Hands off the breech

'The baby’s breech, come quickly.' The midwife’s voice was sharp and squeaky. She had already hung up the phone. My head, muddled with sleep, began to pound. I staggered out of bed, stripped off my pyjamas and dragged on an old shirt and jeans, pulling my straggly hair into a rough ponytail. I grabbed my jacket on the way out the door.

Outside, the mist enveloped me in stillness. An early morning frost had coated the windscreen with ice. I scraped it with my hand, but it was stuck tight. I turned the car’s heater on full, put the windscreen wipers on to maximum and pulled out of the driveway. With my head out the window, I could just negotiate my way between the gum trees lining the road. The mist swirled kaleidoscopically in the headlight beams. My eyes began to water, and I wiped them with fingers numb from the cold. As I finally reached the highway, I pushed down harder on the accelerator, trying not to spin my tyres on the icy bitumen.

In the birth room of the tiny rural hospital, Matildhe was emitting short, low moans in between loud pants. Julie had got Matildhe’s legs up in stirrups, but she was lopsided on the bed. I pulled her buttocks to straighten her up. I noticed my hands were shaking as I took up position between Matildhe’s legs. She smiled briefly at me with her mouth but her eyes were fixed on the wall behind me.

The baby’s buttocks were visible, with thick bottle-green meconium oozing out of the anus. There was no one else to call for help; the other GP in town was on holiday. Julie was the only nurse on duty for our small country hospital, and this baby was coming soon. Julie was an experienced midwife but I doubted she had delivered many vaginal breech babies in the past 20 years or so. The only breech birth I’d ever seen was when I’d been called in to observe as a medical student; I had been one of twenty or so people in the room. I shuddered.

'You can push, Matildhe,' I said, trying to stop my voice from trembling. My mind was a muddy puddle. My eyes were fixed solely on Matildhe’s perineum; everything in my peripheral vision was blackness. I could hear Julie murmuring words of encouragement to Matildhe, but I couldn’t see her.

Phrases came to me from deep within, the voices of professors and tutors long gone:

Hands off the breech

Keep the back up

Let the body hang when you see the nape of the neck

I heard each of these slowly and clearly intoned in a deep and authoritative voice. I uncurled my thumbs from where I was clenching them under my fingers.

Matildhe continued to pant and moan as I coaxed her through the birth. I followed the voices in my head, leaving my hands off except to assist the delivery of the baby’s arms, and ensuring its back was uppermost in the birth canal. At one point, I heard Julie murmur to me, 'I can’t find the heartbeat,' as Matildhe pushed, shrieking.

I clamped my teeth together, biting down hard. I now held the baby’s legs in my hands, with its head still inside Matildhe. Its blue feet hung down limply over my wrists, lolling to each side.

'Come on,' I said to Matildhe. 'Another push.' I placed forceps on the baby’s head, but an image came to me of a different manoeuvre I remembered from the textbooks. I placed my hand tightly over the baby’s face, my middle finger in its little mouth, my ring and index fingers on its cheeks. 'Come on baby,' I cried.

Finally the baby’s head slipped free of Matildhe’s vagina. I held it in my hands, willing it to take a breath.

'We have to take your baby for a bit of breathing help,' I said to Matildhe. She nodded, her eyes closed, her face still. The baby was cold in my hands and rapidly turning white. I wiped it down with a towel and began the resuscitation. My hands were shiny with sweat and vernix; it was hard to get a good seal on the facemask.

'Is Matildhe okay?' I called to Julie.

'Bit of bleeding over here,' Julie replied. 'Can I give some extra oxytocin?'

I took a shallow breath before I began to bark orders at Julie for more drugs.

'Your baby’s a bit flat,' I said gently to Matildhe as I continued the resuscitation. I had already started pumping the baby’s tiny chest with my index and middle fingers, trying not to break its ribs as I pressed down quickly, again and again.

With the ventilation mask slipping off the baby’s tiny face with every puff of oxygen, I grabbed a small tube to insert into its lungs. My hands were shaking so much, it was hard to hold the baby’s head still to see the vocal cords. I tried once, twice, three times. Each time, the baby’s chest failed to rise as I pumped oxygen down the tube. I tried for a fourth time. My fingers felt numb. My chest was heavy. I could feel Matildhe’s eyes on us. Please, I willed. Finally, the tube was through the cords.

Something shifted in the room. A flick of the baby’s eyelid. A slight movement of a tiny fingernail against the resuscitation cot. The baby had a heartbeat again.

'The bleeding’s slowing,' called Julie. “Matildhe’s blood pressure is holding and her pulse is settling.” I breathed out the air I’d been holding in tight against my heart.

'You have a baby boy,' I said finally to Matildhe. She smiled.

'Will he be okay?' she asked, craning her head towards the resuscitation cot.

“We need to wait”, I said quietly. 'But he’s okay for now.'

At the nurses’ station, I struggled to write my notes. Despite the blood pumping hard through my arteries at my wrist, the pen wouldn’t move on the page and my sentences didn’t make sense. I found myself staring into space on several occasions. The retrieval team were kind on the phone, asking me to repeat myself over and over. They said it would be three hours until they arrived. I paced back along the long, empty corridor to the birth room, with the sound of my footsteps bouncing off the sterile walls.

Matildhe was cradling her son’s head in her hands. He was lying peacefully. 'Thank you,' she said. 'Thank you for everything.'

As I walked outside the hospital entrance into the morning, the air opened up around me. The sun was shining through the clouds, sending rays of light high into the sky. Magpies cawed to each other across the bitumen.

The window of my car was still open. I wound it up and drove home, watching the sunlight dance over the defrosting ice crystals on the windscreen.

Hands off the breech was the winner of the 2012 MJA Dr Eric Dark Creative Writing Prize and was published in The Medical Journal of Australia.