The Midwife's Child

‘Well, the classes do teach you certain techniques for relaxation,’ Brooke told her, ‘but if you went a few times then you will have grasped the basics. We use lots of different methods to help you relax here—aromatherapy, the water pool and massage for starters.’

‘This place is more like a health farm than a hospital,’ Alison’s husband joked, and Brooke nodded seriously.

‘In some ways it is. The emphasis is all on keeping the woman as happy and relaxed as possible.’

Alison bit her lip, her dark eyes worried. ‘I’m just afraid that all the breathing and massage in the world won’t be enough for me. I know how much of a coward I am when it comes to pain! If I decide to have an epidural, will you think I’m awful?’

‘Not at all.’ Brooke gave her a reassuring smile. ‘We are totally committed to giving the mother the type of birth she wants. If someone is adamant that they want an epidural then we can arrange that. It’s nothing to do with bravery, Alison. The pain is different for each person and people cope in different ways, but we never, ever judge anyone, I can assure you of that! Do you have any strong views on the type of delivery you’d like?’

‘I did a birth plan.’ Alison reached for her bag and pulled out a piece of paper which she handed to Brooke a little hesitantly. ‘To be honest, I wasn’t sure that you’d want to see it. My midwife said that you don’t like them on this unit.’

‘Well, she’s right in a sense.’ Brooke took the birth plan and tried to explain as carefully as possible. ‘The reason is that we’ve found that some women have set themselves all sorts of goals and expectations and then, when things don’t go according to plan, they’re disappointed. For example, you might think you don’t want any pain relief but when you’re in the middle of things you might want to change your mind. We’ve had a few women who felt that they’d failed and let themselves down by not sticking to their plan, and that was awful. Everyone should be allowed to change their minds at any point.’

Alison nodded and gave a small smile. ‘I suppose you don’t really know how you’ll react to the pain until you experience it.’

‘That’s right.’ Brooke glanced between the couple, her expression serious. ‘It’s important not to think you have to stick rigidly to what you planned. We do look at birth plans if a woman has made one, but we really like to work with the mother and respond to what she’s feeling at the time.’

‘That sounds sensible—Ooh.’ Alison winced and screwed her fingers round the bedcover as a contraction started to build. ‘I never expected the pain to be this bad. Oo-ooh, Tim!’

Her husband stroked her shoulder awkwardly and cast a worried look at Brooke.

‘She’s fine,’ Brooke murmured, moving her palm over the woman’s swollen abdomen to feel the strength of the contraction. ‘Remember your breathing, Alison. In through your nose and out through your mouth. Perfect. Well done. There—it’s tailing off. Now, I just need to examine you. Has anyone explained to you about this machine?’

She moved it slightly closer and ripped off the trace that was hanging down. ‘This is called a CTG and it basically tells us about your contractions and your baby’s heart rate. At this stage we want you as mobile as possible, so we’ll only use it occasionally, just to get a picture of what’s happening.’

‘Does it look OK? It looks totally incomprehensible to me.’ Alison frowned down at the graph but Brooke nodded and filed it carefully in the notes.

‘It’s fine. Now, let’s take a quick look at this birth plan together.’ She read quickly and then glanced up at the couple. ‘You seem to be pretty open-minded about most things.’

‘I really didn’t want to have my membranes ruptured,’ Alison murmured, looking at her husband for support, and he nodded firmly.

‘That’s right. I gather a lot of hospitals do that, but we’d rather let nature take its course.’

‘So would we.’ Brooke slipped the birth plan into the notes and gave them both a warm smile. ‘You’re right that some units artificially rupture the membranes the minute the cervix is 4 cm dilated, but we never do that here. We don’t rupture membranes, we don’t monitor without a reason and we don’t do routine internal examinations either. We do them on admission and then when we feel they’re necessary.’

Alison’s husband frowned. ‘But if there’s a medical problem?’

‘Then we involve our medical team,’ Brooke told him promptly. ‘That’s the good thing about this unit. You get the nearest thing to a home birth without sacrificing the safety of a hospital. Now, then, I’d just like to feel the way the baby is lying, Alison, if that’s all right with you.’

She palpated the abdomen carefully, glancing up as Paula slid discreetly into the room and introduced herself to the couple.

‘Is it still the right way up?’ Alison looked anxious and Brooke nodded with a smile.

‘Absolutely. He’s coming out head first—what we call a cephalic presentation. And he’s nicely flexed so that’s good.’

Paula cleared her throat. ‘Sister wondered if you’d nip into 4, Brooke. They need some help.’

Brooke glanced at her and caught the urgency of her expression. Trouble, obviously. ‘Fine. Well, you’re staying with the Neals for the rest of your shift now, aren’t you? I’ll be back as soon as I can. Just help Alison with her breathing.’

She left the room calmly, and then speeded up as she made for the other delivery room.

‘Oh, Brooke—good.’ Gill Wilson glanced towards her and then back to her patient. ‘Mrs Fox is going to need a section. She’s bleeding a bit and we suspect a placental abruption. We’ve bleeped Mr Matthews, the consultant, and he’s meeting us in theatre. Fortunately she’s had an epidural so she shouldn’t need a general anaesthetic. Is Alison Neal all right for a while if you give me a hand? Suzie needs to go back to her student in 5 so I was hoping you could scrub and take the baby.’

‘No problem. Alison’s fine with Paula.’ Brooke could see from the debris around her that ‘bleeding a bit’ was something of an understatement, and she knew Gill well enough to know that she was concerned.

Suzie was checking Mrs Fox’s blood pressure again. ‘Eighty over fifty,’ she murmured, and Gill nodded briskly.

‘Right. Into theatre.’