Zac was coming! He was due to arrive after lunch, and Ava glanced around the clinic and decided it wasn’t too untidy to show off. The patient load was calming down now that the half a dozen seats in the waiting room had nearly emptied. She methodically completed her assessment of a child with asthma and was relieved to see the wheeze Zoe had shown yesterday had lessened, as they’d thought it would. ‘You did well with your puffers, and your chest sounds much better,’ she told Zoe with a smile, then turned to the mother. ‘Keep following the asthma plan and ring the helpline if you get worried.’
‘Thanks, Ava. Will do. Come on, Zoe.’
Ava washed her hands and moved on to the elderly diabetic gentleman from the community whose ulcer was also improving, and then dealt with an elderly lady with a scraped knee and a twisted ankle.
‘I’ve wanted to come here to Uluru for years,’ the lady was saying, ‘and I fall over and twist my foot on the first day.’
‘It’s a shame but all is not lost,’ Ava reassured her as she bandaged her leg. ‘If you put your feet up today, you should be feeling even better tomorrow. You can take the bandage off for your shower in the morning, but put it back on for walking, as support.’
‘Yes, Nurse.’ The woman looked doubtfully down at her foot. ‘You sure it will be fine?’
‘You can take your weight on it now, but it will only get better if you rest it. Watch the sunset from your room and pop your feet up on the outdoor table. It’s a beautiful afternoon.’
Yes it was, she thought as she helped the woman to the door. And Zac would be here soon. She gazed through the window at the dark sapphire of the sky. The colours seemed deeper, the birdsong louder, everything brighter and crisper, despite the warning that they might be in for a dust storm later. But not before Zac touched down.
By two pm, she knew Zac’s plane would have landed. She pictured his big frame on the bus from the airport to Yulara, but she kept her head down as she carefully cleaned the gravel from another scraped leg.
By the time it was done, her stomach jittered with tiny twitches of excitement and her mouth kept smiling at the clock as if she had a new friend in the ticking hands. For the last three days in her staff accommodation, in the back of her mind, she’d been planning Zac’s introduction to Uluru, the park, the base walk, the cultural centre, Denise and her husband. All the places to watch the sun rise and set. And other things …
She needed to calm down. Anyone would think she’d fallen in love with a guy she’d known for a week. Had she been that foolish?
Her mind skittered back to Zac. He’d jumped on her suggestion to book a rock-view room at the Yulara resort, so they could step out onto their own verandah in dawn’s light and know exactly where they were. It was impossible to miss what stood on the horizon from that vantage point, and she wanted him to see it too.
Surely he’d drop in here as soon as he’d unpacked. They only had tonight and tomorrow and then he’d go back to work and she’d go on to her family’s station.
The clinic door opened and suddenly he was there, watching her, hand still on the doorhandle as if frozen by the sight of her, checking her out with a warmth in his eyes that made her skin heat and her delight bounce in her chest.
‘Hello,’ he said, his voice deep and familiar like a much-loved song. The door closed behind him and the room felt as though it had shrunk to the size of a telephone box.
They grinned at each other like loons and she crossed to him and held out her hands because, really, she wanted to launch herself into his arms, and it just wasn’t professional to do so at work. He took both of her hands in his and searched her face as if he wanted to memorise every feature, and yep, her belly flipped and flopped. She was alone in the clinic as the other nurse had dashed to the supermarket to pick up milk for tomorrow.
‘Perfect timing. We’re just closing.’
‘Beautiful,’ he said. And if she heard that right, so much more was being whispered underneath. Whether he meant her or the circumstances, she didn’t care. Both boded well for the night and the coming days.
That was until the hubbub of noise erupted outside and the screen door scraped open in a hurry. Denise ushered Jessamine into the room and the mood flew away like a startled lorikeet. Zac stood back to allow the women to push past into the clinic area and Ava knew they’d just taken a raincheck on their reunion.
‘Jessamine’s waters have broken,’ Denise blurted out.
Jessamine’s face screwed up in pain. ‘Baby’s coming.’ Judging by the grunt that followed, she was spot-on.
Well, then. Ava’s eyes met Zac’s, and she thought, Just like in Alice! Did drama always follow this guy, or was it her?
She snapped out of that thought as Jessamine took a step back when she noticed Zac. Ava kept her voice low and tranquil, as if it was a lovely coincidence that the women had visited. ‘Jessamine. This is Dr Zac. He’s an emergency doctor from Alice Springs. I worked with him when Kareena had her baby and he was a big help. Do you know Kareena?’
Jessamine nodded reluctantly.
‘It’s so lucky, really.’ Ava drew her in further. ‘If your baby’s coming, he’ll be here to help us. It’s good to have a doctor around. I’ll look after you and he’ll look after baby.’ Ava glanced at her friend. ‘Denise will stay too, of course.’ Denise’s relief at finding the clinic still open was evident and Ava smiled at her. ‘Good job.’
Denise shook her head. ‘I found her walking in from the community. I’m happy to see you still here.’
Jessamine’s fingers were white on the internal clinic doorframe. Then another contraction began to build and her breathing sped up. Her eyes darted around the room as if there was somewhere she could hide from the pain in her belly.
Ava saw the edge of panic and rested her hand very lightly on the young woman’s shoulder, sharing her calmness through touch as older, wiser midwives had shown Ava in the past. In response, Jessamine dug her fingers into Ava’s hand and squeezed as she bore down. ‘Don’t you let go,’ she ground out and Ava smiled.
‘You’re safe. Just breathe slowly and let the tightness roll over you like a wave.’
The outside door opened again. ‘And now we have Nurse Jill –’ the short, grey-haired nurse raised her brows at Ava in question – ‘who is back from the shop, so there are plenty of hands to look after you.’
By the time they’d helped Jessamine into the treatment room, another contraction had pushed a small rivulet of pink fluid to drip onto the floor, confirming Denise’s warning about broken waters. At least the colour of the liquid was reassuring, Ava thought, as she began to run through what she needed to do for an imminent delivery. The nurse grabbed a towel and dropped it on the puddle before someone slipped.
‘I can’t lie down.’ Jessamine leaned forward over the day bed the clinic used for critical patients, and with a nod from Ava, Denise moved around the other side to gently take the young woman’s hands in hers for comfort. Denise began to murmur soothing Pitjantjatjara words that dipped and hung quietly around her.
Relaxed a little by Denise’s crooning, Jessamine rocked and swayed, almost in a dance. Jessamine’s dusty footprints began to form a circle like a painting around the towel on the cream vinyl of the floor where she stood. She rocked and stepped through the escalating contraction, and Ava imagined the young mother was creating her own circle of safety. She liked the idea. They’d take all the help they could because she doubted any RFDS plane would make it in time for this baby.
Ava didn’t want to interrupt that instinctive response to her body that Jessamine had found to direct her labour. They wouldn’t have to wait long for another change that would indicate the labour had reached the point where Ava would have to look.
Jessamine made a strangled noise and Ava exchanged a glance with Zac that said, Right now.
‘Can we lift your dress, Jessamine, and see if the baby’s coming?’ Ava asked.
‘You’d better,’ Jessamine said with a groan as she shimmied out of her wet underwear, which plopped onto the floor. ‘’Cause somethin’s happenin’.’
When they lifted the damp skirt up to her back, a much thinner back than Ava expected, they could see the roundness of a tiny baby’s buttock.
‘Breech,’ Ava breathed as she caught Zac’s eye, and Zac frowned worriedly at her. Be calm, she told him with her eyes. ‘All the spontaneous ones I’ve seen had no complications, so let’s keep it like that,’ she said softly. Zac’s eyes still held concern, though, so she said quietly in an aside, ‘Good thing I did a refresher in Sydney. Allow the presence of trust,’ she said, repeating the mantra they’d pushed at the course and smiling at him. To Jill she said, ‘We’ll let mum and baby do the work, but get ready for a baby, Jill.’
Nurse Jill’s fingers shook, but she handed Ava and Zac a pair of gloves each from the pack beside the day bed. ‘I’ll phone for the RFDS.’
‘No.’ Jessamine shook her head as tears rolled down her cheeks. The young woman turned her head to look at Ava. ‘I shoulda come yesterday.’ Ava had been to see Jessamine again yesterday, but hadn’t been able to cajole her into allowing an examination.
‘We talked,’ Ava soothed her. ‘You and Denise did well coming here today. And Jill will call the RFDS to pick you up so they can make sure you and baby stay okay.’
Jessamine shook her head and glanced at the door as if she was going to run away. ‘You can ring ’em. But we’re not goin’ on that plane.’
Ava guessed something had happened to Jessamine or one of her family to cause this fear of hospitals or aircraft, but they didn’t have time to find out now. They needed to be calm for the next stage. ‘I hear you. We won’t worry about that yet.’ Ava met Jessamine’s eyes and said quietly, ‘Nurse Jill has to ring so they know we might need help. I understand you don’t want to leave country. We’ll talk later when you’re not so busy.’
Zac peered around the now crowded room. ‘How did you get here, Jessamine?’
‘I walked. That’s how I saw Denise.’
‘It’s a good thing to walk,’ Ava said gently. ‘Most breech babies curl themselves into a ball and sort themselves out. Movement helps that.’ She turned to Denise. ‘What about her man’s mum? She not here with you?’
This time Jessamine narrowed her eyes. ‘I didn’t tell anyone. She’ll be mad I didn’t come in after you left yesterday. We don’t get on too good.’
Better she’s not here, then, Ava thought philosophically. Emotional friction didn’t go with birth. She repeated, ‘Walking through labour is good. Really good because your baby is almost here.’
Jessamine nodded and swallowed. ‘I can’t stand. I wanna kneel down on the floor.’ With that the girl pushed off the couch and awkwardly knelt down until she’d buried her head between her elbows and then into a pillow Denise hurriedly dragged off the nearest bed. Nurse Jill was like a sprite dragging towels from cupboards, helping Ava put protection under Jessamine’s knees and body to shield against discomfort and cold, then tossing a thin blanket over her back.
Even Zac, who hadn’t done a lot of obstetrics, didn’t look surprised that a strongly labouring woman wanted to throw herself into the best position. Ava knew Jessamine had listened to her body telling her the most useful way to use gravity.
Ava saw that Zac had found a stethoscope for the baby and was making a space on a nearby bed to examine or resuscitate the infant if he needed a work surface, a task Ava was glad wouldn’t fall to her.
As Jessamine knelt down, Zac used his foot to slide a little footstool for Ava to sit on so she could hover close by and help if needed. In the background, she picked up the quiet rumble of the tumble drier. Jill must have switched it on to warm towels and a blanket for the baby on her way to the phone. This wasn’t the first time a child had been born in the clinic, but it was certainly unusual. Everything had better work out well because there was no backup aside from those present.
A few minutes later, Jill returned with the emergency birthing kit and an injection drawn up to give after the birth. Ava flashed her an appreciative smile. They certainly didn’t want a post-partum haemorrhage.
‘It’s coming,’ Jessamine gasped as the baby’s body gradually appeared with the help of gravity and the mother’s pushing.
In slow slides, centimetre by centimetre, the baby’s hip descended. Denise’s eyes grew huge and even Jill looked incredulous. It became apparent that Jessamine’s dream about a new male in the family was right as a tiny scrotum swung into view. Her man would be pleased.
‘Let the legs come themselves,’ Ava murmured to Zac, even as she privately thought, It’s so hard not to flick those legs out! She was mindful of the words of her recent instructors and explained quietly to Zac, ‘While the legs are folded inside the mother, they’re stretching everything for the head. If the legs are flicked out too early, the birth canal misses out on the extra stretching that helps the rapid descent of the head.’
He nodded. ‘Sensible.’
As Zac hovered, and Jill scurried away and came back with a warmed towel to wrap around the baby, first one and then the other of the baby’s legs dropped down, all by themselves, so that the curve of the baby’s belly and a stretched part of the umbilical cord appeared.
She spoke to Jessamine, but she was really talking to Zac. ‘Same for the cord. People used to ease that loop of cord out to save strain on it, but now we’re taught to leave it in case we cause a spasm in it.’
‘Got it,’ he said and they smiled at each other, both aware of how amazing the natural birth occurring in front of them was.
They watched a section of the slippery rope tumble out of the birth canal. Ava chanted to herself, Wait. Wait. All she needed to do was wait.
In fact, it all made beautiful sense to let the baby drive the birth. With progress this smooth, it would go well as long as she didn’t interfere and startle the baby into lifting his chin and interrupting the curve of his spine.
Ava continued speaking softly to Zac. ‘See that dip between the baby’s nipples on the chest wall? See the space it makes for the cord to sit protected? Isn’t that wonderful.’ The little pale chest and legs hung between the mother’s buttocks, and slowly the tiny calves and thighs began to jiggle, as if the tiny human inside his mother had decided to slowly ride an invisible unicycle.
‘Will you look at that.’ Denise’s awed voice floated across in a whisper.
Jessamine moaned.
‘He’s moving his legs to help him come down,’ Ava murmured to Jessamine. ‘That’s what you can feel. Soon he’ll be sitting on the ground under you, so let me know if you want to move.’
‘I ain’t goin’ nowhere,’ Jessamine ground out.
With the baby doing his circus act, first one arm and shoulder appeared and then the other. Now there was only the head to come. The baby was sitting almost cross-legged under his mother, until suddenly his chin dipped forward and Ava had to lean over quickly to catch him before he fell face first onto the towel. ‘Spontaneous breech birth,’ she announced, wanting to laugh with the exhilaration of it all. Instead she asked, ‘Born at?’
Zac made a noise. ‘Good catch,’ he said with an exultant note in his voice. He took the warmed towel from Jill and rubbed the baby firmly until the little boy screwed up his face and roared with disapproval.
‘Born three thirty-one,’ Jill intoned as if they were in a normal birthing suite, and they all sighed out at the same time. ‘Will I give the injection?’
‘Wait.’ Something wasn’t quite right, though Ava wasn’t sure exactly what it was. She hadn’t had a chance to feel Jessamine’s uterus and she knew the young mum hadn’t had a lot of obstetric care. This baby seemed too small for the size of his mother’s belly. While she thought about it, she allowed a minute for the extra blood from the placenta to flow into the baby. Anaemia could be a problem for some outback and especially Indigenous babies if the mother was anaemic, and the extra blood could mean a much healthier start to life. After a moment’s pause, she clamped and cut the cord to allow Zac to lift the baby away and around to the front of the mother.
But Jessamine was busy again. Another gush of water, not blood, flowed from her, and another tiny buttock slid into view.
‘Second baby,’ Ava breathed.
‘Exciting times,’ Zac murmured.
‘I did wonder,’ Ava said, glancing quickly at Jessamine. ‘Jill, can you put a cannula in for Jessamine? I want Zac free for the babies. Then give that injection, IV. With twins, our PPH risk just went up.’
The second baby was also a frank breech, and again two little buttocks presented and another little scrotum. Ava couldn’t help a tiny laugh as once more the procedure was accomplished easily. This baby’s trunk delivered quickly and Ava allowed the infant to rotate slightly to the left as the natural curves of the mother’s pelvis facilitated delivery of first one shoulder and arm and then pivoted the other way so that the other arm came free. Then there was a plop as the baby’s head eased out and he fell forward into Ava’s hands. Another baby who knew what to do.
Ava waited again for an extra minute before she clamped and cut this cord, too. There was a small gush of bright blood and the cord lengthened suddenly as the placenta began to come.
‘Needle now,’ said Zac. Ava had no doubt he’d be thinking about the last post-partum haemorrhage they’d had in Alice Springs.
Ava nodded. ‘Jessamine, I’m worried that you’ll bleed. So we have a needle here to give you. Is that okay?’
Jessamine eyed the needle in Jill’s hand with trepidation. ‘Better be quick before I change my mind.’
Ava marvelled at Jessamine’s fear of the needle when she’d just pushed out twin boys. She said soothingly, ‘Needles make people nervous, but Jill’s really good at it.’ At Jessamine’s nod, Ava said to the nurse with a smile, ‘Now would be good, Jill.’
Jill tightened the tourniquet and inserted the cannula. Denise helped her strap it, and then Jill slowly inserted the uterotonic injection, then assembled an IV line. The look on Zac’s face was priceless – it was so full of amazement.
‘We’ve worked together before, you know,’ Denise told Zac. The whole procedure was completed quickly, before Jessamine could change her mind.
Very soon after the injection Ava delivered the enormous placenta, and after a quick check down below, she encouraged Jessamine to roll over so she could massage the mother’s stomach. The idea was to reduce the placental site on her uterus and squeeze off any haemorrhage vessels. To Ava’s immense relief, everything settled with remarkably little fuss and they all breathed more easily for the moment.
Zac made light work of helping Jessamine up to the day bed to lie down. Ava and Zac put the babies back against their mum’s skin, while Jill put a warmed blanket across the trio. Done.
Ava laughed and stood back, stripping off her gloves. ‘Oh my. Now that’s an exciting event. Alice Springs maternity will be horrified, and jealous, that we had such a fabulous outcome here. Brilliant birthing, Jessamine.’ She couldn’t help thinking, That’s one way to keep off the labour-ward bed: a few kilometres of walking. ‘But don’t go starting a trend.’
Both babies looked less than three kilograms, and to Ava’s surprise Jessamine didn’t seem perturbed that there were two. ‘Jim will be real pleased,’ she said quietly. ‘They’re both good, eh?’ she asked Zac. ‘They can stay on country?’
Ava knew she couldn’t promise that. Everything might be fine, but they were too isolated. ‘I don’t think so. But we’ll wait for the team. You’ve done amazingly well, Jessamine. But twins! Your poor uterus is stretched and tired. I’m sorry. They’ll want you to go to hospital for at least a day or two so they can watch you don’t bleed, and these boys need to be putting on weight.’
Jessamine’s face dropped. ‘I don’t want to go.’
‘We know.’ Zac crouched down. ‘But these little boys need their mum, and having two babies at once makes your uterus risky. If something happened to you, their life would be sad. It’s best to go to the hospital and then you can come back in a day or two when everything is settled. You were amazing.’
She sighed and there was a long pause. Ava held her breath. Finally Jessamine said, ‘At least they’re born here.’
Zac nodded. ‘A big story they will hear from you when they grow up.’ Zac lifted his stethoscope. ‘Can I have a listen to them while you have a cuddle?’
Good job, Zac, Ava wanted to say, but she glanced at the clock. Jessamine had been there for less than an hour and so much had happened. They were having a very big week.