LITMIR.BIZ

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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

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