“So,” I start to say and curse myself for sounding too conversational. I need to be more assertive. “Is it going to deliver vaginally?”
I was at the head end for this particular birth, offering encouragement and pushing the monitor into the poor woman’s abdomen so that we had some sort of idea how her baby was doing. Her baby who had decided to escape 10 weeks earlier than expected – hence the presence of two doctors in the room. Midwives can be in charge when everything is normal, but for high risk births the doctors rule. And a baby delivering so early is such a risk we had two doctors – one of whom was a consultant.
The consultant was in his sixties. He gave the impression of a carnivore choosing between two options in a vegan restaurant – undecided but unexcited either way.
“We’re doing ok…” he said calmly, non-committedly. His colleague – a younger woman – gave me a look which I’m sure was supposed to communicate something but I wasn’t particularly sure what.
The baby’s heart rate was all over the place – it was hard to monitor well but from what we could see it wasn’t happy. Not so bad that it needed an immediate exit but we had to be confident that it was coming out soon. Hence my question.
You might think that having a consultant in the room relieved me of my responsibility. But annoyingly it doesn’t completely. For example when a doctor is trying to deliver a baby by forceps it isn’t certain it will work. If it fails the baby needs to be delivered by caesarean section (and really quickly as having had its head yanked around it’s not often in the best of moods). It’s a midwife’s duty after the third attempt at pulling the baby out to say “Enough!”. Potentially if they don’t they could be accused of a failure of care. It’s not quite such an onerous position of responsibility as the doctors’ but it’s enough to regularly get my heartrate pumping.
So back in the delivery room I’m still not sure what’s going on and I’m mentally rehearsing my evidence to the coroner’s court (to be honest I tend to catastrophise quite a lot – the heartbeat wasn’t that bad and [SPOILER ALERT] the baby was born in a pretty good condition for 30 weeks – I just didn’t want to become complacent). I have another attempt at prompting the doctor into action, “Shall we get the theatre team ready?” again it sounds like a causal question, like it involves sending a text message saying ‘hey, whazzup? U fancy getting ready for doing some surgery…LOL’ [sorry – don’t actually understand text speak – that’s just what I imagine my children write]. In reality it means sending out an emergency message via the bleep system that will get a crew of people charging into delivery suite ready to assist.
He does a rather endearing nod and reminds me of David Attenborough which makes me feel even less like I can bully him into making a decision on this one. So then Imaginary Midwife Me (who is this amazing, inspiring woman I live in awe of and who also doesn’t exist) spoke up:
“David,” she said in a confident tone, using the doctor’s first name because she doesn’t follow archaic hierarchical medical tradition, “I respect your position as senior professional in this birth but I would like to state my concerns.”
At this point the doctor, deeply impressed by Imaginary Midwife Me’s authoritative tone merely waved a hand as if to say please proceed.
“I would like to draw your attention to the recording of the baby’s heart rate which shows two concerning features which NICE guidelines would define as pathological, i.e. this baby should be delivered promptly. Although I appreciate your plan to aim for a vaginal birth progress has been halted as far as I am aware and we should consider an operative delivery.”
Before the good doctor had a chance to reply the labouring woman suddenly stopped puffing away on entonox, as if the balm of Imaginary Midwife Me took away her pain, she said, “I would like to say thank you for being my advocate and in no way have you scared me witless with your discussion of my baby’s heartrate or lessened my faith in the doctor”
After this of course the doctor took my concerns into view and made a decision to alert the theatre team.
Since Imaginary Midwife Me doesn’t exist none of this happened. But I did make what could be described as “a bit of a face” at the doctor which maybe prompted him to examine the woman again (euphemism for sticking his hand into her vagina) and say that the presentation had changed and we should probably deliver the baby by section. The labouring woman was strangely unconcerned about the decision.
And everything was ok. But reflecting back: either I was over-worrying and my weak hints were just a distraction to a more experienced clinician or my worries were right in which case my weak hints were pathetic and insufficient. Afterwards I didn’t even attempt to talk it over with the consultant – which again is a pathetic fail – although I did discuss it with the other doctor who was thinking along the same lines as me. So also, I guess failed.
The dynamics of the relationship between midwife and doctor is difficult, also I suppose, between senior and junior doctors. It’s good that we are all deemed to have at least some responsibility in any given birth but how that is divided out is tricky to manage.
Photo by Aarón Blanco Tejedor on Unsplash