I've just spent the last five hours trying to polish 800 words; it's not easy this writing lark when you aren't writing for a blog, but instead for a format you've never tried before.

I think I've got the 'blog post' format down pretty well, but to write for something else when you have never really studied writing is harder than you would imagine.

I'm looking forward to my 'day job' tomorrow, as I can do that job pretty easily.

Over the radio today I heard what sounded like a nasty job. It started as our Control asking for any free ambulances to deal with a 24 year old female who was having a seizure; I couldn't take it as I was dealing with my second 'maternataxi' of the day (waters intact, contractions every few hours).

After dropping off this walking, healthy and not about to give birth any time soon patient at the hospital we heard a crew 'blueing in' a 24 year old female who wasn't breathing.

I don't need to explain how this would be reported in the media as I've written enough about it in the past.

It's still a damn tragedy though.

37 thoughts on “Tough”

  1. None taken! I think a lot of people have misconceptions about what we can and can't do as midwives and I for one would welcome the ability to have a blue flashy light and go in bus lanes like emergency GPs do, grrr we are more emergency than that when you've someone giving birth and the average ambulance arrival time is 20 mins because there are no ambulances… all the times I've REALLY wanted an ambulance there they have taken ages. once my colleague called an ambulance and then called me, I got there before they did and I live 25 mins away! And the call? Sole midwife at unplanned home birth, baby needing resus and woman bleeding… gaaaah.

  2. Come on Tom, writing is easy.You put pen to paper and move it about. Then you look at what you've written, screw it up and go again. After a several hours of this you have something near to completion.There nothing to it. A wasted day, tons of coffee, valium and a sudden realisation you have developed a nervous twitch.Oh… See what you mean.

  3. Hi Tom!Im from Germany, and althogh Ive been reading about these Problems in your blog and elsewhrere, I dont qiute understand. Why cant control tell her when she phones 999, that she doesnt need an ambulance? When she insists that you come, cant you just say to the woman after looking after her: “This will still take some hours, wait and then take some taxi?”

    I think if your management would spend some of the few money in educating people at school and elsewhere, how and when an ambulance is to be called (among other things, like basic CPR), you would save a lot of this money at the other end. From what Ive read, there ist much respect for the service, but few knowledge what it is about. Here, one would rather call the police if there is a drunk lying in the street, and they would decide if he needs an ambulance or a cell (in which he would be seen after by a doc, anyway).

    sorry for the bad english,

    Eva from Germany

  4. Argh! Of all the things that I read about on this blog, the thing that most annoys me is the idiots that ring for an ambulance because they may have a baby sometime in the next week.I'm expecting a baby at the moment (tomorrow in fact). Our timing is pretty spectacular – we're booked for Cheltenham, and it's the middle of Race Week. The roads are jammed solid. No less than 3 other expectant morons mothers have told me, quite seriously, that the moment I go into labour I should ring an ambulance so that I can be blue-lighted through the traffic jams. Another has told me that they are planning on going in by ambulance 'to avoid the car parking charges'. Idiots.

    In my last labour, I was transferred by blue-light from the local maternity unit to the consultant unit at the big hospital. The crew arrived to collect me incredibly quickly and got me there as quickly as they could (though they really could do with bigger Entonox cylinders on the big yellow bus), just in time for me to be wheeled in and give birth, then tell the staff who I was so that they could write the my name on my daughter's wristband, then be whizzed off to theatre. If that crew had been tied up dealing with any of the idiots above what was a happy outcome could have been entirely different. My daughter would probably have 'Layby, A46' as her place of birth, and I would have leaked an awful lot of claret over the back of the ambulance.


    OK, I'll stop ranting now. Must be the hormones.

  5. Sorry I have to reply to this coz I am Dutch but have lived and worked (as an EMT) in Germany for almost 8 years…It is exactly the same shit we deal with here day by day. Aditional to that the German system has got (as u know) emergency doctors sent out on the roads to everything that might need some intervention such as intubating, giving drugs etc etc.

    Dial 112, tell them you have got difficulties breathing and you get an ambulance + an emergency doctor + another paramedic asap and tell them you are in labour to get exactly the same team. Great, isn't it?

    And we do not have a system to put calls into categories here. It depends on the dispatcher taking the 112 call but from my experience they do not necessarily make sure an ambulance is absolutely needed in most of the cases and that's what really pisses me off. They ask what happened where and that's it. Control here sucks. Sorry but I really prefer the English system and also the training you get as our “paramedics” don't have as many rights. Most of the things are performed by the “Notarzt” (emergency doctor) and as soon as it gets difficult we have to call him, otherwise we might get into trouble.

  6. Here, one would rather call the police if there is a drunk lying in the street, and they would decide if he needs an ambulance or a cell (in which he would be seen after by a doc, anyway)

    Mmh… Do you work on an ambulance or how do you know? Because it might be correct that the police gets called but then they call us cos they're scared who ever it is could die on them or whatever. The police in Germany are very good at calling us btw, that's why we don't like them very much. “Oh well, he's got a cut to his eye, let's call a “Rettungswagen” (ambulance)”

    In general people here do hesitate more and A&E departments are less crowded, but at the end of the day we get the same “oh my back's been hurting for 2 weeks” and “my nose has been running for 3 days” idiots *sorry*

  7. Got the same problem in the US, too. If someone calls for an ambulance and there is one available, failing to respond is considered negligence, for which the ambulance company and the even the crew on duty at the time can be sued in civil court, possibly even charged in criminal court. But once you start treating a patient, you can't leave them until you pass care to someone of equal or greater training. This leads to such ridiculous situations wherein a paramedic treats a person with a cut and can't leave them until they are handed off to the ED, even if a “code 500” (ie, a full cardiac arrest) is waiting in the queue. But, that's the law!Most ambulance companies try to have at least one paramedic on duty at all times but not all jurisdictions have them available, or available all the time. A basic crew (a BLS – “Basic Life-Saving” crew) is two EMT-Bs (B for “Basic”). An ALS crew (“Advanced Life-Saving”) has an EMT-B (or an EMT-I, “I” for “Intermediate”) and a paramedic (an “EMT-P”). Most US states have these gradations but some have their own (for example, New York still has the “EMT-CC” designation, “CC” for “Critical Care”, graded just below an EMT-P). we are getting closer to having a uniform training-standard and grading system spanning across all 50 states and probably will soon; there is for example now a national test for the EMT-B that allows a person to be one in any of the states without having to re-test if he moves to a new state.

    Anyway, there used to be doctors included on ambulances back when the whole thing started but after awhile the medical establishment in the US concluded it was better to train people to keep a victim alive long enough to get them to a hospital where the doctors can have all their equipment and other support staff available. Generally this seems to work out well but of course there are exceptions. It's the template-approach to emergency situations– this works 99% of the time and given the costs, opportunity and otherwise, associated with having MDs on ambulances versus not, we went with the less-expensive option. Cost is a real big factor. MDs in the US, esp. trauma MDs, make a lot of money. If 99% of the time a paramedic is fine for saving a person's life, and that para makes $15/hr., it's a lot cheaper to field the para than the MD. On top of that, the opportunity cost of placing an MD in an ambulance where he can only treat one patient at a time is very high. In an ED, a trauma MD can treat as many patients as will fit in the place (of course within reason, but it's going to be more than one patient). So finally, the “fast-transport” model was adopted over the “in situ” model.

    It just happens to really suck for those who fall into the 1% category.

  8. OK, if birth is imminent, you are premature or there is a medical condition which indicates straight to labour and delivery, call an ambulance, but dont do it if your waters haven't broken and contractions are every 2 hours, or lets just evade the congestion/car parking/public tranpsort fee, lets just call the ambulance.Suppose, hell mend, this 24 year old female dies, if she already hasn't, she could have stood a better chance of survival had the ice cream van not being playing maternitaxi to probably another teen in the first stage of labour and cant handle the pain, cynical me!

  9. I'd like to know what (if anything) mums are being told to do at ante-natal? Maybe this is where the message should be being drummed home?

  10. Where I live we are given very clear advice – for normal pregnancies that are full term we are told to ring the Delivery Suite when contractions are five minutes apart and lasting about a minute, then make our own way to hospital. If in doubt, ring the your midwife and see what she advises. At the antenatal classes we were told that in the majority of cases labour is a natural, non-emergency event, and we shouldn't be calling an ambulance, and that if we don't have a car we should make arrangements with a relative or friend, or make sure we have money for public transport or a taxi. They also give guidance on when you SHOULD call an ambulance (eg heavy bleeding, birth imminent) and discuss what to do should you find yourself about to deliver without a midwife or ambulance crew on hand. This in itself usually gets most fathers-to-be announcing that they'll get their partners to hospital in plenty of time. The midwife reinforces all of this at the clinic visits as you reach your due date, and will give additional advice where necessary – for example, we've been advised to leave extra time for getting to hospital because of the heavy road congestion at the moment, and because my previous labour was rapid. Seems like common sense to me, and it's what we'll do anyway as getting to hospital in good time is FAR less stressful than having to leave it to the last minute.Every expectant mother I know is clear on the guidelines – some just seem to expect an ambulance by right, and choose to ignore them. For the most part these are intelligent people. I find it staggering that they can be this blind to the situation, even when I ask them to think about the people who may genuinely need the ambulance that they're calling.

  11. And here's a question – how many emergency births actually DO occur in the back of an ambulance. I know medics with 15 years experience who have maybe performed one birth in that time. I would guess it is a fairly low number. GET IN THE DAMN CAR, PEOPLE.

  12. *coughs* And if you don't HAVE a car :o) have a taxi number or three to hand, maybe some taxi fare as well would be nice, in other words have A Plan…. seems a great minimal requirement for someone about to become a parent after all.I might have a baby in the next 10 years, better dial 999 now and get my Jaffa Cakes, because who knows, it could be an emergency.

    Great point about teaching this in ante-natal classes, but the sad thing is that the public hear what they want to hear 99% of the time.

  13. The amount of times I have blue lighted to a hospital for a matty transfer then had to stand around and wait for 10,20 even 30 minutes while the staff “prepare” the patient for moving is ridiculous. And then when we eventually head off we end up having to turn back to the matty cause they are to far advanced!I have even been called as a 999 call to the matty on numerous occasions to insert a cannula because, as the staff put it, “we haven't done one for a while and you lot are doing them all the time”!!!

    In over 10 years of service I have only ever had one baby born in the back of my motor (attended plenty home births etc).

    Glad to see its not just me that gets irked with “matty jobs”!!

  14. Considering the large numbers of “maternataxis” that seem to be called, would it not make sense to have an ACTUAL maternataxi service? It couldn't be as expensive as using the ermergency system to provide such a service surely?I ask this because, if you don't have a car, it is genuinely not all that easy to be flexible. A number of private taxi firms, for example, won't take heavily pregnant women in case they leave a mess in their taxi. And what if your friend with the car has left their phone at home, or the car won't start. There are conceivably scenarios where pregnant women may have serious difficulties getting to a hospital.

  15. Posted on behalf of uphilldowndale, who is having trouble logging in at the moment.Not many babies are born before arrival, (but it does happen, I know, I am looking at one right now! And the men with the gas and air did a fine job of delivering him.) But when it does happen it is pretty scary for all concerned and two lives are at risk.

    But I was wondering if the reason so many women and their partners (who panics the most?) think normal labour warrants an ambulance is to do with the way in which maternity care has become so very clinical, and has stepped away from being seen as the natural process that normal delivery is? Have we got to the stage that women in labour just give up taking responsibility for them selves?

    Answers on a post card please.

  16. I personally don't have a problem turning up to someone in the throws of child birth who has no way of getting to hospital, it must be a scary situation to be in, (i refer to previous posts about not having cars, friends with cars and taxi's refusing to take them) however there have been a large number of jobs that are “expected at the unit” where mum to be has called the birthing suite and she is expected. What is more frustrating is when you get there the midwives are shocked to see you, because yes they did speak with Mrs Bloggs about ten minutes ago, but told her not to worry about coming in tonight as when she left the unit 2 hours earlier there was no need for her to be there. So even when a medical professional tells you that there is nothing to be concerned about, they ignore the advice anyway. Like it was mentioned before, 99% of the time we don't pay any attention.Good idea about the maternitaxis though, that would make things a bit easier. Another idea might be for the midwives to get on scene for the birth rather than 45 minutes after like they have managed on the last 3 home births I have been on. (sorry wasn't going to rant about that, but it slipped out)

  17. Actually I really like this idea. Manned by a couple of midwives, with all the appropriate equipment for labour/birth if something does go awry, and used to dealing with the particular variety of “headless chicken” behaviour that goes with the miracle of birth.Or even, if the midwife centres could make a deal with just one cab firm each.

    “Mrs Midwife, it's Mrs Mumtobe here, I've gone into labour.”

    “Okay then, [questions about contractions etc]… Are you at home? Good. You've got your bag ready? Excellent. We'll send a cab and meet you at the hospital/unit. Don't you fuss, everything will be fine.”

  18. I can tell you it isn't the teenagers. It's the People Who Won't Be Told, they are many, I had a 'firm word' with one and the GP Registrar observing said afterwards 'gosh, you're firm'. lolBut sorry, if I have someone sat in clinic telling me that they are going to get an ambulance because them going into labour is an emergency I will put them firmly straight. I am always very apologetic if I have to call an ambulance when I think it's a bit daft but necessary (11pm on a Friday when you need a cab to get to hospital is not the time, when you won't get one for at least 3 hours…) but the crews in those instances are mostly great. The only rude ambo crews I've met have been when we've actually needed an ambulance, I've complained about one crew because they were so rude to us! And yes, a baby born that needed resus and had meconium stained liquor IS a reason to go in an ambulance even though 'it's fine now'.

  19. Dunno what it's like where you work, but when I am on call I am expected to cover an area that is basically Most Of South London and I surprisingly don't know ALL of that area. Also if I am on call then I am at my house, asleep in bed, because I'll have done a full working day beforehand. Oh and it might well take 45 minutes to get to the other side of the patch.If these were home births and not BBAs, then the women should have been told to call earlier or the midwives should have given them instructions of what to happen if it all goes megafast.

    Totally agree about people hearing what they want to hear. I've even known people say to a mate of mine 'the midwife who I saw on Weds said XYZ' and she was like 'er no she didn't say that cos it was me and I didn't say that!'.

    But it is your Right to have free care (sod the rest of us and the fact that we can't work a million hours on no sleep so you call the on call phone at 3am cos you have a pain in your leg, that you've had since before you were pregnant) and it is your Right to a free ride to hospital, because after all, you are PREGNANT!


  20. Errmmm, I had a BBA, without a midwife, at home. I was aiming for a homebirth but there was a problem contacting the midwife and things were happening megafast. My husband only had one option (unless I was going to have the baby in the car) …. to call an ambulance. I never once considered the idea of calling an ambulance during the early stages of labour and no-one I know who has had children did either. I'm sorry that there are people that think it is their right. The midwives whose care I was under did not instruct me on any procedures for things happening megafast apart from …. call an ambulance. Reading blogs that rant about maternataxis has frequently made me reconsider my husband's decision to call 999 but I have always come back to the same point – we had no choice. In the event, I couldn't fault the crew who did a fantastic job and judging by their reaction, they enjoyed the call too!To add to the debate – I don't think the closure of maternity units is helping.

  21. Robin, Wow, so did I, although I wouldn't have thought of calling it a BBA. I was booked for a home birth but my husband delivered the baby with a phone in one hand. It all went pear shaped when we phoned maternity control to tell the midwife my contractions were 5mins apart and getting business like. The midwife was already at another home birth and the second (and only other) midwife on duty was on the other side of the city with a river to cross to get to me. Husband started to get edgy and once I got the urge to push went into headless chicken mode. Between contractions I told him to phone again. More panic. Finally, in desperation I yelled “Well, call an ambulance then!” They arrived after the baby (by about 5 minutes and told us they took only 7 minutes to get to us) but Control did an excellent job of getting dh focused on being midwife. My point is that I don't think we were premature in calling them. The midwife arrived about 2 minutes after that.I totally agree with the person who said that some of the problem lies with the perception of birth as a big emergency. My husband was in a blind panic – he was convinced that the lives of his wife and baby were in his hands. If I hadn't been so busy I would have told him to go next door and have a cup of tea, but I suppose the fact that I fought so hard for a home birth meant that I was already predisposed to view childbirth as a normal life event with only the potential (rather than the certainty) of going wrong.

    Incidentally, only two hours before the birth I had been visited by my community midwife and she witnessed a couple of contractions and told me I had hours to go yet, whilst assuring my husband the midwife would arrive in plenty of time and there was no chance of him having to deliver the baby. The proper maternataxi idea might well work simply because midwives take a much more robust line and don't mind/are allowed to turn people away if they think it's too soon.

  22. Very good stuff – because some cab companies won't even take a sick dog to the vet (no matter how much polythene sheeting/hard cash bribery is offered), and if things start getting sticky at 3am on a weekday, or halfway through the working day, friends with cars aren't that much help.A lot of women go into labour without anyone present to drive them about as well – woman whose husbands are in the forces, single mums, widows, all sorts, so making life hell for anyone lacking their own car and/or driver just doesn't make sense.

  23. maybe I should rephrase how I put that, or say more about the births at home, they were all in the day time, each time the midwife was coming from the local hospital, and with the exception of one, we were given an eta of about 10 minutes. I know its an estimate, and they can't fly through the traffic like us, but on those occasions it was not impossible for them to get there in good time.As for calls in the middle of the night, I can't complain if it takes a while, we all know what it is like to be woken and kicked out on to the streets with only a few minutes notice (not that we have much time to sleep on nights mind) and I wouldn't hold it against someone to take time to get to a job if they have no idea where it is and have a long distance to travel

    Hope no offense was taken as it was not meant in anyway

  24. As the of the people who recieve the materna taxi passengers let me assure you that not only did they ring the hospital maternity department first for advice, and were told to wait at home and then make thier own way in. That secondly once they have reached us no midwife or obstetrician can convince them that they are not about to deliver the baby any minute now. Only when on average 10 or more hours have elapsed will they admit it wont be happening “any time now”.

  25. “I'm expecting a baby at the moment (tomorrow in fact).” 14th MarchDid you?

    Mind you, I guess if you did then you'd have quite a bit on your hands right now so blog comments aren't a top priority…

  26. Fantastic idea!!I know most of the taxi firms around here won't take women in labour, and I'm the only car owner out of all of my friends – with a husband who hasn't taken so much as a lesson in his life!!

  27. Ooh, anyone want to do a sweep? I'll take 6am tomorrow morning :)Seriously, best of luck and hope it's not too long a wait.

  28. I'll have, just before teatime on 17th March.For sake of precision call it 4pm, and then if you're lucky you'll be home before the chippy shuts (had a friend once who believed this was the reason her little brother was born mid-afternoon).

  29. I thought that readers might be interested in this story from The Independant: “Record numbers of women are being harmed or dying as a direct result of childbirth in what doctors are labelling a “crisis” in maternity care.There has been a rise of 21 per cent in deaths of pregnant women in the care of NHS maternity services. Deaths over the past three years now total 391, up one fifth on the comparable period, and 17,000 women have suffered physical harm while on labour wards.”

    And if you want something really sobering to read here's a link to the Healthcare commission's report into 10 maternal deaths at Northwick Park hospital:

    What I will say from personal experence is that every person's labour is different – I know two mothers who gave birth in the car, and several whose husbands delivered the baby at home. Someone else I know was checked by a midwife at home (she was booked for a home birth) shortly before delivering the baby once the midwife had left 'it'll be ages…' – she then had to wait a while for the midwife to come back and cut the cord etc etc. The impression from Tom's posts is that every labour follows a set pattern and takes ages – this isn't necessarily true. My first baby was an undiagnosed breach and he was delivered by emergency section shortly after I arrived at hospita as I had completed the first stage of labour without realising it; my second child was born 3 hours after I arrived at hospital. The registrar wrote in my notes that I wasn't in labour as I could hold a conversation! My waters broke a few minutes before the baby was born.

    There's a very lively debate going on on Dr Crippen's blog regarding home births and independent midwives, which Dr Crippin is opposed to as he feels that they are unsafe: (scroll down to 'More from the Madwives').

    An official 'Maternataxi' service would never be implemented because of the cost implcations – also how would the poor taxi driver cope if a woman delivered in his vehicle and what would be the legal implications should something go wrong? – ie cord prolaspe, abruption etc

  30. As someone who knows the actual facts and figures surrounding the 'midwife crisis' and also the indy situation (two different things entirely) I'd have to say that press reporting of it is wildly inaccurate or misleading and so is Dr Crippen's blog, to be honest (more so because despite evidence to the contrary, he will not sway from the opinion that ALL midwives are dangerous and don't know what they are doing, which I find insulting so I don't read it any more because it patently isn't true).There IS a shortage of midwives; there are not enough midwives employed to do what they are meant to do. However; there is also a shortage of jobs, which means that newly qualified midwives aren't guaranteed a job at all once they finish training, I know some people who worked in Tesco's because they couldn't get a midwifery job. And even in London where it used to be easy to get a job, it's not any more. The problem is that the Trusts can't afford to pay more midwives so the posts don't exist.

    Re the Independent Midwife situation, if you are indy you are ten times more likely to get investigated by the NMC for some kind of irregularity- not because the client puts a case but because some local hospital complains about you (where they have no jurisdiction over what you do!). Of those complaints as far as I am aware, NONE have ever resulted in the midwife being disciplined or struck off, where the midwife was an indy. Litigation is much higher within the NHS where a 'not my problem' attitude is magnified by fragmented care.

    Independent midwives often take difficult cases, where women may have been told they are 'not allowed' what they want on the NHS (be it a vaginal birth after 2 caesareans, vaginal breech or even just a straightforward home birth!). If I was to have a breech baby I'd want an indy. If I was to have twins vaginally I'd want an indy, because they are truly not deskilled in these areas of childbirth.

    On a last note re Northwick Park- I read the cases the other day- not altogether shocking to be honest but the main failures were palpably made by obstetric staff, usually registrars, making errors that midwives can't be expected to rectify, for example the clinical appropriateness of drugs that midwives can't prescribe. Other staff were culpable in many cases also (GPs, paramedics and A&E staff in some cases). It simply wasn't, as some would purport, 'midwives are rubbish'.

    Anthea- you are totally right though, sometimes labour can just catch you by surprise! But you can't assume that someone might be in silent labour when they don't look like they are in labour and have no clinical signs of labour cos chances are you might be there for days!


    NHS Midwife

  31. There is an assumption with a lot of births that because the woman isn't screaming her head off she's not in labour at all.Story: my friend's due date for her first baby had already passed, she took a bath one night and noticed LOTS of liquid pouring out of her an hour later, once she was all dried and in bed. She also had contractions far stronger, and more painful, than the BH ones she'd been having all week. But they weren't coming in regular waves that she could easily time.

    Calls the hospital and is told that the fluid was bathwater, the contractions just BH, and is strongly advised to go to sleep and don't fuss. Eventually she can barely think straight from the pain and so gets herself (in a cab) to hospital, at the initial exam the baby's head was fully outside her cervix and she delivered in an extremely distressed state due to the complete lack of pain relief.

    Mum and baby (now child) both did fine in the end, but she recalls the way no-one took her seriously because she wasn't howling her head off and is seriously unimpressed and disillusioned by it.

    Her favourite topic is people who favour painkiller free, “natural” births not as an option but as the norm – reckons they're about as viable and humane in the 21st century as painkiller free “natural” deaths from stomach cancer….

    Just throwing this into the pot, because for every maternataxi there's probably a mum or two who never got the delivery she wanted and who was left feeling like she could have got in deeper trouble if she'd followed the advice she was given.

  32. Dear Smoochie597 – ref painkiller free births – my 2nd delivery was essentially painkiller free – I don't count 'gas and air' as it doesn't give me any relief, just spaces me out – and the birth honestly wasn't that bad – the after pains were worse and the pain I had post operatively from my C section with my first child was way beyond anything I have ever experienced before. The point being that everyone is different and perceptions of pain differ enormously.I'm just a bit wary of the 'all women who call an ambulance to get to hospital in labour could have made their own way' train of thought because it's not true.

  33. Ref Clarabelle's post – for those who haven't read Dr Crippen's post – he is of the opinion that all babies should be delivered by a Doctor and not a midwife. He particularly dislikes independent midwives.Ref the Northwick Park report into the maternal deaths – as a 'lay person' reading the report I felt for these poor women, their families and the children they leave behind who were badly failed by 'the system'. Childbirth is not without its risks.

  34. It's very true that perceptions differ – my mate was in shock! (Not medically, emotionally.) Point is, as ever, the fuss and extra care always goes to those who scream the loudest, despite the fact that others may be more in need of help. No-one believed she was actually in labour because she could TALK, and wasn't howling down the phone to the hospital. Bravery isn't factored in these days, we're all supposed to just let it all hang out.Well done on your two anyway, and agree re your concern in the last line.

  35. Just to make it clear, I'll happily go to births that need an ambulance, but it's those that have contractions measured on a calender who cynically abuse ambulances that annoy me.

Leave a Reply to Anonymous Cancel reply

Your email address will not be published. Required fields are marked *