Part of my role as a more experienced neonatal nurse is to attend the delivers of babies that are born prematurely, are known to have antenatal health problems or who are born sick.
I’ve attended many deliveries over the past four years.
Singletons and twins
Babies who are unexpectedly sick.
Babies who are not expected to survive.
The most challenging of these was the delivery of a baby born at 26 weeks who was known to not only be premature but also to be breech. Mum had gone into spontaneous labour and by the time she arrived at the hospital it would have been more dangerous to attempt a c-section than it would have been to deliver the baby naturally.
I was called down to the delivery with another nurse when mum was imminently about to deliver; there was nothing we could have done if we’d arrived earlier apart from wait.
We grab the green bag containing our emergency equipment and run down to delivery suite.
At nursing school we were taught never to run; that running was unprofessional and panicked the patients and visitors and that there would never be an emergency where the seconds gained by running would make any difference.
Clearly the tutors had never attended an emergency neonatal delivery.
We get to delivery suite slightly breathless and fuelled with adrenaline.
The baby hasn’t delivered yet and mum’s still labouring.
Unsure as to what the future holds for her baby.
Whether they will even survive.
She is contorted on the bed, bent in on herself with her knees up by her head and her eyes screwed shut with pain and concentration.
A pair of tiny feet appear, followed by some skinny little legs.
Then the torso; the skin red and fragile, almost translucent.
We wait for the head.
The baby hangs from mum’s body, suspended between pregnancy and birth.
A foetus and a baby.
Life and death.
The midwife encourages mum to push, calmly at first but then more urgently. She’s an experienced midwife who knows how to deliver a breech baby, even though these days most babies know to be breech are delivered by c-section. She also knows that the longer the time between the body and the head delivering the higher the risk of damage and death to the baby.
We only have about two minutes after the delivery of the baby’s torso before they become deprived of oxygen.
The potential for catastrophic brain damage is very real.
She supports the baby, keeping the neck and the spine straight to prevent damage but can’t do anything else without mum; she can’t pull the baby for fear of damaging the neck.
She can’t make mum push.
She tells us she can’t do it.
Her partner stands beside her, desperation written across his face. He fidgets and twitches, begs and pleads with her to give one more push, powerless to ease her pain or help her to deliver their child. He knows something is wrong even though we try to keep our worry hidden; keeping our faces calm and our hands still.
Her mum shouts in a foreign language; whether she’s being encouraging or angry we don’t know.
Mum cries, unable to focus on anything but the pain.
We’ve only got gas and air to give her, the window for inserting an epidural has long since passed and the midwife can’t let go of the baby to get some alternative pain relief or find another midwife to help.
We have to wait in the delivery room in case the baby suddenly delivers.
We stand, helpless.
Willing mum to push.
Willing the baby not to breathe.
Mum just wants the pain to stop, for this nightmare she finds herself in to end.
I remember reaching the point, just before Squidge arrived where I didn’t care if I lived, died or ripped apart.
I put everything I had into one last push, truly believing that I was about to split in two.
I didn’t scream; the noise I made came from the depths of my soul and was truly animal.
She doesn’t reach this point.
The tension and fear in the room is palpable.
The midwife sweats.
My colleague and I hold our breath.
Our eyes fixed on mum as though we can somehow transfer some of energy to her, to give her the strength for that last push.
Then mum summons the last ounce of her will and delivers baby’s head.
He slips into the midwife’s waiting hands.
It’s a boy.
He’s alive but only just.
He doesn’t cry; he’s far too small and early to make the effort.
The midwife wraps the baby in a towel and hands him straight over to us, her attention now on mum and helping her to deliver the placenta.
Mum collapses back onto the bed, sweating and exhausted. Her head lolls onto the pillow and her eyes are closed.
It’s hard to believe that delivering someone so small could be so difficult; could take so much out of one person.
There’s no time for us to relax, we’re not even nearly out of danger yet.
Mum asks us if he’s all right, her pain forgotten almost the second that it’s over. She strains to see him, craning her neck to see over us and the multitude of equipment we’ve bought with us.
We put him in a clear plastic bag to try and keep him warm and stop him from losing too much fluid and then put a mask over his face and give him some rescue breaths to get some oxygen to his brain. The doctor intubates; deftly inserting a tube into the baby’s airway so that we can ventilate him and then puts a vial of surfactant down the tube to reduce the surface tension and make it easier for the lungs to expand.
We put him into the transport incubator, make sure he’s stable and then get him back up to the unit as fast as we can.
The incubator is heavy; it takes a lot of work to push it and we have to be careful not to unsettle or jostle the baby. Aside from this being uncomfortable and distressing for him, he’s so tiny and sick that a going over a bump in the floor too quickly could cause his breathing tube could become dislodged or his heart to switch into a dangerous rhythm.
We get him to the unit safely and the other doctors take over, inserting lines and writing up emergency medications.
I don’t know what happened to this baby; few weeks after his delivery I moved to a new job. I don’t know how long he stayed on the unit or if he ever went home.
So much uncertainty.