Thursday 31 May 2012

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.


  1. I don't think this needs any comments...

  2. I would agree with the above comment but ... and anyway thank you for trying after all "don't ask: don't get"

  3. just glad people are around to do this stuff, because I don't think I could

  4. I would have loved you. When I was 17 I went into hospital at 24+1 in labour, the midwife on duty got all the stuff ready to help my little boy. Then the shift changed, midwife walked in and read my notes, disputed my term, on what grounds I will never know and simply said 'not viable'
    When Connor was born he really fought hard and died in my arms an hour after his birth. Now I know full well that 14 years ago his survival rate was minimal, but had someone just tried then I would have felt much better.

  5. Just being there, to do something, makes all the difference when it's looked back over by the family, just for someone to have wanted to make a difference, against the odds, but still wanted, means so much, you're a credit to your profession

  6. Oh im cryimg now and as i suspected i officially love this blog and now you a bit too (in a non stalker type way.)

    On this day, you made a difference.

    Wow. As above. just wow.


  7. I know just how it feels - I once delivered 27 week old twins and both us as a crew and the midwife had to go to a hearing as it was said we should never have attempted resuscitation!
    I agree with you and would never have done anything differently. The couple had tried for 9 years on IVF to have them and again those immortal words - "Just save my babies".
    One only lived 3 days and one lived 10 days but the family thanked us many times over for trying.
    It shouldn't be our decision but often is and it's well done - you made a difference x

  8. I know that the mother probably had it in the back of her mind and also the husband but if there is that slight glimpse of hope you grab it. I suppose its the brains way of dealing with it. Definitely worth trying everything you never know miracles and odds might be in your favour. It is a sad story and hope the parents have grieved and moved on. The "what if" game is the worst game to play.


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