It's Complicated The Midwives

Hello, ward 4, midwife speaking.

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

With the highest birth rate in 40 years...

Look what you've done!

You are just amazing. Look at him.

..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...

6lb 11oz, I reckon. He's about 6lb 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, OK?

It does touch you. This is the reason we do what we do.

It's OK! You smell nice.

It's more than a job. It's...

You're part of somebody's life, and they never forget you.

Every woman will come to an antenatal unit for at least

two scans during pregnancy, to pick up any problems.

When a complication is detected, mums need to come in

more regularly. And, for some, it becomes their daily routine.

At the University Hospital in Cardiff,

there are number of specialist clinics,

caring for the most serious maternal and foetal cases across South Wales.

Li Plim?

Sarah Bendham is a specialist midwife on the antenatal day unit.

Hiya. That's OK, you spoke to me on the phone.

Nice to meet you.

Li is 33 weeks into her first pregnancy.

I feel like a whale.

You're not too bad, you're fine.

Li has been coming in every day for the past two weeks

due to concerns over her baby's growth.

BABY'S HEART BEATS

Li is known to have a small baby, and we keep an eye on

our small babies with movements, making sure mums are happy.

The scan that Li's having as well helps to give us

an idea of the health of the baby, because we don't know what's

causing it, whether it is just genetic that she is carrying

small babies, or if it could be that she is growing a small baby

because the placenta's not functioning or the cord isn't functioning,

or something isn't getting through that needs to get through.

I would say my pregnancy has been quite...difficult.

It's not something straightforward like what everybody else thinks.

It's not just finding out that you're pregnant,

go for your natal scans and then just pop the baby

when it's after 40 weeks - it just doesn't go that way.

Babies born before 37 weeks are considered premature,

and there are concerns that if Li's baby stops growing,

it'll need to be delivered early.

The longer we can keep a baby in utero and keep them

where they need to be and where they're nurtured

as much as we can, then we do.

But if anything changes over the next couple of weeks,

if the growth stops, we would need to take the baby out

in order to save the baby.

Today, the baby seems to be fine, and will be scanned again tomorrow.

All right then, thank you. Take care.

All right, see you tomorrow then. Ta-ra, Li.

Well, it is nice to send them home

and know that they are another step closer to term,

and, I mean, for Li, she's what, 33 weeks now?

So she's got four weeks to go. Four weeks of a battle, possibly,

but, you know, at least we know that we can, we're here for her.

And it does feel good, there is a lot of...job satisfaction,

I think is the word,

to know that we're able to help these pregnancies through.

Helen Jane is a midwife practitioner.

Hello, how are you? Not too bad, you all right?

I'm all right, yes, thank you.

Every day, she visits different departments of the hospital

where expectant mums have been admitted.

Well, I'm going over to see one of our antenatal ladies,

her name's Carly Harris, she's having her third baby

and she's, em, a patient in Coronary Care at the moment.

So I'm just coming over to do a tracing of the baby's heart.

Carly is 32 weeks pregnant,

but was rushed in last night with extreme heart palpitations.

Hello there, it's Carly, yes? Yes.

We haven't met before, I'm Helen, I'm one of the labour ward midwives,

I've come over to do a tracing of the baby's heart.

That OK? Yeah?

Are you feeling the baby move? Yeah, she's really...

Lot's of movement? Yeah. Oh, it's a girl, is it?

Little girl, yeah. What do you have at home?

I got two boys. Two boys? 12 and six.

Oh, that's really good, excellent. OK.

There she is.

BABY'S HEART BEATS

So what are the names of your two boys?

Levi and Jayden. Ah, right. It's going again.

Yeah, don't worry, try and ignore those alarms

if you can. I know it's hard, isn't it?

A normal heart rate during pregnancy is 85-90 beats per minute.

My heart rate went up to 199 last night.

I can't really catch a breath, because it's like, chest pain, so...

I thought because my heart was going so fast, her heart would be racing.

No, her heart is lovely actually, very good.

So you didn't have these problems with your first two? Not my two boys.

Must be a thing with girls. Must be!

We'll have trouble with this one. Aww...

ALARM RINGS

Don't worry now, don't worry.

Right, I think we can probably take that off now, it's absolutely fine.

So no worries about baby so far? No worries about baby.

OK, great.

OK, see you tomorrow, Carly. Thank you, bye. Take care now, bye-bye.

Carly has been known to the cardiac team since childhood,

and after her last baby was advised not to get pregnant again.

Well, basically, yeah, I was born with a congenital heart defect,

it was back to front, all the four chambers were upside down and inside out.

So, obviously a lot of surgery had to be done

in Great Ormond Street from a baby,

so as soon as I was like three months, they done the first op.

When I was four they did the second op,

and then obviously when I was 11, they done a third op in the Heath.

Honestly, since I've had my last surgery,

this is the only bit of trouble I've had, since I...since I was 11.

Working alongside Helen, and overseeing Carly's obstetric care,

is consultant Dr Claire Francis.

Hi, Carly. Pull this round a minute.

I just wanted to come and say hello today really,

and have a chat and catch up.

When we saw you in the beginning of the pregnancy we were all fairly positive

and optimistic that this pregnancy would go the way the other two went,

because your two first babies were - considering you've got a major heart problem -

quite straightforward, weren't they?

We were hoping things were going to go the same,

and unfortunately, probably the stage in your pregnancy,

the fact that your heart isn't quite normal

and being pregnant on top, has just pushed you into this

extra, sort of, fast rate,

with all the palpitations that you're getting.

I suspect it's not necessarily going to go away completely

until you've had your baby.

I know, because I've been ill. But I think it is going to be a case

of waiting to see over the next few days

whether the medication does the job,

or whether we're going to get to the stage where you become unwell again. Yeah.

Hello, antenatal clinic. Midwife speaking, how can I help you?

Jamila is 32 weeks pregnant with her second child.

Everything was normal until three weeks ago

she developed an unusual liver disorder that causes severe itching.

Jamila?

Hiya. Hello, you all right?

Yeah, not too bad, you? Sitting in the far corner.

I know, I never sit there usually, it's so hard to hear anything.

Let's have a little look.

It's a condition that affects fewer than one in 1,000 pregnant women.

Jamila has obstetric cholestasis,

which is an itching problem in pregnancy.

It's characterised obviously by the itching,

more so with palms of hands, soles of feet and worse at night.

She's had it before, so unfortunately for her she knew what was coming.

The itching did kind of get worse towards the end

of my last pregnancy, but it was summer last time as well.

This time round I recognised the symptoms,

so I thought I'd better call up.

A developing baby relies on the mother's liver

to remove bile acids from the blood.

Anything with a bile acid over 40 is classed as severe.

Hers were 59 last week.

If uncontrolled, there's a risk of foetal distress and premature birth.

OK, I'm going to take you off now because that looks beautiful. OK, thank you.

OK, can you manage? Yep, thanks, Sarah.

Yep, no worries, take care. See you next week.

'This time round when I knew I had it again

' - and I knew - as soon as I felt that itching I knew what it was.'

I even considered not reporting it for a while,

because I just didn't want to face all this again.

Jamila's previous pregnancy turned out fine, and she

and her husband Mark now have a healthy two-year-old son, Bruce.

It seems to be exclusive to pregnancy

and vanishes just like that as soon as you give birth.

From what I understand they don't really know why it happens.

It's not the itching itself that's the problem, you can handle that.

It's what the itching represents

and, you know, we just want to make sure that the baby's healthy, so...

In hindsight, I realise how lucky I was that Bruce was fine

and that I have a healthy baby,

and that, as much as possible, everything was perfect.

So in a sense, this time round,

being far less naive, I'm much more worried...

about actually what the risks really are and what this condition means.

LIFT DOORS OPEN

Next on midwife Helen's round is another woman in coronary care.

Alison is 35. She's pregnant with her third child.

Two weeks ago, I thought I had a cold, thought nothing of it,

a bit worn out, thinking, "Oh, this is like constant flu."

And to find out that...

it was obviously a lot more serious than that.

29 weeks pregnant, Alison was rushed into hospital

with pneumonia and chest pains.

Alison has rheumatoid heart disease,

which is a disease of the valves in the heart.

This is about as serious as it gets with structural heart disease

and pregnancy, and the condition that Alison has is very complicated

and very advanced, and women die of this in pregnancy.

Until this pregnancy, Alison's heart problems hadn't been detected.

SHE BREATHES HEAVILY

This is something that she's had for a very long time, just that

the degree of heart disease wasn't as bad when she was younger,

so she got away with her first two pregnancies without any problems.

Now that it's got a bit worse, as is the natural history of this condition,

she's just got to the point where her body doesn't have the reserves

left to take her through this pregnancy in good health.

For the last three weeks,

the doctors have been trying to stabilise Alison's heart condition.

She has another month to go to get to full term.

Knock, knock. Hi, Alison. All right?

How we doing? I don't feel good today.

Don't you? In what way?

They took some blood today. Did they? And that doesn't help.

There's hardly got any blood in there to take!

Well, they've taken it all now, have they?

I think so. I don't think there's any left.

Let me just cover you up.

So do we have a firm plan now for delivery, or are we still...?

Well, he said, he said what they're going to do,

they're going to sit down and decide what they think's the best way

of getting baby out basically, because obviously my heart is...

You've had two normal deliveries, haven't you, yeah?

Yeah, but because of my heart, they really don't know what the best way is. OK.

So they've got to think of a safe way for the heart, I think.

For you and... Yeah.

'She was quite quiet today I thought, but I think it's just

a combination of her being in for such a long time,

possibly not sleeping as well, that's probably it, I think,

and missing her two boys.

And it's a long time for her to be in as well,

and obviously she's anxious about, you know, what's going to happen,

how she's going to have this baby.

But, no, I think she seems OK.

Right, we'll see you over the weekend, OK? OK.

Take care now. Bye, Alison.

I find the midwifes are brilliant,

because they explain it to me in a way I sort of like, understand.

We're possibly easier to talk to than cardiologists

and, you know, maybe they can, we're a bit more perhaps

down to Earth with what we tell them, especially with Alison.

I think she does need things explaining to her

in quite simple terms.

I find sometimes it's really hard to understand

because of my learning disabilities.

So I find that really hard, to find what's going on really.

After concerns over her latest scan,

Li was admitted to the ward last night.

See, there's no need to worry, we do all the worrying.

She's been assigned to midwife Emily.

So Li is deemed high risk at the moment, for two reasons.

One - because of baby measuring a little bit small, and we're

slightly concerned because she's had a bit of abnormal blood results,

and her blood pressure's been sitting a little bit higher than we'd like.

It's 7am, and the doctors have more test results.

Knock, knock.

A nice wake-up call.

SHE LAUGHS

How are you feeling this morning?

Blood pressure's up a little bit, lots of protein in the urine

as well, plus the blood tests, one of them is slightly elevated.

And all that together is this blood-pressure problem in pregnancy, pre-eclampsia.

The cure is always delivery, so it is the right thing to do.

But if we couldn't induce you, you'd still need delivery,

and that would be Caesarean section now.

But you're definitely in the right place, see you later. OK. Nice to see you.

Sorry, horrible wake-up call. No, it's OK.

'At the moment she's late 34 weeks,

'so it's a little earlier than we'd usually like to induce someone.

Anything less than 37 weeks is something we deem premature.

It's a bit daunting. I'm not physically and emotionally prepared

for...labour yet because it's, it's only 34 weeks.

It's actually six weeks away, so I'm not prepared for it yet,

to be honest with you. I'd rather have a C-section.

I'm sure she'll be in the mindset, "Just get it over and done with."

But we want to give her the best chance possibly to get

into labour herself. Because the more we do, the more interventions,

the more things may change, and not necessarily for the better.

Jamila is back for more tests.

Thank you. This time to make sure her liver condition

is confined to pregnancy, and not a longer lasting problem.

So you're the unlucky one that gets the early start then? THEY LAUGH

This is cold now, sorry. That's all right.

As well as scanning the liver,

they also take the opportunity to check the baby.

..looks fine, Jamila, OK? So let's have a look at baby now.

Here we go, little face peeping out at you there, look.

Oh, yeah. See the little eye? Facing the same way.

Nostrils there as well. Oh, wow, yeah!

JAMILA LAUGHS

And lips, see the top lip just coming over there? Yeah, yeah.

So just going to get all the measurements now, Jamila, OK? OK.

But there's a concern about the baby's measurements.

Thank you.

So Jamila is sent to see specialist midwife Sarah.

Everything else has grown, bar the tummy.

So it's, unless the bile acids are starting to affect baby maybe.

SHE SIGHS

So potentially, we may have an issue with baby.

But we don't know until we see -

you can see the consultant tomorrow and we can make a plan from there.

OK about the, the...? About where we're going, yeah?

OK?

All right, thanks, Sarah. If you want me, you know where I am. I will.

Thank you so much. Take care, Jamila.

Well, as Jamila knows, they can cause stillbirth.

So it's just a case really of seeing what else is going on

and keeping a close eye on this baby.

I'm OK. It's just this up and down...

The rollercoaster started like this, and now it's more like this.

Thing is, as a parent, it's a stressful time anyway,

and when you're told bad news it's even more stressful.

I do wonder what else is going on,

there's something else going on, we need to sort it.

And the last thing we want is a stillbirth - not fair.

BABY'S HEART BEATS

Just four hours into Li's induction, there's a problem.

Baby's starting to show signs of getting a bit stressed,

so we don't want to prolong this whole process.

So the idea is, by breaking your waters, we're taking away

that cushion between the baby's head and your cervix,

so by taking it away the head will come down harder

onto the cervix, and hopefully make it dilate a bit more.

And also release all the hormones

that bring on contractions. All right?

Li has been joined by her husband, Eng Su.

All the way up through on that gas.

All right?

LI SOBS

As the baby becomes more distressed, the doctors are called.

SHE MOANS

Focus on your breathing. You're doing really well.

That's it, come on.

This heart rate is still going down quite a lot, OK?

And it's quite slow to recover as well.

We need to deliver you, and the answer is

we need to take you to theatre and do a Caesarean section, OK?

So I'll get one of the nurses and we'll take you down. Back in a moment.

LI SOBS

Once we broke her waters, that cushion went between the baby

and the cervix, and baby dropped down quite quickly,

which shocked baby a bit too much, really.

And because she wasn't even in established labour,

the choice was made to come straight to theatre.

Li's baby will be delivered prematurely at 34 weeks.

Connected.

All right, guys, it is a boy.

They're just going to give him some inflation breaths

just to help him breathe, OK?

But because he's little he's going to struggle breathing on his own,

so that's why we're giving him the breaths.

He's little, but we expected him to be little.

OK?

BABY CRIES

..cry, yeah? Yeah.

That's more like it.

He's doing really well, all right?

He's doing all the things that we'd want him to be doing.

So we're going to weigh him.

Chances are they probably will take him over to neonatal unit,

just because he is really little.

But, again, we were expecting that, weren't we? He's doing really well.

So it's 3lb, 13oz. He's not needing much support.

His saturation, so his oxygen levels are coming up really well,

and he's got a lovely heart rate, he's nice and pink.

Mmm-hmm. All right? Do you want to see him?

Yes, please. Yeah, meet your son!

NEONATAL NURSE: Hello. Congratulations.

He's needing a bit of help with his breathing just at the moment,

so we're going to take him round to the neonatal unit, get him

in a little incubator, yeah? And we'll look after him round there.

And when you're able to come round,

you can come round and see him then, yeah?

All right, so don't you worry, we'll look after him.

OK?

He's gone to neonatal unit just so he can be helped with the breathing,

and just observed really, to make sure that he is stable.

This is the thing with labour and childbirth,

you never know what's going to happen.

Things can change like that. In this case they did.

Li will need to spend time in recovery

before she is able to visit her baby in neonatal.

You've been here before, Bruce, haven't you? Several times now.

Next morning, Jamila has returned with her husband to see what

obstetric consultant Dr Griffiths makes of her baby's growth.

I think the midwife was slightly concerned

about the scan results yesterday. OK, sure. It looks like this.

95% of all babies will fall in between those two outer lines. OK.

And this is what baby's done.

There, there, slight drop off, but actually,

in terms of slight off, you're talking millimetres. OK.

And essentially, it is a little bit of a tail-off,

but I wouldn't do anything about it. Great.

Usually what you find is, lots of these charts

get these odd little bumps of going down

and the next one is back to normal.

And it's one of the disadvantages of scanning every two weeks,

it's probably the earliest you can scan together.

Yeah, and this was nine days apart. Exactly, yeah.

I did say, if you weren't concerned, I wouldn't be concerned.

Thank you, nice to see you.

Oh, I love Mr Griffiths, he's just so practical.

And I was saying to Mark, it's kind of this tug of war, I think, between the consultants

who are practical and don't want to see you,

and the midwives, who want to make sure everything is OK,

but they want to see you all the time.

They just want to make sure everything is perfect for you

and the baby, and I love them for that.

We surveil their pregnancies and keep a lot of time

and effort into helping them get these pregnancies to term,

which is ultimately what we want.

We want these babies healthy and happy, we want these mums happy

and healthy, which is the ultimate goals of midwives anyway.

Do you want me to try and adjust that a bit for you? Let's see if we can...

Oh, thank you.

The day after her arrival, Carly's heart is still racing.

All right then. Take care now, see you soon. Bye.

Dr Francis is with heart specialist Dr Masani,

who has known Carly as a patient since she was a child.

She's tough as old boots, isn't she?

She's a great girl actually, and she's very resilient,

but she's obviously got a good systemic ventricle, that's the thing.

Her systemic ventricle can cope with heart rates of 180,

which is pretty impressive.

So there's nothing we can do to sort of, fix it electronically?

It's drugs. It's got to be... And you're happy with Flecainide?

Yeah, yeah, I've got no problem with that.

The next day, and the drugs bring Carly's heart rate down

to a normal level.

And she's visited by her mum Jacky.

Hi, Mum, all right? Hello, my darling.

God, you had me a nervous wreck. Hi, you OK? Nice to see you.

So glad for seeing you. God, I've been so worried about you.

Oh, my God. Heartbeat has stayed down.

All I've done is cry and pray and cry and pray.

Cry some more. Oh, don't...

TEARFUL: You scared me so much yesterday. You really scared me.

I'm fine, honestly now.

No, but...you looks beautiful, and you always looks beautiful,

but you haven't got as much colour as you had in your face the other day.

And, to me, your lips looked a little bit blue.

Yeah, but they did say, you know, "You've got a very unique heart."

Unique heart? It was back to front,

it was inside out, it was full of holes,

everything and anything went wrong.

And maybe five, ten years previous you would never have survived.

Yeah, all it is, it's just this pulse has got to stay down,

but it's been at 72 all night now.

They tried me on a new drug and it kept it down, so...

The best thing is you're in the hands of Dr Masani, and you know

he is absolutely great, he's brilliant at what he does.

He's at the top of his profession.

And, you know, I've got a crush on him.

CARLY LAUGHS

Because they've got such a brilliant heart unit here,

and they did tell Carly after she had Jayden,

"Now, listen, Carly, under no circumstances get pregnant.

"No circumstances, not pregnant."

And she got pregnant.

But... I'm going to tie her legs together after this.

You know, I think she thought her body clock was kicking off.

She's got a little girl now, so...

It's Dr Masani.

Oh, God. I'm going to marry that man.

I've had the hots for this doctor now for, like...

12 years. 12 years.

Hi, Carly. You all right?

Thank you, Dr Masani, I know you're busy.

Everything's under control right now, I've got a couple

of patients to see and it sounds like you've got your hands full,

but we can get together over the weekend and we'll have that chat.

Brilliant, because I know you're so busy,

and I don't want to take up your time,

but you know, you're always like... God, I trust everything you say.

Oh, thank you so much, thank you. Cool. All right.

OK. Talk to you soon.

OK, thank you, thank you. You've still got that lovely smile.

Thank you.

Love you.

Love you too. I'll be down on Sunday. Ta-ra, baby girl.

If Carly's heart remains stable,

she'll be able to go home in a few days.

You're a wanted woman today. SHE LAUGHS

I know, I'm always wanted.

At 33 weeks pregnant, Alison has recovered from pneumonia.

Her heart condition has improved,

but the team are still concerned about how it will cope in labour.

I mean, all I know is there is talk of a C-section.

And that they, I have heard, the latest I have heard

is she's definitely, definitely got to come out at 36 weeks.

'I suppose it's hard because at the moment I don't want a C-section,

'but then if it's in the best interest of the baby,'

then I'll do whatever's best for her.

Here you go, Mum. Baby's heart beating away there nicely.

Can you see that just in here? Yeah.

And the little one's head is down at the moment.

Oh, she's just...

'Being a mum means the world to me,

because I didn't have a very good start in life.

For the first, say, six and a half years...

I didn't have a very nice life at all.

So I suppose, in a way,

I want to give to my children what I never had.

And I suppose I want them to live

a life I would have liked to live when I was a child.

And, yeah, it was just over a year ago

I lost a baby girl through a miscarriage.

So this pregnancy is very, very special to me.

At the moment, I think we just carry on

as far as the pregnancy is concerned.

Baby's scan today is very normal, so from the baby's perspective,

we haven't got any major worries.

If you're well enough to get all the way to 36 weeks,

then there might be the possibility of you having a normal delivery.

That's the best we're going to aim for. Yeah.

I think if we're looking at delivery before 36 weeks,

then I think it's increasingly likely that we're going to be

looking at Caesarean section.

It is hard, you know, this is what's going to happen,

you ain't got much choice in this, you know.

I appreciate that. I understand the reason why, but it's hard.

And I suppose, the other two were natural births...

But you were well then. And now just the extra burden

of being pregnant has just tipped you into heart failure.

So, we'll see how things are in between. Yep.

If we could make Alison not pregnant,

her heart function would improve considerably,

certainly she'd get no worse

and she could get quite, sort of, rapidly better within a week.

As far as the long term concerns, I think

her heart disease is such

that she's probably going to need fairly major cardiac surgery

to replace that abnormal valve that she has.

It's 10.45 at night,

and Jamila and husband Mark have rushed into the delivery suite.

She's reached 39 weeks without her liver condition getting worse

or needing to be induced.

SHE GROANS

Are you still managing to focus? Yeah.

Midwife Alison has examined Jamila,

and found her to be in the advanced stages of labour.

How are you feeling about the bed, are you happy to stay up a bit more?

I'm all right.

This baby's hurting me round the front.

That's good news though, because at least it's not back-to-back. Yeah.

She's making all the right movements.

It looks like she's pushing with the contractions, so...

Oh, it hurts, it hurts, it hurts, it hurts.

Let's have a look, sweetheart.

You're nearly there!

JAMILA GROANS

Well done. Just popped your waters.

I'd forgotten about that. LAUGHTER

Oh, this hurts.

I'm going to get somebody else in the room.

The position you want to deliver in, it's sometimes good to have someone

to hold the leg for you, is that all right? OK, yes please.

I'm just going to gently examine you and make sure that you are fully,

if that's all right.

Oh, it's nearly out!

I can't, I can't...

Listen, listen, you're there, you've done most of it.

You're nearly there now, sweetheart, let's put this in here.

SHE GROANS

Relax that leg, just relax that leg. That's it, well done.

JAMILA SCREAMS

Don't panic, it's going to burn like mad.

Just take the gas, all right? Puff away on that gas like mad, all right?

Breathe, breathe, breathe, breathe, breathe. There, head's out.

Hello, baby.

Just relax that leg for me. Hey! There we go. Well done.

BABY CRIES

Here he is.

The baby's born. That's my baby!

That's my baby. He's here. Why didn't you tell me my baby was here?

Oh, my baby's here.

CRYING CONTINUES

Oh, I couldn't think, I'm so sorry if I wasn't listening.

MARK: Don't be silly!

It's a boy.

Go on, Mark, are you going to? Go on, Mark.

It's quite tough, it's quite gel-like.

Shh-shh-shh. Mummy's here.

In less than four hours, Jamila gives birth to a healthy baby boy.

So what's his name? Toby. This is Toby.

3.4...

3.6 kilos, which is 7lb, 15oz.

Cholestasis, now that she's delivered will probably be OK.

Her bile acids will drop slowly,

liver function will come back to normal

And she'll stop itching, which is the main thing.

I'm so happy, I'm so glad he's OK. (I'm so glad he's OK.)

After a week in hospital, Carly has been discharged

and told to take it easy.

Well, basically since I've been out of hospital

it's just been like, decorating, new carpet,

that's down, and by the end of the week it'll be done.

To protect her heart from further strain,

she's booked in to be induced at 37 weeks.

Yeah, what it is, not too much on the heart you know, thing,

but on the baby situation now, how she's going to cope

if my blood pressure drops too low or something, you know,

I just hope it goes a straightforward birth.

Hello baby. Oh, look at you. Hello, my darlings. Hello!

Alison's pregnancy has reached 35 weeks with no further complications.

Every other day, she is visited by her partner Paul

and their two boys, Luke and Josh.

Alison hasn't been able to go home for the last six weeks.

The furthest she's allowed with her boys is to the hospital shops.

Go over to the Thomas books then.

I do try and explain to them what's wrong with Mummy,

but they don't really fully understand, you know,

and, "Mummy's in the best place,"

you know, and, "Let's go and see Mummy."

Just try and cheer her up for that couple of hours that we're here,

and it makes her smile, so that means a lot.

I love seeing my boys. My boys always cheer me up.

They always cheer me up.

Have a look at them ones, love, see they're all the same.

'It's sad to see Alison the way it is now and sort of,

I really feel for her at the moment

and I wish she would just get better soon.

Thank you, ta-ra.

The team have got together in the last couple of days,

the cardiologists, the obstetricians, and the plan is to

deliver Alison's baby by Caesarean section on Tuesday morning.

I think she was hoping maybe she would just have this one naturally,

but, you know, I'm sure she understands that

this is probably the best option for her.

Good morning, Alison. How are you this morning?

Not too bad. I just can't wait to see her now. Yeah, no, I'm looking forward to seeing her.

Cos you've been in for six weeks, and how do you feel

about having a Caesarean this time? Because I know...

I said, it's like, I'm not 100% happy.

I was hoping to have the epidural,

but they said it's just far too risky.

So, they said it's going to have to be the C-section,

which is a lot safer option.

Yeah, I I'll probably come to theatre with you actually,

you see, because I'm working

and I'll be bringing the baby over to see you, and you can have

her on your chest for the whole of the time the operation's going on.

But then because you're probably going to go back to cardiac intensive care,

aren't you, that's the plan?

Because you're going to go back there afterwards,

they wouldn't be able to have the baby there with you,

so baby will go into the nursery in special care.

But, you know, you will definitely see her the minute she's born,

and you will hold her as soon as possible.

Yes, that would be nice, just so I can...

I mean, she's bound to be anxious,

I think anybody would be anxious so she's obviously doubly anxious

about the problems she's got, but...no,

I was quite happy with her today,

I think she fully understands everything that's going on, and, no,

I think she's quite looking forward to it really, to seeing her baby.

Let's go and see baby.

Let's see our little one, OK. Have you thought about a name?

Yep, Oliver. Oliver. Very nice. Like the baby opposite you. He's Oliver as well.

Oh, that's lovely.

Li is now well enough to visit her baby.

I'm Helen, I'm looking after little...Oliver, is that right?

Yep, Oliver.

Just over here.

OK, so... How's that?

Is he OK? Yeah, he's lovely.

When he first came, all right, he just needed a little bit of help

with his breathing with the oxygen.

So, he's just getting a little bit of oxygen that was just helping,

but I've taken him off his oxygen

and he's just had his nappy changed about ten o'clock and he's been,

just been on his own just in there and he's doing really nicely.

He's smiling. Yeah, it looks like he's smiling.

Oh, congratulations. Thank you.

Do you want to have a little cuddle?

He's just so tiny and I'm a bit scared that I'll just break him.

No, you won't break him.

Do you want to touch him then? Yeah.

Can you manage to put your hand through there?

It's good for him to know that you're there

and to hear your voice and to feel your touch.

He's so cute.

Baby Oliver will have a short stay in special care

before being allowed home with Mum and Dad.

PHONE RINGS

Labour ward, midwife speaking.

And is it your first baby?

And when are you due?

So it's your fourth baby.

PHONE RINGS

Having reached 37 weeks, Carly is in to be induced.

She's joined by her mum and her partner, Matthew.

Hello. You all right? Have you got your notes with you?

Yes, I've got them in there.

So what we'll do is we'll just settle you in at the top,

and then...

The general plan with Carly for her birth

and her labour is to have an early epidural so she's quite comfortable

and she's not in too much pain which is going to put stress on her heart.

And just to let her labour normally,

but ideally we don't want her to be in labour for too long.

Just leave you on this for a little bit.

Carly is being delivered early to avoid the risk

of her going into spontaneous labour without medical support.

Her heart is quite unpredictable so we need to ensure that

all staff are available if something did happen.

So, we're trying to time her induction and trying to time

her birth sort of in the daylight hours

when there's people about and on hand,

so you need the consultant obstetricians,

the consultant anaesthetists and as well as the cardiologists

being involved as well, just in case something does happen.

At 4am, Carly is given a fast acting induction gel,

hoping she'll go into labour around midday.

OK, pop that under your bottom.

So this is just the gel, OK?

Well done.

Doing really well. OK.

Fab. All right. Yep.

So, we'll leave you on the monitoring for a little bit longer,

just to check if the baby's happy with what we've done.

And then, I'll take you off that and you can go back to sleep

until it all kicks off. All right.

So in six hours, what we'll do is we'll re-examine you,

cos that's how long it takes till it's sort of all dissolved in really.

So, if we re-examine you and then from that, hopefully,

we'll be able to break your waters and then the labour will commence.

So, we're hoping it's going to be enough

and we'll have a baby today.

It's the day of Alison's C-section.

If you can sign your consent on there for me?

The Caesarean section itself is a fairly straightforward operation.

The risks for Alison are all related to her heart.

We have to be very careful with her anaesthetic.

There is that potential for tipping her into heart failure

just by virtue of the anaesthetic itself.

When she delivers her baby, there's quite significant changes

in the circulation, and that can push her into heart failure.

So yeah, the potential for risk is very high.

Alison's partner Paul will be allowed into theatre to support her.

This is really scaring me, you know,

to see her have an operation, I've never seen an operation before.

I'm just like, it hasn't hit me until now, until the day.

I mean, I am strong for you, aren't I, but sometimes I do like,

break down and I mean I feel a bit now, you know...

How you doing there?

Just nervous. I know.

You're doing grand, it's OK.

Listen, my dear,

I need you to calm down and relax, you will be fine, OK?

Yeah, you're doing so well, you really are.

Try not to jump, I know it's easier said than done, but just...

You are, you're doing very well.

Lie down. On your side, that's it.

Don't lie backward.

That's fantastic.

A second midwife, Tatiana,

is assisting Helen with looking after Alison and the baby.

She's kicking, she's all ready. Yeah.

Alison is in one of the main operating theatres

to be close to emergency cardiac services.

Even for midwives, for me after ten years,

it's a first case I have to come in the main theatre,

so imagine how it is for her.

OK, Alison?

I'm just nervous that's all. Alison, Helen is here.

I'll be taking this baby, so I'll bring her to show you,

and I'll take her to resus here and Tatiana can bring her

when she's dried off and all that, OK?

Alison asked me if she could have her baby skin-to-skin

as soon as she's out, so I said that I hope it's going to be possible,

so hopefully they're both going to have this nice moment.

There's nothing unusual.

It's going well, all right? It's going well.

Are you going to be all right?

I will be, yeah. I'll be fine, won't I?

You're braver than I am, aren't you?

Hello! Perfect.

BABY CRIES

Here we go. Here we are, have a look.

Oh! Oh!

Oh, my baby. Oh, my darling.

Oh, my darling! Oh, my baby! Oh!

That was amazing, so quick.

Thank you so much.

BABY CRIES

Yeah, she was born very quickly

and in a very good condition for her gestation.

Perfect.

I can't see much at the minute.

Everyone's around her, I can't see for the minute.

Hiya. Congratulations, she's lovely, making a lot of noise.

Shall I just take her and put her skin-to-skin with her? Please do, yeah.

It would be nice to have a nappy on, but hey-ho.

There we are.

OK, darling.

I think everything's gone fine.

Really good. And it's a lovely baby, isn't she?

She's just over 5 lbs, OK?

It's a good size, yeah.

We couldn't expect any better, fantastic.

So the baby's going to stay with us,

not going to the neonatal unit as you saw,

cos she was born in a perfect condition.

I feel a bit sick.

You feel sick? OK, it's OK.

I feel really sick, I feel really ill. Like, my head hurts.

Shall I take the baby, OK?

Yeah. OK, darling.

BABY CRIES

Alison's blood pressure has dropped to nearly half the normal level.

How are you feeling now? Bit better?

I feel really sick. Do you?

The anaesthetic team give her a drug to bring her blood pressure back up.

You're doing well. It's moving nicely down.

But as the C-section is completed,

Alison's heart rate suddenly accelerates.

She's checked by the cardiac anaesthetist.

Right at the end, her heart rate became very fast

so we got her reviewed by the cardiac anaesthetist.

She seems very happy with Alison,

so we're able to transfer her to coronary care

where she's going to stay, probably for a couple of days.

I mean, it's obviously a stressful time for Alison and Paul

and they did both need support, so I think between us,

Tatiana and I managed to keep everything calm

and I think we were pleased with the outcome.

It's over 12 hours since Carly's induction began.

Yeah, that's better.

My friggin' back is killing.

There hasn't been any progress,

so a second, stronger-acting gel has been given.

She's just been bouncing on the ball.

She's just had enough, she's tired now.

Midwife Ruth Leonard is coming on shift.

Hello, Carly. Hello, I'm Ruth. I'm here for tonight.

How are you doing?

I just don't know what to do for her now.

It's just heart-breaking watching her now.

Did you sleep last night? No. No?

No. Have you been here since yesterday as well?

Yeah, since last night. I don't know what to do with myself.

They're just as bad as each other.

Do you mind if I have a little feel of your tummy first?

I know you'll have to lie on the bed, if that's all right?

Just for a quick... I'll give my hands a wash.

Big deep breaths.

Your cervix is still the same as it was

when Hannah examined you earlier on.

It's, I would say, one centimetre.

It would be difficult to break your waters.

I was just hoping you would be about three or four centimetres.

With pain relief, it is a bit early for an epidural

because it's going to sort of keep you bedridden

and if you're lying down,

your labour's going to be slower than it will

when you're walking about, so, as soon as we can,

as soon as your cervix opens up a bit more and you show signs

that you're going into labour,

I will get you an epidural as soon as possible.

Any questions? No. No, just a bit gutting.

Yeah.

We want it to crack on. She wants to have the baby, don't you?

Going to be a stubborn little thing, girl, no doubt.

With labour some way off, Carly is left to sleep for an hour.

Don't be putting needles in her. She's already got enough.

All right, see you later. Bye, Carl. Love you.

OK, Carly, sleep well and just give me a shout if you need anything.

She's getting a bit fidgety and restless at the moment.

She won't be able to sleep,

but at least she may be able to lie down and close her eyes

and hopefully, if she does that, labour will progress quicker.

BUZZER SOUNDS

That was blooming quick! Come on in here.

Come on, over in the bed.

Before Ruth is able to help, Carly's baby had already been born.

And your mum's not here. No.

Back you go. Good girl.

Give her a cuddle.

BABY CRIES

I'm going to cut this cord now.

There we are. Just give her a little wipe down.

That's the cord.

Oh, you didn't get your epidural. I know, I delivered her too quick!

That's good stuff that paracetamol then.

Relieved, shocked.

Mega-quick.

She's absolutely gorgeous.

Don't know, I left her to sleep

and er... buzzed, and she was standing by the side of the bed

and baby came out.

Can't believe my mother missed it.

They both missed it. I know.

No, no. You are joking. Oh, did you not get...?

Just now, just now.

You're joking.

Oh, my God! You're joking.

Oh, my God! What?

Oh! Oh, my God, let me see her.

Oh, I'm so sorry. What happened?

I just pushed her out, I was on my own.

No stitches, no pain or anything.

I'm so sorry.

I'm so sorry. I'm so sorry.

I'm so sorry.

You OK? You all right? Yeah. Shocked. Have a sit down there.

Hey, baby girl!

Are you OK?

Yeah, shocked I am. Well, you will be, you will be.

I thought we'll have a quick half of lager in the pub,

looking to get you a pizza or some fish and chips or something.

I thought my God, my God! Carly-Ann!

"Look," I said, "I need... She's coming, she's coming."

I stood on there, felt like I needed a poo and she just come out.

I delivered her on my own, I caught her.

Oh, my gosh. Oh, my poor baby.

So proud, just shocked, yeah. You know.

Can't believe it.

After all the planning, no early epidural, no breaking the waters,

it all happened very naturally and all very quickly,

which is good.

And her heart has managed OK.

Oh, I'm so proud of Carly,

I am so, so... Ah, but you missed it.

I missed it, I'm going to shoot myself in the foot,

in the head, everywhere.

So if you have another baby now, don't leave her.

No, no more. We're going to call a last one now.

She's gorgeous, Carly. Well done. Congratulations.

Carly and baby Amelia

will both spend the next two days on the maternity unit,

being observed by the cardiologists and the midwives.

This is it now, this is it.

After 48 hours in coronary care,

Alison is well enough to be reunited with her baby.

And your daughter. Yeah.

Not to be parted again, eh?

Hello, my darling! Thank you.

Oh!

Oh, my baby, oh!

It seems like I haven't seen you for ages.

Oh, my sweet darling.

In a few days, Alison will be allowed to go home with her family...

to return for a heart operation in three months' time.

So is she behaving? No...

48 hours after the birth,

Carly is also free to go home with baby Amelia.

She's so sweet, isn't she?

So is there going to be no more now? No, she's the last one, she is.

Good. OK, take care, all the very best.

All right, bye-bye.

Carly will only need a heart check-up in six months' time.

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