Emergency midwife

I remember a mentor when I was a student used to say, ‘midwifery is not an emergency service’. But at 5am on Friday morning I was called by my neighbor for just that. P was in a panic because his wife K  was contracting strongly and felt her baby was coming. They had called the paramedics but 1/2 an hour later no one had arrived. Its important for the reader to know that in Spain, paramedics are really gloried taxi’s and their training leaves much to be desired. Depending on who you call, you can be dispatched a private ambulance with drivers who have no first aid training at all or one with drivers who have had very basic training and work for the public hospital.

Of course, if you come from a northern European country or the UK or even the USA, when you ring the paramedics you expect fast service with well trained individuals, this is not the case in Spain. My poor neighbors are from Northern Europe and they live here with no family support. They had planned a’ normal as possible’ hospital birth and organized a Doula to be with them at home for dilation and support, which was a great idea as this was their first baby. They were ready to labour at home for a good while before going to hospital and had planned everything out very well.

Laboring at home is a good idea and one that midwives suggest because as soon as you step through the hospital doors time is against you and interventions are more likely. So this couple had done their research and were prepared to have their hospital birth. But some times birth does not go to plan and at 4am K began contracting and at 5am she felt like pushing. The paramedics had not arrived and her lovely husband thought to ring me.

I had met K at one of my Engish speaking mothers meetings. She was very skeptical about the birthing system here and being from Germany, she was worried she would not be respected or allowed to birth normally and with out unwanted intervention. I spent time with her and gave her many contacts who could support her and her husband with their birth. She made it clear to me she did not want a home birth but did want things as normal as possible.

 As they were alone here I made an effort to stay in touch with them and they knew they could ring me if they needed anything, which was what they did this morning. I was actually awaiting a home birth client, so my bag was prepared and I was resting but fully dressed when they rang. On answering the phone I heard a very freaked out and frightened P on the other end with a screaming wife in the back ground. I quickly understood they were alone and in need of help, so I collected my bag and ran the 10 min distance from my  home to theirs.

Arriving at their building I was met by their next door neighbour who took me to their flat, as I had never been there before. Walking in I saw two very frightened paramedics, one standing and one kneeling holding the head of baby which was now out. P and K looked absolutely shocked as did the paramedic holding babies head. The standing paramedic shouted, the midwife is here! and the kneeling paramedic looked at me and asked what he should do! I quickly took his place as K told me she felt she needed to push again. I delivered baby onto mums tummy, he was very white and not making very much effort to breath. This baby was obviously very shocked at his speedy entrance into the world and needing a bit of stimulation to encourage a normal birth response.

The paramedics asked if the cord should be cut and I calmly explained to them, while drying baby and telling K to talk to her baby and greet him,that, at present the cord was babies life line. After a couple seconds I could see that baby needed a bit more than a little stimulation as he was still making very little effort to breath. I quickly asked the next door neighbour who had been watching the scene unfold, to go into my bag and give me my ampu bag and mask. Luckl,y she was very together and followed direction quickly and well. Giving the baby 2 sets of inflation breaths helped him to clear the fluid from his lungs and her began to cry and breath normally.

While this was happening another set of paramedics arrived looking as dumbfounded as the first pair. One even started saying how he knew nothing about pediatric resuscitation and was glad I was there, as was I. A few moments later the cord stopped pulsing and I cut it so that the mother could hold baby skin to skin more comfortably. After checking babies heart rate and respiration a 3rd time and feeling mums uterus was contracting normally, the paramedics took mum and baby to the ambulance and to the hospital, where placenta was delivered and baby began breast feeding like a dream. All is well that ends well.

One hour and a half after the call I was back in my front room. It all seemed like a strange dream, and as I explained what had happened to my mother who had woken up when I left, I felt a strange since of fear and sadness. What if they had not rung me? What if left to their own devices the paramedics had cut the cord and separated mother from baby. With no neonatal resus skills, what would have happened to this lovely family? I felt proud of my work but frightened that I would be reported by the paramedics for attending a birth call at home. Its not illegal in Spain but its not exactly legal either. My home birth clients are required to sign a contract of care so that they assume responsibility for their birth and for their choice to have us assist them, but this was not the case with P adn K.

This was also, my first experience with the emergency services in Spain. I had been told they were not very reliable and that we never ring them if we need to transfer to hospital because they can cause more harm than good. I now understand this to be very true. Their lack of training was shocking and their inability to instill calm in a situation that demanded cool heads all round, was disheartening.  In the end I found myself feeling, not grateful that I was able to support this family but very depressed that things had happened in the way they had.

P and K felt that I had saved them and their babies life, but what I did was what I was trained to do. I was glad to be there but saddened by the dangerous inability of the paramedic team.

Ahh well, I do love ‘Call the midwife’, the book and the series and for a moment there I felt like an old time midwife being called on an emergency birth. Maybe I should get a bike just in case