A Baby at Any Cost The Midwives

Hello, Ward 4, midwife speaking.

Don't panic, it's going to be over soon.

With the highest birth rate in 40 years...

Look what you've done.

Oh, congratulations!

..midwives are under more pressure than ever before.

You are kidding me,

we have a lady on the table in theatre waiting to come out.

We filmed in busy maternity departments

in Birmingham, Manchester and Cardiff...

-6lbs, 11oz, I reckon. He's about 6lbs, 11oz and a half.

-Oh!

..as the midwives deliver the next generation...

The scary bit is, you're all going to be midwives.

CHEERING

..with care...

Oh, please help me.

We're here, we're here, we're here.

..and dedication.

My baby's life is in your guys' hands. That's it now.

Not good for the stress levels, this job, at all.

You'll be absolutely fine, I told you I'll be with you.

-It does touch you.

-This is the reason we do what we do.

It's all right, it's OK.

You smell nice.

It's more than a job, you're part of somebody's life

and they never forget you.

-This is it.

-Push, push, push. Push, push, push.

St Mary's in Manchester

is one of the busiest maternity hospitals in the northwest.

There's two ladies that... Intensive HTU care is room nine and ten,

so they can easily be doubled up.

Over half of all expectant mums seen here are classified as high risk.

It's the midwives' job to manage this rising number

of complicated pregnancies and challenging births.

Oh... Hello, trouble.

Triage Unit, midwife Heather Massey speaking.

Years ago, women with very serious conditions were told

"You'll never be able to have a baby",

and they were advised not to have a baby.

But now the medical management of these women is so much better.

If they're well enough to get pregnant,

we support them through that pregnancy.

Come on, mister. I would like some crying, please.

Oh, what are we doing, sir? A good cry is good.

It's a massive challenge to get them through pregnancy.

Hello, it's Susan, diabetic midwife.

Some women have put their own health at risk to achieve

that dream of having a baby.

So a huge amount of time

and resources are spent looking after women who are very complex.

We've probably got about 32 ladies coming this afternoon.

Hiya, Lydia. Hello! Hello, darling.

Susan is a specialist midwife who works closely

with colleague Greta to support pregnant women with diabetes.

We've seen a huge increase in pregnant woman with diabetes,

specifically with type 2 Diabetes, and that's because

obesity is an epidemic in the UK, and a consequence of obesity is diabetes.

So we've got really mad busy clinics.

So today is March.

-Yeah. You haven't had a scan today, no?

-Yes, I have.

-Have you?

-Yes.

Definitely will never be without a job!

I blame that book for my pregnancy.

Fifty Shades Of Grey, basically, has put me here.

When you mention the name Karla, you've just got to laugh,

cos you just get the picture of a very bubbly, happy girl.

-Have you read Fifty Shades Of Grey?

-No.

-Have you not read it?

-Uh...

-What about your wife?

If you write down the name, I will see that...

-I'll write the name down for you.

-Thank you.

You just never forget Karla.

Actually, when she came through the door this time,

just straight away - "Oh, my goodness."

Karla is in the last two weeks of her pregnancy with her third baby.

She has type 2 diabetes

and needs to attend a clinic every two weeks for a checkup.

-You look lovely today.

-Oh, thank you.

I thought I'd get dolled up, considering I'm coming here.

Ah. Take a seat.

-Have you got a urine sample for me, pet?

-I haven't, not yet.

I'm ready to rock, though, for one.

-You know where the bathroom is, don't you?

-Yeah, yeah, yeah.

-OK.

-Pregnant woman, I know where every bathroom is.

SHE LAUGHS

The Diabetes Clinic has seen its numbers double

in the last ten years.

With having diabetes, the risks of hypertension are higher,

the risk of miscarriage is higher,

the risks of congenital abnormalities

is, you know, five/sixfold.

So we're seeing a lot of these ladies,

and the whole pregnancy is quite intense and very time-consuming.

-That's not very big, is it?

-Look at that.

Think where you got...

BABY'S HEART BEATS

That's fine, Karla.

I told you that I'd get to 38 weeks.

You said that right at the beginning.

I did, didn't I? I said and you were like...

"Stop worrying. Stop worrying. I'll be fine."

Karla's diabetes means her baby

is five times more at risk of being stillborn.

Greta's been telling me about how brilliant your blood sugars

have been over the last couple of weeks.

I know. I couldn't have got them any more perfect. Unbelievable.

So, that's all that hard work you've put in.

Honestly, it is.

We all have, though, haven't we? We've all done it.

We need Karla's blood sugars absolutely perfect

in these last few days of her pregnancy, and it's not,

"We're at the end, so we're OK now and can relax."

Not until that baby literally is delivered,

in the mother's arms, can we relax.

That's what I have to do every morning.

This is slow-release insulin.

I inject in my stomach because I've had two C-sections

and I don't feel a dicky-doo-dah in there.

SHE LAUGHS

What you've got to understand is that I weighed...

I weighed a lot, yeah?

I was probably about...near enough 23, 24 stone.

The doctor did turn round to me and say,

"Either lose weight, Karla, or die."

So, I lost a lot of weight and, you know,

it was all about pot for me.

As soon as I cut that out,

the weight just kind of started plummeting down.

Karla lost ten stone in an attempt to control her diabetes.

Now she needs to manage it even more carefully

for the health of her baby.

Now I've got to take this one, yet again, in the belly.

Diabetes can be a huge responsibility on a woman

and we really empathise, but with Karla

she has the added burden that her baby has got some problems

that will need attention and specialist care afterwards.

This is her at 22 weeks.

If you look here at the bottom, there is, like, a lump

there at the bottom in between the legs.

That's actually the exomphalos that's poking through.

Karla's baby has an exomphalos,

a rare condition that affects around one in 5,000 babies.

A weakness in the abdominal wall means that some of her baby's

internal organs have developed outside the body.

I was terribly, terribly shocked at the time when they told me.

I was... I didn't know what to do.

The baby will have surgery soon after she is born.

But the size and seriousness of the condition

will only be known at birth.

It breaks me inside to even see this little thing, and I'm just praying

that one day I'll wake up and there she is fast asleep, and all well.

SUSAN: As a mother myself, and as a woman, your heart goes out to her,

cos nobody wants to hear those words that your baby has something wrong,

but I see my role as a midwife who's there as an advocate

and a support for women. And as a team, we hope

to carry Karla through this pregnancy, so that she's...

emotionally stable and able to cope

with what's to come once the baby's delivered.

I'm prepared for the worst.

-TEARFUL:

-No matter what's wrong with her, I don't care.

I want to cuddle her.

I so much just want to give her a cuddle.

SIREN BLARES

Triage Unit, midwife Heather Massey speaking. Can I help you?

Heather is one of the large team of midwives

working on the main delivery unit.

And what is your hospital number?

Today, she is in charge of Triage,

offering 24 hour emergency assessment

and advice to pregnant women.

Transfusion are on the phone.

There's two ladies coming in as well.

'We have to be ready for anything.

'We're seeing more and more ladies with complex medical needs,'

ladies with conditions that sometimes I've never heard of,

and I've been a midwife and a nurse for a very long time.

Is your baby moving OK?

'You just hope you're not going to find anything that you can't cope with.'

Stephanie? Hi, Stephanie, my name's Heather.

I'm going to take you through to one of the rooms, OK?

See if we can get you out of this wheelchair.

I'm sure some porter will tell me the correct way to push a chair.

Are you all right to just pop on the bed for me?

23-year-old Steph is seven months pregnant.

How are you feeling now?

Still out of breath and I keep getting chest pains.

You've still got the chest pain. Right.

She's been rushed into hospital by her husband, Dan.

So when did this start, the breathlessness?

Yesterday, I collapsed in Tesco's.

-Right.

-And since then, I've been having...a real tight chest.

-Right.

Breathlessness and then sharp, stabbing pains.

I'm just going to do some observations

and check that your baby's not been affected by your breathlessness.

-OK, is that all right?

-Yeah.

Steph has a complex congenital heart condition

that was only discovered after getting pregnant.

No, baby sounds fine, but obviously we just need to make sure

that baby's happy with what's been happening with you.

-OK?

-Yes.

-Then I'm going to get a doctor to come and see you.

I have symptoms which I've had on and off all my life,

but I didn't realise that every time I have them

there's a chance that it could be fatal that time.

'She is a complicated case.'

Women with a cardiac condition, obviously the body is put

under extra pressure by the pregnancy,

and as the pregnancy grows, the heart is put under more pressure.

The danger for Steph is that her heart

and lungs may not cope with the strain of the pregnancy.

LOUD HEARTBEAT

Well, they were very clear at the beginning

of what we were risking - well, what I was risking.

We spent three years trying for him,

we wanted this chance so much, we wanted to give him a chance, so...

She's trying to get as far into the pregnancy as she can.

No matter what happens to her, she wants...

him to have the strongest chance.

-All right?

-Yeah, I'm OK.

After a night of observation, Steph's symptoms have settled,

and she's back home in North Wales.

When I found out about my heart condition,

they sat me down and explained that they couldn't guarantee...

the pregnancy. They couldn't guarantee that I'd come out of it,

and that gobsmacked me at that point.

Despite all signs that the baby was healthy,

the medical team gave Steph the option of a termination

for the sake of her own health.

To me, there wasn't a choice.

Already I knew he was there, and that was it.

From very young, I dreamt about having a family of my own,

and I always saw children as my main goal in life.

Yes, I'm living, but so is he.

It is her choice. Erm..

Yeah, very worried, very scared for her. Scared for them both.

Even if that means at the risk of my own life,

I will try and protect him. Cos that's what a mum does.

She is brave and full of hope.

I could never call anybody stupid for having that desire.

People will always take a risk, won't they?

They've been dealt a bad lot of cards, really, and it could have

major consequences, but she obviously has the need to have a baby.

It's an instinct in a woman, isn't it? To be a mum.

Midwives in the specialist antenatal clinics at St Mary's

in Manchester support over 2,000 pregnant women every year,

with a wide range of medical conditions.

That's quick. Very good.

So I'll get one of the doctors in to come and review you,

and then they can decide when we need to do the next scan.

Midwife Charlotte works closely with the doctors to offer support

every step of the way.

We do see a lot more high-risk women,

so we have to be a lot more knowledgeable from a medical side,

rather than midwifery and obstetric side as well.

Well, at least we got a parking spot today.

Makes a change.

Sophie and Prince are expecting their first baby

in eight weeks' time.

We were pretty certain that we were having a girl because...

We couldn't find any bits.

At one point she opened her legs as well,

and they said "Oh, yes, we're pretty sure she's a girl."

I don't know. I think I always wanted a girl more

because I feel they're easy to manage.

-How wrong am I?

-Yeah!

Our concern at the moment was,

obviously cos I've got the condition achondroplasia,

we didn't know how I'd carry the baby,

and so it's all a learning curve with it being our first pregnancy,

of how the whole experience will be, but then also

we're not sure if she's going to have the same condition as I've got.

So that's going to be a whole another learning curve.

Sophie, do you want to come through?

Sophie has a rare genetic disorder that affects

the growth of her bones and causes

the most common form of short-limbed dwarfism.

I know I've just left you with everything! Sorry.

CHARLOTTE AND SOPHIE LAUGH

Oh, no, it's all right. You've got a whole lot to be carrying already.

Pop up on the couch, we'll have a listen to baby's heartbeat.

-Is that low enough for you there, you all right?

-Yeah.

So there's the top of your uterus now.

So no wonder you're feeling that hardness right under your ribs,

-cos the top of your uterus is right up there now.

-Yeah.

'Sophie is actually the first lady with achondroplasia

'that I've looked after in pregnancy, so it's a new experience,

'but we're not looking at Sophie as someone with achondroplasia.'

She is a pregnant woman who has come to us for care

and that's, I think that's the most important thing.

It's cos she's a woman having her first baby,

having her first pregnancy.

BABY'S HEART BEATS There you are.

It is nice to hear this cos then you know

that she's all right and everything's...

-It's reassuring, isn't it?

-Yeah.

Sophie, toes pointed.

So it's hips forward until the ball comes in,

push it back as far as you can, back in again.

Out, in, out, in, out, shake it all about.

Yeah, I've been married just over four years now.

Having a family was on both of our list of things to do.

(Come on. Big push.)

Well, I always wanted to be a dad.

For me, that's going to be the most amazing feeling in the world.

Finding the right person, doing what was, I think, half the struggle.

SOPHIE LAUGHS

Sophie is a Paralympic athlete

and came fifth in shot put and discus at Beijing.

The main hope was to make it to London 2012.

The competition was really difficult

and unfortunately, we didn't get selected.

So, erm, even though the disappointment

was so big at the time, we thought, "Let's try for a family, then."

-Good.

-OK.

Obviously you don't know if you're going to be gifted with a child,

and I wasn't too sure if my disability would

make that decision for me in any way

but then, once I did become pregnant,

you start to think then if there's going to be any complications

with me carrying a baby, and with the fact that there

would be a 50-50 chance with us of passing on dwarfism to her.

I hope she doesn't decide to come out now.

-Can you feel her twitching?

-Sophie's baby's limbs are being monitored

for signs of a slowdown in growth.

But it won't be until her next scan

that Sophie will finally know if her baby has achondroplasia.

It's all just a waiting game now, really.

Not that I'll love her any less and not that she'll mean any less to us.

I'll just worry that bit more

about how she's going to cope in life.

It must be a really big decision for,

for a couple knowing that they've got a genetic condition that,

when they do plan to have children,

there's that risk there that that genetic condition is passed on.

I think on this occasion, it would be wiser

if we read the instructions before putting it in the car.

Nah, don't worry. There you go. Done it.

-How do you get it off?

-SOPHIE LAUGHS

'Sophie's worried that that could be potentially the case, and until'

she's seen the scan and it's been confirmed one way or another,

she won't be able to sort of get past that, until she knows for sure.

Feels like the middle of the night, don't it?

Jeannie's only just gone to bed over the road as well.

Karla has reached the end of her pregnancy,

and due to having had two previous C-sections,

she's having planned surgery to deliver her baby.

Yeah, I'm sure the way she's kicking this morning,

she's coming out kicking and screaming.

Karla's baby will have an operation soon after she is born.

I think it's come round pretty quick, you know.

Yeah, YOU think it's come round pretty quick.

Come on, kid.

Karla's 20-year-old daughter, Terrie,

will be supporting her throughout.

It's like our work has got her to this point,

and it's about delivery now. And, as a midwife, you want to almost

give her some strength to get through the other side.

Hello!

THEY LAUGH

-I know, finally got here. Yeah.

-Hi.

-You OK?

-Yeah, yeah.

You look a bit tired. Have you not slept very well?

No! You know that's another way for "You look rubbish!"

No, no, no. You just look tired.

I expected that.

Can I give you a big hug? Cos I'm going to be busy...

-Yeah.

-..and I won't see you going in there.

Oh, come here. Thank you so much.

You take care, and I'm thinking about you.

'I don't know how I would be in her situation.'

We can't wait.

'You never forget there's a huge journey for Karla'

the other side of delivery,

and you really do feel for her, and you hope this little girl

of hers has got the same character and strength and attitude

that Karla has, that'll bring her through

this difficult few days of her life.

How are you feeling? Are you worried about anything?

Yeah, I'm worried about you, being my birthing partner

in this traumatic situation, and then I'm worried about baby.

I'm scared to see her as well as, like, really excited,

because how am I going to feel when I see her?

Well, I can't change my mind now, can I?

Only after Karla's baby is born will surgeons know

the full extent of her health problems.

Oh, God. This is a bit...

My mum's one of those people that'll put up a front,

she'll act as strong as anything, but she's fragile.

I think she's scared if anything happens, like anything bad

happens to baby, cos I don't think she'd be able to handle it.

-All right, Karla?

-Yeah.

-Paediatrician's here.

OK.

KARLA CHUCKLES GENTLY

-I love you.

-Love you more.

OK.

That's the waters gone.

-PAEDIATRICIAN:

-And most of the pushing on the chest.

OK, here she comes.

OK.

Hello there, little one.

OK, nice and gently, now.

Hello.

BABY CRIES

Oh, my baby girl.

Oh, she's beautiful. How are you?

KARLA SOBS

Thank God for that.

Oh, look at you. She's gorgeous, Karla. Well done.

Karla, Karla, quick look.

KARLA AND TERRIE: Aww!

How did the exomphalos look? Did it look that big?

I couldn't see it that much but...let's just take the next step.

Just feeling overwhelmed now. I can't wait to see her again.

BABY CRIES

Karla's daughter, Bella, is taken to intensive care

for the paediatricians to assess the seriousness of her abdominal defect.

The defect itself is only three or four centimetres

but the actual amount of stuff out there is quite a lot,

and the maximum damage to the sac with the exomphalos out is a ten,

at its maximum point. There's a small bowel in there.

Getting everything back in one go is sometimes impossible.

I think we'll have to wait and see when we're down to theatre,

how it looks and how everything goes back.

SUSAN: It's a reality check.

You know, she's carried Bella all these months, and this is it.

She's got to get through surgery and Karla will be

so anxious that things go well.

Hello, midwife speaking. OK, yeah.

It's been three weeks since Steph's blackout,

and the team at the hospital's Cardiac Clinic have been

running tests to discover the reason why.

-The baby been moving around OK?

-Yeah.

-Any more dizzy spells?

-They've been getting more frequent,

but I don't know if that's cos I'm getting to the end of the pregnancy

-and that's putting more strain on.

-Yeah.

Just have a seat on the couch

and then I'll just have a feel of your...stomach.

-Does that feel like a bone there?

-Yeah.

Spot on.

Midwives here work closely with the team

from the Manchester Heart Centre,

who support over 80 pregnant women a year with cardiac problems.

Get these on, Stephanie, I need you to relax

-and be as still as you can for me, sweetheart, OK?

-Yep.

'Ladies like Steph previously may never

'have even got to childbearing age.'

If that's the choice that they've made, then we're not there

to say that they can't do it, we're

there to say, "These are the risks",

and they go into that knowing what the risks are.

Have you got names planned and everything?

-Er, yeah. His name's Aiden.

-Aiden?

-Yeah.

'People might argue that she's made the wrong decision

'or she's been selfish.

'I'm not in her shoes, I've never had a heart condition,

'I've not had the discussions with my husband about what would happen'

if that was the scenario.

So I can't pass judgement.

All I'm there to do as a midwife is to support her,

irrespective of what the outcome might be.

The strain of the pregnancy on Steph's heart

is becoming a real concern for the team.

-Hello, hi.

-Have you had any more blackouts?

-Not complete ones, have I?

-- Not complete, no.

-Not complete ones? You've had some that are...?

-I've been getting black spots again.

Do you remember the 24 hour ECG recording we did last time you came?

We've got that now and have analysed that yesterday.

That shows that there are periods where your heart slows down

and the rhythm becomes very abnormal.

What that means to you is that we would recommend

-that you have a pacemaker fitted for that.

-OK.

It's a thing called Complete Heart Block,

and we need to do it now, really.

The intention, if you're happy with this, is that we'll admit you today

to the maternity ward, and tomorrow afternoon I'll put a pacemaker in.

Would it be better to induce me and just have him born first?

-No.

-No?!

-HE LAUGHS

-I think we need rhythm safety for you,

-for whichever mode of delivery, you know, comes.

-OK.

-OK?

-OK.

'Complete Heart Block is dangerous because we know that some'

patients may die of this, and we can't wait until the baby's born

before we implant the pacemaker, because if her heart was to stop,

then potentially, her life would be at risk, and clearly then

the baby's life would be at risk

and that's not a risk that we're prepared to take.

-I need to ring Mum.

-Mmm-hmm.

I'm petrified now.

Aiden, what are we going to do?

What are we going to do?

But I've been a bit too lucky all the way through, to be fair.

SHE SIGHS

I'm sorry, Daniel.

Oh, Steph, you don't have to be sorry.

OK.

It's not ideal having surgery in pregnancy,

particularly surgery on the heart.

But she knows that she's got no option

and it's something that she's really got to go through.

And you just hope that it all goes well, because potentially,

for her, it's a one-in-a-lifetime opportunity to be a mum.

It's Susan at St Mary's.

I was just ringing to see how her blood sugars are.

She's not left her diary with you, has she?

This is, for a lot of ladies, what they've dreamed of

since being a little girl, and that's what drives them at all odds

and at the expense of their own health to have a pregnancy,

to feel real like you, just like anybody else.

But it's huge for us,

as a service that is under a lot of pressure, to deliver for women.

There's a lot of expectation on us as midwives,

and we feel that day to day.

Now, this is alien to me. You know, I feel really...

I get anxious about here as well, do you know that?

Here, let me.

24 hours after her caesarean section,

Karla is visiting her baby daughter Bella in Intensive Care.

-Oh, my goodness.

-Isn't she tiny?

-Oh, she's beautiful. Oh, Karla!

-Isn't she beautiful?

-She is.

Bella will have surgery today to try

and repair the defect in her abdominal wall.

It's got to be done. Yeah, I'm worried.

I don't really, you know, want her to have the operation,

but she's got to and that's the only way we can get her home.

This last little bit, yeah? This last little bit for her.

I've just got to let her go, haven't I?

And just let them deal with it now.

I can't do this now.

I don't want to say goodbye to her, I don't want to.

I don't want to go down to theatre.

I don't want to go in that room. I went in that room yesterday

and it scared the living daylights out of me,

just being in there with Terrie, let alone her.

It sounds awful, don't it?

It really does sound terrible.

-TERRIE:

-She can only be so strong for so long. Yeah.

She's got me, I'll make sure she's all right.

If you want to say bye-bye now, you can.

Right, good luck, beautiful, and do us proud.

Any baby who needs an operation within one day of life

is having a risky operation.

The first thing we're going to do is make sure

the bowel looks healthy through the membrane.

Then we're gently going to reduce it, which means push it back

inside her tummy, and if we fill her tummy up with lots and lots of bowel,

it's much harder for her lungs to fill with air

and for her to breathe on her own, and that can cause problems as well.

So, there a lot of things to think about.

It's panicking.

You've got no control over the situation.

You've got to literally trust a complete stranger

to make sure that your kid's all right.

In theatre, surgeons reach the critical part of the procedure.

It comes quite nicely.

That's great, thank you.

Bella's bowel is carefully squeezed through the base

of her umbilical cord and back inside her body.

OK.

Yep. OK, that's the sac.

-Did you do it?

-Yep, all done. How are you?

Oh, I'm all right.

She's doing fine. Everything's back inside where it should be.

Tummy looks good, tummy button looks good.

-Is it an inny or an outy?

-It's a sort of half and half at the moment.

I hope it'll be an inny but we'll have to see

how she heals, but it looks nice and neat at the moment.

-Thank you.

-My pleasure.

And when can I have a cuddle?

-Probably now.

-Really?!

Yeah. You should be able to pick her up very soon.

Going to go and cuddle my baby now. Going to cuddle her.

LAUGHTER

-Oh, my God.

-There you go.

It's amazing, innit? How clever are they?

I can't believe it.

Come here. Hello.

-There you go.

-Oh, my Lordy. You're so tiny. Hello!

Hello, it's Mummy here.

Ooh.

You're so beautiful.

This is the moment I've dreamt of.

This is the moment that's kept me going.

This is, like, kind of the moment that's drove me through all the way.

You're so beautiful.

I never want to let you go, do I?

Oh, look at her. Isn't she gorgeous?

There you are. I'm not going to argue with you.

She's beautiful, absolutely beautiful.

We want a photograph on our wall, Bella, we do.

I could sit here all day with you, you're nice and warm.

'I think we can learn a lot from how Karla managed that pregnancy.'

She just stayed amazingly positive and just really strong,

and she believed in her baby.

At that stage, you didn't know that I had achondroplasia,

-and you can't really tell from those pictures, can you?

-No.

Not really.

Sophie is seven months into her pregnancy and is having a scan today

to find out if her baby has inherited her dwarfism.

Then they finally said at about six months that you had achondroplasia,

and there was nothing they could do about it, and

"Cross each bridge when it came to it" sort of thing.

Well, I bet that was a shock for you,

-cos you didn't know anything about it, really.

-No, I didn't.

Around one in 25,000 babies a year are born

with this condition, and Sophie was the first in her family to have it.

My legs were extremely bowed, so we had to straighten the legs out.

The operation was very painful and very traumatic

and left me in a wheelchair for about a year.

And this is something that I am extremely worried,

that if she ever had to go through,

if it was just a case of her having short arms and legs and having

to deal with society being a bit cruel, you know,

we'd teach her to be fine with dealing with that

and make her into a strong person.

It's the medical side of things

that is the thing that's worrying me the most.

I have that fear, knowing how difficult it has been at times

to live with, that I've passed on this condition to her.

I know it's come from me, and you go through those feelings of guilt,

thinking, "Was it selfish of me to have a child with this condition?"

Looking at it from another angle,

if my parents had known about me and then decided,

"Oh, because she's achondroplasia we don't want to have her",

then I wouldn't even be here.

So... It's just all the emotions going on in your head.

-I need the toilet again.

-Do you?

-Nightmare.

Early in the pregnancy, Sophie and her husband

decided against genetic testing, because of the risk of miscarriage.

Instead, they're relying on scans to chart

the growth of their unborn baby.

We'll just have a quick look round.

There is a 50% chance that Sophie could pass on dwarfism to her child.

Now, she will finally know the outcome.

Thigh bone...

All right.

-Hello.

-Hiya.

-Hi.

Erm, I was just looking at your scan before we came in,

and the head's grown as much as we would have expected

on this, on the average line, and this is the tummy.

And this measures the thigh bone, and what we can see there

is that baby's legs haven't grown as much

-as we would have expected them to.

-Right.

-And is actually shorter than we would expect.

-Okey-doke.

-OK.

So it's looking pretty certain?

It does look as though baby's got achondroplasia, which...

..wasn't what you were hoping for, was it?

Well...no, but as long as she's healthy.

-Hello.

-Hiya.

-So you've seen the doctor already today?

-Yes.

It's looking like she's definitely going to have achondroplasia. Erm...

So how do you feel about it all now?

Erm...all right. I have to go home and take it all in, really.

-That's it.

-That's how I am.

It's, you know, discuss it with my husband and...

And, you know, everything's fine.

You're really healthy in the pregnancy, which is really good.

-And the baby's well.

-Exactly, that's the main thing.

-And you've got your date for the caesarean section.

-Yes. Yes.

-So you've got a date to work to.

-Yes, counting down.

I'd be lying to say that I didn't have that tiny bit of hope,

thinking, "Oh, maybe her legs have grown a lot

"and she'll be absolutely fine, and there'll be no problems."

So, still felt that little bit of disappointment,

but that's a bit of a strong word. I still felt emotional and worried

and all those things, but it takes

you a while to take in that information.

She's grown up with achondroplasia.

She knows her daughter has to do that, so it's difficult.

And she just wants the reassurance that everything's going to be OK.

Why should it be any different now?

I mean, as long as she's still healthy,

it doesn't really matter if she's a dwarf or not.

Listen, there's nothing you can do about your condition, dear.

-There's nothing that's...

-No, I know.

..a problem for it, and I know that, because you've done so well,

even if we have to go through the hard times,

you wouldn't be the same person if you didn't go through those things.

You're right.

So don't think about it as the worst thing in the world

that could have happened, think about it -

this may be the way she's meant to be

because she has something greater in the world to do.

She'll have been put here for a reason, to make a difference.

Exactly.

Yep, you're right.

So, how are you feeling yourself?

Scared, to be fair. Very scared.

Baby's very happy in there. That's an ideal trace, that.

Good.

Eight months into her pregnancy, Steph is having surgery

to fit a pacemaker to help control her abnormal

and life-threatening heart rhythms.

I think it's easier for me, more straightforward for me,

cos I'm not the one who's going to be sitting outside the theatre

and having that hour drag on for half a lifetime.

The main thing is staying strong for her.

It's what we chose as parents to do.

She had the choice, we made the decision...

..and we have to live with the consequences.

It is a big deal that this pregnancy is occurring.

There's a lot of complications,

so, you know, there is a sense that Dan may feel a bit helpless.

I'll be even better when I'm going back that way.

But it is emotional, he is just a mix of emotions

and he doesn't really know where he's at some of the time,

but I think he's done really, really well.

She means the world to me. Steph's turned my life around.

I kind of got lost in my teenage years,

and then when I met Steph, I kind of found the old me again.

I'm a recovering alcoholic and my life was going nowhere.

And she's my rock, she's what keeps me strong.

I don't know what I'd do without her.

I don't even want to think about it.

We're going to implant a permanent pacemaker for Stephanie

through one of the veins just under the left shoulder.

Throughout the operation

the baby will be closely monitored by the maternity team.

We've got Mum on a tilt to make sure that the blood supply

to baby's good, and Catherine, the midwife,

is monitoring the baby with a CTG machine,

and we're just sort of standing by in case there's a problem.

Two pacing leads are fed through a vein directly into Steph's heart.

-Might be pushing top of the left shoulder, OK?

-OK.

I've got the lower chamber lead in, the most important one in.

Now we're after the second one, if we can get that bit.

Yeah, there's been that many complications and things gone on.

We have spoke, me and Steph, that it could all go wrong, and...

Steph told me what she wants me to do if the worst happens.

If the choice is between her and Aiden,

then it's to be Aiden all the way.

I agree with her, but I don't want to lose my wife.

I don't want to lose either of them.

The two pacing leads are in.

I'm now trying to make a pocket for the pacemaker under the skin,

and then we'll pop the pacemaker in and sew her up, fingers crossed.

Once the pacemaker is connected to the pacing leads,

it will send electrical pulses directly to Steph's heart.

-Yeah. Pacing well with a good...

-Little bit of pulling now.

By stabilising the heart, the team are giving Steph the best chance

of surviving to the end of her pregnancy.

Better than I expected. Phew.

-Happy?

-Yes, very much. Very much. Right.

-NURSE: Here we go.

-Hello.

Good to see you.

-How are you feeling?

-OK, actually.

Yeah. Just glad to be back with her now.

We are now happier she has the pacemaker and it's working,

than we were previously, going into labour without that,

because that would have been a very high-risk situation

and that's why she's had all this input,

to make it as safe as we can possibly make it.

There's no guarantees

but at least we can put everything in place to, you know,

try and have a live baby and a live mum at the end of the day.

Hi, it's Mandy, I'm the midwife on the elective list today.

We've got a patient called Sophie Gay, she's got achondroplasia.

And so we, you know, we will need somebody there at delivery.

I've been told that the baby has it as well.

-You're asking me what you need.

-How do you feel?

-The cameras.

-I've got

-A

-camera.

-Right.

Because of her condition and the small size of her pelvis,

Sophie's only option for a safe delivery is a caesarean section.

-Have you come in for a section, then?

-Yeah.

Because she has achondroplasia, they have to be very careful

when they're doing the spinal anaesthetic,

because they need to make sure it's in the right place

and make sure she is anesthetised properly.

Oh, it's racing a little bit.

-Mm. It has been since last night.

-Has it?

-Yeah, I look stylish, don't I?

-You do look amazing.

Just ready to meet her now and just hope the operation goes well

and without too many complications.

She's putting on the bravest face I've seen in a while,

but I think she wants the whole process to be done with.

-Oh!

-It's just like...

I wish you could go through this, you little bugger.

-Women have to do it all.

-He will be going through it, trust me.

- Going through into theatre now. Lots of people. Big room.

Everyone is needed. We only...

I think the spinal...that was the thing

she was most apprehensive about,

because of her anatomy being a bit difficult, a bit more...different.

Hello. They are struggling to get the spinal in.

He's on his third attempt now.

Erm...so we're just waiting to see what happens.

You don't like to think that there could be complications,

and I'm just trying to stay positive

because there's going to be a baby at the end of it.

BABY CRIES

Oh, dear. Oh, dear.

SHE EXHALES

-Well, she's not impressed at being born.

-Oh, really?

-I'll tell you that much.

-Oh, dear me. What are you?

-We had a right scream.

-Oh, that's a good sign.

-Uh-huh?

-She's yours.

-It's not that bad.

-She's really gorgeous.

She's beautiful.

Look at you.

BABY CRIES

Is she photogenic like her midwife?

-Aww.

-Gorgeous, isn't she?

Here's Mummy.

Let me give you a kiss.

-BABY CRIES

-Oh, dear. Oh, dear.

-I just can't believe this is my baby.

-All yours.

-Our baby.

I can only go on my own experience,

by how I felt becoming a mum for the first time.

It's just amazing and you can never underestimate it, really.

You smell nice.

I just feel really content and happy.

All my problems have disappeared, and nothing else really matters

right now apart from our little family.

Now she's here and we know she's got achondroplasia,

it doesn't really matter at all, cos she's just so perfect to us

and all those worries and everything just go out the window.

-BABY CRIES

-Oh. Hi.

If she has the sort of life that I've had

and the opportunities that I've had, she'll be absolutely fine.

I'll have to go down to his second favourite lady in the world.

But I suppose if there's anybody you have to be second best to,

it's your own daughter.

-Oh, no.

-How are you feeling?

-OK.

-Excited?

-Yeah. Yeah.

I mean it's... After all the complications,

-it's nice to do something normal.

-Yeah.

Two weeks after having surgery to fit a pacemaker,

Steph is almost full term,

and is being induced so her labour can be carefully managed.

She wants to give birth naturally,

so will be closely monitored to see how her heart copes with labour.

I'm quite surprised we finally got here after all the worry

all the way through, and now doing something really natural

and something what I've always wanted to do.

The only time I'm going to feel completely relaxed

is when Aiden's here, and I know that Aiden's fine and Steph's OK.

-Hey.

-What?

She's determined to have this baby naturally.

Five hours after the induction process began,

Steph is in established labour.

So, how are you feeling?

Great, I think. Ask me in a couple of hours.

Hiya, you all right? I'm Jackie, I'll be looking after you tonight.

I'm going to take you round to the delivery room.

From now on, midwife Jackie will manage Steph's labour

in a high-dependency delivery room.

Just putting ECG electrodes on

so we can monitor Stephanie's heart rate throughout her labour.

You know, we're just observing closely to make sure that

there's no real abnormalities and,

if there is, just get the doctors in as soon as we can.

So at the moment, your heart is beating a little on the fast side,

sort of around 107. At the moment, there are no paced beats,

so that's your heart doing all of its work.

Thank you.

Have you got a contraction at the moment?

Now your waters have gone. OK, you felt that then, yeah?

That's good. Do you feel like you need to push?

Yeah. I'm trying not to, though, yeah.

SHE GROANS

To minimise the strain of labour on Steph's heart,

Jackie needs her to hold off pushing for as long as possible.

Ughhhhh.

-Got lots of pressure?

-Yeah!

Well done. You're fully.

-I'm ready?

-Yeah.

Try and hold off just for a little bit longer, just let baby's head

come down, because you've only got 30 minutes.

You know, we don't want to put too much pressure on your heart,

so that's why we only want to push for 30 minutes.

So, if we hold off until you can't hold off any longer.

Steph has just half the normal time to try

and deliver her baby naturally, or the doctors will step in.

Big, deep breaths. Big, deep breaths. Big, deep breaths.

Hopefully, if she manages to hold off pushing,

then we'll have a nice, normal delivery

rather than having to get the doctors involved.

-INTERVIEWER:

-Hopefully, we'll have a baby soon.

-Hopefully.

I'll go back in.

-Right, how are you doing?

-Rotten.

All right. Is it getting too much, Steph?

Yeah, yeah? OK. Nice, deep breaths. Nice, deep breaths.

Keep going. Put your bum on the bed.

It's OK, it's OK. Well done. That's brilliant.

I can see the top of your baby's head.

That means you can push next time, yeah?

Well done. Go on, again, come on, and again.

Just relax your legs. Go on, that's fabulous pushing.

Well done, well done.

STEPH MOANS It's OK. Well done. That's brilliant.

I just want to see my baby boy.

-He won't be long now.

-He won't be long now, hun.

Just a little push now, Steph. Blow, blow. Nearly here.

A little push...there we go! Well done.

-Hello, baby.

-Here he is.

-There he is, there he is. There's your boy.

-Congratulations, darling.

-He's not breathing.

-It's OK. He will do in a minute.

-- Just going to have a little look at him, OK?

-Yeah, yeah.

-He's fine.

-He's OK, don't worry.

-DAN:

-Come on, little man. OK, Aiden.

-He is, he's fine.

-There you go.

BABY CRIES

-Hey, my boy.

-There you go.

Hey. It's OK.

You were giving me a fright, you were.

You were making me worried, I didn't want anything to happen to you.

I don't really know how it feels, to be honest.

It's surreal, really.

I dreamt about this for so many years

and yet...it's hard to explain.

You're my dream come true. Yes.

I'm just so pleased that everything worked out for them.

All she ever wanted was to be a mum

and she was prepared to go through it despite all the risks.

'But she did brilliantly.'

Oh, he's lovely, Steph.

Let me give him back to you, honey. Aww.

Steph takes her baby home and we're on to the next one.

The next challenge, the next patient that we have sleepless nights about.

MUSIC: "For Once In My Life" by Stevie Wonder

SUSAN: You can pass it on to the next lady and say, "Do you know,

"there was very little hope for another baby and it did really well."

So if there's, you know, if there is life, then there is always hope.

Bella, look at Mummy.

-Ba-ba-ba, ba-Babybel.

-Look, she's giving big smiles as well.

You know, all that hard work was worth it for everybody.

We'll do it again next time. We'll go through it again.

We'll do it again.

-Aww.

-I do genuinely love you ladies.

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