Virgin River (Virgin River #1)(100)

“I’ll hope, too—but for Anne’s sake, not yours or mine.”

Anne’s blood pressure was stable and her labor was difficult. Three hours later, in spite of walking, squatting and laboring, she was still only at four centimeters. At midnight she was at a possible five. Doc suggested a Pitocin drip and breaking her water, which Mel had just been considering. Her contractions were coming every two minutes. Near midnight Mel checked her and with great relief, found that she had progressed to eight centimeters. But then, just thirty minutes later, she was back at five. Mel had been down this road before—the cervix had swollen and appeared as though it was shrinking. That indicated they might not be able to have a vaginal birth. She examined Anne during a contraction when her cervix widened and literally tried to hold her cervix open to the great discomfort of the patient, but it just wasn’t working. Anne was wet with sweat and growing more exhausted by the minute.

It was three-thirty in the morning when Mel made the call to John Stone. “God, I’m sorry to do this to you,” she said. “I have a delivery that might be going south. I’ve got a patient who’s been laboring for hours, stuck at five. Her cervix advanced to eight and swelled back to five. She’s not progressing. We could ride this out, but mother is wilting and I have no indication that… I think it’s very possible the baby’s not going to fit. I suspect I’m going to need a caesarian.”

“Did you pit her?”

“Yeah. Pitocin running and I broke her water.”

“Okay, stop the pit, turn her on her left side. How long has she been laboring, stuck at four or five?”

“Ten hours with me. She labored at home for about eight.”

“Have you tried stretching the cervix?”

“Unsuccessfully,” she said. “Our ultrasound at your clinic showed a competent pelvis and average-size baby.”

“Things change,” he said. “Any fetal distress?”

“Not yet. The doptone shows a strong, regular, even heart rate, but mother’s pressure is up a bit.”

“You could ride this out awhile, but if she’s exhausted, I vote for not waiting. I’ll meet you at Valley. Can you make the drive or do you need helicopter transport?”

“We’ve got some real good shocks on that Hummer,” she said. “Either way, she’s an hour or more from the hospital. I’ll wake Jack. Get his help.”

Mel checked Anne once more; she had finally made six centimeters, but she was weakening. Anne’s heart rate was increasing and the baby’s had dropped just slightly. Jeremy was growing nervous and pale despite the number of times Mel reassured him that this wasn’t unusual. It was starting to look like even if the baby was going to fit, Anne might not have the energy to push him out.

It was 4:00 a.m. when Mel called Jack. He didn’t sound as though he’d been asleep. “Jack, I’m going to have to transport my patient to Valley Hospital for a caesarian. John’s going to meet us there. I could use some help.”

“Be right there,” he said.

“I’ll try to get her downstairs and then if you’ll—”

“No, Mel,” Jack said. “Leave her where she is. I’ll get her downstairs. I wouldn’t want both of you to fall.”

“Okay, sure. Thanks.”

Then she went back to her patient. Although Doc was standing by, this was Mel’s case and a decision like this was entirely hers. “Anne,” she said, gently brushing the hair away from her soaking brow. “We’re going to transport you to Valley Hospital for a C-section….”

“Nooo,” she cried. “I want to have the baby normally.”

“Nothing abnormal about a C-section,” she said. “It’s a good operation, and it keeps you and the baby out of distress. Fortunately, we have the time so you’re not at major risk. But with the distance to the hospital, we shouldn’t wait until you are. It’s going to be fine, Anne.”

“Oh, God,” she cried.

Then she was gripped by another hard contraction and fear gave way to pain. Her husband tried the breathing with her, but after all these hours of hard labor, it was futile. She had very little space between contractions and some residual pain that made it feel, to her, as if her contractions were continual, back to back.

Mel had had tough deliveries before, but it was different in the hospital, when you could just wheel your patient down the hall to surgery and let the surgeons and anesthesiologist take over; in a hospital she would give the mother every chance to make it through, if she wanted to try. It was different for her here, when the hospital was so far away, staffed and equipped for only routine procedures and surgeries. She couldn’t help but feel very disappointed for Anne, who had so looked forward to a natural childbirth with her husband.

“Anne, it’s just one of those things. Sometimes a C-section is the best answer,” Mel said. “You’re not going to have this baby here, but we want you to have as many healthy births as you desire.”

“Of course you’re right,” she answered breathlessly.

Mel heard the front door open, Jack’s feet on the stairs and then his voice outside the door. “Mel?”

She pushed the door open.

“Let me take her down for you. I’ll drive you to the hospital in the Hummer.”