Trigger warning - pregnancy complications

"Bloody hell, what have we gotten ourselves into" Sirius muttered as he unlocked his apartment door. Begrudgingly, Sirius had agreed to look after Draco while Narcissa was in hospital, and she was not happy about it in the slightest. They'd left the hospital just twenty minutes ago and Draco hadn't stopped crying. On the way home, James insisted that before the shops shut that they should quickly stop off at the nearest baby shop and picked up a second highchair, double maclaren pram, more nappies, clothes, bottles and dummies.

"Took your time you two" Remus snorted. He sat cross-legged in front of the TV with Harry, making a tower that was knocked down almost immediately after Harry saw James.

"Dada!" Harry gasped with a wide and toothy grin. He slowly got to his feet and toddled over to James. "Dat?"

"This is Draco" James answered as he passed Draco to Sirius and picked his son up. "He'll be staying with us for a little while. Did you have a good time with uncle Moony?"

"Yes" Harry answered as he popped his thumb in his mouth and rested his head on James' shoulder.

"Did he nap okay? Finish his bottle of milk? Eat all his lunch?"

"Yes, yes and yes" Remus answered. "He's been good as always. Now are you two actually going to tell me whose child that it? Please tell me you didn't kidnap Malfoy's kid".

"We didn't kidnap a child, Moony" Sirius scoffed. "So as you know today was the Malfoy and Lestrange trial. We decided to leave a bit early and guess who we bumped into? My baby cousin".

"Thought she disappeared" Remus frowned slightly.

"Yeah well anyway now she's back. Passed out, we took her to hospital. She had to stay so now we're babysitting because that's what James insisted on doing". Sirius glared slightly at James.

"So now we're friends with Narcissa bloody Malfoy?"

"Black" James immediately corrected. "She's trying to get a divorce, preferably before she has the baby. It's black".

"Before she has the baby? So she's pregnant? Again? I need a fag" Remus announced.

"Me too mate, me too" Sirius agreed. "Think you'll be okay having both kids with you? While we head outside".

"It's like having twins" James shrugged. "What could go wrong?"

…

James was very much regretting his choice as he paced his bedroom floor that night. He thought having to look after two children would be easy enough—plenty of people managed with twins just fine, Draco hadn't even begun walking so it was somewhat easier as he didn't need to chase after him. Harry was usually okay with sleeping and would quickly fall asleep with a story, his teddy and a bottle of milk. It seemed the influence of Draco's refusal to sleep was having an impact as Harry was stood up in his cot, jumping up and down as though it was a trampoline rather than a bed.

"Come on Draco, please sleep" James murmured as he rocked the screaming child. "It's almost midnight for Merlin's sake. Come on".

Harry looked at his stressed out dad and giggled.

"Don't know why you're laughing" James shook his head. "You're not sleeping either. Okay, let's turn off the light, lie down and go to sleep".

It seemed that both Harry and Draco were insistent on staying up for the majority of the night—in Harry's case happily babbling to himself and as for Draco, crying and babbling "mama". Until Harry started to cry too, so James handed Draco to Sirius to allow him to calm down his son; fortunately Harry fell asleep quickly within his dad's arms in the double bed, leaving the others to go to the living room instead.

"Shh, please!" Sirius hissed at Draco. He stopped crying for a few seconds before going back to his hiccuping sobs. James sighed once more and continued to jiggle Draco in his arms, putting the baby over his shoulder and rubbing his back to get the sobs to stop.

"I don't think he got the memo" James drawled as he paced.

"It's giving me a headache".

"It?" James rolled his eyes. "Him. He's got a name".

"Is it illegal to give a child sleeping potion?" Sirius wondered.

Remus looked at Sirius in horror. "You can't do that!"

"Well, I'd do anything for a bit of sleep right now" he snorted. "Even if it entails dealing with the wrath of an angry pregnant and hormonal Narcissa Malfoy".

Draco wasn't sleeping no matter what they tried to do, babbling "mumma", crying and kicking his legs. The sight of the tot was absolutely pitiful even with his face covered in snot and eyes red.

"Well, you go to sleep then. I'll stay up with the child in the living room. Put a silencing charm around the room"

Once Sirius and Remus had awoken, James was already up and dressed with the boys, a steaming hot cup of coffee on the table, Paddington bear on the tv and rocking Draco who had finally fallen asleep with a pacifier in his mouth.

Andromeda had many patients that would be labelled as 'difficult' during her time as a healer. Though there was always something deep down, another reason usually behind the behaviour that would make them be a difficult patient. When her sister was admitted to the accident and emergency department of St Mungo's, she knew almost immediately that her sister would be a difficult patient. And the worst part was that she couldn't blame her. The hardest part of it all, from the moment she swept back the curtain was that she couldn't blame her sister for being a difficult patient. The moment she was called out for, having to leave the break room and immediately head to accident and emergency changed it all. Andromeda knew she'd have to stay well beyond the time her shift ended (then return again the next morning), and she didn't care—for she finally had a chance to reconcile with her sister after all these years. Though her sister seemed to think she in herself was fine, barring the dizziness that landed her in hospital in the first place, andromeda saw the bigger picture and felt she knew better. Which in theory she did, though this one hit much harder. A part of being a professional was to not let emotions get in the way and to continue with the job, so she pulled herself together, said "knock knock" before pulling the curtain back and walking to her sister's bedside.

"I have some things for you to take" Andromeda said as she perched on the end of the bed, a silver tray with a glass of water and a small white circle.

"What is that? That's not a potion" Narcissa stated.

"It's a sort of potion. Muggle medicine" Andromeda explained at her sister's confused look. "It's called a pill. You put it in your mouth, then drink some water to help it go down".

"And what does it do?" Narcissa asked sceptically.

"Reduces your blood pressure, which is way too high" Andormeda said with a tight smile. "You've already been here one night so the watch and wait approach with the usual bed rest hasn't worked so we've had to start medication. Come on, drink up".

"That's disgusting" Narcissa snarled.

"That's why you have to swallow it straight away".

Narcissa looked slightly skeptical then had a few more gulps of water. "There's something stuck in my throat".

"Keep drinking. Big gulps. It'll pass" Andromeda said as she looked at her chart. She didn't usually like to use muggle methods combined with magical, as she wouldn't be aware of the potential interactions and side effects that could come about as a result. She wouldn't tell her sister that, but she did have to sneak into a muggle hospital to procure the usual beta-blockers used in pregnancy, as with witches rest and relaxation was recommended with delivery of the baby as soon as possible. She couldn't do that. It was too early, so muggle medicine would have to suffice.

"Is it muggle medicine? Why are there no potions?" Narcissa asked.

Andromeda sighed. "This condition is very rare in witches in their second trimester. I have heard of cases where there has been pre-eclampsia which can usually however be resolved with calming draughts and bed rest as usually the baby is almost full term therefore ready to be delivered. However, you are only twenty-one weeks pregnant so barely half way. This is a case that even the most experienced of practitioners haven't seen before".

"So why keep me here?" Narcissa asked, a hint of anxiousness in her voice. "If you don't know what you're doing?"

"It's the best option we have" Andromeda sighed. "We cannot release you, its wouldn't be safe for you".

Narcissa frowned. "It wouldn't be safe for me how exactly?"

Andromeda shifted uncomfortably, unsure of what to say. On one hand, if a patient didn't want treatment, then that was up to them. On the other hand, that patient was her little sister. "Pre-eclampsia puts you at a serious risk of premature birth again. I know you had Draco prematurely, however he was born at thirty-two weeks which puts him at much better odds. You are only twenty-one weeks, premature labour can be fatal. If you do not stay in hospital for constant monitoring, that could happen".

Narcissa didn't say anything, merely sighed deeply. "You don't even have a maternity department".

"I am aware" Andromeda's eyes narrowed. "We will find a ward to put you in".

"Where, Janus Thickney ward? With the other victims of our lovely sister" Narcissa scoffed. She knew it was a low blow, Andromeda raised an eyebrow in response and Narcissa sighed. "Look, I appreciate all you've done for me but I have to be able to have a choice in all this. This is my body, my pregnancy, my illness. And I wish to go to a muggle hospital instead".

"And you'd use your normal name?"

"No, I'd use an alias. Izzie".

Andromeda looked thoughtful for a minute. "Let me get back to you on that one". She looked straight ahead as she walked out, closed the curtain and made her way to her office, sitting at her desk with her head in her hands. She wasn't even supposed to be working today, though had picked up a bank shift with the full intention of only having that one patient. Narcissa. A sore spot, and had been for some time. She knew that she had to stick a needle into her sister and should be replenishing her body with fluids and potions to help lower her blood pressure, but the sad thing was that she knew that it would likely mean the pregnancy wouldn't end well. No matter what she was taught, the Hippocratic oath was drilled into her mind; to prescribe only beneficial treatments though the case was difficult, technically having two patients. It was too much to deal with, for this wasn't just any patient. It was Narcissa. Her baby sister, that would excitedly await her return from Hogwarts. Her baby sister, the only family she had left. She had Ted and Nymphadora of course, but it could get lonely just them. While her childhood was terrible, she was always surrounded by other cousins and her sisters. Now, none.

There wouldn't be any harm in allowing Narcissa to attend a muggle hospital. She could always go along with her—after all, she wasn't technically needed on this shift and was only there for one patient anyway. She apparated to a nearby phone-box around the corner from St Mungo's and called an ambulance.

…

A part of Andromeda wondered why on Earth she agreed to this as she stood in the freezing cold outside St Mungos, waiting for the ambulance. Narcissa insisted on walking out of the hospital, though was currently sat down on the floor outside the main door and round the corner, shivering. James Potter was sat on the floor next to the blonde, Draco on his lap as the baby tried to reach for his mother.

"How's Harry?" Andromeda asked.

"He's with Sirius for the day" James answered. "Godfather and Godson bonding".

Andromeda's eyes flicked back to her sister, she knew the situation with Draco's godfather was strained. "For fucks sake, where is the ambulance?" Andromeda muttered to herself, they had said it seemed best to prioritise Narcissa being pregnant, though it had almost been half an hour. Technically, it was her day off so she wasn't strictly skiving her shift, having picked up an additional one to ensure she could look after her sister, so it wasn't like they'd miss her over at the hospital. She'd abandoned her once before, and Andromeda was determined to not let the same happen ever again. Soon she could hear the sound of sirens around the corner as the halogen blue lights became closer and brighter.

Narcissa squinted and firmly shut her eyes. "That's way too bright".

"I know" Andromeda said soothingly, the back doors opened and out came the paramedics.

"Hi, I'm a paramedic" one of the paramedic's dressed in green introduced.

"A what?" Narcissa asked sleepily.

"A paramedic" he repeated. "Is it okay if I take your observations in here? It's much more nice and cosy in there, rather than staying outside this run-down John Lewis".

Narcissa nodded, refusing the offered hand from James and Andromeda as she forced herself to her feet, staggering to the ambulance.

"Alrighty then" the paramedic said as he helped her onto the bed. "Just going to take your blood pressure, is that okay?" Narcissa nodded in response and the cuff bleeped as it inflated, "well that's way way way too high looks like we need to take you in. Anyone going with you? Sister or brother-in-law tagging along?"

Andromeda bit her lip nervously. To work or to go with family? She could use the extra money, but this was her baby sister. No amount of money would ever get in the way of the little family she had, the little family that she didn't want to give up on.

"I'll come" Andromeda piped up as she clambered into the ambulance. "I'll send a patronus or an owl" she looked to James then back to the paramedic. "Which hospital?"

"St Thomas' hospital, I think that would be best as they have the mead ward".

"Thank you James, for everything. I'll be in touch" Andromeda smiled slightly.

"I'll be back at my place" James said.

Andromeda didn't say anything, the ambulance doors closing. The blue lights and sirens were on as the ambulance drove away, and James was left holding Draco. He looked at the tot and apparated home.

The ambulance soon arrived at the hospital, the stretcher taken down via a ramp, doors opening to bright corridors with green floors and beds. Narcissa was led into a bay, a pat-slide across the bed and stretcher with one of the nurses announcing "one, two, three, slide", a flurry of professionals entering the room. Andromeda felt pushed to the back as they went around their jobs, attaching IV's and a blood pressure cuff. Narcissa looked confused but stayed with her arms out as a midwife and obstetrician entered the room. The flurry of people soon died down, leaving just the obstetrician and midwife in the room alongside Narcissa and her sister.

"This your first baby?" the obstetrician asked as he wrote down something.

"No, second" Narcissa answered.

"Any history of complications there?" the obstetrician asked again.

"He was premature".

"I don't think we can deny it even if we wanted to" the midwife said. "Your blood pressure is extremely high and there's protein in your urine".

"You have pre-eclampsia".

"Now what's going to happen?" Narcissa asked.

"You'll be in hospital for the foreseeable future" the obstetrician said. "At least until we can get your blood pressure under control, hopefully a few nights should be okay".

Another morning meant it was time to go back to the hospital once more. Again, Andromeda had the morning off work so she headed over to the muggle hospital's maternity unit, knowing that she'd meet James there in order to have handover of Draco. It had been a while since she'd had a baby in the house, though Nymphadora was excited to have another child to play with. She knew her sister had nowhere else to go, and with another baby on the way there was no doubt she was struggling—and that was without the addition of complications. Andromeda and James arrived early in the morning, though the doctors thought James was the husband and then sent him outside when he explained the situation. At nine o'clock, the doctors began their rounds for the day.

"What do we think it is?" Androemda asked. "Is it pre-eclampsia?"

"That's what we think too" the midwife said.

"We just need to run some more tests for other things too" the obstetrician said. "But as a minimum we're looking at pre-eclampsia with a possibility of intravenous coagulation".

"Okay, that's not looking good" the midwife grimaced.

"I take it the blood results are back?" The obstetrician checked.

"So what is it?" Andromeda asked.

"She has a severe form of pre-eclampsia called HELLP syndrome—we need to get her blood pressure under control now".

"Confirmed?" the obstetrician checked.

"Confirmed" the junior doctor said as he walked in. "Severe pre-eclampsia and disseminated intravascular coagulation".

The midwife turned to Andromeda. "Her clotting factors are all over the place. Low platelet counts, prothrombin is high as is partial thromboplastin. The blood clots inside the veins and can lead to bleeding elsewhere".

Narcissa remained semi-upright on the bed, looking confused.

"So what are you saying? The thing in this" Andromeda gestured to her sister's arm cannula, "isn't working? Blood pressure still high and worsening is what you're saying?"

"We're putting her on seizure watch" the obstetrician announced.

"Seizure watch?" Andromeda bit the inside of her cheek.

"Page the blood bank as we need a minimum of three units now, I need four grams of magnesium sulfate via IV, we need two more cannula's and I want blood taken" the obstetrician ordered around. "Could I have your hand please? And then the midwife needs your other arm to take blood and cannulate".

"Okay" Narcissa whispered hoarsely as she held out her hand and reluctantly removed her arm from around her bump.

"We need to move her to ITU as soon as possible" the obstetrician continued. "We need to try oral nifedipine and low-weight molecular heparin".

"Uh, I don't think so" the midwife cut in. "The patient cannot tolerate oral medication, not to mention it won't be absorbed as quickly as necessary. It'll have to be IV".

"I don't see why we can't try" the doctor shrugged. "Put in an order for PO nifedipine and low weight molecular heparin".

"I'm not putting in an order for oral nifedipine" the midwife argued. "And low-weight molecular heparin is currently untested in pregnancy".

"You!" the obstetrician pointed at the junior doctor. "Go get me an order of low weight molecular heparin".

"W-w-w-what dose? What's the dosage?" the junior doctor stuttered.

"Patient has a weight of 58kg, figure it out" the doctor snarled.

"Okay" the junior doctor quickly scurried from the room.

"Fuck that hurts" Narcissa moaned as she hunched over.

"What hurts, sweetheart?" the midwife asked. "Is it alright if I have a quick listen into baby's heartbeat?"

Narcissa nodded and the midwife bent down with her pinard.

"How does it hurt? Tightening, nausea, headaches?" the doctor asked.

Narcissa nodded and closed her eyes.

"Which one?"

"Heartbeat's good on baby at 160" the midwife announced as she stood up straight. "Baby's doing well in there".

"I don't" the blonde trailed off as she started into the distance, arms and legs taut.

"Cissy?" Andromeda frowned.

"Are you okay, ma'am?" the obstetrician asked.

"Can you hear me?" the midwife asked as she gently shook Narcissa's shoulders.

"Isabella, can you hear me?" the doctor said.

The blonde began jerking from side to side, limbs flailing. She tried to keep herself still, to stop herself from shaking and turning but she couldn't. No matter how hard she tried, she lost control over her body.

"What's going on?" Andromeda asked as she stepped aside. The obstetrician nodded to the midwife, who pushed a red oval button on the wall, a blaring alarm filling the room and hospital corridor.

"Obstetric emergency, eclampsia" the obstetrician declared.

"Ventricular tachycardia!"

"I've got the magnesium sulfate" the junior doctor announced. "Intravenous injection?"

"Now" the obstetrician nodded, stepping aside to allow the junior doctor to inject the medication. "Hold the arm as still as you can, I don't want that magnesium sulfate coming out".

"Turn patient to left lateral and get the wedge".

"Secure the airway!"

"Suction to avoid aspiration".

"Blood pressure is 200 over 120".

"Tachycardic at 120 beats per minute".

"Indwelling catheter required".

"Inject the blood thinners".

"Oxygen sats of 94".

"Displace the uterus and be prepared to start basic life support if required".

"Oxygen sats remain low".

"Imminent delivery advised".

"What's going on?" Andromeda asked.

"She's having an eclamptic fit" the midwife explained. "We may have to deliver the baby".

"Ignore the pregnancy, treat the eclampsia" the obstetrician shouted.

"But it's too early?" Andromeda frowned. "She's only five months along".

"The baby won't survive another one" said the midwife gravely. "And your sister may not either".

"Fuck" Andromeda gasped as she put her fingers to her temples. "What'll happen?"

"We've given her the medication, we'll probably have to move her to intensive care from here once stabilised".

"Blood pressure remaining high despite absence of seizure now, we can move to theatre or ITU" the obstetrician announced.

"I don't think theatre will take her with disseminated intravascular coagulation" the midwife said.

"Someone page intensive care and ensure there's a side-room available, let's try to go to theatre" the obstetrician said. Curtains were pushed out of the way, the side-railings of the bed pulled up and Narcissa wheeled away, Andromeda following her sister while James looked confused, Draco finally asleep on his shoulder.

"What's going on?" James asked.

"Emergency c-section" Androemda said.

"What! Now?"

"I'll come find you later or send a patronus" Andromeda said, following the bed down corridors and through double doors to the delivery unit, followed by more corridors and double doors with a large sign above them reading OBSTETRIC THEATRE. She followed them through a pair of white double doors and into the large operating room, where they tried to put another cannula into her sister.

"Ouch! That hurts" Narcissa said.

"We need to do an emergency c-section" the obstetrician announced. "Let's get patient onto the table, start anaesthesia".

"Er, do you mind?" Narcissa asked as she was pulled across the pat-slide onto the operating table. Andromeda was left in the anesthetics area that would have been usually used, if not for the emergency.

"I'm just going to listen to baby's heart now okay?" the midwife said as a flurry of people in scrubs came forth and went around to do their jobs.

"What's going on?" Narcissa asked the midwife, though she said nothing and went to the obstetrician.

"Okay, this is the anaesthetist who will put you to sleep in order to do the caesarean" the obstetrician said, making eye-contact with Narcissa for the first time.

"I don't want a caesarean section" Narcissa frowned.

"It's what's best for you and the baby" the obstetrician said.

"No, it's not. It's too early" Narcissa cried.

"Let's get this on" the obstetrician said and pulled the mask over Narcissa face. She paled, pulling it away as she looked around.

"I think I'm going to be sick" Narcissa said meekly.

The midwife noticed, grabbing a kidney shaped sick bowl just in time. The doctor frowned as he noticed some blood streaming out of Narcissa's nose.

"I won't sedate a patient with DIC" the anaesthetist announced. "Or blood pressure this unstable".

"Okay" the obstetrician huffed. "Fine! We treat the eclampsia, ignore the pregnancy. There's too much bleeding, it's clotting unnaturally. We need treat the intravascular coagulation and eclampsia. We're not doing a caesarean but I want her on intensive care with an arterial line and on seizure watch. Any more, and we are doing a crash section".

"Thank you" the midwife said. "Okay, let's move to ITU".

Andromeda frowned as the theatre doors opened again, her sister being wheeled out. "What's going on?"

"Her blood is unnaturally clotting so we need to sort that out before the surgery. She won't have a c-section, instead to be moved to intensive care. Page them".

Andromeda watched as the medical professionals rallied around her sister, transferring her to the bed then walking to the intensive care unit. She didn't know how they could do it, and was glad for the transfer of care as she knew it would be too difficult to continue to care for her sister, especially in her in a state like this. Now all she could do was hope that everything would be okay and take care of Draco.

A/N: bank shift - an additional shift that was not on rota/planned in advance - or if extra staff are required. In this case, Andromeda decided to work when it wasn't necessary for her to.

Pat slide - something used in hospitals to transfer patients between beds

Mead Ward - the first intensive care unit in London

Fag - British slang for cigarette

Songs listened to while writing this chapter:
Warrior - Avril lavinge

Lost Boy - Ruth B
If we have each other - Benjamin Alec
Someone to stay - Vancouver sleep clinic