Signalling with her eyes that Dawn was more than a little anxious, Tia busied herself getting things ready for the anaesthetist.
Duncan talked quietly to the couple for a few minutes, explaining the procedure and the risks involved, pausing while Dawn had another contraction.
‘OK, I need to start by putting a drip in your arm.’
Tia handed him a wide-bore cannula and Kim, the student midwife, checked Dawn’s blood pressure.
‘All right, Dawn, I want you to sit on the edge of the trolley for me—that’s it.’ Tia helped her to adjust her position until she was as comfortable as possible and waited while Duncan scrubbed up.
He put on a sterile gown and gloves and positioned himself behind Dawn. ‘All right, I want you to tell me if you feel a contraction coming so that I can stop,’ he said quietly as he gave the local anaesthetic into the skin.
Duncan nicked the skin with the scalpel and introduced the Tuohy needle, advancing it cautiously towards the epidural space. He checked that the needle was in the right place and Tia watched Dawn carefully, knowing that even the slightest movement at this stage could result in a dural puncture with unpleasant consequences for the patient.
Fortunately Dawn remained still and Duncan quickly threaded the epidural catheter through the needle and withdrew the needle.
‘All right Dawn.’ Duncan glanced up briefly and then returned to his task. ‘I’m going to inject a small dose of anaesthetic now.’
He gave a test dose and then taped the epidural catheter in place and attached an antibacterial filter to the end. Tia timed five minutes and then checked the blood pressure.
Satisfied with the reading, Duncan gave the remainder of the anaesthetic dose.
‘All right, Dawn, Tia is going to need to check your blood pressure every five minutes for the first twenty minutes just to check that it doesn’t drop.’
Dawn gave him a grateful smile. ‘I can feel it working already—the pain is nowhere near as bad.’
‘Good.’ Duncan gave her a warm smile, talked to Tia about giving top-ups and then left the room.
Now that the pain had gone, Dawn’s face regained some of its colour and she was a great deal happier.
‘Will I still be able to push the baby out?’
‘We’ll certainly aim for that,’ Tia told her, checking her blood pressure again and recording it on the chart. ‘As you progress towards the end of the first stage of your labour, we’ll let the epidural wear off so that you can feel to push.’
It was towards the end of her shift when Dawn started pushing and the baby was delivered normally, with the minimum of fuss. Tia quietly praised Kim who had performed a textbook delivery.
‘I can’t believe it’s all over.’ Dawn collapsed, exhausted, her face pale. ‘I can’t believe we’ve got a little girl. We’ve only thought of boys’ names, haven’t we, Ken?’
Her husband gave a shaky laugh. ‘We’d better start thinking fast.’
Tia gave an absent smile, her eyes on the student midwife. The placenta wasn’t coming away as quickly as it should and Kim was obviously concerned. Tia knew that with the use of oxytocic drugs and controlled cord traction, the third stage of labour—the delivery of the placenta—was usually completed in ten minutes in the majority of labours.
In Dawn’s case they were well past ten minutes and Tia was well aware that there was a danger of bleeding if the placenta was retained.
‘Stop using cord traction,’ she instructed Kim in a low voice. ‘There’s a risk that the cord might snap or the uterus might invert.’
Tia pressed the buzzer to call for help and then palpated Dawn’s abdomen. If the uterus was well contracted then it could mean that the placenta had separated but was trapped by the cervix.
Outwardly calm, still making small talk about the baby, Tia gently palpated the uterus with her fingertips. Instead of feeling firm and contracted, it felt soft and distended and her heart gave a little lurch.
She massaged the top of the uterus with a smooth, circular motion, careful not to apply too much pressure.
‘Is something wrong?’ Dawn looked at her with tired eyes and Tia gave her a reassuring smile, noting that she seemed very pale and restless.
‘Your placenta isn’t separating as quickly as it should do,’ she said carefully, ‘so we’ll just get the doctor to take a look at you. Nothing for you to worry about, Dawn.’
Sharon entered the room seconds later, her eyebrows lifted questioningly.
‘I think we may have a retained placenta here. Can you bleep the senior reg?’ Tia asked quickly, and Sharon nodded immediately.