Jack's phone rings at a time when one says "is it really late, or really early?" Mel is awoken by it since she stayed at his place last night. They'd been at the bar, talking and laughing with the other residents of virgin river. Jack had helped fill drinks and serve meals in between sitting next to Mel who drank water and hoped no one noticed she didn't have her usual whiskey.
"Jack…. I think the twins are coming!" Charmaine whispers into the phone. It's obvious she's crying.
Not comprehending what she means Jack says, "I'll have doc or Mel take a look at you in the morning. I'll call them." Charmaine doesnt need to know Mel is currently in his bed.
"No, I think I'm in labor." She cries. It's too early. She's only 28 weeks. "Get Mel?" Is all she can utter. Jack hangs up after saying he will.
Mel is already putting on her jeans and shirt. Jack asks to Mel, "what do we do?" He grabs his jeans and is quickly getting dressed
Mel is already on the phone herself "Charmaine, what's going on?"
"I was having a lot of cramping yesterday but figured it was Braxton hicks as I had a busy day at the salon. I went home and figured laying down would help bu… oh God… "she stifles a cry, "But I woke up and I'm still contracting. Then I think my water just broke! There was a gush of fluid when I stood up to go to the bathroom! Oh God. It's far too early."
Mel tries to remain calm but inside, she's deeply panicked. They are no where near a NICU to care for babies born at 28 weeks, they aren't even close to the hospital at this point. "Ok, I'm getting Doc and then we will all be over. Do not panic! Try to go lay down and rest. Put your feet up above your heart!" She hangs up. She hears Jack waking Doc up on his cell.
Jack is grabbing his keys as he says, "you didn't say it would be okay" She stares at him with sorrowful eyes. She follows him out the door and they get into his truck.
"Jack," she says softly, "Babies born this early dont have a great chance of survival when they are born in a hospital and can get to a level 3 NICU."
"Cant you reverse the labor? Make it stop? Keep them inside longer? Sew it up so they can't come out?" He is speeding to the clinic. She grabs onto a handle to steady herself and he eases off the gas some
"It's incredibly hard to stop or even slow labor in the hospital. If her water truly has broken, it may be past the point of return." She is nervous for Charmaine and Jack knowing how awful it is to lose a child in childbirth. She's also nervous for herself. What if she cant keep them alive until the hospital?
They pull into the clinic. Doc is already waiting and throwing a packed medical bag into Jack's truck. "This has everything ready to go for OB." Mel had recently restocked the bag herself after delivering a baby nearby.
"Doc, tell me Mel is wrong" Jack asks Doc. Mel cant even bring herself to be offended because she sees the terrified look in his face.
Doc looks at Mel first with knowing eyes, "Let's make sure Charmaine is truly in labor first." He says to Jack.
The drive to Clear River is quiet. Mel grabs Jack's hand that isn't on the steering wheel and gives it a squeeze. He doesn't respond to her touch. Mel understands but there's still a slight twinge of jealousy that creeps in. The fact that Charmaine is more likely to give him a healthy baby still seems reasonable to Mel. She can't imagine her own body being able to do the same.
The clock says 4:35am when they pull into Charmaine's driveway. Jack let's himself in with a key, Doc carries the medical bag and Mel throws her hair into a pony tail and puts on gloves as she follows behind them.
"You're 9 centimeters dilated, "Mel says. She paused a moment, "and your contractions are regular. Yes, you are in labor".
Jack pulls Charmaine into a hug and holds her there. Doc and Mel walk into the other room.
"How quickly can an ambulance get here?" Mel asks.
"To Clear River, probably 30 minutes, they aren't far from here. Might save some time if we meet them halfway"
"I want to have them here! You know I hate hospitals! I wanted a home birth!" Charmaine yells from the other room as if she knows exactly what they are discussing. Women in labor were always irrational, thought Mel.
"No!" Jack and Doc both say at the same time Mel says, "absolutely not!"
Back to Doc, she says, "this isn't good!"
"I'll call Grace Valley hospital and have them get a helicopter on stand by to take them to the nearest level 3 NICU" Doc says.
Jack joins them in the kitchen. Doc continues, "let's get in the truck, Charmaine in the back with Mel. I'll drive."
"No. Mel needs to drive. I don't want her bouncing around in the back of my truck." Jack says. Doc is the only one who knows about her pregnancy. Jack gives him a knowing look. Mel feels a tug on her heart for Jack. He is continuing to put her above everything. Her constant protection.
"I know, Jack, but it won't be for long. We are going to meet an ambulance. But Mel's midwifery skills are needed with Charmaine."
Doc calls the ambulance while Jack helps Charmaine into the back of the truck. Doc gets behind the wheel and again, they are off. Doc not being as reckless with his speed as Jack was with so many unrestrained passengers and Jack's concern for newly pregnant Mel.
Mel sends Dr Stone a text. He's the OB at Grace valley, whom she has interacted with professionally now on a handful of cases, met with for her own obstetric care and now considers a colleague and friend.
Mel: it's not me- I'm fine. Charmaine is delivering her 28 week twins. Meet us at the hospital? not looking good.
John Stone: I'll be there 45 minutes. Should beat you there. You're a more than competent midwife. You've got this!
Mel checks charmaine's cervix again. "Oh my god. She's 10 centimeters. And- oh crap- she's crowning!" Mel looks at Jack who isn't understanding "I feel a head!" Charmaine is wincing in pain, "You'll have to fight the urge, but do not push!" Jack tenderly brushes Charmaine's forehead and Mel has to look away. This is why she didn't want to enter into a relationship with Jack months ago. This is the hard part.
"Doc! Where is that ambulance?"
A few minutes later, Charmaine has a big contraction and despite her efforts to not push, the first twin is born. Their boy. Mel catches a tiny baby that fits into one of her hands and wraps it in a blanket.
"Doc! What do I do!" Mel is panicking. She's used to having resources available when there's a preterm delivery. She would typically be handing the baby off to the NICU team immediately who could put in a breathing tube and swoop it away to the NICU. Mel reassures Charmaine, "you're doing great, momma!"
"Wrap him in a blanket and give him to his mother". Doc says into the rearview mirror but the meaning behind his words is "Let his time on this earth be in his mother's arms." Charmaine is crying. Jack is tearful. Jack takes the tiny baby and places it in charmaine's arms.
"There's the ambulance up ahead!" As Doc lowers his window to wave them down. Mel hopes they can somehow keep baby girl inside long enough to get to the hospital with the helicopter waiting.
Doc pulls over and the paramedic meets them as the trunk is opened. Mel immediately filling them in "37 year old female, gravida 1, para 0 until a few minutes ago. 28 weeks gestation twins. Pregnancy complicated by HG. Baby A, a boy, was just born. Baby b remains inside. Do you have neonatal intubation equipment?"
"Just pediatric" the EMT says.
"Grab it!"
The others get Charmaine onto the stretcher. Mel holds the baby while the EMT returns with the equipment. It's far too big for the tiny neonate.
"Doc!" Mel helplessly says "we can't intubate with this!" Baby boy is decompensating in her arms.
Doc takes the baby from Mel's arms and takes him over to Charmaine who is now in the ambulance who holds him closely.
Doc returns to Mel's side. "There's nothing more we can do." He puts his hand on Mel's shoulder, "Charmaine knew the risks of having twins. Of being further from the hospital. Of being hesitant to go to the hospital. She didn't even call us until she'd been contracting for hours. Now, this is not her fault by ANY means, but it's out of our control."
The paramedics look at Mel, "are you coming? We have room for one more. We could use a midwife!"
Charmaine's voice carries from the ambulance, "yes! She's coming with us!"
"I'll drive behind you in the truck" Doc says. Mel doesn't want to part from him and his calmness for treating situations without medical resources, "you'll be okay. We have another hour. Faster with the sirens" with a squeeze of her shoulder and a gentle nudge toward the ambulance, he turns to get behind the wheel again. Mel walks over to the ambulance and gets in.
The paramedic is busy putting monitors and oxygen on Charmaine hoping to help any fetal distress the second twin may be experiencing still in the womb. Mel is somber as she takes a seat next to Jack on a bench. The first baby is gone. She's never seen him look so stressed as he looks over at Charmaine. His head in his hand and rubs his eyes.
Her joining him causes him to look up, "Hey city girl" ever his pet name for her, Jack gives her knee a slight squeeze, "you're doing the best job, midwife".
Mel feels for Jack. Trying to support his babies' mother but also his girlfriend who is assisting their delivery. It's messy. It's complicated. She hates it. She hates every moment of this early morning.
"I'm not. I don't have-" Mel is cut off.
"You're doing the best..." he trails off before saying "you can".
Charmaine groans with another contraction. Mel waits for the paramedics to finish and get out of the way.
She slides Jack's hand off her knee. "Jack, this is -"
He feels it instantly. Her pulling away. The complicated stressful push and pull between the 2 women and Jack in the middle. What is she about to say? Too hard? Too much?
"Hey. Bunjee cord." his little reminder that she can pull away some but not get away from his love.
It causes Mel to take a deep breath and let it out. She goes back to Charmaine, "let's just hold that baby in until we get to the hospital, okay?" She checks again to make sure they still have time and is pleased to find no baby awaiting immediate arrival.
Jack and Mel attempt to get Charmaine to the hospital comfortably. She grimaces through contractions. Holds Jack's hand throughout. Jack whispers encouragement into her ear. Mel senses that the second delivery is near.
Jack pulls back for a minute to look for himself. Mel whispers to Jack, "I hope that helicopter is ready at Grace Valley."
"Mel, I can't get on a helicopter. I'll panic." Jack confides. His PTSD is untreated and worsens with stress. A glass shattering in the bar can cause him to have flashbacks, a helicopter might make him not sleep for weeks.
"I'm not sure they'll take Charmaine since she just delivered. You might have to as the other parent!" Concern in Mel's eyes.
They pull into the ambulance bay where Dr Stone meets them with an incubator. He gives Mel a solemn look when he checks over the first twin but doesn't linger and immediately tries to reassure Charmaine. "Let's get you up to the L unit"
Jack follows as they push Charmaine down the hall on the stretcher. Mel fills Dr Stone in on the events of the morning, "we don't have magnesium! I had nothing to try to slow down the contractions!"
Dr Stone, "you know you shouldn't start magnesium in the field. Mel, you did everything you could! I have had to make similar deliveries in this rural area too. I can only do so much. If we are lucky, we fly them to a higher level of care!"
"But they're Jack's babies!" She says defeatedly.
Dr Stone puts a gentle hand on her abdomen, "and I know where another one is being held safely". He pauses when she gives him a look, "you had infertility. You had a stillbirth. You were told you could never conceive. But yet, here you are. You are fully capable of carrying and delivering a healthy baby of your own." She gives a small smile. John continues, "now come on, we have another baby to deliver!" And they walk quickly down the hall together.
Mel finds Doc standing outside the room they put Charmaine in. The Grace Valley labor nurses and neonate team are the room making it quite crowded so they both remain in the hallway.
"Hope will be on her way. She'll take us back to Virgin River." He says. Mel nods.
One of the nurses pops her head out, "Are you Mel? Charmaine and Dr Stone are both asking for you"
Mel enters the room. She's handed a blue surgical gown and gloves. Charmaine is again in active labor with the second twin. Jack is on her left and Mel takes a spot on her right. They both grab her hands as she pushes. Dr Stone catches the tiny baby girl and immediately hands her to the neonatologist.
The room grows quiet as Charmaine is handed the second baby wrapped in a blanket.
The room spins around Mel in a moment of PTSD for herself. Why aren't they doing anything? Why aren't they trying something? Put in a breath tube! Charmaine is sobbing. Jack is crying. They are both in the bed together now. Dr Stone has backed away from the couple giving them space.
Her vision starts to shift as she slowly walks toward the door. Her own daughter wrapped in a pink soft blanket. Still. Monitors suddenly silent. Quiet. The looks from her OB. The nurses trying to hide their own tears from her. Doc meets her and helps steady her. She slides down the wall in the hallway and lets out her own frustrated, sad tears. Doc hands her a water bottle.
"Why aren't they doing anything?"
"Because Charmaine had expressed that if and when she delivered the twins, that if they weren't going to likely make it, that she'd get to hold them instead. It's what she wants, Mel"
Mel takes a large breath in and lets it out. She can understand that. As strong as it is to want to do more, the mother's instinct to comfort her baby is stronger. Doc pats her hand, "the helicopter was taking another kid up to Seattle Children's anyway. I didn't want to say anything earlier."
Eventually Dr Stone slides down the wall himself, joining them. He makes sure Mel is okay. They all grieve together for a bit. Dr. Stone is called into another delivery, "Mel? Want to join me for a happy delivery?"
She shakes her head, "I'm beat. Next time though!" She honestly would love to counteract the grief with the high that accompanies a baby being born but she can't imagine moving right now.
They sit there until Hope walks down the hall and finds them on the floor in the hallway. "Well, should we get out of here ?" For once, she minds her own business and doesn't attempt to enter the room.
Mel, feeling better, peeks into the room. Charmaine and Jack lay embraced on the bed. Both holding a blanket wrapped bundle. Both with tears streaming down their face. The Labor nurses have cleaned up the room. The neonatal team cleared out their stuff.
Mel hands Jack his truck keys, "Hope is going to drive Doc and I back to Virgin River." He barely looks up at her but says "okay."
Mel grabs Charmaine's hand and squeezes, "I'm so sorry" Charmaine meets her eye and gives a small and soft "thanks" in return.
In the car on the way back Mel sends Jack a text
Mel: please don't stay alone tonight. Meet me at my place. I love you. I'm sorry.
Jack: …
But then the text bubble fades and no response comes.