Loco Parentis

The door is opened by a middle aged woman, cigarette hanging off her lips, her attitude delighting us almost as much as the smoke in our faces.

"You take this bag, and I'll bring her out in a minute!" She dumps a pink hold-all in my surprised arms, and shuts the door almost completely, leaving us in the pouring rain. The inch of artificial light shining between the door and the frame means the gap is just wide enough for us to hear our patient and her cries of pain. Our requests to be allowed in to at least see and start to assess the patient are met with defiance.

"You stay out there. I don't want your muddy boots in my house. I told you she'll be down in a minute."

The tirade changes direction and is re-aimed at the patient.

"Come on already. They're here. And you make sure that you don't have any of that gas stuff they're gonna offer you. You don't need it!"

A minute or so later, Mina appears. 18-years-old and a week overdue with her first baby, she looks just about ready to pop. She has a look about her that's a mix of excitement and anticipation, as well as fear of the unknown.

We invite Mina into the back of the ambulance, and ask her whether she'd be more comfortable sitting on the chair or lying on the trolley. She chooses the chair, and as she sits down, another contraction begins. I write the exact time down on my glove, ready to time the frequency and length of each contraction.

Her pregnancy notes suggest that all has been well for the duration, that the health of mother and baby is satisfactory, and even, from just the day before, that the baby was head down and ready to be born. Her vital signs are normal, and contractions now two minutes apart. She seems to be at the stage of labour that makes most ambulance staff nervous about a BBA, a baby Born Before Arrival at hospital, and start to think about the mess they're going to have to clean up.

I offer Mina some entonox, the magic pain relieving gas. She takes the equipment in her hand, only for her mother to snatch it away.

"I told you, you don't need that rubbish. I never had any when you were born, and you're certainly not going to have any with your baby either!"

Mina looks downtrodden.

"I'm sorry", I say to her mother, "but you're not the patient in this case. If Mina decides she wants the gas, then she is more than welcome to use it".

"You. Are not. Her mother", she spits through gritted teeth, "And you're not going to make the decisions. She's MY daughter, MY responsibility, and it's MY decision!"

"You're absolutely right, it's not my decision. But it's not yours either. It's Mina's. She's old enough to make her own decisions. If she wants to use the entonox she uses it. I understand you're almost as anxious as she is, but right now you're not the patient. Mina, would you like the gas?"

She's terrified, struggling with the conflict between the pain she's in and her mother's overbearing presence. She nods an almost imperceptible "yes", and I hand her the entonox once again, just as another contraction starts.

"Well, if she keeps using the gas, then I'm not going with her to the hospital!"

Shocked looks are exchanged between Mina, her mother, and the crew.

"That's your choice! You decide! Yes gas, no mother!"

Another contraction starts, and I tell them both that we're leaving, as this baby wants to make an entrance, sooner rather than later. Mina screams with the contraction, takes another few lungs-full of entonox, and her mother storms out the back door and back into the house.

"You do it on your own then!" she screams, as she slams the door behind her.

Mina's resolute, and tells us to go, as her partner should be at the hospital within the hour anyway.

The transport is relatively uneventful, other than the contractions strengthening and becoming more frequent, causing us to move Mina onto the trolley. Just in case. We arrive at hospital, and Mina moves across onto the delivery suite's bed. As she does so, her waters break, and a baby's head appears.

"Stay with me", she begs the two of us. We do.

A minute later, her baby boy is born, and in loco parentis we witness her joy.

"Thank you, both of you. And don't worry about my mother. She'll be up here apologising soon enough. Stubborn cow that she is."

We congratulate Mina, refuse to have our photo taken with her and the baby, and head back to the ambulance to pack away the trolley.

As we sit back in the front completing the call, a car races into the car park, its driver rushes straight past us and into the department, begging to be allowed to see her daughter.

Congratulations

You know what? I understand.

I understand that you have strong religious beliefs. And I respect that.

I understand that you have a long list of do's and don't's. And I accept that.

I understand that you'd rather not have a man deliver your baby. And I can deal with that.

But only because there happened to be a female paramedic with me.

What would you have said if there wasn't?

What would you have done?

Would you still have slammed the door in my face?

No. I don't know either.

Oh, and by the way -

Congratulations.

Skinny-mum

I hate doing it.

It's filled with the possibilities of disaster.

It frightens me half to death.

It's messy and smelly.

I really hate doing it.

So how come, every time I do, I end up grinning like a Cheshire Cat?

________________________________

Maternataxis. That's what we call them. The calls for an ambulance that the mum-to-be has had nine months in which to plan her transport, and at the last minute realises that a free taxi, even if it is bright yellow with blue flashing lights, is the cheapest taxi of all. More often than not, in fact I'd guess that in about 90% of the time, when we are called to a woman in labour, her contractions are still miles apart, and she still has hours to go. She walks on to the ambulance from home, walks off again at the hospital, and on many occasions walks out of the hospital again after a short while for another 24 hours until the baby's actually ready. Most paramedics whinge about these calls not being "proper" ambulance work. I agree to some extent, and sometimes join in the whiny chorus, but then always count my lucky stars that someone else will actually have to do the delivery bit.

This time was different. Dad-to-be was downstairs, outside the block of flats, looking pale as a sheet. "THE BABY'S BORN! THE BABY'S BORN!". Millions of expletives rush through my head as I grab four different bags of equipment and follow the dust trail he's left as he's sprinted at world record speed up to the fourth floor. Why are the proper jobs never, ever, on ground level???

Mum-to-be, Andrea, has had the sense to get in the bath. Not like the last time I went to a delivery to see the white couch and rug totally destroyed. When I say she had the sense, it was really more by luck than judgement. She'd had no contractions, still had a week until the official due-date, and her last labour lasted two whole days. So she had no forewarning as to what was about to happen. Andrea gets in the bath, and has a first contraction. Followed closely by a second. Followed very closely by a third, a push, and then a baby.

As I catch up with Dad and enter the flat, there's yet another flight of stairs until we get to Andrea. Just as I get there, baby is fully delivered, and all I've got to do is get him warmed up, breathing properly and turn him a better colour. I hand Dad the scissors and the honour of cutting the cord. Good thing it doesn't have to be a particularly surgical cut, as his hands are shaking so hard, that he almost cuts in zig-zags.

Babies born in a hurry sometimes struggle to get their breathing regulated. Part of the process of labour is to tell baby's lungs that they're about to start needing to breath air instead of amniotic fluid. If labour's only been 15 minutes, the lungs have a bit of a shock when they're exposed to the totally alien environment that's going to be home for the (un)foreseeable future. So I add a bit of oxygen to the atmosphere, and baby's colour starts to pick (or pink) up. The ambulances turn up as well, and we get ready to transfer Andrea and baby to hospital.

In the process of baby's unexpected arrival, another role has been created. That of The Big Sister. TBS is, understandably, very excited with her new job. She takes to the role like a duck to water. She may only be three years old, but she knows that while mum's gone, she has to look after everything, make sure that dad's ok, remind nan that she has to be there to help, and tell mum that she has to look after the baby during the journey, and come home soon.

Andrea is ready to go, and we head down to ambulance. A mass convoy of ambulance people all grinning like Cheshire Cats, one holding mum, one holding baby, and three holding all the kit that I dragged upstairs.

As we arrive at the ambulance, the newly-installed Big Sister is standing on the balcony, observing the scene like a member of the Royal Family standing at the front of Buckingham Palace. Just as mum's about to disappear into the ambulance, a yell from upstairs halts the procession. "MUUUUUUUUUUMMMMMMMM!!!!!"

"Yes, Big Sister..."

"MU-UM...", there's a long pause as Big Sister thinks about how to phrase it.

Mum's delight amongst the discomfort is evident.

Just in time, several other people appear on their balconies to hear Big Sister make her important announcement.

"MUM, HOPE YOU COME BACK SKINNY!!!!!"