Hoa was dead, and the other obstetrician who normally helped out was off sick, having just been diagnosed with breast cancer.
It looked like Vivienne was the total of midwifery and obstetric knowledge here.
She could see the baby’s head tight against the perineum. This wasn’t the first time she’d dealt with a shoulder dystocia. But usually a diagnosis was followed by hitting the emergency buzzer, with two other midwives, an anaesthetist and an obstetrician all rushing to assist.
Those people weren’t here now. It was her. It was just her.
Deep inside, part of her wanted to scream for this poor woman. She’d worked with Duc over the years, and she knew he was a good doctor. The absolute worst-case scenario here would be the Zavanelli manoeuvre, where they had to try and put the baby’s head back into the vagina and perform an emergency caesarean section. Duc was the only surgeon here. She doubted if he’d performed a caesarean section before but, if need be, she could talk him through it.
She pushed that thought away and tried not to think about it, taking a note of the time on the clock on the wall.
Viv moved automatically into midwife mode, reassuring her patient, even though she didn’t speak the language, and letting Lien or Duc take time to translate everything she said.
It was a stressful situation for everyone in the room. Joe and Lien were calm influences, moving smoothly and easily. They seemed to foresee each other’s actions. It was interesting to watch them work together.
Vivienne took charge. Assessing her patient. Directing her not to push. She attached a monitor to the baby that would alert her to any signs of distress.
‘Okay, folks,’ she said calmly. ‘We’re going to try a change of position. It’s called the McRoberts manoeuvre and it’s used in this condition to try and release the shoulder. What we really want to do is create some space in the pelvis, and we need to move mum and, sometimes, baby to do that.’
She gave Lien a nod, waiting for her to explain to Resta that they were going to help her to lie on her back and move her legs outwards and up towards her chest. As this was a delivery room there was no end on the bed and Vivienne could move easily to try and assist.
She kept her face completely neutral. ‘This entirely depends on the baby’s position. If it’s the anterior shoulder caught under the symphysis pubis, this tends to work.’
‘And if it’s not?’ Duc’s dark eyes met hers. He’d moved behind the patient, supporting her position.
Vivienne kept her voice calm and low. ‘If it’s both shoulders, they’ll be stuck under the pelvis brim and this won’t help. But this is where we start.’
She kept calm. Running through the mental checklist in her head. Waiting to see if the change of position would have any effect on the baby’s ability to be delivered. She was lucky. This baby wasn’t showing signs of distress. Yet.
After a few minutes she shifted to the side of the bed, giving Duc a nod. ‘I’m going to press on the abdomen just above the pubic bone to try and release the shoulder. Can someone explain to Resta and keep reassuring her?’
Duc nodded and spoke in a deep, low voice, his hand gently on the woman’s arm. She could tell that the woman seemed to trust what he was telling her, even though she was clearly exhausted. Viv understood that at this stage all any woman wanted was to deliver her baby and have it safely in her arms.
It was interesting. She was in a room with three doctors, who were all perfectly willing to allow her to take the lead. There were no power struggles in here. Everyone just wanted this baby out safely.
Vivienne kept a careful eye on the clock and the baby monitor. Timing was crucial.
‘Okay, time to try something else, I’m going to do something called the Rubin manoeuvre to try and release the baby’s shoulders.’
She explained carefully, then slid fingers in on either side of the baby’s head, trying a number of techniques, without success.
The baby’s heart rate started to slow. Both mum and baby were tired, and the baby was starting to get distressed.
She was calm and methodical, secretly glad that the heart monitor wasn’t on her instead of the baby because, despite everything, panic was definitely setting in. She wasn’t quite sure how long it would take them to set up a theatre if need be.
‘Okay,’ she said. The baby’s head was still wedged tightly, with very little room for a blade to make an episiotomy. ‘Let’s try mum around on all fours. Let’s see if a further change of position lets things move on.’
In another few minutes she would need to attempt to deliver one of the baby’s arms or give Duc the nod that they needed to head to Theatre. She was running out of options.
Lien explained in a reassuring manner to Resta what they wanted her to try, just as Vivienne sent a little prayer skyward. Joe and Duc helped mum around and baby let out a little grumble at the change of position.
But within a few seconds it was clear it was the right move. Resta was on all fours on the bed. Viv hated the fact she no longer had eye contact with mum, but this was a case of needs must.
Almost instantly she could see a change. ‘Give me a second,’ she said to the others. The baby’s face looked a little more relaxed. ‘I think the shoulder’s been dislodged. Tell Resta to give me a push on her next contraction.’
One minute later the little bundle slid out into her arms. After a few seconds of shocked silence the baby started screaming. Vivienne did a few quick checks. Colour was good. Baby was breathing.
Joe appeared at her side and held out his hands for the baby. Duc helped her clamp and cut the cord, then they helped Resta turn back around to deliver the placenta. Viv caught Joe’s eye. He gave a hopeful nod. When shoulder dystocia had a complicated delivery there could be injuries to the baby’s shoulders and nerves. The baby would need to be observed. But for now he brought the baby over to let mum have a cuddle. ‘Đó là một cô gái,’ he said.
A girl. She recognised the word. Mum looked thrilled. The relief in the room was palpable, all the professionals exchanging glances. Duc shot her a smile and gave a grateful nod of his head as he walked back towards her. ‘Thank goodness you were here,’ he whispered.
Viv looked around the room as she started to tidy up. ‘I’m sure you would have all got there.’ The clenching in her stomach was only just starting to ease.
Lien came over and rubbed Viv’s arm. ‘Thanks so much.’ She glanced at her husband. ‘Sorry for the rude introduction earlier. Joe and I can take it from here. You must be exhausted.’
Viv nodded. ‘I am, but let me finish the notes and a few final checks on mum.’ It didn’t matter how tired she was. She would always make sure her clinical work and her paperwork were completed.
One of the aides brought in some jasmine tea, and Joe did some more checks on the baby. As Vivienne made sure she was satisfied that mum and baby were settled and well cared for, Duc slung an arm around her shoulders.
‘You look as if you haven’t slept in a week. Let’s go. Those jammies are still waiting.’
They walked back out into the cooler night air. Viv stopped for a moment, putting her hands on her hips and arching her aching back.
‘Okay?’ He was right next to her, the warmth from his body crossing the minuscule space between them.
She looked up into his dark eyes. ‘You weren’t joking, were you—when you said you’d no one for obstetrics?’
His dark eyes clouded. He shook his head. ‘No. No one. I don’t know when, or if, our other doctor