born before arrival

There’s a woman standing by the side of the road with a phone to her ear; she waves as we approach, then hurries back inside. The street is quiet and dark. A fox glides out of a garden ahead of us, hesitates in an isolated pool of light thrown down by a streetlamp, then hurries on into the darkness on the other side.

I grab an obs bag and maternity pack; Rae fetches the Entonox.

Stacy’s house is up on a shallow rise, all its lights blazing. It’s not immediately clear where the front door is, but the sounds of a woman crying out in pain leads me round the back.

Stacy is on all-fours in the living room, surrounded by a hasty scattering of towels. Her sister Kate has hung up the phone and is down on the floor supporting her; Stacy’s husband Richard hangs back near the kitchen, one hand flat on the top of his head like he’s trying to stop it blowing away. He looks at me as I come in with my bags, desperate for me to help.

As I say hello and ask a few questions, I’m unzipping the maternity case, unpacking the kit, setting it on a nearby sofa, pulling on my gloves and then crouching down to see how far advanced she is. What I find is nothing I’ve ever seen before, something like a pale, prolapsed balloon, tight with fluid, extending out of Stacy’s vagina. There’s no sign of the baby’s head, but Stacy’s contractions are powerful and quick and there’s no doubt she’s ready to deliver. Richard tells me they were up at the hospital earlier that day. He said she’d had a scan, but apart from showing that the baby was back-to-back, everything else was fine. Today is her due date. Stacy’s had two other children, neither with any complications. Her health is good.

This balloon-like structure must be the amniotic sac. But is there any chance the placenta could’ve been dragged out of position to block the cervix? In a couple of hours? I don’t think it’s likely, but I’m no expert. And anyway, even if it is the amniotic sac, could it obstruct the birth? Is the foetus in distress right now, struggling to be born, the cord compressed?

It’s only been a minute or two since we came in the door but it feels longer. I’m horribly aware that all the time I’m hesitating the baby might be struggling.

I decide to rip the sac. It tears without much effort. There’s a rush of clear liquid over my gloves and up my arms. Almost immediately I can see the dark hair of the baby’s head as it emerges. I get Stacy to pant as the head crowns and is born. The baby’s face is puce, all bunched up in that way newborns have. I check round its neck, which feels clear of the cord.  

Rae is next to me with a clean, white towel. She’s ready to help me catch the baby.

‘Okay, Stacy. One  more push and we’re out,’ I tell her. ‘Whenever you’re ready. One last push.’

She bears down. The baby emerges, shoulders, body, legs, flopping out into our blue gloved hands in a splattering of bloody discharge, mucus and amniotic liquor.

‘It’s a boy!’

I hold him whilst Rae clears first his face then his body. Almost immediately the baby opens it eyes, squashes his tiny face up and lets out a great, squalling cry that fills the room with a sense of relief, and release.

He pinks up quickly, beautifully.

We wrap him in another clean towel and whilst Richard holds him, we help Stacy turn over and sit on the floor, resting against the sofa.

‘The midwife can cut the cord,’ I tell them. ‘There’s no rush.’

And as if I’ve summoned her by using her name, here she is, backing in through the door with a drag-along suitcase of maternity things, looking as smiling but exhausted as a woman who’s just landed at the airport.

‘Is that baby I can hear?’ she says. ‘Congratulations. What did we have? A he or a she?’

*

 When we’ve drunk the tea Stacy’s sister makes us, seen the placenta delivered safely and everything good, the midwife happy for mum and baby to stay at home, said our goodbyes and congratulations again, we head back down the drive to the ambulance.

Above us the sky is brilliantly clear, a dizzying throw of stars, stars on stars on stars, leading out into the unfathomable deeps of space. It’s strange to think of that tiny life emerging, in that chaotic, warm, brightly lit room, with a sky like this above it.

*

The rest of the shift passes without incident. Half an hour before we finish and we’re back on base. The morning is already so well established our night feels like ancient history.  I’m so tired I wonder how I’ll make it home through the rush hour traffic, but the thought of going to bed, pulling the duvet over my head and diving into sleep is so wonderful I’d risk anything to make it happen.

Dermot arrives for the start of his shift. He’s been a paramedic for about a thousand years, so I tell him what happened.

‘Sounds like the amniotic sac,’ he says, yawning. ‘There’s that expression – born in the caul. It’s quite rare. I’ve only seen it once. They’re okay being born like that without having to tear the sac. Nine times out of ten it’ll tear as the head comes out, but if it doesn’t, you can wait till the baby’s born. A lot of doctors tear early, of course. They like their interventions. But either way’s fine, I think. There are arguments for and against. And there’s that superstition thing, of course. Your little man won’t ever drown, so it goes. In the past the midwives used to frame the caul and sell it as a good luck charm to sailors.’

He yawns again, then stretches as he stares out of the window into the car park.

‘I had a different birth experience the other day,’ he says. ‘Not quite so nice, though. Twenty weeks old.’

He holds his hand out and looks at it.

‘A perfect little thing, this big,’ he says, drawing an imaginary outline in his palm with the forefinger of his other hand. ‘And it was making these tiny little gasps.’ He pauses, then closes his hand. ‘Twenty weeks – I mean, that’s got no chance. But we thought – well, maybe they got the dates wrong. And the way things were, we couldn’t just stay there. So we took it in, wafted a little bit of oxygen its way. Foregone conclusion, though. They didn’t do anything in resus. I knew they wouldn’t. Just gave mum some privacy whilst it faded away.’