Pregnant With Her Best Friend's Baby. Alison Roberts

No problems with pregnancy and she’s full term. Name’s Kathy Price.’

      It wasn’t Kathy who met them at the door of the house a few minutes later but her husband, Darren, who looked like he’d just come in from working on the farm. He had a checked shirt on over a pair of shorts and he dropped a pair of boots onto the veranda of the farmhouse before inviting the paramedic crew to come inside.

      ‘Dunno what all this fuss is about,’ he said, as he led them through to a bedroom. ‘I could have driven Kath in to the hospital. We don’t need all these bells and whistles.’

      ‘I think Kathy’s midwife was a bit concerned about how tired your wife was sounding,’ Joe said calmly. ‘And it is quite a drive.’

      Maggie was slipping her arms out of her backpack straps. She crouched down beside the bed.

      ‘Hi, Kathy. My name’s Maggie and that’s Joe. We’ve come to take you into hospital to have your baby on your midwife’s advice. Are you happy with that decision?’

      The exhausted-looking young woman nodded. ‘I’m just so tired,’ she whispered. ‘It’s been going on since the middle of last night.’

      ‘Your midwife checked you this morning, yes?’

      ‘Yeah...and I was two centimetres dilated at ten o’clock. She came back after lunch at one o’clock and I’d only got to four centimetres by then.’

      ‘So...’ Maggie checked her watch. ‘That’s about four hours ago now. How often are you having contractions?’

      Kathy rolled her head from side to side. ‘I’m not sure. It feels like every couple of minutes and...and it hurts. I know I said I didn’t want any pain relief in my birth plan but I didn’t know it was going to hurt this much.’

      ‘We can give you something for the pain.’ Maggie glanced at where Joe was opening their packs and readying the equipment that they might need. A birthing pack that included neonatal resuscitation items like the miniature airways and bag mask. IV gear. Their small tanks of oxygen and Entonox. ‘We’ll start with some Entonox but we’ll put a line in your hand, if you’re happy with that, so we can give you something stronger if you need it.’

      ‘He’s a big baby.’ Darren sounded proud. ‘They said that at the last scan.’

      ‘Oh?’ An alarm bell sounded a warning for Maggie. ‘How big?’

      ‘Not too big,’ Kathy said. ‘My midwife said it was below the limit for it being a problem for a home birth and we both wanted that.’

      ‘Birth’s a natural process.’ Darren nodded. ‘Why go near a hospital if you don’t have to?’

      ‘You can’t just tie a rope around a hoof and pull it out,’ Kathy snapped at her husband. ‘I’m not one of your sheep. Ow...it’s starting again.’ She dropped her head back against the pillows and groaned. ‘It hurts...and...and I feel sick...’

      Joe was right beside Maggie now. He raised an eyebrow. ‘Transition?’ he suggested quietly.

      Kathy was shaking as the contraction subsided. ‘I need to go to the toilet,’ she moaned.

      ‘It’s okay, Kathy,’ Maggie said reassuringly. ‘I think that perhaps you’re a bit closer to having your baby than we thought. I’m going to get your clothes off and see what’s happening, okay? Joe’s going to take your blood pressure and things and...’ She caught Joe’s gaze. ‘Let’s get some oxygen on, shall we? And it would be great to get a foetal heart rate.’

      ‘What’s going on?’ Darren asked as they worked over Kathy. ‘I thought you were just going to take us in to the hospital.’

      ‘That was the initial plan,’ Maggie replied as she cut clothing clear. ‘But we can’t transport Kathy if a birth is imminent. We can manage things a lot better here than in the back of a helicopter.’

      ‘Crikey...’ Darren’s face became noticeably paler. ‘It’s happening now?’ He moved to the head of the bed to lean over his wife. ‘You okay, hon?’

      ‘No...’ Kathy grabbed at his hand. ‘Where’s that gas? I can’t do this... I need to push...’

      ‘Wow...you’re crowning, Kathy.’ Maggie could see the dark whorls of damp hair on the baby’s head. ‘Your baby’s almost here... Keep pushing—you’re doing great.’

      Joe had the blood-pressure cuff wrapped around Kathy’s arm and the bulb in his hand but gave up trying to take a reading as he leaned to see what Maggie was watching.

      They both saw the moment that it happened. The baby’s head was almost born and then it pulled back like a turtle retreating into its shell.

      ‘Turtle sign,’ Maggie said very quietly. She glanced up to catch Joe’s gaze. They both knew that this had the potential to become an obstetric emergency in a very short space of time.

      ‘Don’t push any more for the moment, Kathy,’ Maggie said calmly. ‘Try and pant for the rest of this contraction. Darren? Can you take Kathy’s pillows away? We need to get her lying as flat as possible.’

      Maggie was going to hold the baby’s head and apply some gentle traction with the next contraction. Kathy was red-faced and gasping as she pushed. This time the baby’s head came a little further but then it stopped.

      ‘What’s going on?’ Darren looked fearful as he looked up from the baby to meet Maggie’s gaze. ‘Why isn’t it coming out?’

      It was an effort to keep her voice this calm, especially as Kathy started sobbing. ‘Baby’s shoulders are just a bit caught behind the bones at the bottom of Kathy’s pelvis.’

      Darren put his arms around his wife. ‘It’ll be okay, hon. These guys know what they’re doing.’

      ‘Why is this happening?’ Kathy cried. ‘After all this time and it’s been so hard...it’s not fair...’

      ‘It could be a positional thing,’ Maggie said. ‘Or maybe your baby’s a bit bigger than the scan suggested. Don’t worry, we have several ways we can help.’

      And less than five minutes in which to do so.

      Joe was right beside her and they were able to talk quietly for a few moments as Darren tried to comfort and reassure Kathy as she sobbed.

      ‘We can only spend about thirty seconds on each manoeuvre to deal with shoulder dystocia,’ Maggie said. ‘I know the protocol but I’d like to get some expert obstetric backup on the radio.’ She lowered her voice even further. ‘We need to be prepared for a neonatal resuscitation, too.’

      Joe reached for the radio clipped to his belt but he was still listening to Maggie. ‘We’ll try the McRoberts manoeuvre first. If that doesn’t work, I’ll need you to provide traction while I put on some suprapubic pressure.’

      Maggie turned to Darren. ‘Help me move Kathy down towards the end of the bed,’ she told him. ‘And, Kathy? I want you to pull your knees up to your chest and then push as hard as you can with your next contraction.’

      Even as she was encouraging Kathy to push and telling her how well she was doing, Maggie’s brain was racing through the next steps, which would mean applying pressure to try and move the baby’s shoulders both externally and then internally. If that didn’t work she would have to follow guidance from one of the consultants in the maternity wing of Wellington’s Royal Hospital. She didn’t want to have to think about the more drastic measures that might need to be taken or the risks to both baby and mother.

      Joe caught Maggie’s gaze as the sounds of the effort Kathy was putting into pushing began to fade into exhausted groans. Maggie nodded and they shifted positions, with Joe gently taking hold of the baby’s head and Maggie moving to the side of the bed where she could feel for the position of the baby’s shoulders.

      ‘You’re