I feel the need to explain myself. In case anyone has not actually worked this out, I am in fact a student midwife, nearly qualified. A brief bit of explanation in case a midwife means something different to you (classically, once, an Italian friend thought I meant I was going to university to become a better wife, not someone who delivered babies), because midwives are different across the world, especially in the US. A midwife is a woman who is the primary person responsible for a woman and her family during pregnancy, labour and a period of time afterwards. She will be the responsible health professional unless serious complications develop, in which case she will refer appropriately to a medical team. This means that we deliver babies - in the US especially, midwives are no longer permitted to do so in many states. Midwifery is a difficult and complicated job, but sometimes it can be ultimately rewarding. I hope you'll forgive the obvious vanity - this midwife is the biggest Mary Sue to have ever hit the stage, but I refuse to write a midwife who would do anything I wouldn't do! I hope you'll enjoy this little perspective into my world - this has been a very personal labour of love. Little glossary at the end to explain any terms you're not familiar with.
The word placenta will be mentioned, as well as various terms for the female organ. If you have a squick, hit back now, it's not too late. Some people don't like that sort of thing.
"Being a midwife is going to put you in danger of having your heart pierced, but that's ok, because when it does, a lot of love gets out that will make you a better midwife."
Somehow, she should have known today was going to be a strange day when she woke up fifteen minutes late. Running around like a headless chicken, showering and racing out without even so much as a cup of tea, pedalling to work faster like a bat out of hell, and breathing a sigh of relief when she heaved in the door to the labour ward, she smacked her identification badge to the reader, waited impatiently for the doors to swing open, and walked to the changing rooms. Divesting herself of her outside clothes, she affixed her scrubs on, attached her badge to one label, a rubber fob watch to the other, popped her essentials (name stamp, pen light, tourniquet) and a few pens into her pocket, popped her phone on silent, took a deep breath, and walked out onto the chaotic labour ward, professional hat firmly in place.
The handover room was crazy - the board was full, and the co-ordinator was tearing her hair out trying to authorise two agency staff to cover for the three staff out sick - the unit was already closed to transfers, and very close to being closed entirely to any admissions. She allocated midwives left, right and centre, prioritising imminent and high risk cases, until she got to room 14.
"Room 14, anyone? SGA, primip, 5cm, let's get on it." There was an awkward shuffling in the room. "Come on girls, let's get going, Janet is waiting to go home, stop staring at your feet."
There was an awkwardly loud whisper from somewhere at the rear of the group of gathered midwives, waiting to begin the long night shift. "God, I saw Janet on the way in - she said the husband is a right idiot, and a stress-pot."
That settled it. Catching the co-ordinator's eye, Rena stepped forward and declared, "I'll take her, Sister, that's fine." The aged midwifery sister gave her a grateful smile, and she walked out of the room to find Janet to take the handover.
Janet was standing at the desk, signing and dating her final entry into the labour notes, and the expression she wore was nothing short of exhausted. Rena affixed a beaming smile to her own face, and swooped in from behind to give the woman a comforting hug.
"Oh, I knew you'd take over from me, you love the awkward ones, don't you!"
Rena laughed. "Yeah, you know me, glutton for punishment. Has it been awful?" She did not believe that for a moment, but she was not so naive as to attempt to argue with cynicism. Janet looked at her over the edge of her glasses, and Reno gave a knowing tight-lipped grin. "Never mind, love. Gimme the handover, and go home and get some sleep."
"Oooh, that sounds heaven after my day. Seriously, Ree, I have been to theatre twice today, I'm dead on my feet." She closed the notes over to the front of the page. "Right, ok. Her name is - well, you can see it written there, I'm not going to try to pronounce it, I've already mangled it enough today." This was a common occurrence, as the unit was in a fairly diverse area of Sternbild, and unusual names were an every day happenstance. Most midwives who couldn't make the effort just called their clients 'mum', and, if they bothered remembering they were there, any partners 'dad'. "She's a twenty-seven year old gravida two, para nought plus one. Booked at eight weeks, regular occurrence, low risk pregnancy. Had serial growth scans and confirmed SGA, but has been along the normal growth curve, so not IUGR. She came in at six this evening to triage, contracting two to three in ten, examined and in early labour. SROM'd during examination - five centimetres dilated, so got brought in here. She's on the monitor, it's fine. Contracting well, three to four in ten now, she seems to be coping fine, not using any pain relief just now."
"Sounds lovely."
"Oh, she is. The partner is a different story."
Keeping a smile on her face, Rena gave a sympathetic nod.
"Oh?"
"Yeah. He keeps asking questions, and he never lets go of her hand, and god, he won't stop blabbing and he makes the most stupid jokes."
"Oh wow, sounds hard." This was a bare-faced lie. This sounded wonderful. Rena liked questions. Rena liked hand-holding. Rena liked stupid jokes.
This was sounding like the best day ever.
"Do you want me to go introduce you?"
Rena put an empathetic arm around the larger woman's shoulders and squeezed gently.
"Janet, honey, go home to Leo and get him to make you a BIG cup of tea and go watch Hero TV live already, if you leave now you'll catch the recap from last night." Janet's face lit up with delight, and she closed her eyes with an expression of gratitude, waved a goodbye, and walked off in the direction of the changing room with slumped shoulders.
Rena took a moment to read the notes and history, beginning hers with a brief history and plan before she went to introduce herself.
'Care handed over to SM R. Odent. Client is a 28 y/o G2P0+1. EDD...'
Once completed, she printed off the latest blood results related to her client on the pathology system, noted the low pre-existing haemoglobin level, stuck the folder under her arm and walked around the corner to where room 14 was waiting. She hesitated a little at the door, then took a nice calming breath, affixed her best smile, and knocked firmly, opening the door.
"Hello? May I come in?"
A quiet voice answered. "Yes?"
The only sound in the bright room was the steady, distorted heartbeat coming from the speaker of the cardiotocograph by the bedside, which was attached to a slim, elegant-looking brunette. Rena's first thought was how beautiful she looked. Her second thought was how frail she seemed - slightly matted hair, pale skin, bags around her eyes. She had been awake for a while, not gotten very much sleep. Rena grinned - this was very common. Then she cast an eye to the figure standing by his wife's side.
Her third thought was hot damn.
God, he was gorgeous. Properly gorgeous - that kind of unassuming naturally handsome being that only comes along once in a lifetime... and was always already married. She could immediately tell by his stance that he cared very greatly about his wife - he was tense, bending over the edge of the bed to hold her right hand, concern painted all over features meant only for smiling and casual bliss. He was tall - wonderfully tall on long lean legs that radiated strength, broad shoulders and... that was before you noticed his eyes.
His eyes stopped her still, and her heart ached - she had a lot of work to do for the next while, because every single emotion bursting from those shining eyes was disheartening - fear, sadness, worry. It was going to take a miracle.
His wife was a lot more reassuring - bodily fragile though she appeared, the defiance and command present on her face spoke of an inner strength that was far more than that of the flesh she had been born in.
Rena took a deep breath, and began.
"Good evening! Tomoe?" The woman nodded, a little surprised at Rena's attempt, and more surprised at her getting it right. "Nice to meet you. My name is Rena, I'm one of the midwives here, I'll be taking over your care for the night shift. And uh... is it..." She flicked to the next of kin details. "Kotetsu? Is that right?" His eyes widened, and the barest hint of a smile teased the edges of his lips.
Oh, dear. She was going to have to be careful, here. He was dangerous.
She was here to support him and his labouring wife, not fantasise about him pushing her up against the wall and caressing her with his-
No. No. Professional hat on, please.
He nodded. "MMhmm, Kotetsu Kaburagi, at your service!" He winked, gesticulating in a rather cheesy manner, and she noticed as he did so that a slightly worn smile flashed across his wife's features, and immediately, Rena warmed to both of them - both the hint of his goofy demeanour, and Tomoe's sweet adoration of him which was obvious with even a look. He stuck out the hand that he was not clutching his wife's with, and she met it with her wrong hand, shaking it awkwardly.
"Well, I'll be making use of that service this evening!" Oh, god, Rena, shut up, you sound like an aging prostitute, not a reliable healthcare professional, good grief. "Tomoe will need you right here, so that's great." She said this as she washed her hands, then she turned her head to face Tomoe, sat on the edge of the bed, and asked, "So. Tell me what's been happening." Despite knowing the history from her handover, a first-hand account was always the most important thing to get to open a relationship with a new client.
"Well..." Tomoe's voice matched her eyes, not her hands, and Rena felt slightly relieved. "I woke up in the middle of the night and I was having contractions - I thought they were just more Braxton Hicks but they were much stronger. They were really irregular though - but I just knew something was happening."
"She was really upset, it was different from those other cramps, I-"
"Kotetsu." Her voice was firm, but her smile was patient. "It's ok, don't worry. We're here now. Sit down and let me tell the midwife what happened, ok?"
Rena saw the stiffness crease his brow, but he did as his wife asked and sat down in the high-backed chair next to the bed.
She continued. "So yeah, strong contractions. Every twenty minutes or so apart, so I would just get to drop off and then get woken up again." The evidence of this was written all over her - the skin around her eyes was a dull, sallow colour, even though the eyes inside shone brightly.
Rena nodded sympathetically. "Oh, how awful."
"I know! But everyone says it's like this, so I just have to grin and bear it, you know? I'll sleep when the baby's out and fed."
Rena loved her already.
"Excellent point."
"Ha, well it's true." Even Kotetsu smiled at that, and they exchanged a little glance, one that warmed Rena's heart. "Anyway, it was like that all morning, and then all day, and then at about four I realised they were every five minutes apart or so, so I phoned up and they said come in, and then when I got seen, they examined me and my waters broke while they were doing it." She paused. "Does that happen often?"
A nod. "Yup. They're not good with being prodded, those membranes. But then they're not expecting to be, so I suppose we had better not start criticising them yet."
The laugh at that was rich, and genuinely amused. Tomoe's laugh tinkled like a soft chime, and it echoed in the room, leaving behind a quiet sense of amusement. "Yes, I can understand that. Then they brought us in here, hooked me up to this thing and I've been waiting ever since. Do you know what's happening? The other midwife didn't really seem to want to give us any answers."
Rena opened her mouth to speak, taking a solid lungful of breath - this speech was not a short one. "Ok. I've looked at your history - you were last examined at around six, and you were found to be five centimetres dilated at that time. Now, we would expect normal progression to be somewhere in the region of around half a centimetre to a centimetre an hour, up to ten centimetres, at which point we'd give you a little while to allow your baby to come down a little so you only have to push them out, and not down and out. We don't usually examine more often than four hourly, and even then that's a guideline. If you give me a reason to, I'll examine you, but given how relaxed you are just now, I suspect delivery is not exactly imminent!" Tomoe chuckled, and Rena knew they would be within her grasp, her thrall, within minutes, and then they could move forward, together.
"Other than that, we are simply playing the waiting game - waiting for things to heat up a little, and helping you to cope with it while you do. I could be wrong, but I feel like you're coping somewhat well at the moment - you're not falling off the bed, and-" As she was saying this, Tomoe's face creased up and she shut her eyes. Rena popped the notes folder on the edge of the bed, and shuffled along closer. "Contraction coming?" She cast an eye to the CTG to confirm and the tocograph confirmed that yes, the pressure in her uterus was increasing as a contraction rushed forward.
"Tomoe, just do what you've been doing, I'm just going to pop a hand on your tummy to see how strong it is, ok?" Tomoe nodded, and breathed in sharp, shallow breaths, holding them in between. Rena had to keep herself from frowning, and watched the woman cope with the contraction. She pulled back the hospital gown that Tomoe wore, and lay a gentle hand on Tomoe's swollen abdomen. Oh good, very strong. Fetal movement felt, good. Only thing to do was help Tomoe learn to breathe a little better.
The contraction continued for a good forty seconds, which was encouraging, and all the while, the heartbeat thumping from the machine sped up reassuringly, then dropped back down to its baseline. Perfect.
Hopefully, this would be a good one.
Eventually, the contraction receded, and Tomoe relaxed back into the pillow.
"Lovely!" Rena laughed. "Although you probably don't think so, that contraction could have been described in a text book. You need good, strong contractions to push your baby's head against your cervix to cause it to open up, and more like that'llfit the bill nicely!"
That worked. Tomoe's shoulders dropped slightly, relaxing. Rena carried on, "Now, I'm just going to have a little feel of where your baby is, if that's ok with you?" Tomoe nodded her assent. "Ok, thank you."
Tomoe's abdomen did indeed look small - small enough to mean she had escaped without any striae gravidarum, at any rate. No obvious marks or scars, and the shape seemed fine. By landmarks, she seemed to be about thirty-five weeks pregnant, but her scan indicated she was in fact three days after her due date, and the gulf between those was worryingly large. If she had been a very small woman, Rena might have worried less, but as it was, neither Tomoe nor Kotetsu struggled to reach a top shelf. On palpation, the baby was lying head-down, most of its head was in the pelvis, and lying with its back up - all of which was exactly what Rena wanted to feel.
"Ok, that's great! Perfect, in fact. Are you still feeling waters trickling?"
"Yes, I thought it'd have stopped by now though..."
"Hehe, nope! There's a lot in there, and there'll be a big gush after baby is born, too. Are you wearing a pad?"
"I am, yes, they gave me one in triage."
"Oh good, mind if I take a quick peek?" Tomoe shook her head to give her assent, and Rena lifted the sheet a little to look at the liquor draining onto the pad. Clear fluid, with the slightest hint of pink from a few little drops of blood - again, textbook.
All in all - a good overall picture.
"Fab. Ok. In terms of what we're going to do going forward from here, I'm going to need to do a little monitoring of the baby - but you can move about while you're on it, no need to lie down, and in fact, better to keep mobile - get gravity on your side. Lying on your back will just slow things down. I'll need to take your temperature every four hours, and your blood pressure and pulse hourly. Alright?"
"Alright."
"Now, I have a few questions for you - both of you!" She was watching him through the whole conversation, noting how he sat eagerly forward while she was palpating his wife, and then sinking back into the chair, trying to remain unnoticed the rest of the time. It was about time she brought him into the conversation - his want to be involved and do this alongside his wife was almost as obvious as her need to have him do so. At her statement, he raised his head, and met her open smile with a naked optimism that was almost disconcerting.
"Do you know what you're having, or is this a secret agent baby?"
Kotetsu chuckled at that - the smile that broke across his face at her dull joke like a shaft of light in a storm. That was how he was meant to look, and if she had not been expecting it, it would have taken her breath away - he was handsome enough while troubled, but he was magnificent when happy. He exchanged a quick glance with Tomoe, and said, proudly, "She's a girl."
"Oh wonderful! Does she have a name waiting for her?"
"Well..." He hesitated. "Yes. She does. But... we want to wait to say it out loud when she's here to hear it."
Oh god, this is too precious. She meant that - not in a mocking way, but in a 'that is the right way to do things and why doesn't everyone do this' sort of way. It was hard to not squeal at how adorably embarrassed he sounded, but years of having to grit her teeth and smile at hearing some of the worst names a child could ever hope not to hear had taught her everything a human being ever needed to know about masking a reaction.
"Awww, that sounds like a lovely idea, I can get behind that. Mystery girl until then. Are you going to cut the cord, Kotetsu?"
To his credit, he didn't quite adopt quite as much of the 'deer in headlights' look as she had been expecting, instead appearing as though he had simply not given that consideration until now. "Uh, w-well, I guess I could? I mean, is that allowed?"
"Kotetsu, sweetheart. Of course you can, that's why she's offering you the choice."
He blinked, and blushed. "Ah, yeah. I'd like it."
Tomoe stared forward, and rolled her eyes ever so slightly, not so much that Kotetsu would have seen it, but Rena missed nothing, and caught the movement.
"Tomoe, would you like a cup of tea? Although, you'd have to teach me how to make it... are you particular about how you take it?"
"Yeah, she is, I mean the only person she'll let make her tea at this stage is me, so I... Oh, wait, 'Moe, you want some? I can make some for ya, if you like...?"
Rena had to hand it to Tomoe - the honest thankful look that she adopted could have fooled the Spanish Inquisition. "That would be just the thing, honey. Yes please."
"Where can I...?"
"Oh! Good idea. Out of the room, turn left, follow the corridor around and there's a visitor's room just there, and there's a boiler and all the accoutrements there."
Kotetsu jumped out of his seat, banging an arm against the edge of the bed with a loud crack, planted a wet kiss onto Tomoe's cheek, and practically skipped out of the room, yanking the door open and pulling it shut behind him. It closed with a noise so loud both Tomoe and Rena winced, then turned to each other and laughed.
Tomoe spoke first. "I'm sorry, he can be a bit of a... handful sometimes."
"I don't mind in the slightest - it's nice. He's just worried about you."
"He does that too much."
"...in my experience, that's a lot better than not enough."
A knowing smile accompanied Tomoe's response. "How very true."
Ok, I do actually have a few questions for you still. Pain."
"Pain?"
"Pain. You seem to coping just fine, but had you any ideas for how you'd like to move forward should you find it a little more difficult to deal with?"
"Oh! Yes, definitely. Well, I thought I'd try to go without as long as I could, but really, I don't want that injection, and I really don't like the idea of an epidural, so maybe just the gas and air if I need it?"
Tomoe could not have known it, but these were the exact words Rena wanted to hear. "Ok, that sounds like a plan. Now, has someone spoken to you about the delivery of the afterbirth?"
"...no..."
"Well, we offer an injection of a synthetic hormone to help contract your uterus and speed up delivery of the placenta and membranes - it's up to you if you want to have it."
"Do people usually do it?"
"...sort of, yes. For some people we recommend it, if we think they're likely to bleed, it can help prevent that. The only reason I would ask you to think about it is because I have checked your iron level from your last set of bloods, and it's a little low, so you could be affected by even a small bleed."
Tomoe considered it, but the little shake of her head answered before she opened her mouth. "No thanks you, I think I'd rather not."
"That's fine - no problem. If something goes wrong, there may come a time that we have to give it to you regardless, but really, I'm sure we'll be worrying about something else rather than that! Now, do you want baby wrapped and dried first, or popped straight onto your tummy?"
"Oh, straight onto me, please."
"Lovely. Last question then - has anyone asked you about vitamin K for your baby after she's born?"
"No - vitamins?"
"Vitamin K - newborns are deficient in it, and it helps with clotting, so we offer a dose of vitamin K either by drops or injection to help prevent internal bleeding."
"Well, internal bleeding doesn't exactly sound like a riot, so we'll go with yes for that one."
"Cool. Can I just take your blood pressure and temperature?" When Tomoe agreed, Rena popped the cuff from the dynamap on, set it inflating, and pulled out a thermometer from the basket.
Perfect. All within normal range. All along her baseline.
All in all, textbook. Rena kept coming back to that phrase - but for the slightly small baby, Tomoe's labour seemed to be textbook. "Alright, Tomoe, that all seems lovely. I'm happy with everything now - your obs are fine, baby is happy, and you seem to be coping." She grabbed a thick cable from the wall, reached into a bag, unwrapped a valve mouthpiece and attached it to the end of the cable, and popped it onto the side of the bed.
"This is the gas and air. If you feel you need to take it, it's right there - all you do is, when you feel a contraction coming, breathe through the mouthpiece niiiiiice and deep, and stop when the contraction does. Easy peasy. I just want to make a few notes and grab a quick cup of coffee. The call bell is just here-" - she unhooked it from the wall and placed it on the bed next to the labouring woman's arm - "-so if you need me just give me a yell, ok?"
"I will."
Another contraction came and passed, the same as before. When it was over, Rena patted the woman's shoulder and said, "Try to rest for now - you'll need some energy for later. Have you got any questions?"
"Just one - have you got any children?"
Ah, that question. That question came up every time. How does one accurately answer that? Rena knew of one midwife who lied and made up children that she did not have in order to forge an easier relationship with her clients. Lying did not come as easily to this midwife, however.
"I don't, no. My sister has a little girl, though, so I look after her a lot, and I delivered her, amusingly, but I don't have any of my own, yet. Give me time, have to find a man first, and all the good ones are taken!"
"Don't I know it." The atmosphere in the room warmed as the unspoken message passed between them - 'your husband is one of the good ones' and 'yes, I know'.
"I'll be back in a little while, ok?"
"Sure. Enjoy your coffee!"
"Oh, I definitely will."
Outside, as expected, Kotetsu was still standing in the little area, waiting impatiently for a sad-looking teabag to steep in a chipped once-white mug. Worry lines creased his brow. Reno stopped next to the little tea trolley, and grinned at him.
"You're doing fine, you know." Owl-like eyes met hers. Oh dear.
"I am?"
"Yes, sweetheart, you are. It's frightening, to watch someone you love go through something you don't understand, even when you're trying really, really hard. It's ok to let it show, you know. You don't have to hide it."
"But... she's in so much pain..."
"Of course she is! Her body is putting in more effort than a marathon runner, and it's something that really, the steadier it goes, the better for her in and baba. You don't need to do anything more than just be there for her - and I can tell by looking, she already appreciates you there a lot."
"It's just... well, I'm used to being the one doing to strength 'thing'. I protect people, and..."
He looked like he was going to cry, but that wasn't what was needed right then - no, what was needed was that goofy laugh she suspected he had and was waiting to confirm existed. "You already are, dear. Later on, she's going to find it more difficult, and I need you to help me keep a hold of her. Babies aren't borne of one person - she's your baby too, she'll need both of you there, ok?
"I promise. You're going to do great." She tapped her nose with her forefingers. "My spider senses are tingling."
And... there it was. That laugh. The laugh she was expecting to be goofy, not rich and deep and warm, but it was and more - the kind of laugh that picked you up and held you close and then reached inside you, deep down, to make even the coldest parts of you tingle. He was laughing as he stirred in a halfspoon of sugar, and still chuckling as he picked the mug up.
"So are you secretly a Spiderman NEXT?"
It was her turn to laugh.
"HA! I wish, being a NEXT would probably make my job either easier, or more troublesome." Something unidentifiable flitted across his face then, but it passed so fast she wondered if she'd seen anything at all. "I have to go make some notes and get myself assembled. I'll talk to you in a little while. Call if you need anything?"
"You got it!" He cocked two fingers and gave her a little mock salute, and she curtsied in an exaggerated fashion, before heading off towards the nurse's station. Kotetsu stared after her, amusement settling in his golden eyes.
Half an hour passed before Rena came back to the room - in that time, she'd spoken to the obstetric registrar regarding Tomoe's Hb level, and gotten ferrous sulphate prescribed. When she arrived, she immediately knew Tomoe was cracking on - the readout on the CTG told her immediately that her contractions had increased in frequency, strength and duration, all of which screamed towards one conclusion - the labour was progressing nicely. On opening the door, the sound of the valve in the entonox mask being sucked on floated into the corridor, and indeed, Tomoe held the mouthpiece between her teeth, eyes shut tightly while Kotetsu gingerly rubbed her shoulder, the contact almost too faltering. Rena was pretty sure that if Tomoe even felt it, she was a lot more sensitive than Rena would give anyone credit.
The contractions were definitely stronger, that much was obvious. The tension in her face, the tension in Kotetsu's face, communicated better than any words could have. She breathed deeply on the entonox, and Rena was pleased to see her doing it in a manner that would benefit her most - deep, sustained breaths.
When the contraction faded, a quick glance at the CTG feed reassured her that all was well with the fetus - no decelerations, good variability, great baseline... all good.
Kotetsu however... he was different matter.
Rena understood. Fathers were always the most anxious - because they couldn't do anything. It broke her heart where there was the type of person you knew was going to make the kind of father that just made everyone around them smile, and he was one of them - but his need to protect his wife was so evident, so clear, that while heartening, it had the potential to be worrying - the ones who cared the most could become the most frightened, and the most dangerous. One or two trips to the emergency room to nurse a black eye had taught Rena just how quickly a dedicated partner could turn into a violent psychopath. Although... somehow, she sensed this was beyond Kotetsu.
Right now, he was fighting tears, and his arms were awkwardly placed, not knowing where to stand, where to hold, what to do.
She'd have to fix that.
"Well, this is slightly different!"
"It's... I think they're getting stronger now, she's in a lot more pain." What she thought was No shit, Sherlock. That wasn't what she said, though.
"Mmm, I can see that. Tomoe, how are you feeling?"
"Like... it's getting stronger."
"Good. Where are you feeling the pain?"
"Around... my... back now. It was in the front earlier, now it's at the back."
"Is that bad? Is she in trouble? What do you need to-"
Rena didn't often cut someone off, but this was necessary. "That's a good sign. It means that the baby is pushing her coccyx, her tailbone, out of the way. It's hinged for exactly that reason." She demonstrated with a flick of a hand. "See, imagine this is your baby-" She balled up a fist, and pushed it against her curved outstretched fingers on the other hand. "-and this is her coccyx. It's slightly in the way, but it bends backwards like so-" - she bent her fingers backwards at the knuckle - "to accommodate your baby. And guess what - bones moving in ways they don't usually hurts. But it'll go after the baby's born, guaranteed!"
"Oh good!" He looked pleased, very pleased. Time to give him something to do.
"You know, you can help her a lot with it, want me to show you?"
His bright eyes lit up even further, and he nodded furiously. It was just too sweet - he was desperate to be of use, to help, to care for his wife. Tomoe, for her part, looked patiently at him, love in her brown eyes.
Rena walked around to the side of the bed he was sat at, and gestured for Tomoe to sit up straight, which she did gladly. As expected, there was a slight bulge at the small of her back, and Rena touched her fingers to it, knuckles outward, and then pressed hard, stroking up and down, pushing against each individual vertebra.
"Oh yes please that feels better."
Rena stopped and pulled back. "Like that, ok? She took Kotetsu by the hand and guided his fingers to his wife's back, and, her hands on his, moved his knuckles against him in an imitation of what she had just done by herself.
The effect was immediate, and electrifying. Tomoe tipped her head backwards, a soft moan escaping her lips, and Kotetsu leaned into her, laying his forehead on her shoulder.
"Oh honey, that is just lovely - don't stop, please, you're really helping." She reached a hand back and caressed his cheek, before another contraction grew and peaked. He pushed even harder throughout the contraction, feeling the pressure of the baby from the other side, and Tomoe did not even reach for the entonox, instead sinking back into her husband's embrace as he massaged her lower back, pushing the pain away with strong, loving hands.
It was wonderful to watch.
It didn't last long.
Forty minutes passed in this manner - Kotetsu willing his wife's pain away with every touch of his hands, and all the while, her contractions becoming longer and longer, until she was having very little respite between then, and they were lasting for well over a minute with each one. All the while, Rena sat on a stool by the bedside, scribbling in her notes, keeping an eye on the CTG and filling in the partogram. Briefly she entertained herself by checking the resuscitaire was stocked and working (which it was), but for the most part, she was quietly waiting. Although Kotetsu attempted some brief stilted conversation, his attention was mostly on his wife, and she was contracting to close together now, he gave up. Rena didn't mind. This was what she lived for.
Then... then it happened, and Rena sat up straight - she had been waiting for this moment.
"Tomoe... you're doing great!"
"Oh for fuck's sake, Kotetsu, get off me, you're driving me insane." He sprang back from her like a wounded animal, hands raised, eyes wide, but before Rena could reassure him, he fled out of the door. Tomoe's face fell.
"Oh god, I didn't mean to say that, I-"
"Sssh, it's ok. Don't worry. I'll go get him. He's a bit sensitive, I'll explain it."
"It just came out, I- god, I can't do this, Rena, I can't, it's too much, it hurts so much, I can't take it any more, I want an epidural, hell, fuck that, just give me a caesari-"
"Tomoe." Her voice was so serious, so cutting, that it actually did stop Tomoe mid-flow, and enormous, tearful brown eyes stared up at her. "Stop. Don't worry. This is what birth is - it is uncontrollable, and crazy, and an emotional ride." Rena bent at the knee, and put her hands over Tomoe's, squeezing them hard, trying to impress upon her the sense of honesty that was needed in this situation. "Every couple goes through this, and it's all forgotten about as soon as you see that baby, I promise. Now hold on, I'll go out and talk him back in here." The woman nodded sadly, sniffing. Rena handed her a tissue and smiled warmly, before striding out of the room. The door shut behind her, and she shook her head wearily, before heading off in the direction of the visitor's lounge.
It was empty. Huh. Most of them turned up there, but Kotetsu seemed quite a bit more sensitive than most. It was only just approaching ten though - where could he have found to hide in the short few hours he had been here?
Oh, of course.
Stopping by her locker to grab her coat, she walked past the security desk, nodded to the guard there, and left the unit, turning right immediately. She ducked into a narrow alleyway, behind the renal building, and after a few more steps, she emerged into a small courtyard, with a fountain, surrounded by statues of playful animals, streaming majestically into the night sky. Kotetsu was seated on a bench, the arm of which was occupied by a small, realistically-hewn rabbit. For that reason alone, this was where Rena sat for her day shift lunches, or on a warmer night than this, but he seemed not to notice the little statue, staring blankly into the churning water in the fountain's pool. Rena took a seat next to him, but said nothing.
Three long minutes passed. She could have waited several hours, but thankfully, embarrassment got the better of Kotetsu, and he spoke, though his eyes never peeked out from underneath the hat pulled low on his brow.
"I can't do anything right."
"You think so?"
"I know so. Didn't you hear what she said? She said I was driving her insane."
"Don't you do that normally? Most couples I know drive each other insane all day and night."
"I... well, I suppose..." Finally, he looked up to look at her, but she was focused on that same spot he had just been staring into oblivion. "But she seems so much... angrier."
"Wouldn't you, in her place?"
"But she was so patient before. She's always so patient. I mean, I drive her CRAZY. I'm always breaking everything, and I always forget when she asks me to pick things up on the way home from- well, I mean, I work long hours, so... I don't know why she puts up with me."
"I don't know either."
He looked shocked. "What?"
Rena shrugged. "I'm not her, I'm not you. I don't know why your relationship works, or if it does. I don't see her when she wakes up in the morning, I don't know if she makes you lunch, I can't tell. All I know is that at some point, the two of you decided to get married, and now you're here, together. I'm no expert, but I think if you got this far, she doesn't mind you that much."
"O-oh." He looked at his hands, staring at the palms, and Rena laughed at him. "What?"
"You know, we have a little rule around here - when a wife tells her husband to leave her alone, that's when you start getting ready, because it's nearly time to start pushing."
His eyes almost popped out of his head. "Really! Then why are you out here!"
"Because it's YOUR baby, Mr Kaburagi, and she won't be able to do it without you. So if you don't want to miss it, you'd better hurry in there."
He stood, but for a moment, he looked torn. "But..." When she looked up at him, he was turned to her, looking utterfly forlorn. "What do I do?"
"What else? Just be there. She needs you to be strong, because she needs to put her strength into this baby, until there's nothing left for herself. All she wants from you is for you to catch her when she falls. Think you can do that?"
He straightened entirely, and a determined look spread across his handsome features.
"Catch her when she falls? I've had some experience with that."
Rena gave them a few minutes to themselves before she re-entered the room, and by the time she did, the atmosphere had lifted entirely - Kotetsu was holding Tomoe's hand once again, and she was sitting upright, her chin tucked into her chest. The entonox mouthpiece was between her lips once more, and she was breathing very hard now. Rena examined the CTG, to find that the last few contractions had brought a little friend with them - the heart rate line descended with the contractions, just a slight drop, troughing with the contraction's peak and returning back rapidly. Variable decelerations, ok, well, let's see how that plays out. As she was about to open her mouth, another contraction came, right on the back of the last one, and Tomoe let loose a long, low moan, unable to keep breathing on the gas.
As Rena watched, she saw the telltale signs of progress - Tomoe went into herself, and pushed her breath out slowly, grunting as she gave into the urge to push. She kept that up throughout the contraction, and then... as the pressure waned, Rena heard the heartbeat start to fall. From a baseline of one hundred and fifty, the fetal heart fell to around a hundred, and, though neither parent-to-be noticed it, Rena sighed heavily internally. The contraction ended, and, five agonising seconds later, the heartbeat right itself back to around one-fifty once more.
"I... Rena, I feel like pushing... Is that right?"
"You tell me! You're the one who's feeling it!"
"I can't help it, I just have to..."
"Then good. Let's give you a little while to take a breather, and then if you like, I'll examine you?"
"No, do it now, please - I need to know."
"Sure. Let me get my little bits and pieces, ok? I'll do it right now."
Tomoe nodded, and Rena drew a line across the CTG feed and scribbled 'involuntary pushing'. She did not really need to examine her - time would tell if she was ready to push - but some mothers needed to know, and so she would. It was useful to know when she was fully dilated at ten centimetres, anyhow.
Out in the storeroom, she assembled her examination kit - a trolley, a vaginal pack, set of sterile gloves, and antiseptic lubricating cream. Wheeling the trolley into the room, she opened the pack while maintaining the sterile field, squirted the antiseptic cream into the little waiting cup, opened the sterile gloves and dropped the inner packet onto the paper tray, then proceeded to wash her hands, telling Tomoe to lie back against the bed, bring her ankles together and let her knees flop to the sides. She dried her hands using the sterile towel in the pack, put on her gloves, gave Tomoe a little vulval clean using the clean water in the pack, and lubricated her fingers, perched on the edge of the bed, and waited for the next break between contractions.
"You ready?"
"Yes."
"Ok. You might want to use the gas to breathe on while I do this - there are few people who don't find it at least a little uncomfortable." Rena did it then - pushed her fingers inside Tomoe to see if it was time to start pushing.
"Ok, you're fully dilated, which was fast! Well done. Just let me complete the examination - I just want to see what way around your baby's head is." Kotetsu and Tomoe looked at each other, and he wrapped his arms around her in a hug, whispering in her ear. Rena couldn't make out what he was saying - she was concentrating on feeling for the fetal skull landmarks - but she definitely read the word 'proud' form on his lips. A few more brushes against the baby's head, and she pulled her hand out.
"Ok, so you're ready to begin pushing, but I need to just go and grab the delivery pack and update the board. Don't worry - the pushing bit takes quite a bit longer than on television." She said this as she disposed of everything in the clinical bin, washed her hands again, wrote 'fully' on the CTG and pushed the trolley in the room, returning it to where it lived in the storeroom.
"Sister?" she called as she rounded the corner to the handover room, where the co-ordinator was standing with a clipboard, trying to work out who could cover whom so the staff could take their breaks later in the night.
"Mmm?"
Rena grabbed a whiteboard marker, and wrote the time and 'fully' next to Tomoe's name in the section for room 14. "My lady's fully, involuntary pushing. Keep an ear out, would you? The head is at +1 and it's an SGA baby, and she's a strong-looking lady."
"Righto. Any dips?"
"Yeah a few variable decels, but the last contraction had a late one. It recovered fast, less than 30 seconds total, but it was there."
"Ok, thanks for letting me know. I'll get Marie to listen out, she's just next door."
"Thanks Sister."
"Good luck! Pity you haven't got a student today, would have been a good one, I think."
"Yup! See you in a while."
When she got back to the room, Tomoe was definitely pushing - and the heartbeat was doing the same thing - little shallow dips, no more great big decelerations, thankfully. In anticipation, Rena had grabbed a delivery trolley, and unpacked the delivery pack, laying everything in it out neatly. Tomoe's parted legs allowed her to see what was happening, and there was a definite pressure behind her perineum. This baby was on the way.
The pack opened and ready, with all of the clamps and scissors laid out neatly, Rena finally turned to the couple. The contraction had gone, and Tomoe was panting, sweat beading on her forehead. Rena soaked some paper towels under the cold tap and passed them to Kotetsu, who dabbed at his wife's face.
"Ok, Tomoe, it's concentrating time now, ok?"
"H-how do I push?"
"I can't tell you that, dear - you have to follow your own body's cues here, it knows what to do better than I can tell you." This was a matter of some debate - an older midwife would of course have taught Tomoe the Valsalva technique for pushing, but Rena had read far too many studies of the difference between coached and physiological pushing, and she saved Valsalva technique for a very urgent situation. Which, at the moment, this was not, but evidently, Tomoe thought it was even less urgent than she did.
"Oh, no, Kotetsu, we've..." she sighed, "...we've missed... Hero TV Live."
Rena didn't realise she'd barked out a laugh that wasn't just in her head until she looked at two gawping faces in front of her. "Oh! Sorry, it's just... sorry. I checked the results a while earlier, not much happened - just a few petty thieves. Slow night. They got caught. Not much fun without- well, hehe."
The look Tomoe shot her was calculating, and slightly disarming. "Without?"
For the first time that entire evening, some semblance of a blush that took away from Rena's outer mask appeared. "Ok, don't laugh, but uh... well, my favourite Hero wasn't there, and it's just not the same without him. I know he's not exactly top of the leader board or anything but..."
"Who?"
She sighed, and swallowed hard. People always laughed when she told them, so she didn't tell people, usually. "Wild Tiger. I don't really know why - ok, that's a lie. He's just - he hasn't got the most elegant style or anything, but I feel his heart is always in the right place. You don't see him on a lot of sponsorship deals, or on underwear commercials or any of that, he just... saves people and fights the bad guys. And I like that a lot."
She wasn't prepared for the cheek-splitting grin that burst across Kotetsu's face. "Wanna know a secret?"
"Sure?"
"He's Tomoe's favourite too."
"Is not!"
"Don't lie."
"His suit looks stupid, Kotetsu." Her eyes were teasing as she spoke.
"Hey, that suit is a classic, you love it. Always saying how sexy his legs look."
"Oh get over yourself."
"Actually..." They both stopped arguing, and looked at Rena. "I do think his legs look great in that suit, but it's not the best suit I've ever seen. You know, you're probably going to think I'm dumb for saying this, but he reminds me a lot of Mr. Legend, you know? That same sense of honour and duty. Legend wasn't exactly the most careful with property either, but he got the job done all the same."
Kotetsu's face fell, and Rena instantly knew she'd said the wrong thing. "I'm sorry, if you think that's stupid, but-"
"You really think Wild Tiger reminds you of Mr. Legend?" His voice was tiny, a squeak compared to his normal baritone.
She nodded carefully. "Yeah, I do."
"Oh. That's - well, I don't you could understand-"
Before any more could be said, another contraction hit, and this one was a big one - Tomoe shouted, before bearing down, tucking her chin to her chest and pushing unprompted.
"That's it, Tomoe, you're doing great, keep it up. Breathe, don't forget to breathe!"
"I AM BREATHING!"
"I know, some people forget! Now use that contraction, push, don't let it go!"
"OKAY I AM!" Just as the contraction peaked, however, once more, the heart rate dropped, just as the vulvae parted slightly - Rena squinted carefully, and saw a tiny tuft of glossy, sticky white hair receding back into the folds of the birth canal. She grabbed a pen, hastily wrote 'vertex visible' on the CTG, quickly washed her hands and put her sterile gloves on.
Thankfully, a few moments after the contraction dropped, the heart rate picked back up again, and Rena wondered about cord compression - it was the likeliest culprit. She picked up a drape, unfolded it, laid it out on the bed and put it under Tomoe's buttocks, to protect the bed. As she did so, another contraction came, right off the back of this one - and this time, Tomoe pushed well, groaning as she did so. Kotetsu stepped up this time, encouraging her.
"That's it, love, that's it! You're doing great, you really are!" He had finally found himself, and it heartened Rena no end.
"Good woman, Tomoe, that's it! Listen to Kotetsu, see what he has to say."
The head was descending, and fast. With each push Tomoe made, the labia parted more, the perineum stretched, and thick, curly black hair pushed forward and forward.
After a few more contractions, it was becoming obvious that something was wrong. The head would only come to a certain point, then even with the mammoth effort Tomoe was putting in, it would go no further. Tomoe herself could tell.
"IT KEEPS GOING BACK UP."
"I know, honey."
"What's wrong?" Kotetsu's fearful voice was back, and Rena swallowed a curse and tried to adopt a neutral expression.
"Nothing's wrong. She just... I think something might be in the way. Tomoe, is it ok if I examine you? I want to see if there's anything obstructing your baby if that's ok." Receiving a terse nod in response, she re-examined Tomoe, to find that, unnoticed before, there was the edge of fingers just at the side of the baby's head - a compound presentation.
That explained that much.
Rena gently pushed the fingers down out of the way, in front the baby's face, until the presenting diameter was small enough. The skull was moulding well, the bones sliding over each other to fit through the pelvic outlet. As she was about to take her fingers out, another contraction waxed and Tomoe pushed, and the head surged forward against Rena's fingers. She removed them quickly, triumphantly, and watched as the head pushed right against the perineum.
"Kotetsu?"
"Yeah?"
"Want to see what her hair looks like?"
"You can SEE IT ALREADY?"
"Mmmhmm!" She beckoned, and he leaned over Tomoe's leg, and then he paled as he saw the little black curls. In fact, he looked positively sick, but Rena knew better - he was merely overwhelmed. He stood backwards a step, shook his head, looked Tomoe in the eye and gripped her hand anew.
"Tomoe. She's right... she's right there. Right around the corner. Come on Tomoe, I... I really want to meet her."
"Ok Tomoe? Tomoe? You need to listen to me now, this is important. Very soon, the head is going to deliver and I'm going to need you to stop pushing, and just pant. That way, the head will come out niiiiice and gently and hopefully you won't tear."
"I DON'T FUCKING CARE IF I TEAR I JUST WANT THIS FUCKING BABY OUT NOW."
Kotetsu and Rena swapped a bemused look, and Rena answered, "I know, honey, but I want you to be able to still poop unaided afterwards, ok? Ok, here's the next contraction, coming, now go for it!"
"DO I PUSH!"
"Yes honey, push until I tell you stop, go go!"
She did. She pushed and pushed and pushed, and then the head cleared the perineum, and she quickly yelled "OK STOP! Tomoe? Tomoe! Just pant now, honey, ok? Pant with me." She started gasping and panting, and Tomoe panted along, eyes wild. The head came gently, face sweeping the perineum and then, with a small pop and a gush of yellow-green fluid, the head was delivered, and it turned sideways until the baby's face was staring at her mother's inner thigh.
"Oh god, Tomoe, I can see her head, her head is right there!" Kotetsu was shaking, more from delight now than fear.
"He's right. Tomoe, you want to feel her head?"
She did so - reached a hand down, and touched her daughter's head - sticky with fluid and vernix, and a sob escaped her. When she pulled her hand back, Rena reached her own between the folds of the baby's neck, and was utterly unsurprised to find the umbilical cord looped once, no twice. That explained not only the decelerations, but also, now, the green tinge of meconium to the amniotic fluid in the hindwaters.
"Ok, Tomoe, one last effort - one last push and this baby will be out." Rena's voice belied her worry - the baby had been sitting with its head out for more than thirty seconds, and had no made a single effort to move - no gasping of lips, not even a slight compression of eyelids.
A knock on the door sounded, and she shouted "Come!" Marie entered the room shyly, smiled at Tomoe and Kotetsu, and immediately went to wash her hands and put a pair of gloves on. "Kotetsu, Tomoe, this is my colleague, Marie. She's here to help me with the baby, ok?"
"Nice to meet you both." Marie muttered quickly. She'd looked at the CTG and seen the same issues as Rena had. "Rena, everything ok?"
"Yeah, double-looped cord, but free now. Might need a few inflation breaths, we'll see."
"You want cord pHs?"
"Yeah please."
"Sure." Marie drew two needles and got them ready. Then... everything happened all at once.
The final contraction overcame Tomoe, and she pushed with everything she had, and with one almighty push, a little girl entered the world, followed by an enormous flood of greenish-black liquid. Ignoring her earlier discussion entirely about Kotetsu cutting the cord, Rena dried the baby while Marie clamped and cut the cord, and she lifted her to the resuscitaire, flicking the heating lamp on, calling as calmly as she could, "She's out! Time is... 22:32. She's just being a big sluggish to have a scream at us, I'm just going to give her a little encouragement." She started the APGAR timer.
Colour pale. Tone floppy. Heart rate below 100. No chest movement. Rena dried the baby vigorously, stimulating her as much as she could and assessing her along as she could. The baby lay perfectly still on the resuscitaire surface, and her own heart hammered in her chest, even as she heard the pop of the syringes behind her, indicating that Marie had taken the cord pHs.
Colour pale. Tone floppy. Heart rate below 100. No chest movement. There was nothing for it - she grabbed the inflation mask, whacked the oxygen flow on, covered the baby's mouth and nose, and gave five solid inflation breaths.
Colour pale. Tone floppy. Heart rate below 100. No chest movement. Oh come on, baby, I am not in the mood for this, she thought to herself.
"Come on baba, no sulking just 'cos you've been kicked out, your mama and papa are dying to meet you."
And then... then it worked. First it was an arm movement, then a little leg kick, and then that first, gurgling cry as the baby took its first breath independent of its mother, and everything in the room seemed to slow down.
Colour pink. Good muscle tone. Heart rate above 100. Regular chest movements. The timer above her head beeped to let her know one minute had passed since birth, and she made an instant assessment of an APGAR of eight, then wrapped the now-crying infant in the towel, and turned around. She wanted to weep from relief, but that was someone else's job - she had a placenta to deliver.
"Come on, you, go cuddle your parents."
There was nothing quite like the look on someone's face the first time they look on the product of their love. Rena had seen it many times, but, in her own quiet moment, she would think to herself that Kotetsu's face looking at his daughter was her favourite - the ultimate example of an instant bond born of anticipation, fear, relief and... love.
Love was in every tear that fell from his and Tomoe's cheeks. Love was in every racking sob that escaped his chest. Love drew the smile on his face, and love made his eyes shine so bright that the whole world was simply better for him being in it. Love for his wife, awe of her power, and adoration for his new daughter.
"You did it." He kissed his wife, then bent and kissed the forehead of his baby girl, nestled snugly in her weary and shaking arms. She was a beautiful child - round wide eyes, thick, brown hair and tiny fingertips that grasped his little finger just so, in a way that had never happened before yet seemed perfect on its first touch.
Rena busied herself with Marie, delivering the placenta and watching for any excessive bleeding. She couldn't bring herself to intrude on this tableau - it was breaking her enough as it is, and she still had a lot of work to do before she could consider this done and dusted. She'd never felt like this about a couple - in her heart, she realised that there was a seed of love in her, too - love for this couple, for their child, and she said a silent prayer of thanks that she was the one blessed by fate to be the one there for them that day.
When she was satisfied, Rena removed her gloves, washed her hands, and pushed the delivery trolley out of the way, and stepped to the same side of the bed as Kotetsu, to get a proper look at the tiny thing in Tomoe's arms.
"You did well, you know."
Tomoe was crying, and couldn't choke out a response, but she nodded, thanks in her eyes.
"Oh she's gorgeous! Look at those cheeks, oooh, she'll break hearts this one." She noticed a slight hesitant fluster, then, and realised that Kotetsu was aching to pick her up.
"Am I allowed to know her name, now?'
Husband and wife exchanged a smile, and Kotetsu said,
"Kaede. She's called Kaede."
"Well, Kaede, would you like to cuddle your Papa? I think he needs it."
He froze, but Tomoe's smiled warmed even more, impossibly warm, and she passed the gurgling child to Rena, who in turn handed him carefully to her father.
"Well, then, Kaede... happy birthday. It's lovely to meet you. I could cuddle you forever, but there's someone more important here." He opened his arms, and she lifted the little bundle into his arms. "Kaede - meet Papa."
TEN YEARS LATER
Rena fought her way home through the snow, falling in the door to her apartment building and slamming the door behind her with a tired sigh. She was worn out - it had been a very, very long shift, and she was two hours late leaving as they'd been understaffed, and, as an experienced co-ordinator, it had been up to her to arrange cover.
There were a few cards and letters in her letter box, and... oh. That one.
Invigorated, she raced up the stairs to her apartment, ran inside, dropped EVERYTHING she was carrying on the floor and lifted the envelope to her chest. Her eyes closed, and she took a moment to savour it, before carefully ripping open the envelope and pulling the Christmas card out.
It was here again.
Shaking, she opened the card, and read the neat little inscription.
To Rena,
All my love at Christmas. For everything you are, everything you've done, and every life you've touched.
love always,
Wild Tiger.
She re-read it a few times, and then popped it on that shelf, away from the rest of that year's Christmas present, but next to the other nine it belonged to.