Midwives On-Call At Christmas. Tina Beckett

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СКАЧАТЬ 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.

      The fire-and-rescue guy pointed at the collar. ‘She was conscious for only a few seconds after we arrived and had no feeling in her legs. That’s why the collar’s in place. The trauma doc said not to move her. He was waiting for you to arrive.’

      She nodded. ‘Well, tell the trauma doc we’re here and she’s in labour. We need assistance to move her as safely as possible now. Can you get us a backboard?’

      She pushed her way around the other side of the car. The driver’s door was wedged up against a van that was on its side. It was a struggle to push her arms through and try and wind a blood-pressure cuff around the lady’s arm. ‘Do we have a name?’ she shouted to Jacob.

      ‘Holly Burns.’

      She pressed the button on the machine. Now she’d squeezed around the other side she could see him a little easier. There were deep furrows along his brow; he was clearly worried about this patient and so was she.

      ‘BP’s low,’ she said quickly as the result displayed.

      A number of the fire-and-rescue crew had collected around them, all talking in low voices. ‘Doc, we’re going to have to move the car. We need to cut the patient free and we can’t do it while the van’s in place. You’ll need to come out.’

      Jacob didn’t hesitate. ‘I’m going nowhere. This mother and her baby need monitoring every second. Move the car with me in it.’

      One of them stepped forwards as Bonnie wriggled out from the other side. She could see clearly why they would need to separate the vehicles. There was no way they could get Holly out on a backboard otherwise. If she had spinal damage they had to do everything possible to try to minimise the movement.

      She shook her head and touched the fire-and-rescue chief’s arm. ‘Don’t waste your time arguing with him. He won’t change his mind and it’ll just get ugly. This woman could deliver very soon and her position makes it dangerous for her life and her baby’s.’

      She was quite sure this went against every health and safety check imaginable. But she’d seen fire and rescue, paramedic and police services do similar things before. They all made the patient their priority.

      She stood back as equipment was positioned and blankets shoved inside the car as Jacob was told to brace himself and his patient.

      The car and van were wedged tightly together. The sound of metal ripping apart made her wince. Nothing about this was delicate. Both the car and van were juddering, wheels spinning in the air. It seemed to take for ever before they were finally yanked apart and the fire-and-rescue crew moved in with their cutting equipment.

      It only took seconds for them to cut the side from the car. One of the other trauma doctors appeared with the backboard and had a quick confab with Jacob inside about the best way to cut Holly free from her seat belt and support her spine. It was a delicate operation. Twelve pairs of hands ended up all around her, ready to ease her gently onto the spinal board as the seat belt was cut. ‘Hold it,’ said Jacob abruptly. ‘She’s having another contraction. We’ll have to wait a few seconds for it to pass.’

      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.’ СКАЧАТЬ