Lynn Saves The Day

My second delivery story. The one where everything nearly went pear-shaped.



Written very clearly on the first page of her assessment sheet was a clear instruction. The message was that because of complications in previous pregnancies this lady must be in theatre for her next delivery.



Oh Great.



At this moment in time she is screaming her head off. She is well due to deliver and she is a long way from Dr So and So's theatre in Cairns.



In Cairns she would have a team of specialist doctors, midwives, neonatal nurses and more fancy equipment than you could poke a stick at. They also have blood. Heaps of it.



We have a bed ( two actually but one doesn't work properly, it goes up but does not go down until a really big person goes on it and then it goes down very quickly). We have some basic delivery equipment, some basic medications, fluids and a security guard and myself. Oh and today we have Lynn.



In the remote areas it is not unusual to work with relief staff. They might fly in for a couple of weeks and then disappear forever. I met Lynn about 5 minutes ago, just before our non-Cairns attending lady arrived.



On hearing the screams Lynn wanders down.

'You're not a midwife are you?' I ask. When I ask this I'm expecting a negative reply. The chances of a positive reply is so remote any bookie would take the bet. The bookie would not even lay the bet off now matter how much was at stake.Do you know how rare it is to have midwife just turn up for a few shifts?

'Yes.' she replies.

For a few seconds this sinks in. I allow myself a little hope we might get through this.

Luckily Lynn is a little more on the ball than me. She is on the telephone talking to people who understand the weird language of obstetrics. The bits I understand is the G 2 P4, massive tears, hemorrhage (the most difficult word in medicine to spell but not of concern right now), and Caesar (not the salad).



She comes off the phone and starts checking things, she does a PV and I tell her the FHR ( little guy's heart rate, which is normal). I'm trying to cannulate. Lynn is straight back to the phone. I'm dying to ask what is going on but it is obvious my questions can wait. She 'll tell me what I need to know.



I get the entonox out and it quietens the poor lady, a little. The chance of getting anything stronger at this stage is remote. Morphine or similar now to the mum might relieve her pain but big chance of a narc'd baby.



Options are to deliver here, fly out or drive out. The chopper is up north but is heading back. Drive out is possible but risk of delivery in the van (ambulance) could be a disaster. We are left with deliver here.

I turn off the air conditioner. Despite the humidity I've found cold babies are hard to warm again and can lead to further problems. We don't have a heater.



Without getting too tied up in the medical talk the ladies previous problems have resulted from trying to deliver a coconut down a straw. Even if there is some give in the straw it is too narrow and something will rip. There is a great probability the child will die if nothing is done. The risk to the mother is significant as well.

The bulging down below is beyond anything I have seen. Even fully stretched it is obvious to me there is no way a normal delivery can occur.

Lynn announces she will perform an episiotomy. Using a pair of special scissors she will cut to make the opening a little wider. By this time the pressure is causing the area to be white. The head of the baby is squashed up against the opening. His scalp is visible. At a guess I would say the diameter of the opening is about 5cm. This is only a guess from memory. It was hardly an ideal time to measure.

Lynn puts her index and 2nd fingers of her left hand between the baby's head and the woman's external organs. She is unable to get the scissors into position. The whole area looks stretched but no tear. She has to pull with the left hand and insert the flat blade of the scissors in between to baby's head and the opening of the vagina. She can not insert the scissors.

Lynn hands me the scissors. They are wet, slippy and suddenly look huge.
'I'll pull, you insert the scissors and cut.' She says, slightly out of breath

I notice she doesn't say 'please' or anything but I decide to let it go this time.

As Lynn pulls up on the labia I pop the scissors in. She strains under the effort.
'Cut, cut, cut.' She implores me. Again I note no 'please'.

I cut. Now before I complete the description I had never done this before. I think I saw it once as a student but that was a long time ago and I was probably hungover anyway. So I cut. Maybe a centimetre

Lynn watches, not quite in horror but she certainly looked surprised. She slowly moved her gaze from my incision and our eyes met. This was our 'Jaws. The Movie' moment. Instead of saying, 'We're going to need a bigger boat,' she said in a calm but very firm voice,
'A little more please Robert.'

A-ha now with the 'please'. I thought one snip would cause a sort of ongoing slice like when cutting fabric that is being held tight.

I literally had to chomp into the muscle. After a few centimetres I could tell that was enough. How could I tell. Well the little guy came flying out like a high-speed train out of a tunnel. I am sure he landed by her ankles.

After the usual clean up Lynn took the lady over to Cairns for suturing and routine check-up. Both mum, baby and midwife did well.

I often think how I would have done if no midwife was available. I like to think I would have done the same but I'm glad I wasn't tested.