Hard Labour

1Dr Vincent Hanrahan woke the second his phone started ringing. It was a habit he’d developed over the years so the subsequent raucous sound wouldn’t wake his sleeping partner … back when he had a sleeping partner. He glanced at the clock on his bedside table: four-ten am. ‘I hope she’s bloody well ready this time,’ he muttered sleepily, groping around for his jangling mobile. This was Vince’s version of the standard prayer of the Obstetrician who’d been called in several times during a long labour. Each time the phone rang, he hoped it would be that fat lady singing. The patient, a young idealistic first-timer, had started out with high hopes of a natural, drug-free birth. Instead, it had been brutal and soul destroying, so her birth plan, as well as her confidence, lay in tatters on the labour ward floor. ‘Hanrahan,’ Vince muttered, hoping for the best but fearing a stalemate with maternal distress or a compromised baby. The tone of the midwife’s voice would reveal all. ‘Good morning, Doctor.’ The salutation was at once loud and familiar but upbeat and cheerful. A good sign. ‘Better get yourself up here if you want to catch this one, matey. Your girl’s pushing and the head’s on view.’ This was music to Vince’s ears. No Mozart symphony was ever as sweet. He rolled out of bed and pulled on his clothes. Ten minutes later he pushed open the doors of the birth room at the Warrnambool Base Hospital and inspected the tableaux within. Normally, the patient would be on the bed, attended by a couple of midwives with the partner at the top end. Sometimes, he would arrive in the lull between contractions and everything would be eerily quiet; the nurses checking the baby’s heartbeat and the anxious father-to-be offering sips of iced water to the resting woman, with the soothing beep-beep-beep of the foetal monitor in the background. Or else it would be all action with a cacophony of the characteristic sounds of labour. The patient, red-faced and pushing, straining and shouting or sobbing and laughing simultaneously, like an over-tired toddler; the partner gripping the sweaty hand, making reassuring noises but looking bewildered; the midwives providing counter-traction with experienced hips and exhorting the labourer for that last big effort. Other times Vince would arrive too late and be greeted by the tell-tale sound of a baby crying. Smiles all round. This time he stood blinking under the blazing birth room lights, gobsmacked and incredulous at the scene he beheld. For an instant he thought he must be in the wrong ward. His patient lay on the birth mat on the floor, surrounded by a group of figures momentarily frozen like an impressionist painting. Protruding from the mother’s slack mouth was a rubber tube connected to a cylinder on a trolley; leads were attached to stickers on her chest. A doctor, wielding large white paddles, stared at the monitor on the resuscitation crash trolley—a foreign vehicle in this midwifery terrain. A nurse clutched a black ventilation bag, a young intern was looking intently at the digital display on the blood pressure machine, and in the corner at the head of the king-size bed stood an ashen-faced youth holding a tightly wrapped bundle revealing a glimpse of a wet pink head at one end. Suddenly the doctor looked up from the monitor and shouted: ‘Stand clear!’ All sprang back as he applied the paddles to the girl’s chest and watched her limp body twitch convulsively. He barked an order to a nurse who turned up a dial on the trolley, then he did it all again. At once all the players in this macabre drama paused and looked at the monitor and were then galvanised back into action. The intern pushed forcefully on the girl’s chest, the nurse began squeezing the black bag, and the senior doctor stared at the screen. ‘Bugger it,’ he said. ‘She’s still in VF.’ Everyone seemed transfixed by the erratic, irregular green tracing. Even a mug Obstetrician like Vince recognised the pattern—Ventricular Fibrillation; the girl’s heart was producing minimal output, certainly insufficient to perfuse her brain. There was a critical point at which the team realised the CPR, ventilation, drugs and defibrillation had all failed. However, they would all persevere with their tasks until the most senior person called a halt. It was obvious this time had come—everyone was looking to the boss to make that call. The doctor grimaced, put down the paddles, took a deep breath, and gently shook his head. The team quickly removed the tube, unhooked the patient from the monitor, disposed of all the spent syringes, packed their gear back onto the trolley, and retreated into the dark corridors of the hospital. Vince turned to the skinny young man who stood like a statue in the corner, still clutching the swaddled babe and staring in disbelief at the motionless form on the birthing mat. Abruptly, he stepped forward, stumbled. Vince lunged, catching the falling newborn as the man crumpled onto the prostrate figure of the dead girl.