Knickers

It's never a good sign when your patient has her knickers around her knees.

—–

'Woman in Labour – outside newsagent shop'.

So far, so boring – another maternataxi job, walk on walk off, baby arrives a few hours after the end of our shift. No sweat.

My crewmate is driving, blue lights to do a job of a taxi, when a minicab swerves across the road and pulls in front of us.

“Oi! Can't you see the lights!?”, shouts my crewmate – we are used to the crazy drivers of Newham (especially the minicab drivers) but this one really takes the biscuit.

“Erm… That's our patient”, I say.

In the rear of the minicab that is parked across our nose is our patient, her husband and her two other children, both under the age of six.

I hop out of the ambulance and walk to the back of the cab. Inside our patient is stretched out and screaming, the husband is on the phone to our Control (and seems a bit upset that they don't understand that he is on some road in some part of town – he isn't sure where he is and is annoyed that the calltaker isn't psychic).

Her knickers are down around her knees – this is not a good sign.

I quickly peer between her legs – and can see nothing out of the ordinary.

I'm aware that we are blocking one of the main roads on my patch – behind our ambulance is a bus, and behind that I row of cars.

Our woman stops screaming and I suggest that we change vehicles to our ambulance. She agrees and, exposed to the world and before I can cover her, waddles into our ambulance giving the bus passengers a sight they never expected to see today.

My crewmate gives the husband a hand with the luggage and the children while I put my patient on the trolleybed.

For some reason people seem to want to bring the entire kitchen sink with them to hospital when they are having a baby – this woman has four bags, along with two children she made earlier.

I take another better look between my patient's legs – again nothing unusual, and I'm certainly not going to stick my hands anywhere they don't belong to see how far along we are – besides it's outside our training.

We get the other children buckled in and I tell my crewmate to start heading for the hospital. I let the patient know that I'm glad that she tried getting a cab rather than just calling for an ambulance like many of our 'service users' – but that maybe she should have called a little bit earlier…

Then my patient lets out an awful cry and I realise that this isn't the normal wimping out about early labour pains.

I take another look and see a bulge…

“On second thoughts my beloved”, I shout to my crewmate, “We're are going to be having the baby here – grab us the spare maternity pack from the side cupboard”.

“What?!”

—–

And so I find myself hemmed in by luggage, with two small children undoing their seatbelts to come and have a look at what is appearing from between mummy's front bottom, all while trying to deliver a child who seems to be in two minds about coming out or not.

The head delivers, and then stops. My patient is convinced that she can't push any more and I suddenly turn into a midwife and start being… rather firm… with her.

A bit of pulling, a bit of pushing, and the baby boy pops loose. The cord is not so much 'cut' as chewed through by the, apparently rather blunt, scissors in the maternity pack, and dad gets to hold the newborn as mum is too tired.

I look at my audience – two gape mouthed, but excited, children and I tell them that they now know where they came from when they were babies.

Turning my attention to the dad I tell him that it is his job to tell them how they got up there in the first place.

Smiles all round, not least from me, because I'm fully aware that if there were a serious problem with the delivery, my training would be sorely lacking.

—–

We arrive at the maternity department after pre-warning them that we were coming in with a 'BBA' – 'Born Before Arrival (at hospital)'. The midwives ignore us until finally one slopes off to make a bed up for the patient. They aren't massively interested in hearing my handover either – but I give it anyway, I'm far too used to dealing with this particular group of midwives to worry too much about their attitude towards a lowly 'taxi-driver'.

Outside, with the luggage and the other children, the father shakes my hand and thanks me – his face a big grin.

And it's all fine – and I'm happy, and it keeps me happy through the shift even though my next patient is a drunk who tries to hit me.

9 thoughts on “Knickers”

  1. I reckon the right moment to call a cab is at any point up until your waters break and the right moment to call an ambulance is from that moment onwards.I've never heard of an umbillical chord being pinched off, and if it is what do you expect an ambulance crew to do about it?

    You've got nearly 9 months to plan your trip to maternity. Get some advice and make a plan before contractions start. 20 years ago ambulance rides to the maternity ward were almost unheard of, now people seem to think it's a necessity.

  2. “I'm not sure what they tell pregnant women in the UK…”We're told “if in doubt, ring the labour ward”. My waters broke a long time before active labour began (about 48 hours and IOL later) and a quick call to the labour ward at 2am to discuss those and other symptoms meant I could safely go back to bed without bothering the paramedics.

    Labour ward are very used to frightened women in pain. They judge pretty accurately over the phone.

    Tom – lovely lovely post today. So nice to hear that you have *good* days even if the drunks are still your no. 1 customers.

  3. I can't believe that you guys are faced with this kind of unprofessional attitude. I know Midwives are overstretched, but then so are the Ambulance trusts and most of the rest of the NHS! Without you guys I would have been in the smelly stuff. Your colleagues on the whole do the service credit and it seems from the tenor of your posts, for little acknoweldgement. It's about time it changed. Keep the faith!

  4. I'm not sure what they tell pregnant women in the UK, but here in Germany everyone tells you “when your waters break and you don't know for sure the head is low in the pelvis, call an ambulance or you risk the umbilical cord being pinched off”. So maybe that's the reason for you being called when there is still so much time? (Secondly, the pain increases very much once the waters break, so this may be another reason for the hurry…)And as for “you should have called earlier”: It's very hard to decide when it's the right moment to go to the hospital. Everything you've been told won't fit – f.e., with my first son I had rather weak contractions, but every 2 minutes. Should I have waited until they come even faster? Some babies need over 24 hours, some pop out after one contraction. So tell me, when is the right moment to call a cab? And when is the right moment to call an ambulance right away?

  5. Well, I can only tell what advice I actually got.If the baby sits still high in the belly, the umbilical chord may lie under the baby. When the waters break it might sink into the birth cannel and when the baby presses on it, it might get pinched off.

    So the advice is, to lie down on the floor and call an ambulance, since those guys can a) check if the chord is free and b) if it isn't they can transport you to the hospital still lying on the back, so the baby doesn't pinch off the chord.

    I have no idea how likely this is, but it's what they tell you in birth preparing courses etc., so I guess it's what at least a part of the medical staff involved is expecting you to do.

    And no, you don't have 9 month to plan something that can be extremely random. True, it will come out eventually. But will you have time to bring your other children to your mother-in-law first and then walk over to the hospital, or will you pop out your child in one contraction after you just started to brush your teeth? I heard both stories, so what exactly do you want to “plan” here? There is no rule how long it takes between first contractions, water breaking and birth. There is no rule how fast the pain gets so bad that you can't walk anymore. How can you plan something if you have no idea how much time you have and in which condition you will be?

  6. “Our woman stops screaming and I suggest that we change vehicles to our ambulance. She agrees and, exposed to the world and before I can cover her, waddles into our ambulance giving the bus passengers a sight they never expected to see today”.From what friends who have had babies have told me the woman probably had more on her mind than worrying about modesty. Also apparently when having a baby you get so used to strangers peering up your flue that my friend said she almost gave a repairman called in to the ward a look by accident.

  7. Sorry to 'labour' the point, but my wife, several of my nieces, my sister and my sisters-in-law managed to make a plan (complete with contingencies) that saw them through 15 births without having to involve anybody other than friends and family (who were part of the plan).And that whole “pinching off” of the cord thing still confuses me. How can you tell just by looking?

  8. What you're referring to is called a cord prolapse. It mainly occurs if baby is not head down and is more likely in multiple births and pre-term babies (so ones that are not likely to be engaged in the pelvis). Sometimes you can see a part of the cord hanging down between the legs… but usually not. Most hospitals/community midwives give a contact number so with a list of times you should contact them such as if your waters break or if you are having regular, painful contractions. Having said that I've been present at a number of births in the carpark while I worked as an emergency nurse prior to my mid training. Tom, sorry you don't get a better reception from the midwives. We try to be nice to the Ambo's whenever we see them.

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