‘Would you consider using the pool?’ Brooke crouched down in front of her, her eyes kind and gentle. ‘Many women find it a great pain-reliever, you know.’
Alison shook her head, tears welling up in her eyes. ‘I don’t fancy it. I’m sorry, I know it’s illogical…’
‘It doesn’t matter,’ Brooke said quietly. ‘I’m just trying to find something that suits you because I think you do need something more, don’t you?’
Alison nodded and the tears slipped onto her cheeks. ‘I’m such a wimp.’
‘You’re not a wimp, Alison, far from it. You’re doing marvellously.’ Brooke sat cross-legged on a cushion and glanced from one to the other. ‘Would you like to consider an epidural?’
‘Paula was just telling us that there is a greater risk of forceps delivery if I have an epidural.’ Alison shifted on the chair, looking uncomfortable and anxious. ‘I really don’t know what to do.’
‘Well, it’s true that there’s a higher incidence of what we call an assisted delivery—that’s forceps or ventouse—with an epidural in place. That’s because you’re not always able to feel the urge to push so well when your lower half is numb. But there’s always the option of allowing the epidural to wear off when you’re ready to push.’
Alison frowned and raked her tangled hair away from her face. ‘And does that work?’
‘Not always,’ Brooke admitted, resting her chin on her palm as she looked at Alison. ‘We can make a good guess as to how quickly you’ll dilate, but some labours can be unpredictable so there’s no guarantee that we can time it perfectly. And some women find it hard to have been pain-free and then suddenly have strong contractions with no build-up.’
‘The truth is, I really want an epidural, but I know midwives hate them.’ Alison bit her lip. ‘You’d rather I tried to do it by myself, wouldn’t you?’
‘Not at all. If you’d like an epidural then that’s fine by me. I would need to examine you because we can’t give you an epidural until you’re at least three centimetres dilated or it can stop your labour, and we don’t want to have to interfere with drips and things.’
Alison glanced at her husband and swallowed hard. ‘I think I would like one.’
‘That’s fine, then.’ Brooke rose to her feet. ‘Let’s get you back on the bed so that I can examine you, and we’ll take it from there.’
Ten minutes later she’d ascertained that Alison was five centimetres dilated and well able to have an epidural.
‘You’re doing really well but you have still got a way to go. The head’s in a good position so I don’t foresee any problems at the moment. Would you like to go for it?’
Alison looked helplessly at her husband and then back at Brooke. ‘I said I wasn’t having anything, but that was before I knew what it felt like.’
‘It doesn’t matter to me, love,’ Tim assured her, giving his wife a quick kiss. ‘You do what feels right.’
Brooke sat down on the bed next to her, her expression sympathetic. ‘You know, there really isn’t a right and a wrong way, Alison. You have to do what feels right to you.’
Tears slipped down Alison’s cheeks. ‘I don’t know. It feels like agony and I’m starting to panic about the delivery itself.’
‘Nothing to panic about,’ Brooke soothed. ‘Just think about now. Let’s work through a few more contractions together and see how you cope.’
She spent another twenty minutes with Alison, at the end of which everyone decided that an epidural was the right option because she was so adamant that she wouldn’t use the pool.
Paula caught up with Brooke in the corridor as she went to bleep the anaesthetist.
‘You’re brilliant with her. I couldn’t get her to relax at all.’
Brooke gave her a tired smile. ‘Don’t blame yourself. She’s very, very anxious.’
‘Is that why you encouraged her to go for the epidural?’
‘She wanted one,’ Brooke said simply, picking up the phone and dialling Switchboard. ‘She just needed reassurance that we wouldn’t disapprove of her choice.’
‘But generally you do try to encourage them to avoid medical intervention?’
‘What we really encourage is freedom of choice for the mother,’ Brooke told her, tucking the receiver under her ear. ‘We want them to have as much choice as possible in their labour and delivery. Alison is clearly not happy about using the pool and she’s in a lot of pain. An epidural is probably right for her. Switch? Can you bleep Dr Penny for me, please?’
‘I’ll need to do regular obs, won’t I?’ Paula scribbled in her notebook and Brooke nodded as she replaced the receiver.
‘Yes. An epidural can lower the blood pressure dramatically. I’ll leave you for now but give me a yell when Dr Penny arrives and I’ll give you a hand.’
The afternoon flew by and Brooke was rushed off her feet, helping students, admitting pregnant women in labour and arranging transfers to the ward.
‘You OK, Brooke?’ Gill caught up with her halfway through the afternoon.
Brooke rubbed her aching neck. ‘Yes, I suppose. I miss spending an entire shift with one woman.’ She exchanged a rueful glance with the senior sister.
‘Yes, well, that’s today’s NHS for you.’ Gill sighed and checked her watch. ‘I hate to ask you this, Brooke, and I suppose your circumstances will make it impossible, but—’
‘Will I work a double shift?’ Brooke chanted, rolling her eyes. ‘Yes, of course I will.’
Gill’s eyes narrowed. ‘You’re sure? I thought you might have to rush back.’
‘No. Not tonight.’
‘Well, that’s great. Thanks a lot. How’s Mrs Neal coming along?’
Brooke pulled a face. ‘Slowly. I’ve just bleeped the anaesthetist.’
‘Right. Let me know when she’s delivering.’
Alison Neal continued to make slow progress and by six o’clock she was fully dilated and had been pushing for an hour. As it was her first baby, in theory she could have been left to push for longer but Brooke was worried about the baby.
‘His heart rate is dipping slightly with each contraction, Alison, so I’m going to give the doctor a ring.’
Bother. She was going to have to ring Jed because his SHO didn’t have enough experience, the registrar was off sick and the senior reg wasn’t due to start for another six weeks.
He strode into the room five minutes later and Brooke immediately handed him the trace, dispensing with preliminaries.
‘We’re getting late decelerations.’ She knew that if the baby’s heart rate dropped after the peak of a contraction it could be a sign that the baby was short of oxygen. ‘I’ve tried changing her position but it’s made no difference.’
‘Right.’ Jed frowned down at the trace, and slipped the paper through his fingers, examining it in detail. ‘How many centimetres dilated is she now?’
‘She’s fully dilated and she’s been pushing for an hour, but the head’s still quite high.’
‘OK.’ Jed handed the trace back to her and smiled at the Neals. ‘I’m Jed Matthews, the consultant. How are you doing?’
‘I’ve been better.’ Alison was looking exhausted, her blonde hair hanging limply round her shoulders.