An Irish Country Christmas (33 page)

“Here.” Kitty offered him an opened pack of sterile towels.

“Thanks.” He took one and draped it over the patient’s pubis and lower belly. He put his left hand on the towel and slipped the first two fingers of his right hand inside her vagina, past the buttocks, and into the pelvis. Reaching as high as possible, he could make out the baby’s thighs where the legs were flexed up against the belly. The toes would be inside the uterus close to the baby’s head, so it was a frank breech, not a footling breech where the feet came first, or a complete breech where the baby’s legs were crossed like those of a squatting tailor. Good. In the frank presentation, there was much less risk of the umbilical cord slipping out past the baby, being compressed and cutting off the oxygen supply, before the child was delivered.

His left hand felt a contraction starting. Gertie moaned and wriggled on the bed. Miss Hagerty’s instructions to huff were falling on deaf ears. O’Reilly felt Gertie’s belly muscles stiffen as she bore down and the baby’s buttocks advanced lower into the pelvis. He managed to insert his fingers more deeply, and to his great relief he could find no evidence that the cervix was not fully dilated or the cord had prolapsed.

O’Reilly, though not a religious man, offered up a small muttering of thanks.

“She’s fully dilated,” he said and then removed his fingers. Jesus, but he wished she was in hospital. For one thing, having her feet in obstetrical stirrups and her buttocks over the edge of the delivery table would greatly facilitate the manoeuvers he’d need to carry out to expedite the child’s delivery. Of even greater importance, he would have an anaesthetist there who could knock Gertie out if any difficult procedures were required.

He’d have to make do, and it wouldn’t be for the first time, with what was at hand. “Kitty, in the packs there’s a kit for putting in local nerve blocks and also a bottle of Xylocaine. Get them.” No time for the niceties of “please” and “thank you.”

“Miss Hagerty, do everything you can to stop her pushing.” He didn’t need to tell such an experienced midwife to listen to the fetal heart between contractions. She would tell him if there were any abnormalities.

“The pudendal nerve block kit’s open,” Kitty said, stepping back from the dresser. “I’ve not seen one of those since I took my midwifery training during the war.”

“I didn’t know you had.” O’Reilly began assembling the large syringe with its very long needle. In Ireland, state registered nurses who wanted to be midwives took two extra years of training after gaining their S.R.N. qualification.

Gertie moaned as another contraction hit.

“I thought I’d like midwifery,” Kitty said, holding the bottle of the local anaesthetic Xylocaine so he could penetrate the rubber cap with the needle and fill the barrel of the syringe.

“Didn’t you?” He drew back the plunger.

She shook her head. “I preferred general nursing.”

To each her own, O’Reilly thought, but even if her knowledge was rusty, it was a great comfort to him to be assisted by not one but two trained midwives.

It had taken two more contractions before he’d been able to identify the nerves that supplied the lower vagina and the area between the anus and pubis. Once they were infiltrated with Xylocaine, he was more comfortable because no matter what he did now, he’d not hurt the patient.

He exhaled a very large breath, used the back of his arm to wipe perspiration from his forehead, and said, “Kitty, there’s a rubber apron in the kit. Could you help me put it on?” As he spoke, he handed her the used syringe.

She slipped the straps over his head and tied the waist tie. The patient was washed and draped; the doctor was gowned and gloved. The labour was progressing, and now came the difficult part. Waiting. O’Reilly knew that more damage was done to breech babies by impetuous attendants who intervened too early.

“Get her pushing, Miss Hagerty. Open that pack, Kitty.” He made a snipping action with the first two fingers of his right hand.

She nodded and opened the pack, which contained a pair of heavy bladed scissors.

He waited until another contraction had passed and one buttock and the cleft in the backside were visible at the vaginal opening.

“Now, Gertie,” he said, “we’re going to move you a bit. See if you can help.”

Aided by both Kitty and Miss Hagerty, he managed to turn Gertie so that she lay across the bed, her head supported on pillows, her buttocks at the bed’s edge. O’Reilly picked up the scissors and moved to stand between her flexed legs. Kitty and Miss Hagerty both knew what to do. Each took a leg and supported it, acting as human stirrups so O’Reilly had the best possible access to the operative field.

He waited for the next contraction, slipped a finger inside, and guided one blade of the scissors into the vagina. At the contraction’s peak he sliced, cutting an episiotomy in the vaginal outlet to give the baby more room. He smelt the metallic blood smell and saw the drips falling on the carpet. Couldn’t be helped. He dropped the scissors.

Now for more waiting. It took self-control not to start tugging and pulling at the baby’s hips as soon as they appeared. “So why didn’t you like midder, Kitty?” he asked, as Miss Hagerty encouraged Gertie to push.

“It wasn’t so much I didn’t like it. I’d spent some time on the neurology and neurosurgery wards, and I just found those subjects much more fascinating.”

Interesting, O’Reilly thought, looking at her. He had always enjoyed obstetrics, might have specialized if the war hadn’t intervened. He’d always been a bit intimidated by the diseases of the nervous system. Their study was a very intellectual discipline. He smiled to himself. He’d not like to admit it, he knew, but it was probable that in some ways Kitty was smarter than him. He turned back to look at the patient. He mustn’t let his attention wander.

“Big push, Gertie,” Miss Hagerty encouraged. “Puuuussh.”

The baby’s body, its back to the mother’s right side, began to emerge and climb upward, forced by the uterine contractions and the configuration of the birth canal. He saw the lower buttock. He noted
no evidence of a swollen scrotum, so he knew it was a girl, and then both buttocks were in the open followed by the hips, the lower belly, and finally the umbilicus and the cord.

Soon it would be time to act. He waited until Miss Hagerty told Gertie once more to push.

O’Reilly used a finger and thumb to pull a loop of cord down; then he hooked one index finger into each fold between the baby’s thighs and belly, pulling gently until the hollows behind the knees appeared. He flexed the baby’s legs each in turn, and by sweeping the lower limbs outward across the baby’s trunk, he guided the legs into the open.

He took his hands away. The trunk rotated until the back faced upward. The rotation was a function of the uterine contractions forcing the widest parts of the little body into the widest parts of the birth canal. More and more of the baby’s back slipped into view, and the trunk and legs hung down toward the carpet. O’Reilly still kept his hands to himself, allowing gravity to help the uterus move the baby out.

He glanced at Miss Hagerty, who immediately put one hand on the patient’s belly to feel for the start of a contraction and to exert pressure to prevent the child’s arms extending.

He reached under the little trunk, slipped two fingers into the vagina, and found the arms crossed in front of the chest, like the stone limbs on top of the tomb of a medieval knight. In a moment he had flipped them out, and they dangled limply.

Gertie started grunting in her throat.

“Another one coming,” Miss Hagerty said. “Puuush, Gertie.”

The trickiest bit was to come. Delivery of the head. It was just about to enter the birth canal, and as soon as it did, it would compress the umbilical cord and interfere with the baby’s oxygen supply. O’Reilly had four minutes to get the head out before the child asphyxiated itself. He knew that two of those minutes must be allowed to elapse to let the head descend slowly into the narrow bony pelvis, thus protecting the soft skull and the vulnerable brain within from compressing too rapidly.

O’Reilly knew that older obstetricians favoured using their hands—one above the pubis to push, and one with fingers in the baby’s mouth and hooked around its shoulders to pull. This Wigand-Martin
manoeuver was named for the two doctors who had first described it. But a Doctor Burns had suggested a simpler method while O’Reilly was still a student, and that was the one he had been taught.

He simply allowed the baby to hang, as the infant girl was doing now, and by its own weight pull the head into the pelvis. He saw the nape of the neck appear, and he turned so he was standing with his back to the patient’s left leg. He grinned at Kitty, who was supporting the right one.

“Hard work,” she said. He wasn’t sure if she was referring to herself, to him, or to Gertie.

He concentrated on his work. Holding the child’s ankles in his right hand, he pulled gently, then lifted the legs to a vertical position above the mother’s pubis.

“Now, Doctor?” Miss Hagerty asked.

He nodded, and as the midwife started telling Gertie not to push if she could help it, O’Reilly used his left hand to put pressure on the perineum beneath the vaginal opening. The combination of that pressure and the cessation of pushes would allow him to deliver the head slowly, avoiding the risk of ripping the soft tissues of the mother.

He saw the face appear and the little mouth. He’d have sold his immortal soul for a second pair of hands. Someone should be using a suction apparatus to clear the child’s mouth and throat of mucus.

Slowly, slowly, he allowed the head to appear until finally he was holding the baby girl aloft by her heels. He used the little finger of his left hand to clean some mucus from her mouth. She screwed up her eyes, pulled air into her lungs, and gave a long high quavering howl.

“It’s a girl,” he roared, so Gertie could hear over the newborn’s noise. “A pretty wee girl.”

Miss Hagerty and Kitty flexed Gertie’s knees and set her feet on the bed.

“Phew,” Kitty remarked. “She
was
getting heavy.”

“Never mind that,” he said. “Open the clamps kit.”

In a trice, he’d clamped and cut the umbilical cord, bundled the child in a towel, and handed her off to Miss Hagerty, who in turn gave her to Gertie to hold.

O’Reilly smiled. To him there were few more satisfying sights than a mother with her healthy newborn.

He’d little time to enjoy the scene.

With a small gush of blood, the cord hanging from the vagina lengthened, and in no time the placenta was delivered, looking like a big lump of raw liver. “Give her the ergometrine, Miss Hagerty,” he said, “and would one of you ladies open the suture pack, please?” He glanced at the open episiotomy wound. “I’ve a bit of embroidery to do.”

He arched his back and pulled his shoulder blades toward each other to ease the kinks, screwed his eyes shut, and blinked. Once the suture pack was opened he removed the forceps, suture, and needle holders and began to stitch.

In what seemed like a surprisingly short time, the wound was repaired, Gertie was drinking a cup of tea Miss Hagerty had made, and Baby Gorman was wrapped up and sleeping soundly in her crib.

O’Reilly snipped the ends off the last suture, put the instruments back in their towel, stripped off his rubber gloves, and asked Kitty to undo the ties of his apron. Then he headed for the bathroom to wash his hands and cleanse his forearms of blood and vernix, the cheese-like substance that coats a newborn’s skin.

When he came back, Baby Gorman had woken and was demanding sustenance.

As Miss Hagerty carried the wee one to her mother, O’Reilly bent, retrieved his jacket, slipped it on, and moved to stand beside Kitty.

She smiled at him. “That was very well done, Fingal. I’ve seen specialist obstetricians not deliver a breech as well.”

“That’s perfectly true, Doctor O’Reilly,” Miss Hagerty said.

Normally he would have brushed off any compliment like that with a gruff rejoinder, but coming from Kitty it pleased him. He felt a warmth in his cheeks. “Thanks, Kitty. It’s a bloody good thing you both were here. I couldn’t have managed without you or Miss Hagerty.”

Kitty quickly kissed O’Reilly’s cheek. “It was a great job and I was lucky to be here. I’d almost forgotten how moving a birth can be.”

He saw her eyes glisten as she turned to gaze at Baby Gorman.
O’Reilly’s cheeks grew warmer, but fortunately Miss Hagerty was too busy supervising Gertie’s attempts to breast-feed to have noticed.

“Even if it cost you your dinner?”

“I prefer having been here with you, Fingal. We can always have dinner some other time.”

He would look forward to it. “I’ll make up the missed dinner to you, I promise,” he said, as his tummy growled. “How about next Sunday? Young Barry will be on call, so there’d be no chance we’d be interrupted like tonight.”

Kitty shook her head. “I can’t make that. I’m sorry,” she said, and she sounded disappointed. “I’ve a week’s holiday starting next Monday, the fourteenth, and I’ve promised to go down to see my mother. She’s eighty-one. She lives in Tallaght, outside Dublin.”

O’Reilly found that her not being available disappointed
him
, and he was going to be occupied or on call for the days after next Sunday. But he had an idea. “You’ll be up north next Friday week for Christmas Day, won’t you?”

“Yes.”

“How would you like to come for dinner at Number One?”

Her eyes sparkled. “I’d love to.”

O’Reilly’s stomach rumbled more loudly.

She chuckled. “You must be starving. Take me back to Number One,” she said, “and if Kinky won’t mind me using her kitchen, I’ll make us both a quick bite.”

“By God, you’re on. Give me just a minute.” He went to the bedside.

He looked down on the feeding baby and her mother. Such serenity was on Gertie’s homely face that O’Reilly immediately thought of
Madonna and Child
by Michelangelo. She smiled up at him. “Sorry we had to bother you, sir.”

“Nonsense. Isn’t it what I’m for?” He didn’t wait for an answer. “What’ll you call the wee one?”