Midwives On-Call At Christmas

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.’ He gave an audible sigh of relief. ‘Thank goodness.’

One minute later the baby slid into his hands and he quickly handed it over to Bonnie.

A little girl. Just like Freya. A fist squeezed around her heart. She’d heard Freya’s first cries, felt her first little breaths against her chest. Holly was missing all of this.

She quickly gave the pale little baby a rub, stimulating her first noisy breath, followed by some sharp cries. She gave Jacob a quick smile before wrapping the baby in the warming blanket and doing a quick assessment. ‘APGAR six,’ she said as she finished.

It was a little low, but would likely come up before the second check in five minutes. It was certainly better than she’d initially hoped for.

She looked up; they were pulling up in front of the emergency entrance at the maternity unit. Three other staff were waiting for them.

Jacob moved into position as the doors opened and helped lift the incubator down. ‘Take her to the nursery and get a paed doc to check her over.’

Bonnie gave a brief nod and headed down the corridor with one of the nursery midwives by her side. The handover was quick. The little girl was pinking up now and was letting everyone know she wasn’t entirely happy with her entrance to the world.

By the time Bonnie got back to the labour suite, Jacob was consulting with the orthopaedic doctor who’d come over from the main hospital. Holly’s notes had appeared at the desk. Thankfully, she had no significant medical history and her pregnancy seemed to have gone well. Bonnie could see from the whiteboard that Miriam, the senior midwife, was with her.

‘Has she woken up yet?’ She was having trouble getting her head around the fact that Holly had delivered a baby without being conscious. ‘In ten years of midwifery I’ve never seen a woman labour while unconscious.’ She blinked back the tears that threatened to spill over. ‘Does she have some kind of head injury?’

The orthopaedic doctor glanced at Jacob, then leaned over and touched Bonnie’s arm. ‘It actually might not be as bad as first thought. She almost certainly has a head injury but her Glasgow Coma Scale responses are improving. I suspect Holly’s in spinal shock from injuries sustained in the crash. She wouldn’t have felt the intensity of the labour pains even though her body naturally delivered. Jacob and I were just discussing the fact that we think she might actually have been in labour prior to the accident. We’ve checked the ward call log. She hadn’t called into the labour suite and she didn’t have any bags in her car. We’re wondering if she was going home to collect her things.’

Bonnie nodded. She could only remember a few things about spinal shock from her general nurse training. It was usually temporary but could cause loss of sensation and feeling. It certainly sounded better than some of the things she’d been imagining.

Jacob’s voice cut across her thoughts. ‘I take it the little girl is okay?’ He was glaring and it took her a couple of seconds to realise it wasn’t at her—well, not entirely. His eyes were fixed on the orthopaedic doctor’s hand, which was still on Bonnie’s arm.

Was Jacob this territorial around all his staff?

She gave a nod to the orthopod and walked behind the desk to pick up some paper notes. ‘Baby Burns is doing fine. APGAR was eight at five minutes. The paediatrician was checking her as I left.’ She waved the notes at Jacob. ‘I’m just going to write up some midwifery notes for what happened out there. I’ll get the clerk to put Holly and baby Burns into the hospital admission system.’

There was a bang at the bottom of the corridor as the doors were flung open. Both Bonnie and Jacob jumped to their feet. It wasn’t entirely unusual for people to enter the labour suite in a rush. This time, though, there was no pregnant woman—just an extremely anxious man.

‘My wife, Holly, is she here? They said there was a car accident. What happened? Is she okay? Is the baby okay?’

Jacob and the orthopaedic doctor exchanged glances. Jacob gestured towards his office. ‘Mr Burns, why don’t you come into my office and I’ll let you know what has happened?’

The man’s face paled even more and he wobbled. ‘Are they dead?’

Jacob quickly reassured him. ‘No, no, they’re not dead. And you can see them both. Let’s just have a chat first.’ He turned to the orthopaedic doctor. ‘Dr Connelly, will you join us, please?’

But the man’s feet were welded to the floor. His eyes widened. ‘Both? The baby is here?’

Bonnie walked over, putting her hand on his arm. ‘You have a lovely daughter. I’ll take you to see her once you’ve spoken to the doctors.’ She helped usher him into the office and, once he was inside, closed the door behind him and left them to it.

‘Debbie’ The labour suite domestic was working in the kitchen. ‘Would you mind taking a pot of tea into Dr Layton’s office? I think the man he’s talking to will need some.’

Debbie gave a little laugh. ‘Tea, for Jacob? You’ve got to be joking. The guy drinks his coffee with three spoonfuls.’ She shook her head. ‘You’ll soon learn he usually has a cup from the café across the street welded to his hand. Don’t worry. I’ll sort it out.’

For the rest of the day Bonnie’s feet barely touched the ground. She finished her notes, took over from Miriam for a while, then took Mr Burns along to see his new daughter.

Holly had gradually started to come round. Things were complicated. Midwives really shouldn’t be dealing with a patient with a head injury. But Holly had a few other complications with the delivery of her placenta. She really wasn’t suitable to be on a general ward either. After some careful calls and juggling, Bonnie finally managed to make sure that either a midwife who was also trained as a general nurse was looking after her, or that an extra nurse be called over from the brief intervention unit. After the first twenty-four hours she’d need to be reassessed and other arrangements made.

By the time Jacob came to find her she’d no idea where the time had gone. Opening one store cupboard to have most of its contents fall on her head, followed by finding some out-of-date drugs in one of the cupboards was making her organisational skills go into overload. She wouldn’t be able to sleep tonight with the ‘to do’ lists she currently had stored in her head.

‘Just thought I should check how you are.’

She picked her way back through the untidy contents of the store cupboard. ‘I’m fine, thanks.’ She glanced at her watch. ‘Is that the time already? The childminder will wonder where I am.’

She let out a groan. ‘Darn it. I haven’t found us somewhere else to stay.’

‘What do you mean? You don’t know where you are staying?’

Bonnie sucked in a deep breath. ‘That’s the thing about agreeing to start at short notice. I haven’t managed to find somewhere to rent. I haven’t even had a chance to view anywhere. The motel I booked is awful. We got in last night and it’s damp and I’m pretty sure there are signs of mildew. It’s going to play havoc with Freya’s asthma. I need to find somewhere else as soon as I can. I had a quick look online last night and most places aren’t available for rent until after Christmas. I’ve obviously come at the wrong time of year.’ She kept shaking her head. She sighed and leaned against the doorjamb. ‘I need to find somewhere quick. I just assumed that I’d be able to find somewhere without any problem. It is a city, after all.’

Accommodation wasn’t something Jacob had even considered for their new start. As a mother she wouldn’t have the option of staying in the hospital flats. They were only designed for singles.

He shook his head. ‘Cambridge isn’t like most cities. We don’t have a huge turnover except when the university year starts. Most students find accommodation and stay in it for four full years.’

She shrugged. ‘I’ll just need to try a bit harder, I guess. More importantly I’ll need to get a car. Relying on public transport is a bit of a nightmare. The sooner I get home to Freya, the better.’

He spoke before he thought. ‘I’ll give you a lift home.’

She blinked. The shock on her face was apparent. Had he really been that unfriendly to her earlier?

‘You don’t have to do that.’

‘I know. But I will. You’ve had a bit of a baptism of fire today. I know you want to get home to Freya and the buses will be busy this time of day.’ He shrugged. ‘It’s only five minutes out of my way. We’ll go in ten minutes.’

The phone rang further along the ward and Hope Sanders, one of the other midwives, stuck her head out of one of the rooms. ‘Jacob? Can you come and take this call?’

He didn’t even give her a chance to respond before he walked swiftly along the corridor. He was impressed. Bonnie was doing a good job. He hadn’t even given a thought to where she might be staying. If she was worried about that—would she be able to focus on her work?

Hope handed him the phone. ‘It’s Sean Anderson. He wants to know if you can help in Theatre tomorrow.’

The call only took a few minutes. Jacob liked Sean, the new Australian obstetrician, and he was happy to scrub in on a complicated case. Hope waited for him to finish the call, her arms folded across her chest, leaning on the door.

‘What?’ he asked as he replaced the receiver.

‘How are you?’ she asked steadily.

He felt himself flinch. Hope was one of the few people he classed as a friend. She knew exactly what kind of year he’d had. ‘I’m fine.’

She nodded slowly. There was no way he’d get away with that kind of answer with Hope. ‘When do you get your test results?’

He shifted uncomfortably on his feet. He hated being put on the spot. ‘A few weeks.’

‘And you’re feeling well? Anything I can do?’

He shook his head and picked up some paperwork from his desk. ‘I’m fine, Hope. There’s no need to fuss.’

She gave him a tight smile. Hope was never bothered by his short answers or occasionally sharp tongue. She just ignored it and asked the questions she wanted to ask.

‘Did you reconsider my suggestion?’

‘What one?’ Hope made lots of suggestions. He should socialise more. He should do less hours at work. He should eat better. He should be more pleasant at work.

She raised her eyebrows. ‘About renting out one of your rooms?’ Oh. That one. Her latest suggestion was a bid to encapsulate all her suggestions: it would force him to socialise, he might work less if he had someone to go home to, someone who could cook, maybe.

‘Haven’t had a chance.’ He walked from behind the desk and gave her a cheeky wink. ‘Been too busy at work.’

‘Jacob...’ Her voice tailed after him but he was already halfway down the corridor. Hope was about to go into interrogator mode. He could sense it. It was time to make a sharp exit.

Bonnie was just finishing at the desk and he welcomed the distraction. If Hope saw him talking to another woman she was bound to leave him alone.

‘Good first day?’ he asked.

* * *

Bonnie blinked. ‘It’s not over yet. Come with me a second.’

She took another quick glance over her shoulder at the bustling labour suite. Her bustling labour suite. She hadn’t even started to make her mark here. They walked down the corridor together.

So many things needed organising to make the place run more efficiently. Once she had things running the way she liked and she knew the staff a little better she’d start to delegate some tasks. All of the staff she’d met today seemed fine. No one had even mentioned what they’d overheard this morning, but she was sure—by the time she came on shift tomorrow—all members of staff would know about it. That was the thing about hospitals. Nothing was kept secret for long.

She’d met seven midwives, two doctors and one other consultant who all seemed good at their jobs. The ancillary staff seemed great too. CRMU’s reputation appeared to be well founded. All the labour suite needed was its wheels oiled a little to help it run more smoothly.

She smiled. First day. After a bumpy start with Freya, and with Jacob, things appeared to be looking up. Good staff. A temporary promotion. Three healthy babies delivered while she was on shift. And another delivered in the back of an ambulance with a mother who appeared to be on the road to recovery.

Jacob had surprised her most with his offer of a ride home. At their first meeting he’d appeared a little detached. But at times today his mouth had betrayed him by turning up at the edges. There was a sense of humour in there somewhere. She’d just have to find a big spade to dig it out.

She pushed open the doors at the end of the ward and walked along to one of the side rooms between her ward and the special-care nursery. Both of them looked through the window. Holly had opened her eyes and was talking to one of the specialist midwives assigned to her. Her husband sat by her side holding the baby in his arms. Another midwife from the special-care nursery was there with the incubator. It was obvious this was the first time she’d got to see her baby.

The whole scene sent a warm glow around Bonnie’s body. Coming here was the best decision she’d ever made.

She met Jacob’s emerald gaze. There was a gleam in his eye. He knew exactly what kind of day she’d had. She kept her face straight. ‘No. It’s not been a good day.’

He raised his eyebrows and she broke into a beaming smile. ‘It was a great day. I think I’m going to like Cambridge Maternity.’

CHAPTER THREE

JACOB TAPPED HIS fingers on the wheel of the car while he waited for Bonnie. He’d already had a few curious stares from members of staff who obviously wondered who he was waiting on. Bonnie appeared two minutes later and jumped in the car next to him. ‘Sorry, just getting changed and sorting out a locker before we left.’ She gave him directions to the childminder’s house and looked around with a smile on her face.

‘I didn’t take you for a four-by-four guy. I thought you’d have something sleeker, more sporty.’

He raised his eyebrows. ‘Really? Why on earth did you think that?’

She laughed. ‘You’ve got that “I drive a flash car” look about you. Wouldn’t have thought there’d be much call for a four-by-four in the city. I’ve been surprised by how many I’ve seen.’

‘Haven’t you heard? It’s the latest fashion craze and I’m just following the crowd.’

She shook her head. ‘Yeah, yeah. Somehow I get the distinct impression you’ve never been a crowd follower.’

He tried to hide his smile. ‘I’m shocked. We’ve only just met and you’re trying to tell me I’m not a people pleaser.’

She started laughing again. ‘Seriously? You were a bit grumpy this morning. The staff seem quite intimidated by you. Are you always like that?’

‘You were late. That’s why I was grumpy.’ It was the best excuse he could give. The truth was he’d spent the last fourteen months being grumpy—and only a few select people knew why. Jacob had always been a completely hands-on kind of doctor. Some physicians who were Head of Department reduced their clinical time by a large amount. He’d never been that kind of doctor but had been grateful to use his position as an excuse for his lack of patient contact at times over the past fourteen months. That was the thing about some types of chemotherapy—at certain times in the cycle, patient contact just wasn’t appropriate. Particularly when you had to deal with pregnant women and neonates—two of the most vulnerable groups around. Grumpy probably didn’t even come close to covering his temperament and frustration these last fourteen months.

She shook her head as they turned into the childminder’s street. ‘I think you were grumpy long before I was late. I need to know these things. I need to know if staff won’t want to approach you about things. I need to know the dynamics of the labour suite.’

He liked her already. She was astute. It wouldn’t be easy to pull the wool over her eyes—exactly what he should want from the sister of his labour suite. He just wished she weren’t using her astuteness on him.

‘You haven’t mentioned what happens with the special clients. Do I get involved with those?’

He raised his eyebrows. ‘The special clients?’

She smiled. ‘Cambridge Royal is known for attracting the rich and famous. I haven’t had a chance to look over the plans for the general hospital. What happens if we get someone who wants a private delivery? It wouldn’t seem safe to have them in another area.’

He was impressed. She’d obviously done a lot of background reading. ‘You’re right. It wouldn’t be safe. It isn’t public knowledge but there are six private rooms just outside the doors to the labour suite, only a few minutes from Theatre. We don’t want anyone to know where our private patients are.’

She gave a little nod of her head. ‘Makes sense. Privacy, that’s what people want. Isn’t it? I guess we’ll need to talk about the midwifery staffing for those rooms.’

There was something so strange about all this. Everything about being around Bonnie made him feel out of sorts. He had looked at her CV and hadn’t understood at all why Valerie Glencross had thought she would be a suitable replacement for their ward sister. Then she’d been late.

But from the second her eyes had sparked and she’d given him a dressing-down in front of the staff he’d liked her. She was different. She’d proved more than competent at the roadside delivery. She was asking all the right questions about the ward and she was making all the right observations. Bonnie Reid was proving to be the most interesting woman he’d come across in a while.

She opened the car door as they pulled up outside the childminder’s. ‘I’ll only be two minutes, I promise, and Lynn will be able to give me a car seat for Freya. That’s the beauty of having a friend who is a childminder. She has a garage full of these things.’

Car seat. It hadn’t even crossed his mind. That was how far out of the loop he was when it came to children. He tried not to focus on her well-fitting jeans as she ran up the path towards the door with her auburn hair bouncing behind her.

What kind of crazy fool cheated on a woman like Bonnie? The guy must have rocks in his head. Jacob had never realised quite how much he liked that colour of hair.

He watched as she ran back down the path holding the hand of a little girl. She was like an identikit of her mother. Same colour hair and pale skin. It only took Bonnie a minute to arrange the car seat and strap her little girl into place. She was obviously a dab hand at these things.

‘Who are you?’ The voice came from the back seat.

The little pair of curious blue eyes was fixed on his in the mirror. She had a little furrow across her brow. It was like a staring contest. A Mexican stand-off. And Jacob had a feeling he was going to lose.

Bonnie answered as she climbed back in the car. ‘This is Mummy’s friend from work. His name is Jacob. He’s going to give us a lift back to the motel.’

He glanced in the rear-view mirror in time to see her shrink back into her seat a little. Was he really that scary? Bonnie had already mentioned the staff might find him unapproachable. He’d never really given it much thought.

‘Hmm...’ came the voice from the back of the car. She really didn’t seem too sure about it. Bonnie gave him directions to the motel and he flinched when it came into view. If this was the outside—what was the inside like?

‘Do you need a hand?’

‘No,’ she said too quickly, then her voice wavered. ‘Actually, could you give me a hand carrying the car seat in?’ She jumped out and unstrapped Freya, leading the way inside.

He followed them in, waiting patiently while she unlocked the door of her room. The first thing that hit him was the smell of damp. The really obvious smell of damp. He winced. How on earth did the motel owner think this was acceptable?

He looked around. ‘This will play havoc with Freya’s asthma.’ The words came out before he really thought about it.

Bonnie sucked in a deep breath and licked her lips. There was a sheen across her eyes, as if she was holding back tears.

She’d already told him how much this bothered her. But now, seeing it with his own eyes, he understood.

Bonnie’s pretty face was marred by a frown. He liked her. He hardly knew her but he liked her already. What was more she obviously had the skills that the labour suite badly needed right now.

And after what he’d seen today? He didn’t want to lose her from CRMU.