Tina Beckett: Midwives On-Call At Christmas

JACOB HADN’T BEEN WRONG. The labour suite was in chaos. And it was all basics.

Bonnie grabbed a ward clerk and made some immediate requests about sorting out case notes, filing things appropriately and keeping the boards up to date. Then she asked for new lists of contact numbers. The one she found on the wall was obviously out of date and, with doctors changing every six months, she didn’t want any problems with pagers in case of emergency.

She spent the next two hours working with various members of staff and patients. After a few hours she was confident in the clinical capabilities of the staff that were on duty. They all wanted to do their jobs and work with patients. They just didn’t want to bother with ‘ward’ stuff. Ordering, stocking, rotas, outpatient appointments, pharmacy prescriptions. It quickly became apparent that her predecessor had dealt with all these things and her quick departure meant there had been no handover.

Bonnie gave a sigh. She’d like to spend all day working with patients too—but that wasn’t the way a ward was run. She started making a ‘to do’ list that she’d have to work her way through.

The other issue was the phones. They rang constantly—often with no one answering. First thing tomorrow she was going to ask about a regular ward clerk for the unit. Just as she finished making a few notes about the off-duty rota the phone rang again.

‘CRMU, Bonnie Reid, can I help you?’

‘Ambulance Control. We need a team on-site at a crash on one of the motorway slip roads. We have a trapped, unconscious pregnant woman. She’s reported to be thirty-four weeks. Ambulance is on its way to pick you up.’

Bonnie put down the phone. First day on the job. You had to be joking. She automatically dialled the page for the on-call obstetrician. Most big maternity units had supplies for emergencies like these. It was just a pity she hadn’t had a chance to find out where they were.

A few seconds later Jacob appeared from his office just as Bonnie was relaying the message to one of the senior midwives. He was holding his page. ‘What have we got?’

She handed over the piece of paper she’d scribbled on. Jacob gestured towards her. ‘Follow me. Equipment is in here. Grab a jacket and a bag.’ He turned to face her. ‘You are coming, aren’t you?’

She hesitated for only the briefest of seconds. ‘If you want me to.’

No. I’m terrified. This sounds like an initiation of fire. It’s my first day, I’ve just agreed to act as temporary sister in one of the most prestigious maternity units in the country and now you want me to be part of the emergency response team.

He acted as if he did this every day, grabbing a jacket with ‘Doctor’ emblazoned across the back and handing her the one with ‘Midwife’. He shot her a smile as he helped her lift the emergency pack onto her shoulders. ‘Let’s go. Leave instructions with Miriam, the senior midwife. She’ll deal with the calls until we get back.’ He walked away, his long strides crossing the corridor quickly, only stopping to wheel a portable incubator to the door.

She could feel the wave of panic lapping around her ankles. There was no way she could let it go any further. She started repeating in her head the list of emergencies that she’d dealt with on her own as a community midwife. She could do this. She could.

Miriam gave her a sympathetic nod as she handed over a few instructions. ‘I’m so glad it’s you and not me,’ she murmured under her breath.

‘What do you mean?’

Miriam rolled her eyes. ‘If you think Dan Daring is harsh on the ward, you should see him at a roadside emergency. The patients love him. The rest of the staff need counselling by the time he’s done.’

‘Let’s go, Bonnie!’ The shout made her jump and she hurried to the exit and into the back of the waiting ambulance. As soon as the doors closed and the sirens switched on they were on their way.

Sitting in the back of the ambulance was more than a little bumpy. She only just managed to avoid practically bouncing onto Jacob’s lap. But he barely noticed. He was holding on to the strap in the back with his eyes fixed on the road ahead.

‘Any more news?’

One of the paramedics turned around. ‘All bad. We’ve just had a report that they think her membranes might have ruptured. She’s still unconscious and trapped. They’re panicking. They think she’s gone into labour.’ He glanced at the clock. ‘We’ll be there in five minutes.’

Bonnie sucked in a breath. A thousand different potential diagnoses were flying through her head. From Jacob’s serious expression he was thinking the same.

When they screeched to a halt Jacob didn’t wait, he just flung open the doors, grabbed the bag and started running.

The first thing that struck her was the smell. Fire, burning metal, petrol and a whole lot more. There were four ambulances already on-site. A few casualties were sitting on the edge of the road. Two children with blood on their faces, a man cradling his arm and an older woman who looked completely shell-shocked. Police had cordoned off part of the motorway but the speed and noise of the cars still passing by was unnerving. Rubbernecking. That was what most of the passing cars were doing. Any minute now there would be another accident on the other side of the motorway. She shuddered and jumped out of the back of the ambulance, trying to spot Jacob’s bright green jacket in amongst the melee of emergency people.

‘Over here.’ A policeman gestured her towards an upended car. She stepped around the pieces of car debris that littered the road. Somewhere, she could hear someone crying. The wails cutting through the rest of the sounds. It was horrible. It was unnerving.

She landed on her knees next to the upturned car. The only thing she could currently see of Jacob was the soles of his feet. His whole body was inside the car, his feet sticking out through the broken passenger-side window. ‘Do you need anything?’ she shouted through the gap.

She adjusted her position to get a better view. Inside the car a pregnant woman was trapped upside down, held precariously in position by her seat belt. It was obvious she was still unconscious, an oxygen mask to her face and a collar around her neck. Jacob was pushing back her coat and gently easing her stretched top over her abdomen. Bonnie didn’t wait for instructions. She fished out a stethoscope and a foetal monitor and stuck her hand through a gap in the broken window where Jacob could grab them.

Even from here she could see the damp patch between the woman’s trousers. It could be two things. It could be urine or it could be amniotic fluid. She was just praying it wasn’t blood. She didn’t even want to consider that—not under these conditions.

After a few minutes of wrestling around Jacob finally spoke. ‘I’ve got a heartbeat—albeit a little quick. But I’ve just felt her contracting and there’s absolutely no way to do any kind of examination.’

He shook his head as Bonnie tried to hand him the nitrazine strips. The best they could do in this situation was rub one against her damp clothes. ‘There’s no point checking. I’m fairly sure her membranes have ruptured. We need to get her out of here now. She’s at risk of uterine or placental rupture. There’s no way I’m delivering this baby upside down.’

Bonnie stood up and shouted over to the fire and rescue colleagues. ‘We need to get this woman out. She’s about to deliver. Can we have some assistance?’

One of them ran over. ‘Sorry, got tied up trying to lift a car off someone’s chest.’

Bonnie gulped. It was chaos all around them and even though the road seemed full of emergency staff, there probably still wasn’t enough.