Holding hands

Patey, Paul

Outside the night is pitch black. The ambulance slows, lurches slightly and slows some more. Wet spatters on the windshield indicate a slight snowfall onto pavement from which heavy spring rains have washed all the salt. The ambulance driver knows the road better than he knows the back of his hand. He also knows the dangers of changing weather.

There are seven of us in the ambulance. The one in most danger is the unborn child, for it has two journeys to make tonight. The ambulance still has more than 60 kilometres to go. There's also the journey of Birth, and that's in trouble.

Labour started on time, at full term. The pregnant young woman was seen promptly at the local rural hospital. Examination indicated she was making good progress but should last to get to the regional obstetrics centre. The ambulance hurried the six of them on their way: mother-to-be, with baby inside, the comforting dad, a nurse, the driver and another ambulance attendant.

Labour was rapid. Less than halfway along their journey Birth appeared about to happen. The driver headed for the nearest rural health care centre. Again it was a place that once provided birthing services but now depends on roads and a regional centre. The cellular phone call from the ambulance gave us five minutes preparation time before they arrived. My examination found that the fetal heart beat was normal; labour contractions strong, long, and frequent; cervix already fully dilated; the head well engaged. At this rate after just some more rotation, and a little more descent the head would likely soon be crowning. It was safer for Birth to occur at the rural site, than in the ambulance.

But the rotation never occurred. Instead the baby's journey got stalled. Deep transverse arrest, the obstetrics text books call it. With this problem, it became very unlikely that the mother would be able to deliver the baby without the help of obstetrical tools and teams that were not on site. Into the ambulance the seven of us went. That was half an hour ago. Now I sit with my back strapped to the side of the ambulance opposite the mother's hips. Opposite her shoulders sits the nurse. I know it's unlikely Birth will occur during the trip, but my position will help me monitor her progress and do my job if Birth does happen. An emergency delivery kit is at hand. The nurse and I carefully watch the patient.

The young woman lies on her back on the stretcher, her shoulders slightly elevated, her body tilted to her left. A thin plastic tube loops around her ears and face bringing oxygen to her nose. Her man sits in the swivel chair just ahead of the stretcher. They are holding hands.

They are not holding hands as would strolling lovers: their relative positions in this ambulance and in this dangerous time in their lives determine their hold. Her left hand is beside her left ear on the pillow, her palm upward with her fingers curled. Her man's left arm rests on her pillow above her head, his palm downward: his fingers curled and interlocked with hers. Their hands show that the couple are clinging onto hope, love, their unborn child and each other.

To the nurse I say, "See their hands. That's doing her more good than the oxygen."

Theme: Birth | Naissance

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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