatory. No one wanted a pregnancy to last forty-two weeks, least of all me. By that stage the placenta is starting to deteriorate, sometimes seriously, and the percentage of stillbirths rises dramatically. I'd seen Maura a week ago and she'd been adamant she didn't want to be induced at all. I'd let her go the full forty-two weeks at her insistence but against my better instincts.

She jerked upwards for another contraction. Jenny and the student shouted encouragement and I watched the monitor. 'Who's the house officer?' I asked the student.

'Dave Renald,' she replied.

'Ask him to come in, please.'

She scurried out.

The contraction faded and one look at Jenny's face told me we were making no progress down at the sharp end.

I took hold of Maura's free hand. 'Maura, look at me,' I said, forcing her to make eye contact. Her eyes were glazed but they held my own. 'This has been an unusually painful labour,' I said, 'and you have done amazingly well to get this far.' She had, too. Inductions were always more intense and few managed without an epidural. 'But you have to let us help you now.'

I could see from the monitor that another contraction was building. I was running out of time.

'I'm going to give you a local anaesthetic and I'm going to try forceps. If that doesn't work, we have to go straight into theatre for an emergency Caesarean. Now are you OK with that?'

She looked back at me and her voice came out cracked. 'Can you give me a minute to think about it?'

I shook my head as the house officer and a nurse came into the room. In a bigger hospital, a paediatrician would usually be present at a forceps delivery, but here we had to make do with whoever was on duty. Jenny whispered something to the student and she scuttled out again to put theatre on alert.

'No, Maura,' I said. 'We don't have a minute. Your baby needs to be born now.' She didn't reply and I took her silence for acquiescence. I sat down. Jenny had the instruments all ready and began, without being asked, to lift Maura's legs into stirrups. I administered the anaesthetic into Maura's perineum and made a small cut to enlarge her vaginal outlet. I inserted the forceps and waited for the next contraction. As Maura pushed, I pulled, gently, gently. The head moved closer.

'Rest now, rest,' I instructed. 'Next one's the big one.'

She began to push again and I pulled. Almost there, almost… the head was out. I loosened the forceps, handed them to Jenny and reached… Shit! An inch of grey membrane appeared – the umbilical cord was wrapped around the baby's neck and I'd nearly missed it. I hooked one finger under it, pulling gently until I could loop it over the head and then, as I reached for the shoulders again, Maura gave one last push and they came out by themselves, followed by the rest of the baby. I handed the solid, slimy, unspeakably beautiful little body to Jenny, who took her up to meet her parents. There came the sound of sobbing and for a moment I thought it was me. I shook myself, wiped a sleeve across my eyes and delivered the placenta. The student – Grace, I remembered now, her name was Grace – helped me sew and clean our patient up. Her eyes were shining but she was quick and neat in everything she did. She'd make a good midwife.