As 0200am rolled around I reviewed the traces for the women on labour ward. It had been a relatively quiet night, 2 vaginal deliveries, uncomplicated. We had 2 remaining in-patients, neither of whom were expected deliver before I finished my shift at 0800 and not a whiff of anyone needing operative interventions. This wasn’t unusual for rural England with a local population in the hundreds.
I signed off the reviews for the 2 in-patients, “normal CTGs, continue usual care” and retired to the break room. I could feel the weight of the last three night shifts bearing down on my eyelids and decided to top up on glorious hot black caffeine.
Mid-pour a midwife crashed into the break room shouting “Jay”. I flinched and poured coffee over the worktop. “We’ve got a possible placental abruption just turned up at the door” the midwife explained. “What? We weren’t expecting any blue light calls right?” I asked. “No, she’s literally just been heard knocking on the ambulance bay doors. Julie’s given her a quick once over, she’s bleeding and her abdomen is rock-solid.” Amy said. “Shit, right” I said, mostly to myself.
I followed Amy to the front of the dated 1920s era maternity building. The patient had been transferred onto a trolley and was being wheeled in through the door. I scanned her from head to toe running through a mental checklist. She was wearing a long, thick cotton dress. The dress was old, dirty and worn out in places. He could see a large patch of blood seeping through the dress between her legs. Her skin was pale, potentially reflecting a significant degree of blood loss. Her eyes were starting to role back into her head - she was losing consciousness and we needed to act quickly. Ordinarily patients would be known to the labour team, especially in a small rural community, however this lady had no notes and apparently no identification on her. In an ideal, or elective situation a patient would be consented for the operation and it would be carried out in daylight hours with a wide manner of support available. Emergencies do happen but you would at least hope to know a little about the patient. This is dangerous and uncharted territory but this mother (and baby) needed immediate delivery. Saving her life outweighed formal consent.
I asked Amy to wake the anaesthetist and prepare the other team members for theatre. A small team of 5 assembled in theatre ready to receive the patient. The anaesthetist sited a cannula and administered sedation, units of universal donor blood were requested in anticipation of further blood loss. Everyone performed there roles with admirable calm and expedience. I scrubbed in and got to work cleansing the operative site. Amy scrubbed in to assist me. The abdomen was firm to the touch and I identified the lie of the baby to decide where to cut. Scalpel met skin and flesh parted. Beads of bright red blood formed along the cut and I proceeded to cut down through the layers of fat and muscle. Alongside the midwife assisting we worked our fingers below the layer of fat and stretched out the incision, flesh tore and the uterus came into clear sight.
I once more brought the scalpel into the abdomen and cut into the thick uterine flesh. Fluid gushed out as I reached into the womb bring the baby into the world and deliver the mother. The baby felt soft and floppy - danger signs. I struggled to grip the baby, my hands unable to get any purchase. After several panic inducing seconds I had hold and pulled the baby as the midwife leaned onto the upper abdomen providing pressure for delivery.
The possibility that the baby may be stillborn was sad reality for the team, however we were not prepared for what emerged from the gaping abdomen. It’s skin a dusky blue. Large, wide black eyes flickered under amniotic fluid. It’s limbs were long with no rigidity or apparent bony structure.
As I stood in shock holding the…baby the anaesthetist’s voice broke through. “She’s waking up” disbelief evident in his voice. “She shouldn’t be able to..to..to” the anaesthetists voice faded away into the silent room.
The patient opened her eyes, a slight grogginess faded and she reached forwards to remove the sheet meant to shield her from looking at her own naked anatomy.
She stared at the baby with pride replacing fatigue. In a heavy accent difficult to place she just said “perfect”.