Choices

There is a recurring conversation that I have with people when talking about my job. It normally starts with a "I couldn't do your job..." with infills of "I don't know how you do it..." and "don't you get scared..." or "how do you sleep at night?" etc etc. My stock answer is something like "Ha! It's fine, things don't really effect me..." with side notes of "I disassociate myself from the patients..." and "I get into a zone and don't really think about it..." etc etc. You see the pattern!

The fact is, most of what I say is true. At the end of most shifts I've completely forgotten about the patients at the start. If someone has a horrific injury, a do what I have to do to it, cover it and move on. If I'm faced with a combustible situation where I might be vulnerable I tend not to think about the what ifs. Instead I focus keeping everything calm. These situations are no place for fear. That said I am by no means immune to feelings of fear, dread, guilt and nausea! We all are, everyone who works for the ambulance service has those jobs which have effected them, or those situations they fear being part of. They differ from person to person and we each react differently when faced with them.

For me, I don't like to see sick, dying or dead children, and it's fair to say that that is across the board, the same for everyone. My greatest is fear in this job is watching someone die and being powerless to stop it. I know it happens but it is an isolated, helpless feeling, especially when you're on your own. Finally, a situation I would have been happy to avoid my entire career, was being the person who has to make a decision between who lives and who dies, when faced with that choice. You can imagine what kind of day I was having, when all three of my fears came to fruition in one job.

"30 year old female, in labour, contractions 1 minute apart."

Not an ideal start to the shift if I'm honest. Early jobs tend to have longer waits for ambulances due to shift change over time, and the prospect of having to deliver a baby on my own is not one I cherish If I'm honest! It is what it is though, I'd have to suck it up and see! 

I grabbed EVERYTHING I could possibly need and headed in through the open door. The patient was on all fours, mid contraction. I started with some history taking and started making a note of times. With women in labour you have to work out if it will be a home birth or hospital birth. At all costs, you want to avoid delivering on an ambulance! They are cold, impractical and dirty! It became apparent pretty quickly, that without an ambulance and the quick fire contractions, that I would be taking on the role of midwife imminently. Balls!!!

I quickly set up a baby resuscitation area just in case! It's something I was taught by a very wise paramedic a long time ago, and I have stuck with it. If things go south, I don't want to be scrambling to find kit, so everything that I would possibly be needed was laid out, opened and ready! Then there was mum! I made a snap decision to cannulate her prior to delivery. I don't know why, it's not something I normally do, but again, with no ambulance I wanted to cover all bases, just in case! 

Anyway, cannula in, everything set up, examination complete and we were ready. She started crowning about five minutes later! I just about had time to update control that birth was imminent and I would require an ambulance as quick as possible, before the head appeared. My relief at seeing the head was short lived. It quickly became apparent that something was wrong. Very bloody wrong. The cord was wrapped around the babies neck. Shivers ran down my spine and I'm sure that all the blood trained from my face. Inside I was panicking. I had never delivered a baby with a cord around it's neck and I wasn't entirely convinced I knew what to do. Well, I knew I had to get cord off the neck, but we were limited in what we were taught on our two days maternity training! She carried on pushing during contractions and after what seemed like an eternity (probably 1 minute) we made enough progress that I could loosen the cord and finish the delivery. 

With baby out and mum overjoyed I started drying and rubbing the little boy. I just wanted him to make that first cry. The first 10 seconds or so are pretty relaxed, the next 10 are a little anxious and by 30 seconds I'm starting to get a little desperate.

"Why isn't he crying, is something wrong?"

Her joy quickly led to desperation. I clamped and cut the cord and moved him over to where all the equipment was waiting. I laid him down on blanket and started ventilating him. This was my worst nightmare. Or so I thought....

"Some thing's wrong, I'm bleeding." she said.

I turned my head slightly and my heart sank. She was having a huge post-partum hemorrhage. It was literally like a bucket of blood had just been poured on the floor and it just kept coming. If I didn't stop the bleeding, she would die, plain and simple. If I didn't work on the baby and get him breathing, he would die, plain and simple. How do you make the choice? It's one I had to make on my own and I could see no way out of this mess. 

I tried to advise mum of what she could do whilst I ventilated the baby. She wouldn't listen, her only concern was why her baby wasn't crying and that kind of made my decision for me. I started listening to heart sounds and when I heard them it was a huge weight off my shoulder. In my head I was screaming 'breathe' over and over again. I managed to hold down the button on my radio long enough to shout exactly what was happening. I couldn't begin to tell you what the reply was because after a slight wriggle, this tiny little boy let out the most amazing cry! 

I turned to the mum, and saw the relief of her pale face, just as she begun to lose consciousness. I wrapped the baby in a towel, left him on the blanket and started a uterine massage on mum. Again, i'd been told what to do years ago but I'd never actually done it! I was kneeling in what felt like a swimming pool of blood. I grabbed my drugs and started drawing up the Syntometrine to stop the bleeding when I heard the door go and a 'Hello?!' in the corridor.

"In here!" I shouted.

Just like London Buses, two crews arrived at once! Thank god! The face of them when they walked in was an absolute treat. Then again, I'm sure my face told a fairly good story. A crying baby on a towel next to resus equipment, an unconscious naked woman in a huge pool of blood and me on my knees amongst it all presumably looking like crap. A hive of activity ensued, fluids were drawn up, drugs given, baby cleaned, wrapped and looked after and we got mum out to the ambulance. 

There was no time to take stock of what the hell was going on. We put in our pre-alert and all headed off in convoy to the nearest maternity unit. The bleeding had stopped but she had lost A LOT of blood. In truth the second I heard the crying of the baby it didn't really get another thought from me. It's easy to compartmentalise patients into fixed and not fixed. Through jobs like this, priorities change. I couldn't stop thinking about whether the mum would ever get to hold her baby. I found myself daydreaming about the 'what ifs' that I don't normally entertain. I also, quite predictably started asking myself if I had made the correct decision. Did I ignore the bleeding too long? Did I chose right? Only time would tell. In situations like this are there ever correct decisions? 

We got to the hospital and handed over. The midwife looked me up and down. 

"Well done, now go get yourself a tea!"

I don't even really like tea, but it's the done thing when chaos ensues. I sat in the blood bath of that ambulance and just starred at the wall. I could feel my hands shaking as the adrenaline continued to rush through my body. What a start to the day! Only 10 hours to go until home time.....

"It's fine, things don't really effect me, I disassociate myself from the patients and I get into a zone and don't really think about it."

Well, we all have very effective barriers we use from time to time.

*                   *                    *

Two days later I found out that despite losing half of her blood volume, mum survived and baby was absolutely fine. And THAT is how I can do my job. There is no better feeling than finding out news like that. At least now I 'know' what to do! Ish!

Maternity Woes

"32 year old female, heavy bleed, contractions every 1-2 minutes"

What a way to start the shift! A materni-taxi! *grumble grumble* Being in labour is not a medical emergency. All other species successfully go through the process without the need for an ambulance and in general, us humans should be no different. Sometimes an expectant mother is caught completely unaware and is suddenly having an urge to push on her living room floor. Others have genuine high risk pregnancies and may need rapid transportation to a maternity unit. These are a rarity though. In my time in the ambulance service I have seen roughly 10,000 patients. Of those, I have delivered 13 babies. The number of women I have driven to a maternity unit because they had a contraction or their waters broke runs into the 100s. There is no need for it. Get a lift, get a taxi, don't call 999 as your first port of call! 25p a week during a pregnancy will leave you enough for a cab, FYI! Most don't even bother phoning their maternity unit first which is just infuriating! On route to the address I had a similar rant to my poor crew mate but managed to enter the house all smiles and laughter! 

The patient was 40/40 weeks pregnant and remarkably, today was her due date. Her waters hadn't broken and despite what she had told the call taker, her contractions appeared to be every 8-9 minutes, if that. She hadn't phoned the maternity unit and hadn't considered getting her husband or any of the other 12 adults in the house to drive her to the hospital, in one of 5 cars parked on the over-sized driveway. Yet still I smiled!

"Have you got your maternity notes?"

"Yes, why?"

"So I can phone the labour ward and see if they want you to go in."

"I'm going in. I'm bleeding."

My crew mate took the lady to the bathroom whilst I flicked through the notes. When they returned it was confirmed that she had had a 'show'. Perfectly normal in the early stages of labour. (Actually, what my crew mate said to me privately was that she would probably be able to yield more blood from a medium sized spot!) Perfectly normal in the early stages ofabour. We did her blood pressure and all the other observations that we do. All were absolutely fine so I phoned the labour ward.

"Hello there, my name's Ella, I'm a paramedic from the ambulance service, I'm with one of your patients at the moment."

"Hello dear, what's the problem."

"Normal labour, full term, water intact, had a show, contractions every 8-9 minutes lasting about 15-20 seconds, all her OBs are normal."

"So why has she phoned an ambulance?! Tell her to stay at home and make her own way here when contractions are every 2 minutes. We are full at the moment so there is no room at the inn!"

"Okey dokey, will pass that on, thank you!"

I relayed the message to the patient and her expectant relatives. 

"No, I want to go in."

"Well the midwife doesn't want you in yet so we won't be taking you there."

"Yes you will, I phoned an ambulance and I want you to take me in, you can't refuse me."

"I'm afraid we can. I have referred you to the midwife who has told us not to bring you in and you're to make your own way when contractions are every two minutes."

The argument continued for a number of minutes whilst I wrote up my paperwork. They became extremely rude and were livid with us. Don't shoot the messenger! Eventually, through polite smiles we left. Unsurprisingly she refused to sign our paperwork. Another happy customer! Another life saved! 

We headed off into the night and my indignant rant continued! We were sent to a drunk on a bus a few miles away so I could turn my mood to bus drivers! A few moments later we received a call from control.

"We've got a call from the patient you just left, she's now in a car around the corner from where you were saying that you refused to take her to hospital despite bleeding. Any other info, over."

"She's in normal labour, the bleeding was a show, contractions are 8-9 minutes apart and the maternity unit is full. The midwife told us not to take her in and told her to make her own way when contractions are every 2 minutes. Over"

"Rog, unfortunately because of the symptoms she is describing and the fact she is now in a public place we are having to send another ambulance. I'll let the crew know what you've told me."

What is wrong with people?! She's now in a car. The hospital is less than two miles away and she's phoning another ambulance because she's in labour! And she's getting another ambulance! I was seething. How can people play the system like this and win?! It is total madness. Being in labour isn't an emergency, it's a part of life! Why do some woman think that an ambulance is the only answer?! And why can't we charge if we are simply being used as a taxi?! Crazy! 

Size Matters

"33 year old female, in labour, birth imminent"

Over the past five or so years without meaning to, I seem to have become the ambulance services resident midwife. That isn't an actual, official or even recognised title, it's one I have made up. I have done so because for most ambulance staff, delivering 1 or 2 babies in a 5 year period is about normal. Some have never actually delivered one, other have done more. I however have now delivered 12, including twins, a shoulder dystocia and breech delivery. That in itself is more than the requirement to qualify as a registrar midwife, and was all done without a hospital as backup and using the 'improvise, adapt and overcome' work ethic! (I was told this by the midwife that trains us! Apparently a registrar midwife needs to have done 'X' about of births including twins, shoulder dystocia and breach!)

I think that's what we pride ourselves on in the ambulance service. We have plenty of shortcomings when it comes to clinical knowledge and ability, compared to that of specialist resus teams, midwives, trauma doctors, nurses and GPs but what we do have is an ability to adapt to any situation, be it someone stuck under a train or someone giving birth in the back of a taxi! We generally don't get phased and can make the best of a bad situation.    

Tonight, it became apparent we had logistical problems! We were dispatched to the 'in labour' and after driving for 9 miles we pulled up at the location which had been given with extra details of 'by the park and the school'. We were on the road we were supposed to be on, next to a school and a small park and we were parked at the exact point on the map that the sat nav was saying we should be. The only problem was there was no block of flats or building to match the name we had. 

"Red base, we are at the location but there is no sign of the building, could you call back with some more location information, over"

"Rog, will do, standby, over"

2 or 3 minutes past by so we got all the maternity stuff together waiting for them to call back. Eventually we got a message on our screen.

'UPDATE: Patient states they are in the orange block of flats next to the school'

How helpful.....

"Red base, we are parked by the school, there are no buildings or blocks of flats, let alone an orange one."

"Rog, will give it another ring back"

5 minutes later.....

'UPDATE: Patient states they are in the large orange block of flats.'

Really?!

"Red base, THERE IS NO BLOCK OF FLATS IN SIGHT! We have driven on all the local roads and up and down the length of this road, there are no blocks of flats"

"Rog, standby....."

7 minutes of area searching and frustration followed....

'UPDATE: Patient states they are in the huge orange block of flats next to the school, apparently you can't miss it.'

*counts to 10*

I'm never one for being rude to, or about control staff. They are bound by algorithms when taking a call and cannot deviate. 99% of the time the dispatchers and allocators are polite and helpful. However, I was getting a bit fed up with having the same conversation over and over again.

"Red base, there is no normal size, large or huge orange building, or any other building that could be flats in a half mile radius of our location. I need another road name or the patients partner or someone will have to come to us and direct us, we have been lost here for 20 minutes now!"

"..................Rog, standby......"

STANDBY! WHAT DO YOU THINK WE'VE BEEN DOING?!

*counts to 10 again*

I get it, some patients are bad at giving directions! However, if you have a crew saying there is no block of flats anywhere near, changing the size from normal, to large, to huge isn't going to change anything! What was the next plan?! Ginormous, Mahoosive, Monstrous?! 'Oh sorry, we found it now, we didn't realise you meant the Monstrous Orange building, silly us'. NO! We need a better location, because quite frankly, there could be a baby stuck in our patients vagina and we are STANDING BY!

'UPDATE: Drive down the road you are on, patients husband will meet you outside, hazard lights are flashing on his car"

Off we went, down the road, no hazard lights nearby. We drove, and drove and drove. After just over a mile we saw hazard lights in the distance. Waving frantically was the hubby. There was no school, no park and the block of flats was averagely sized. Oh, and it was yellow, not orange! He rushed inside and we followed. As I turned the corner into the bathroom, I was presented with a crowning vagina! Within 30 seconds I was holding a crying baby boy! Dad cut the cord, everyone was smiles, photos were taken and they were both taken into hospital. 

Another job jobbed.....!

Not Viable

"31 year old female, in labour"

People say that they attract a certain type of job. Some are trauma junkies, some are shit shovels, some get mental health and some get nasty RTCs. I think I get a nice mix, but if I had to pick one type of job I get more than most it would be maternity. This can be a good thing, with the bringing life into the world part, but equally it has its downsides. When things go wrong there is no greater fear or feeling of helplessness. On this particular day we were sat at the roadside filling in paperwork from a job that was a complete waste of time. Over the radio control did a broadcast asking for an ambulance for a woman in labour at 23 weeks. We were only two minutes away so offered up for it and left our paperwork for another time. On route we got an update:

"Patient is 23/40 pregnant, PV bleed, having contractions every minute, can hear patient screaming in background, husband on scene, access OK"

I have dealt with miscarriages before and they are not pleasant. I can only begin to imagine the emotional pain that it causes beyond our involvement, but from my point of view they are one of the hardest jobs to deal with. Have a read of this blog, 'Darling Iris' by Bookworm Mummy to try and understand the immediate and lasting pains miscarriage brings. Death and loss is always tough, but in children and babies it feels ten times as bad. The high emotion and grief is an added thing to deal with on top of your patient's condition. All we could hope for was that this call was not as given; I wasn't full of optimism though.

We pulled up to the house; an extremely anxious looking husband was standing at the kerb side waving frantically. We jumped out and grabbed the usual plethora of bags.

"Quickly, please, this is too early, please help us"

There was a distressing, desperate tone to his voice. Normally requests to make me move quicker are futile but there are also times where the seriousness of a situation is paramount and warrants an ambulance 'run'. I headed in to the house and up the stairs. In the bathroom was our patient. Within a couple of seconds it was clear she was going to give birth. In all honesty I was scared. There was a weight of expectation on us do something; anything. I know my resus guidelines but I also know none of our kit, even masks, will fit a 23 week old foetus. At 23 weeks, for all intent and purposes, it's a baby. They are in proportion; they have finger prints, fully formed limbs and a face. 24 weeks is the point a pregnancy becomes 'viable'; such a horrible turn of phrase and one I hate to use but maternity units need a number. Being that she would be 24 weeks in 2 days we acted as such. Another contraction began and any hope I had that this job wouldn't be as I feared dissolved. Two contractions later the baby was born. 

No longer than a ruler from crown to toe, was a little baby girl. We cut the cord and laid her on a blanket. For maybe 10-20 seconds she was making respiratory effort but that soon stopped.

"Do something, do something, please, save our baby", the mother wept.

I started CPR with my index finger, I knew it was futile but I couldn't be seen to be doing nothing. And was it pointless? I don't really know. If 24 weeks is 'viable' then 23 + 5 is too. I told her we would take her daughter straight to hospital and another ambulance would take her. It wasn't an easy decision to make but 2 of us could not get both the mother and baby downstairs while doing CPR. The second ambulance arrived as I scooped up the baby and headed to the ambulance. I passed the other crew in the hallway, doing CPR as I walked. My crew mate gave a brief handover and we left. Holding an oxygen mask just over her face we travelled through the traffic. I felt strangely alone in the back of the ambulance; it was shaking quite a lot, the muffled sound of the sirens clearly audible and a very clear noise of the engine screaming. All the while I was staring at this tiny baby, trying to keep it alive. Realistically I knew my efforts were ineffectual but in a pre-hospital setting sometimes you have to do things for the sake of relatives. In this case I was probably doing it for me also. The distraction of being task-focused takes you away from the reality of what is happening around you. It's much easier to say 'it's just part of the job' if you are actively trying.

We pulled up at the hospital and ran in. There was a small team of people waiting for us and I gave the handover as I placed her on the bed. A few moments later the doctor decided to terminate the resuscitation. His rationale? Not viable; there are those words again, so scientific and detached, but I suppose it has to be. Yes, 24 weeks is viable but only in a controlled environment with everything at hand to keep the baby alive. Born in a bathroom, without proper oxygen for 13 minutes and without the expertise of a hospital she didn't stand a chance. I knew that they thought I shouldn't have started, but they have the knowledge and job title to be able to make that decision; I don't. I had a distraught mother and father begging me to try and save their baby and I would make the same decision again. Minutes later the mother arrived. She knew without being told. We shared a look from opposite ends of the corridor. No words were needed. Nothing could be said to make the situation anything other than what it was. I left the department and went back to the ambulance where my crew mate was waiting. He puffed out his cheeks and exhaled slowly. I just nodded.

Blood and Guts

"32 year old female, in labour, 4th child"

When people think of an ambulance they think of blue lights, blood and guts! It's all drama, all Holby City, very Casualty, we climb scaffolding, there are regular explosions and everyone who goes into cardiac arrest is shocked with pads and we get them back. Oh and the helicopter is always there. In reality however there is none of that. There are a lot of drunks, a fair amount of vomit, minimal blood and guts and we rarely get people back to discharge. Oh and the helicopter is never there! Don't get me wrong, there are stabbings, shootings, major trauma and all the things you see on TV but they are few and far between. Today however was one of those 'good days' I often speak about  with 'good jobs'. When we talk about 'good jobs' someone somewhere is either dead or in a lot of pain, life & death is on the line or it is something we have never seen before and probably won't again. To get one in a shift is a rarity. To get two is frickin' awesome!

It was a short shift for a change, we had hadn't done much to be honest, a couple of non-descript bread and butter jobs when this 'in labour' job came down. Normally it is simply a case of get them on the ambulance and pop them off to their maternity unit, hence the tag 'maternitaxi'! The "4th child" rang alarm bells as more often than not, delivery can occur much quicker after a number of children. Then we got the following update:

'4th child. Last 3 have been delivered within 20 minutes of waters breaking. Waters have broken'

OK, so there was a good chance that today I would be playing the role of midwife. We pulled up on scene and grabbed everything and I mean everything; response bag, oxygen bag, entonox bag, paramedic bag, lifepack 12, maternity pack & loads of inco pads. Loaded up like pack horses we trundled in. Sitting on the floor, legs akimbo was our patient....screaming! I waited the 20 seconds until the contraction had passed and introduced myself. No soon as I had done that and off she went again. This baby was being delivered, by me, anytime now. During the following contraction out came the head, followed closely by the rest during the next one! Jobs a good'un! We cut the cord, cleaned up baby and sat back while they shared their first few moments together. The squeamish dad who had been hiding in the hallway came bounding in when the crying started. It's one of the few moments in this job where you can sit back and smile.

Sadly, that moment didn't last long. It became clear that the blood bath on the floor was increasing, she was having a post-partum haemorrhage; so we gave baby to dad and started trying to stop it! She was looking a little pale and in just two minutes her blood pressure had markedly dropped. My crew mate got IV access while I gave a Fundal massage to assist the uterus clamping down and stop the bleeding. Unfortunately it didn't help. We requested a second ambulance and started putting up fluids and administering Syntometrine to contract the uterus. The second crew arrived and fetched our bed from the truck. In cases like this, although a second ambulance seems overkill, we don't want to have to worry about a newborn baby if something goes wrong with mum en route. Similarly we don't want to ignore mum if something is wrong with baby. Two patients, two trucks! Simple! We loaded mum onto the truck, still bleeding heavily, and shot off on blue lights. We arrived at the hospital and left our patient with the doctors and we went to clean up! And oh my, there was a mess!

Having taken the short journey back to the station, to change our uniform and mop out the truck, we made ourselves available for one last job. Annoyingly, we sat there for 20 minutes without a peep coming from our radios so being late off was now a certainty! At last the telling ringing came blaring down our radios!

"30 year old female, had C-section stitches removed today, now bleeding"

Hmmm... like I've said before, jobs tend to follow a pattern in a shift. Clearly maternity and blood was the order of the day. We were only about two minutes away so were there before the call had even finished. As impressive as this was in terms of image for the service, it meant we walked in without the full picture. We went in with the bags we normally take in, nothing extra; what we were confronted with I can safely say I will never forget...

Our patient was sat calmly on the sofa, smiling sweetly and topless. Oh... I should probably point out that her intestines were sitting on her lap. Yep... intestines... on her lap. Her intestines were on her frickin' lap. I starred for a moment and looked at my crew mate for inspiration! 

"Well that's not normal is it?!"

This is not in the book. We have not had specific training on 'intestines on lap' per say but we are trained to improvise, adapt and overcome. My crew mate RAN off to the truck for fluids and extensive wound dressings. After some crashing and banging he appeared with a bed too! How he got it up the three steps on his own I don't know but it was a stellar effort. We soaked a dressing with saline and placed it gently over her 'eviscerated bowel'. I believe that is the technical term for 'guts on lap'! She wasn't in pain; apparently it felt like butterflies in her tummy. She had the stitches removed a few hours ago and the wound started oozing, she then stood up and felt a sharp pain, sat back down, had a peek and phoned 999. Very sensible! In all honesty we really didn't have a clue what we were doing but we blagged it pretty well; after all we wanted a 'good job'! It really is true that life begins outside of your comfort zone!

We rushed off on blue lights having got fluids flowing. We assumed fluids were a good call! 'Intestines on lap' wasn't an indication but was good enough for us. On arrival at the hospital every HCA, nurse, student, junior doctor, registrar, anaesthetist and consultant was waiting. The blue call of '30 year old female with eviscerated bowel, intestines on lap' must have got people talking. No real handover was needed. I lifted up the dressing and said 'she's got tummy ache'! It got a laugh so I left the department sporting a cocky grin! It appears that this job really is all about blood and guts! Home time!

Heads up

"33 year old female, abdo pain"

Bore! OK, not the enthusiasm that should be expected for a potentially life threatening emergency call but in my experience, 95% of 30 year old females with abdo pain are either on their period, about to start their period or have a non-acute common stomach problem.  We headed off with no other information than that, working our way through the busy London rush hour traffic. The rush hour brings out the worst in drivers, not a moment passes without hearing a horn pressed in anger or an angry swerve to stop someone pulling into the line of traffic. Despite the blues and twos progress was slow so the 2 mile journey took us almost 10 minutes. We pulled up outside the house. We'd spent the journey driving through some of the worst parts of east London I've seen but had ended in up in a rather quaint cul-de-sac with a collection of grand Victorian properties. We grabbed our bags and headed up the garden path. As we rang the bell our radio vibrated violently. This is the message that appeared:

"Called states he thinks the head is showing"

What head and why in god's name is it showing? This isn't what we signed up to! Talk about being unprepared. As the door swung open my crew mate run off back down the garden path to grab the Entonox, PALS kit, paramedic bag and maternity packs. He also called up EOC to hurl abuse about the apparent breakdown in communication and request a second crew. BBA's generally have a second crew dispatched as standard in case both mother and baby need taking to hospital. Whilst all that was going on I went in to meet our patient and 'the head'. I'd been let in by the mother-in-law who told be Kate had been in labour for only 45 minutes. I entered the living room to find her propped up by the sofa, naked and legs akimbo. Her husband who was crouched down by her feet gave me a look of sheer joy and relief! Relief that delivering the baby was no longer his responsibility. Nope! It was mine! Obviously I felt prepared, I mean it was only 2 years ago that I did my 2 day course on maternity.......! Eek! Her husband stepped aside, frantically telling the LAS call taker that the crew had arrived, and I knelt down and introduced myself. 

"Hi Kate, I'm Ella, fill me in on what's been happening"

"Here comes another one..."

I looked down and out came a head. I had no gloves on, no maternity pack, nothing of any use. I reached for my gloves but it was too late, she pushed with the contraction and out she came. It was a good catch if I say so myself! On cue my crew mate burst through the door clutching the entire contents of the ambulance but dropped everything in disappointment when he saw me holding a baby. He'd never delivered one, nor seen one being delivered but nature waits for no one. He clamped the chord and I passed the baby to mum. She was crying, the baby was crying and when I asked dad to cut the chord he started crying. It was a very touching moment. With all the death, destruction, drunks and disease we see it's so refreshing to bring an innocent life into the world. It's a feeling I can't really describe. This lovely couple had just become a family and we were privileged enough to be there for that moment.

After a few minutes I took the baby from mum, put a nappy and clothes on and wrapped her up in a blanket while my crew mate phoned for a midwife. Baby was fine, mum was fine, dad was a wreck and we were beaming. 

"Have you decided on a name yet? Because if you haven't Ella is a lovely name!"

Luckily my suggestion was met with laughter rather than disdain!

"Yes we have, we are going to call her Olivia"

Not as good as Ella I thought to myself! BBA's are not only a lovely job because you are delivering a baby but they take ages! Ages spent in the warm, nowhere near violent drunks. Free of pressure from control and free to just sit there drinking tea and eating the biscuits provided by the moth-in-law! Result! We sat there for 40 minutes, chatting about their lives and ours.

"How many babies have you delivered?" she said to me.

"One!"

"Really?! This was your first?! What about you?" she said to my crew mate.

"None!"

"So neither of you had ever delivered a baby?!"

"Nope!"

Luckily this awkward conversation was interrupted by the delivering of the placenta, and that, I assure you, was gross! Within a few minutes the midwife arrived, delivered by an FRU. We left them to it, not before we were forced to smile in photos and get hugs from all! Had having my photo taken at work! 

It was a great job, one I'll never forget but that aside, the fact neither of us had delivered a baby before scared me. So many 'What ifs?' passed through my mind. What if it was breach? What is it didn't start crying? When if there was a hemorrhage? What if the cord was round the neck? I don't think a two day theory only lecture on maternity is enough and if the public were aware I'm sure they'd agree.  That fact we walk in to someones house dressed in green carrying all the kit in the world fills people with confidence. There is an assumption we know what we are doing and can deal with anything and if we act and sound like we do that illusion can continue. I can assure you, inside I'm a wreck when I'm out of my comfort zone! Unfortunately there are no funds for placements in maternity units so for now we'll continue to improvise, adapt and overcome. At least now I know what I'm doing.........

Materni-taxis

Ok, this may be a contentious issue and I don't mean to cause offence, but this is not just coming from the 'me' who works on ambulances. My opinion is partly geography biased, being in a city no one is ever more than 3 miles from a hospital, this means no one is ever more than a £6 taxi journey to a hospital, and this is where my frustration comes from. I fully understand that if you live in the middle of the countryside, 45 minutes from the hospital with no means of transport then yes, an ambulance is totally appropriate, but in the city I am sure any pregnant woman could save the cab fare over a 9 month period. By all means, call an ambulance if you need one but a contraction, waters breaking or a 'show' is not, and will not, ever be an 'emergency'! Please read this post in the spirit in which it is meant, an ambulance girl fed up with playing 'taxi' to expectant mothers whose partner follows in the car and lives 400 yards from hospital! If you need us, call us!


“27 year old female. In Labour”

So what! It’s an all too common job. A woman in labour calls an ambulance for a lift to hospital. She isn’t ill, she isn’t dying, she is going to give birth. Giving birth of a function of nature, thats’s what we do. Women have been giving birth since time began and I can assure you, that was long before the invention of the ambulance. Despite our obvious displeasure at being sent we drove there, lights and sirens and ‘save’ another pregnant woman too lazy to arrange her own transport. 

You don’t suddenly give birth. There is a 9 month pregnancy leading up to it. During that time you would have thought a lift could have been arranged. If not, a taxi?! A saving of just 25p a week throughout the pregnancy should be enough to cover it. Failing that, most people know someone or have a neighbor who transports their litter in a Chelsea Tractor. Bug them. Not us! Obviously, if something is wrong, or you have the urge to push, then that is a different matter but don’t take the piss.

We arrived on scene, grabbed all our kit; response bag, oxygen bag, maternity pack, entonox, Paediatric Advanced Life Support kit, inco-pads (yes, it weighs a ton) and headed to the front door. It took some negotiating to get us and our stuff past the 3 cars on the driveway but we made it. Mum-to-be was dressed and ready to go, bags packed and in the hallway, Dad-to-be clearly to excited to drive was fretting about everything, as was various other family and friends who were going to follow in the car. Contractions were coming along nicely, every 6-7 minutes, no show, waters not broken. This really was a life threatening medical emergency. Oh, and they hadn’t phoned the maternity unit or midwife. It’s OK though because we can do that for them too. Anyway, all aboard, boxes ticked, i’s dotted and t’s crossed we drove the 1.6 miles to hospital. Another life saved.

As mind boggling as this is, and as annoying as I find materni-taxis this isn’t why i’m blogging about it. Shortly after the job I tweeted the following on twitter:

“You’ve had 9 months to plan, call a taxi, get a lift from another mum in a Chelsea tractor. It’s labour. You’re not ill. You don’t need 999”

Within 3 minutes of this tweet I received the following message via my Facebook page, which quite frankly, made me seethe. The message was as follows:

“A woman in labour has every right to call an ambulance. The ambulance has all the medical equipment and the paramedics have the medical knowledge to deal with a birth, a taxi does not and neither does a neighbour with a 4x4. Show me where it says a woman in labour cant call an ambulance. Also while you’re at it show me the HPC code of ethics, as i think your statement is way off and to discourage any woman in labour from calling an ambulance is medical negligence. I would invite you to prove me wrong, if you can fine, but bet you cant??? A woman in labour without a way to get to hospital is hardly a sprained wrist and she much more in need for an ambulance than an elderly person who has just fallen over. I suppose you’re going to go onto long term illness and tell me i cant call an ambulance when my daughter is in DKA.”

Are you serious? What a deluded, self-centred fool. It is people like this which cause all the problems in this country. People who think they have the divine right to an ambulance whatever the circumstance, it’s selfish and greedy and exactly what i’d expect if this vulgar human called 999. Yes, you have a right to call an ambulance, if its an emergency, but normal labour is not. You’ll also be reassured to know that the only training a paramedic has on maternity is a 2 day course. We are given a very brief overview on how to deliver a baby in an emergency. Admittedly taxi’s and neighbours haven't had the luxury of a 2 day course but they don’t need it to drive your lazy arse to hospital. They need exactly what we need. Money for petrol. No where does it say a woman in labour can’t call an ambulance, it isn't advised though. The following has been copy and pasted directly off my employers website:

“Please think carefully before calling an ambulance in pregnancy or normal labour. Call your midwife, birth centre or labour ward in the first instance for help and advice. Ambulances are needed for life-threatening emergencies, and normal labour is not an emergency. During your pregnancy, it is important you discuss with your midwife the signs of normal labour and plan your transport to your chosen place for the birth. Initially any pregnancy or labour concerns should be raised with your midwife or birth centre. This includes worries with foetal movements, or if feeling unwell, as they can advise you further.”

To be honest, a) I can’t be arsed b) I don’t have the inclination to and c) I don't care enough to trawl through pages and pages of codes of ethics to find a sentence that will make my point and appease you. Your comment on the elderly speaks volumes about your character too. You are ill informed about the medical needs of pregnant women and to even suggest that a woman in normal labour is more deserving than a 92 year old lying on the floor with a fractured neck of femur is laughable. It’s people like you that cause these genuine patients to be left on the floor for 4 hours +. And as to your snipe about my sick leave, you don’t know me, you’ll never know me and what my sickness has to do with your daughters DKA I don’t know. What chance does she have anyway when your archaic opinions are what she has as an example to follow. No wonder the NHS is in crisis.

Obviously, I wouldn’t want to deter anyone who is in need from calling 999. On the rare occasions where an ambulance is needed for an obstetric emergency I would want someone to call. If:

• You are immediately about to give birth with a strong urge to push.
• If there is fresh bleeding which is more than an egg cupful (or two changes of pads).
• If you have severe abdominal pain that continues and persists after a contraction.
• If the baby’s cord is noticeable.
• If you are suffering from other medical emergencies, such as breathing difficulties or chest pain.

Call 999!!!! If however, you want a free lift to hospital and you are in normal labour, please don’t. It’s an unnecessary drain on resources and is a massively inappropriate use of an emergency ambulance. Rant over. Be safe x