A Promise...to a Proposal?

CHAPTER TWO

RUBY EXAMINED MRS HARRIS GENTLY.

‘So is everything OK?’ Mrs Harris asked anxiously.

‘I’m happy with how you’re doing,’ Ruby said, ‘but we do have a tiny complication, in that your little one is quite happy being bottom-down rather than top-down. So I just want a quick chat with the doctor to talk through your options for the birth.’

Mrs Harris bit her lip. ‘So the baby’s in the wrong position?’

‘Bottom-first rather than head-first—it’s called being a breech baby,’ Ruby explained. ‘It’s a really common position in early pregnancy, but the baby usually turns by itself into the head-first position before birth. Your baby hasn’t turned yet, that’s all.’

‘Does it mean there’s something wrong with the baby?’ Mrs Harris asked.

‘No. It happens with about three in a hundred babies, and there are all kinds of reasons for it, some of them being plain baby awkwardness because they want to do things their way rather than follow their mum’s birth plan,’ Ruby reassured her. ‘I’ll just go and get Dr Webster, and then we can talk it through with him.’ She squeezed Mrs Harris’s hand. ‘Try not to worry. There are a few things we can do to persuade the baby to turn.’ She smiled, and went to find Ellis in his office.

Her heart skipped a beat when she saw him. Ellis was wearing a charcoal grey suit, a white shirt and an understated tie rather than green Theatre scrubs, and he looked utterly gorgeous. He wouldn’t have looked out of place on the pages of a glossy magazine as a model for an upmarket perfume house.

And she needed to stop herself thinking like this. Ellis was her friend and her colleague. Asking for more was just greedy.

She tapped on the open door and leaned against the jamb. ‘Hey, Ellis. Can I borrow you for a second?’

He looked up and smiled at her, and her heart skipped another beat.

‘Sure. Problem?’ he asked.

‘Complication,’ she said. ‘I have a first-time mum who’s thirty-seven weeks. Her baby’s quite happily settled in the breech position. I know her birth plan is firmly centred round a natural birth with no intervention.’ And she also knew that a lot of doctors would take one look at Mrs Harris’s situation and immediately insist on a caesarean section. Given Ellis’s experience outside the hospital, Ruby really hoped that he’d take a different tack and give Mrs Harris a chance to have the birth she really wanted. ‘So I wondered if you’d mind coming and chatting through her options for the birth,’ she finished.

‘Of course I will. You did warn her that babies never respect their mum’s birth plans, didn’t you?’

She smiled back. ‘I always do.’

‘So what are you thinking?’

‘We’ll start with an ECV to see if we can get the baby to turn,’ Ruby said. ‘But, if it doesn’t work, I’m hoping that I can talk one of the obstetricians—’ she gave him a pointed look so he’d know she meant him ‘—into agreeing to a trial of labour for a vaginal breech delivery.’

‘I think we’ve only had a couple on the ward since I’ve been here, and I wasn’t on duty at the time,’ Ellis said. ‘Are the doctors here not supportive of vaginal breech births?’

‘Theo’s wonderful,’ Ruby said. Theo Petrakis, the director of the maternity ward at the London Victoria, believed in supporting his midwives and keeping intervention to a minimum. ‘But, as you say, it’s not that common—and I need someone who’s had a reasonable amount of experience in delivering breech babies.’

‘Which is why you’re talking to me?’

She gave him her sweetest smile. ‘Got it in one.’

‘She’s a first-time mum, so we have no guarantee that her pelvis is big enough to cope.’ Ellis looked thoughtful. ‘OK. If ECV doesn’t work then—on condition the baby’s not too big or small, the baby’s head isn’t tilted back and I’m happy that the mum’s pelvis is going to cope—I’ll support you and you can call me in, even if I’m not on duty when she goes into labour. But in return I need a favour from you.’

Ruby’s heart skipped yet another beat. What was he going to ask for?

A kiss?

She shook herself mentally. How ridiculous. She really had to stop fantasising about Ellis. This was totally inappropriate. They were at work, and she needed to keep her professionalism to the forefront. ‘Sure. What do you want?’

‘I’d like you to talk your mum into letting a couple of the junior staff observe their first ever breech birth. One midwife, one doctor.’

‘Great minds think alike. I was going to ask you if there was anyone you wanted to come and observe.’ And she really liked the fact that he’d thought of the midwifery team, too, not just the obstetricians. She smiled. ‘I want to reassure Mrs Harris that we’ll try our best to help give her the birth experience she really wants, but I’ll make it clear that if the baby’s in distress at any point then we might need to give her a section, so she needs to be prepared for that to happen.’

‘Which is again where I’d come in,’ Ellis said.

‘Just flutter those disgustingly long eyelashes at her. Actually, on second thoughts, perhaps you’d better not,’ she said. ‘You already look more like a movie star than a doctor.’

‘Very funny, Rubes,’ Ellis said, but he didn’t look the slightest bit offended.

Which was another reason why she should put this whole thing out of her head. If she made an approach to Ellis and he turned her down…Even though she knew he’d be kind about it, it would still put a strain on their friendship. On their working relationship. And Ruby didn’t want to take the risk of wrecking either of them.

Maybe it was just loneliness making her feel this way, and she should take Tina up on her offer of setting her up with the new registrar on the Neurology ward.

‘Penny for them?’ Ellis asked.

No way was she going to tell Ellis what she was thinking about. ‘Just my first-time mum,’ she said with a smile. It was true; it just wasn’t the whole truth.

Back in the examination room, she introduced Ellis. ‘Mrs Harris, this is Dr Ellis Webster, one of our registrars. Ellis, this is Mrs Harris. She’s a first-time mum, the baby’s thirty-seven weeks, and the baby’s quite happy in the breech position.’

‘Nice to meet you, Mrs Harris.’ Ellis shook her hand and smiled at her. ‘Ruby tells me that you’d like as natural a birth as possible.’

‘I definitely don’t want an epidural. I want to manage with gas and air,’ Mrs Harris said. ‘And I really didn’t want to have a section.’ She bit her lip. ‘But, because the baby’s lying the wrong way, does that mean I have to have a section?’

‘It’s a possibility,’ Ellis said, ‘but it might be possible for you to have a vaginal delivery. With the baby being breech, it means that the head—which is the biggest part of the baby—is the last bit to be delivered, so it’s a little bit more complicated. May I examine you?’

At her nod, he examined her gently.

‘As Ruby said, your baby’s definitely bottom-down. But we can try to persuade the baby to move. There’s a procedure called an ECV, which stands for external cephalic version. Ruby here’s very experienced.’

‘What happens is that I’ll press down on your abdomen and encourage the baby to turn a somersault—a bit like him doing a forward roll inside your stomach,’ Ruby explained.

‘And it always works?’ Mrs Harris asked.

‘It works about for about fifty per cent of babies,’ Ellis said. ‘And if it doesn’t work today, then we can always try again tomorrow. Though I should warn you that even if the baby does turn, sometimes the baby then decides to roll back again.’

‘So if you do this ECV thing, what about the baby?’ Mrs Harris asked. ‘Will he be OK? It’s not going to hurt him?’

‘He’ll be fine,’ Ruby reassured her. ‘Plus we’ll monitor him before, during and after the ECV to keep an eye on him. There is a tiny risk that you might start having contractions, and also the baby’s heart rate might go up a bit—usually it settles again pretty quickly, but I do want you to be aware that sometimes the baby’s heart rate doesn’t settle again, and in that case you’ll need to have a section.’

‘But it’s a tiny risk?’ Mrs Harris checked.

‘Tiny,’ Ruby confirmed.

‘All right, then.’ Mrs Harris paused. ‘Will it hurt me?’

‘It can be a bit uncomfortable, yes,’ Ruby said. ‘But, if it hurts, all you have to do is tell us and we’ll stop immediately.’

Mrs Harris looked worried. ‘But if it doesn’t work, does that mean I’ll have to have a section?’

‘The baby’s a good weight. He’s not too big or too small,’ Ellis said. ‘Though I would want to check that his neck isn’t tilted back before I agree to try a vaginal delivery. If the baby’s head is tilted back, then I’m afraid you will need a caesarean section, because that’ll be the safest thing for the baby.’

‘Is there anything else I can do to help the baby turn, or make sure he stays the right way round if you do the ECV? Can I sit or lie in a certain way?’ Mrs Harris asked.

Ruby shook her head. ‘I’m afraid it won’t make any difference.’

‘So why hasn’t he turned round the right way? Why is he bottom-down instead of head-down?’

‘There are lots of reasons,’ Ellis said. ‘Sometimes it’s down to the position of your placenta. As I said earlier, the biggest part of the baby is the head, so the baby tends to fidget round and make sure he’s in the most comfortable position, which means his head will be in the biggest space—in your lower uterus, so he’ll be head-down. But if you have a low-lying placenta, then the biggest space is in your upper uterus, so the baby will be bottom-down.’ He smiled. ‘Sometimes it’s just plain old chance. Babies have a habit of doing things their way, and I know a lot of mums who haven’t ended up having the birth they’d set their heart on. So all I’d say is please try not to be disappointed if we can’t follow your birth plan to the letter.’

‘We’ll do our best to make it work for you,’ Ruby said, ‘but Dr Webster’s right—at the end of the day, babies can be very stubborn and they’ll do things their way.’

‘I think this one’s going to be like his dad,’ Mrs Harris said ruefully. ‘Can Ian be here when you try and make the baby turn round?’

‘Of course,’ Ruby reassured her. ‘We can try this afternoon, just after lunch. Will that give him enough time to get here?’

Mrs Harris nodded. ‘I’ll call him. Thank you. Both of you.’

‘I’ll see you later this afternoon, Mrs Harris,’ Ellis said with a smile.

The rest of Ruby’s clinic ran on time. Just as she broke for lunch, she saw Ellis coming out of the staff kitchen. ‘Got time for lunch?’ he asked.

‘That would be nice,’ she said.

They headed down to the canteen, chatting companionably. At the counter, Ellis as usual chose the vegetarian option.

‘Any excuse to stuff your face with pasta and garlic bread. You’re such a carb junkie,’ Ruby teased.

‘Protein’s important, but I’ve worked in areas where people are so poor and the cost of raising—’ He broke off. ‘You’re teasing me, aren’t you?’

‘It’s very easy to tease you, Ellis—you’re so serious,’ she said with a smile. ‘Look, I know why you’re vegetarian and I admire your principles.’

‘But you don’t share them,’ he finished.

She shook her head. ‘I’m sorry, but vegetarian bacon is never going to be as good as the real thing for me.’

He laughed. ‘You’re such a hedonist. Anyway, Rubes, you can talk about being a carb junkie. I’ve seen you and Tina with cake. It lasts for about three seconds when you two are around.’

‘Busted,’ Ruby said with a grin.

‘Are you OK about doing the ECV this afternoon?’ he asked.

‘It’s fine,’ Ruby said. ‘I’d really like to bring Coral, our new trainee midwife, in to observe, if Mrs Harris doesn’t mind—and if you don’t mind.’

‘Of course not. You know I agree with you; it’s always a good idea to give students as broad an experience as possible.’

‘That’s one of the things I like about you—you’re so practical and sensible. Thanks,’ she said.

Practical and sensible. Not how he’d been when he’d married Natalia, Ellis thought wryly. He’d lost his head and they’d both paid the price.

Though Ruby had said that was one of the things she liked about him. He couldn’t help wondering: what else did she like about him?

He shook himself. This really wasn’t appropriate. Ruby Fisher was his friend. His best friend’s girl—well, widow, but that was a technicality. Time to back off. ‘I try to be practical,’ he said lightly.

‘Ellis, I, um, wanted to run something by you,’ she said.

She looked worried, and Ellis frowned. ‘What’s wrong?’

‘Not wrong, exactly…but today’s a year and a day since Tom died.’

Yeah. He knew. He’d spent the anniversary with her on a Suffolk beach yesterday.

‘And a year and a day is supposed to be the traditional length of time for mourning.’

He went cold. Where was she going with this?

‘I’m never going to forget Tom,’ Ruby said, ‘but he always told me that he didn’t want me to spend the rest of my life mourning for him, and he wanted me to move on.’

Wait—what?

Was she saying that she wanted to date again? That she’d met someone? Who? Where? How? Ellis couldn’t quite process this.

‘And Tina’s going to set me up on a blind date with her new colleague in Neurology,’ she finished.

Ruby was really going on a date? With someone else? But—but…

‘Ellis? You haven’t said anything.’ She looked even more worried. ‘Do you think it’s too soon?’

‘I…’ He blew out a breath. This was a minefield. If he said the wrong thing now, he’d hurt her—and that was the last thing he wanted to do. ‘I think,’ he said slowly, ‘that you’re the best one to judge that. Only you know when you’re ready.’

But the idea of seeing her with another man made him feel sick.

It was different when she’d been married to Tom. Ellis would never, ever have done anything to destroy his best friend’s marriage. But now Ruby was widowed. And Ellis hated the idea of her going out with someone else.

If she really was ready to date again, maybe he could ask her out himself.

But, if she said no, then how could they go back to their old easy friendship, once they knew they didn’t feel the same about each other?

He didn’t want to risk losing her.

So he was just going to have to suck it up and deal with it. Even if it felt as if someone had just filleted him.

Typical Ellis. Sensible and measured. I think you’re the best one to judge that.

Which told Ruby without a doubt that he wasn’t interested in her. Otherwise that would’ve been his cue to suggest that she dated him, wouldn’t it?

So it was just as well she hadn’t suggested anything to him. It would’ve put an irreparable strain on their friendship, and she valued him too much to risk losing him.

‘I guess you’re right,’ she said. ‘I just didn’t want people to think that I was the Merry Widow, not caring about Tom. And I feel guilty about wanting to date again.’ She felt even more guilty about the fact that she was attracted to Ellis, particularly as he’d just made it clear it wasn’t reciprocated.

‘You’re always going to love him,’ Ellis said. ‘But at the end of the day life still goes on. And Tom didn’t want you to be lonely. He wanted you to be happy. What anyone else thinks is simply their opinion. They have the right to think whatever they like, but they don’t have the right to shove it down your throat. You do what makes you happy, Rubes.’

Yeah.

Though sometimes she wondered if she’d ever find that kind of happiness again. If she was being greedy and expecting too much. Some people didn’t even have that kind of happiness once in their lives, so what right did she have to expect to find it twice?

Ellis reached over to squeeze her hand, and her skin tingled all the way up her arm.

‘Be happy, Ruby. You’ve got my full support. And if anyone says otherwise, send them to see me and I’ll put them straight.’

He sounded as if he were her big brother.

And she’d just have to learn to see him as a kind of sibling instead of the man she wanted to start dating.

After lunch, Ruby called the Harrises in from the waiting area.

‘I was wondering—would you mind if Coral, my trainee midwife, came in and observed the procedure?’ she asked.

‘No, that’s fine, love,’ Mrs Harris said. ‘I’ll do whatever you want if you can get this baby to do that forward roll.’

‘I’ll do my best. Thank you.’ She smiled at Mrs Harris. ‘I’m going to check how the baby’s doing, first, on the ultrasound. If I’m happy with that, I’ll give you some drugs to relax your womb—it won’t hurt you or the baby, but it’ll mean your baby has a bit more room to do that forward roll.’

‘All right. Is that nice doctor going to be here?’

‘Dr Webster? Yes. He’s just making a quick phone call, and then he’ll be right here. And I’ll go and collect Coral so I can introduce her to you.’ Ruby smiled at her. ‘Lie back and bare your tummy for me. Though I’m afraid my gel’s a little bit colder than it is in the ultrasound suite.’

‘I don’t mind,’ Mrs Harris said, smiling back.

Once Ruby had established that everything was fine, she moved the screen so that the Harrises could see the baby. ‘There he is—looking very comfy right now.’

‘Hopefully he won’t be stubborn and he’ll move,’ Mrs Harris said wryly.

‘I’ll give you those drugs now.’ Ruby administered them swiftly. ‘Make yourself comfortable, and I’ll be right back,’ she said.

When she returned, Ellis was already there. Ruby introduced the Harrises to Coral.

‘So what we’re going to do today is an external cephalic version—ECV, for short. The idea is to move the baby’s bottom away from his mum’s pelvis,’ Ruby explained. ‘I’ve already given Mrs Harris some drugs to help relax her womb, and we’ve seen the baby on the ultrasound. What I’m going to do now, Mrs Harris, is to push firmly on your abdomen to encourage the baby to do a kind of forward roll. It’ll take maybe a minute to a minute and a half. As I said earlier, it might be a little bit uncomfortable but it shouldn’t hurt. If it does hurt, I need you to tell me straight away and I’ll stop.’

‘All right.’ Mrs Harris looked nervous, and Ruby noticed that she was holding her husband’s hand really tightly.

‘You might even see him do a forward roll in your tummy, so keep an eye on my hands,’ she said with a smile.

Coral came quietly to the side so she could see and, gently but firmly, Ruby performed the manoeuvre, trying to ease the baby into a transverse position before he moved into the head-down position.

But the baby stubbornly refused to move.

After two minutes, Ruby stopped.

‘Is something wrong?’ Mr Harris asked anxiously.

‘No—just that this baby really doesn’t want to move today,’ Ruby said.

‘The longer the procedure takes, the less likely it is to work,’ Ellis explained. ‘But try not to worry. We can always try again tomorrow.’

They checked the baby again with the ultrasound. ‘He’s doing just fine,’ Ellis reassured the Harrises. He glanced at the notes. ‘Actually, his heart rate is pretty much as it was before Ruby started the ECV, so I’m happy for you to go home now, or you can stay in the waiting room until you’re ready.’

‘If we try again tomorrow and it still doesn’t work, that means I’m going to have to have a section, doesn’t it?’ Mrs Harris asked.

‘Not necessarily,’ Ruby reassured her. ‘Remember what we said this morning. We can still try for a vaginal delivery if the ECV doesn’t work next time. We’ll just need a bit of patience.’

‘If it helps, I’ve delivered one or two breech babies in the middle of a field before now,’ Ellis added.

‘In the middle of a field?’ Mr Harris looked surprised.

‘I worked for a medical aid charity for a few years,’ Ellis said. ‘So I’ve delivered babies after natural disasters where there isn’t even any running water in the area.’

Mrs Harris bit her lip. ‘And here I am, moaning about it all, when I know I’m going to have a comfortable bed and all the medical equipment anyone needs! That’s terrible. I feel…’ She grimaced. ‘Well, guilty, now.’

‘You really don’t need to. This is all new to you, and it’s perfectly natural that you’re concerned,’ Ellis said. ‘Actually, I’d be more concerned if you weren’t worried.’

‘I think she should have a section,’ Ian Harris said. ‘I looked up breech births on the Internet, and they said it’s likely that the baby’s head will get trapped or the baby will be brain-damaged.’

‘The Internet,’ Ellis said gently, ‘is full of scary stories. It’s the same with magazines—they’re going to tell you all about the unusual cases and the dramatic stuff, because it’s the drama that sells copies. They won’t tell you that most women have a perfectly safe, normal delivery. As Ruby says, you just need a bit of patience with a vaginal breech birth. I believe in being hands off and letting the mum set the pace, and I only intervene if there’s a problem.’

‘So I won’t have to have an episiotomy?’ Mrs Harris asked.

‘Hopefully not. We’ll see how it goes,’ Ellis said. ‘Though I will say that if your labour isn’t progressing after an hour, then I’ll recommend a section. In my experience, when labour doesn’t progress, it means there’s a complication and you need help.’

‘All right,’ Mrs Harris said.

Ruby could see that Mrs Harris was biting back the tears, and sat down on the bed beside her to hold her other hand. ‘We’ll do our best for you, I promise,’ she said softly. ‘We’re on your side. All we’re saying is that if it doesn’t work out quite the way you want it to, then please don’t blame yourself. You’ve given it your best shot and that’s more than good enough.’

‘OK.’ But Mrs Harris still looked close to tears.

Ruby hugged her. ‘Hang on in there,’ she said. ‘It’s going to be fine.’

CHAPTER THREE

MRS HARRIS CAME in with her husband the next day for another attempt at the ECV. ‘I’ve been feeling a bit off, all day,’ she said. ‘I woke up in the middle of the night with a bit of a tummy-ache. Obviously I must’ve eaten something that didn’t agree with me last night.’

Or maybe, Ruby thought, it was something else causing that tummy-ache. She had a funny feeling about this—and her funny feelings were usually right.

‘Come and lie down, and I’ll examine you before we try the ECV again,’ she said.

Mrs Harris had just settled back against the bed when she grimaced. ‘Sorry. That was another twinge.’

Ruby examined her gently. ‘Has anyone mentioned Braxton-Hicks to you?’

‘The practice contractions, you mean?’

‘They’re the ones,’ Ruby said.

‘Yes—but I don’t think I’ve had any.’ Mrs Harris’s eyes widened. ‘Hang on—is that what the twinges mean? I’m having a practice contraction?’

‘Given that you’re three centimetres dilated,’ Ruby said, ‘then, actually, I think this is the real thing.’

‘But I’m only thirty-seven weeks! It’s too soon for the baby to be born.’ Mrs Harris bit her lip. ‘Do you think it was that ECV thing yesterday that’s caused this?’

‘Possibly. Or it could be that your baby’s just decided that his birthday’s going to be today,’ Ruby said with a smile. ‘Don’t worry about him being thirty-seven weeks. Not that many babies are born on their official due date—some are a couple of weeks before, and some are ten days or so late. By this stage your baby’s lungs are definitely mature enough to cope with being born.’

‘So will I have to have a section?’

‘Hopefully not,’ Ruby said cheerfully. ‘I’m just going to get someone to call Dr Webster for me. And I need to give you a scan to see exactly how the baby’s lying.’

‘Cold gel again?’ Mrs Harris asked ruefully.

‘I’m afraid so,’ Ruby said.

She came out of the cubicle and asked one of the auxiliary staff to find Ellis for her, then went back to see the Harrises and do the scan. She turned the screen so that the Harrises could see it. ‘And here we can see one baby getting ready to be born. His head’s tucked forward, just as I’d want it to be, and he’s in what we call the frank breech position—that’s the least complicated one, with his legs straight up in front of him.’