14
Grace
I glanced at my phone—11:01 P.M. Neva had called twice, which must have been some sort of record, although she had called practically every day since the day we found out she was pregnant. Today, I couldn’t bring myself to call her back. I was still reeling from the last phone call I’d received, three hours ago.
I hadn’t recognized the number, but that was nothing new. Clients called me at all hours, from various numbers. Sadly it meant that I was completely unprepared for what was coming.
“Is this Grace Bradley, the midwife responsible for Gillian Brennan’s delivery?” asked the voice. Nothing about that question put me at ease.
“It is. Who am I speaking with?”
“My name is Marie Ableman. I am an investigator with the Board of Nursing. I am calling because a complaint has been lodged against you by a Dr. Roger White at Newport Hospital. Dr. White was the physician looking after Ms. Brennan and her baby after they were admitted to the hospital.”
Wow. He’d done it. He’d made a complaint. I almost felt proud of him. Almost. It wasn’t the first time I’d been abused by a doctor, of course, and I was fairly sure it wouldn’t be the last.
“These home births keep me in business,” he’d muttered when we met in Emergency.
“Excuse me?” I said.
“They’re irresponsible, and they always end up like this, with a patient being rushed in in need of emergency treatment,” he said unapologetically. “Then the doctors are left to clean up the mess.”
“With due respect”—I used every ounce of restraint and professionalism I had left, for the sake of my client—“there is no mess. We are here to admit an infant with a cleft palate. Even if she were born here at the hospital, she’d have required the same treatment. The mother has a perineal tear—pretty standard for a vaginal birth and hardly a mess.” I kept my voice civil but it dripped with thinly veiled hostility.
“Listen,” Patrick said. “I’m a pediatrician at St. Mary’s Hospital. I oversaw this birth, and it was quite safe. We can iron out all the details later, but our first priority is the patient and her baby. Can we all agree on that?”
“Yes,” the doctor said a little gruffly. “Yes, we can.” Then he pointed at me, his face a snarl. “But I want her details. I’m going to report her.”
Patrick stepped between me and the doctor’s finger. “Now, just a min—”
“You can have my details,” I said, already in my purse, searching for my accreditation. “There you go, write it down. I have nothing to be ashamed of.”
I wasn’t going to be bullied. I knew these kinds of doctors. They wanted to make sure everyone knew their place. He (or she, but more often than not, it was he) was the doctor and I was the lowly midwife, the handy woman, the untrained helper. Rarely, if ever, did they recognize that I had studied for six years and completed a master’s degree to become a Certified Nurse-Midwife. They never made good on their threats to make a complaint, and I doubted they ever would. Intimidating people was simply another skill they’d learned in medical school.
“What is the nature of the complaint?” I asked Ms. Ableman.
“Dr. White claims that you attempted a high-risk delivery at home with detrimental consequences for both mother and child. He reported that the baby was born disfigured and that the mother had suffered a third-degree tear that had not been tended to by the time she was admitted to his care.”
“The baby was born with a cleft lip and palate,” I explained. “Which, I’m sure you’ll agree, has nothing to do with my competence as a midwife. The tear was left as a conscious decision not to separate mother and baby. Gillian indicated that she wouldn’t allow her baby to be transferred to the hospital without her, so I thought it was best that the tear be tended to there. If you speak to Gillian, I’m sure you’ll find she doesn’t have any complaints about my service.”
“I will be speaking to Ms. Brennan shortly, and I’ll also need to question your birth assistant and anyone else present.”
“Okay.”
“I know this must be stressful, but do you think you could answer a few questions for me now, Mrs. Bradley? While it is all fresh in your mind?”
“I don’t see any reason why not.”
A mouse clicked in the background, followed by: “Now, at what time did you realize the baby had a cleft palate?”
“I wasn’t sure it was a cleft palate at first.” I stood and picked my way down the hall toward my office so I could check my notes. “I knew something didn’t feel right. I wondered if it could be breech, but it was unlikely since the baby was head-down at our last appointment. I guess it was about eight P.M. I’ll check my notes to be sure.”
“I’ll need a copy of your notes, but for now, tell me from memory. So, at approximately eight P.M., immediately following a vaginal exam, you suspected the baby was breech. What action did you take?”
“Well, no. I didn’t ‘suspect’ the baby was breech, I simply thought it was a possibility. I told Gillian that I was uncertain of what I had felt, and then I asked my daughter for a second opinion.”
“Your daughter? She was present at the birth?”
“She was my birth assistant. She’s a Certified Nurse-Midwife at St. Mary’s Birthing Center.”
“St. Mary’s.” Her fingernails bashed against a keyboard. “Okay. What happened next?”
“My daughter performed an exam and was also uncertain of what she could feel, but she suspected it was a breech.”
“And you disagreed?”
“I thought it was worthwhile looking at other possibilities before transferring her to a hospital. Gillian was very committed to having a home birth with minimal medical intervention.”
“How long did you look at other possibilities?”
“A few minutes.”
“What happened next?”
“We realized it was a cleft palate we were feeling. Once my daughter suggested it, we both knew immediately. We did another exam to confirm, and then we were certain.”
“What time was this?”
“I don’t know. Eight thirtyish?”
Fingernails clacked against the keyboard. I waited.
“And once you confirmed the baby had a cleft palate, you still felt it was appropriate to proceed with the birth at home?”
I paused. The delivery of that sentence was so laden with judgment, I couldn’t help but respond defensively.
“Yes. I knew Gillian would have a hard time when she saw her daughter’s face. I didn’t see any reason to add the trauma of a hospital delivery to her troubles. Particularly when we had a pediatrician on-site.”
“Dr. Johnson?”
“Yes.” I had no idea of Patrick’s surname, but Marie had clearly done her research, so that must be it.
“Now … Gillian was admitted to the hospital herself with a third-degree tear. Can you tell me about that?”
“A third-degree tear is one that stretches from the perineum right through to the—”
“I mean,” Marie interrupted, “can you explain to me why you transferred a patient with a third-degree tear?”
“Oh, of course, I’m sorry.” I played innocent. “As I said before, it was a matter of keeping mother and baby together. I knew Gillian had a tear, but she was reluctant to part with her baby. And I was inclined to agree with her. The tear wasn’t life-threatening and we wanted to get the baby seen to at the hospital as soon as possible. I made a judgment call, and I’d do the same again.”
I rapped my knuckles against the bedside table. I was talking braver than I felt. Had I made the right call? As I thought back to the events of the evening, I had to admit, there was room for doubt. Was it irresponsible to deliver a baby with a cleft palate at home? As for the tear, obviously it wasn’t life-threatening, but there could have been complications caused by not suturing sooner rather than later. I started to feel a little sick.
“Okay, Mrs. Bradley,” Marie said after an eternity. “That’s all I need for now, but I may need to speak with you again. Once I have spoken with all parties, a committee from the board will review the case and make a recommendation. You will be informed of this recommendation as soon as it is made.”