A Change of Heart for the Cornish Midwife by Jo Bartlett

1

Ella’s father, Jago Mehenick, claimed he knew the roads that led up from the harbour to the countryside around Port Agnes like the back of his hand. Ella could beat that, because there was a very good chance she’d have been able to get to Liberty Farm with a blindfold on, if she had to. Working at the midwifery unit for almost three years had meant a lot of home visits across the Three Ports area and she’d have long since ditched the satnav, even if she hadn’t grown up there. Not to mention the fact that Liberty Farm was home to Ella’s soon-to-be sister-in-law, Lissy, her husband and their three children.

This latest trip wasn’t just a visit to see family, though. Lissy was pregnant with her fourth baby and Ella was due to carry out her thirty-four-week antenatal check-up at home. With a five-year-old, a three-year-old and a one-year-old already, even a trip into Port Agnes was a military operation. Not only that, but Ella had just picked up the bridesmaids’ dresses for her wedding, which was now just over a week away, and dropping off Lissy’s dress meant one more thing could be signed off the to-do-list. Lissy had suggested that she pull out of the role of maid of honour, when she’d realised quite how pregnant she’d be with her fourth baby by the Valentine’s Day ceremony, but neither Ella, nor her fiancé, Dan, would hear of it. Lissy and her children were Dan’s only immediate family and after they’d lost their parents when Dan was still at school, Lissy had ended up all but raising her little brother. The siblings were incredibly close and Lissy’s role in the wedding was non-negotiable. Dan’s sister might have tried to protest that she’d look ridiculous in the photographs, at almost eight months pregnant, but any wedding pictures without her in them would create a glaring gap that no-one else could fill.

Pulling into the driveway of Liberty Farm, Ella brought the car to a stop and couldn’t help smiling, the memories flooding back the way they always did when she was here. The first time she’d come to the farm, when she’d returned to Port Agnes after a decade of living in London, the last person she’d expected to see was Dan’s sister. But it had been the start of finding her way back to where she was always meant to be.

Ella and Dan had been childhood sweethearts, but she’d needed to prove she was more than just Ruth and Jago Mehenick’s daughter: the girl who everyone had expected to settle down and never venture far from the Cornish Atlantic coast. Dan had once shared the same dream of heading off to find adventure, so when they finally got the chance to leave, she couldn’t understand why he’d suddenly wanted to stay in Port Agnes. In the end, she’d left without him and it was ten years before she discovered that it was Dan’s bond with Lissy that had kept him in Cornwall. His sister had needed him in a way that Ella couldn’t understand back then, and Dan had needed to repay the debt he felt he owed Lissy for stepping into their parents’ shoes. Family was still incredibly important to Dan, and it was one of the things Ella liked best about him, and part of the reason why it had been so easy to fall in love with him again when she’d finally come home to Port Agnes. Now here they were, ten days away from their wedding and six weeks away from becoming auntie and uncle for a fourth time.

‘Hello?’ Ella called out as she opened the door to the farmhouse. Lissy had given both Ella and Dan keys and had told them just to let themselves in if they were ever dropping by. Ella had felt awkward about it at first and had wondered if Lissy had felt obliged to include her in the invitation. After all, she wasn’t even family yet and Ella had no siblings of her own to compare the relationship to. But Lissy had been insistent and even more so on a previous antenatal visit when she’d confessed that getting off the sofa to answer the door was starting to take an Olympian effort. Despite her reassurances, Ella was still a bit tentative about strolling into Lissy and Niall’s house, so she called out again from the hallway. ‘Hello? Lissy, are you here?’

‘I’m in the front room. Come on in and please tell me you’ve brought chocolate.’ As Lissy spoke, Ella smiled to herself again. Back when she’d first dated Dan, Lissy had had what amounted to an addiction to Caramac bars and nothing had changed. So every time Ella visited, she brought a bar with her and she knew her soon-to-be sister-in-law loved her for it. She’d told her often enough.

‘Of course I’ve got chocolate! How are you doing?’ Lissy was sitting on the sofa with Bailey, her fifteen-month-old son, curled up next to her, when Ella came into the room.

‘Imagining what life would be like if we’d stopped at two children.’ Lissy gave her a wry smile as she stroked Bailey’s head and Ella knew Dan’s sister wouldn’t change a thing, despite the challenges. ‘I’d be at a loose end right now, with the other two at school and nursery, with nothing that I needed to do other than farm stuff, until they got home. Yet here I am, catching my breath while surprise baby number one has a snooze, and I wait for surprise baby number two to put in an appearance. You’d think we’d have learned after Bailey, wouldn’t you? But at least Niall’s making sure there’ll be no surprise baby number three and that there’s absolutely no chance of us ending up as a family of seven. Can you even imagine?’

Lissy shuddered and Ella couldn’t help laughing. ‘Niall did mention something to Dan about running away from home if there were any more surprises.’

‘Oh yeah, because he has it really hard.’ Lissy rolled her eyes. ‘Unless they do the vasectomy with two bricks, followed up by a double-barrelled kick from a donkey, then he has absolutely no grounds to complain about anything.’

‘Agreed.’ Ella laughed again and then suddenly stopped, as she looked at Dan’s sister properly for the first time since she’d arrived. The other woman’s face was puffier than usual. It might just be a side effect of her pregnancy, but if there was even a tiny chance of it being something more serious, Ella wanted to rule it out as soon as possible. ‘So how have you really been? Any headaches or unusual aches and pains?’

Even as she spoke, Ella was looking down at Lissy’s legs. Her ankles were visible below the ends of her trouser legs and, as much as Ella was hoping she was imagining it, they were definitely swollen.

‘Everything seems to ache this time around.’ Lissy’s wry smile was back in place. ‘But it’s funny you should mention it, because I’ve had a bad head for the last two days. I’m sure it’s all just stress, but I threw up this morning too and I haven’t done that since I got to the twelve-week mark.’

‘Why didn’t you say something? I know you’re really busy running around after everyone else, Liss, but you’ve got to look after yourself too.’ Ella took some urine testing sticks out of her bag as she spoke. She didn’t like the sound of this one little bit.

‘What’s the matter?’ Lissy was starting to look worried too, which wouldn’t help the situation, and Ella gave her what she hoped was a reassuring smile.

‘It’s probably nothing, but I just need to test your urine to rule out anything that might need to be looked at. Have you done a sample?’

‘It’s on the sideboard. Other people display decorative plates or crystal, but I like to be different.’ Lissy started to laugh, but then she grimaced and clutched the side of her head. ‘It’s like having a terrible hangover, but I haven’t had so much as a glass of wine in over seven months.’

‘Okay sweetheart. I think I know what this is. Let’s just see what the reading says.’ Ella dipped the testing stick and there was no mistaking the result, but it could be down to anything from the stress Lissy was under, to dehydration. Except, when Ella considered it alongside Lissy’s other symptoms, there was a good chance it was something far more serious. ‘You’ve got some protein in your urine.’

‘Does that mean I’ve got an infection? I had one of those when I was pregnant with Bailey and it was like peeing broken glass, but I haven’t had anything like that this time.’

‘It could be, but I think it would be a good idea to check your blood pressure before we do anything else today.’ Ella kept her tone as neutral as possible, but Dan’s sister knew her far too well.

‘There is something wrong isn’t there?’ Lissy laid a protective hand on her bump.

‘Like I said, it’s probably nothing to worry about, but I just want to rule out pre-eclampsia.’

‘Oh my God. That’s serious, isn’t it?’ Lissy widened her eyes, shifting in her seat so that Bailey let out a little groan. Ella needed Dan’s sister to stay as calm as possible, if the blood pressure reading she got was going to be accurate. ‘Will the baby be okay?’

‘You’ll be fine and so will the baby, but it’s important to know if that’s what we’re dealing with. Your ankles and face are looking a little bit swollen; have you noticed any puffiness?’ All the signs were pointing to pre-eclampsia and Ella just had to hope it was mild enough for medication and bed rest to hold off the need for Lissy’s fourth baby to be induced. If not, Dan’s sister was going to be a mum of four much sooner than she’d expected.

‘My whole body feels like a barrage balloon, so it’s quite difficult to tell.’ Lissy pulled a face and rolled up her sleeve so that Ella could check her blood pressure. ‘I just thought it was all a bit worse this time because I’ve had four babies, especially with the last two being so close together.’

‘Don’t worry. Whatever it is, we can sort it out. Let’s just see what we’re dealing with.’ Ella had to fight to stop her face from revealing just how worried she really was, as she looked at the reading. ‘Your blood pressure is significantly raised, so it’s almost certainly pre-eclampsia.’

‘Do I need to take something for it, or is it more serious than that?’ Lissy was searching Ella’s face and she wished she could promise it was as easy as taking some tablets, but if the reading was accurate, there was only one cure for pre-eclampsia as severe as this.

‘I’m going to drive you to the hospital, because I think they might want to discuss delivering the baby early.’ There was no time to hang around. If Lissy didn’t get the treatment she needed, she could have a stroke or end up with organ damage. There was even a possibility it could prove fatal for both Lissy and her unborn baby. Ella’s heart would have been racing if she’d taken a blood pressure reading like that from any patient. But, when it was someone she loved, it took all she had not to just give in to the panic that could so easily have overwhelmed them both. She needed to stay professional and try to reassure Lissy in exactly the same way she would any other patient.

‘Can’t we wait until Niall gets home?’ Lissy raised her eyebrows but they didn’t have the option of a debate. Even though Ella didn’t want Lissy to panic, she had to make her realise that she wasn’t going to be able to choose whether or not to have this baby now.

‘We can call him and tell him to meet us there, but we’ve got to go now, because if the doctors think the baby needs to be delivered, they’re going to want to do it as soon as possible. Otherwise the pre-eclampsia could be really serious for both of you.’ Ella squeezed her hand, but Lissy’s eyes widened as the seriousness of the situation finally hit home.

‘It’s too soon!’

Ella squeezed her hand again. ‘At thirty-seven weeks, they’d class you as full term and you’re only three weeks away from that. Whatever they decide at the hospital, it’ll be what’s best for the baby and for you. I’ll take you and Bailey in my car now and Niall can probably be there almost as quickly as we are, if we call him when we leave.’

‘What about the other kids? Niall’s gone to pick up some straw from his friend’s farm in Port Kara and then he was going to get them from school and nursery afterwards.’ Lissy bit her lip. ‘Do you think Dan will pick them up for me?’

‘Of course, but I’m pretty sure he’ll want to come to the hospital too.’ Ella exchanged a look with Lissy. Dan would probably panic more than Niall when he got the news. Having lost his parents at such a young age, his greatest fear was losing someone else he loved and he knew all too well how easily it could happen. ‘Mum and Dad will pick the kids up for you.’

‘Are you sure they won’t mind?’

‘Of course not.’

Lissy breathed out, clearly relieved there was one less thing to worry about. ‘Noah and Tegen will be thrilled that Uncle Jago and Auntie Ruth are picking them up.’

‘Not as thrilled as Mum and Dad will be.’ Despite her desire to get Lissy to the hospital as quickly as possible, Ella’s smile was genuine. Her mum and dad loved filling the role of stand-in grandparents to Lissy’s children. Niall’s family lived in Ireland and, with Lissy’s parents no longer around, Jago and Ruth had become almost as close to Dan’s sister and her family as Ella had. ‘Have you got a bag packed?’

‘After my experience with Tegen arriving a couple of weeks early, I was packed at thirty-two weeks for both Bailey and this one, just in case. It’s in the understairs cupboard and there’s a bag made up for Bailey too.’

‘Great. I’ll grab them both, then Dan and I can take Bailey home with us if they do decide to keep you in.’

‘I really can’t believe this is happening.’ Lissy’s eyes were still wide with shock and she suddenly clamped her hand over her mouth. ‘Oh my God, the wedding!’

‘Don’t worry about that; all that matters is making sure you and the baby are safe. I can let the unit know on the way to the hospital that I won’t be able to make it to my last two appointments. I’ll give Dan a ring too and ask him to call Niall.’ She reached out for Lissy again. ‘It’s going to be okay.’

‘You promise?’

‘Absolutely.’ Ella nodded as she scooped a still-sleeping Bailey out of his mother’s arms. It was going to be okay; she wouldn’t even consider the alternative. Family was everything to her and Dan, and she couldn’t let him or Lissy down.

* * *

‘I’m on speaker phone.’ Ella had given Dan the heads up that they were on their way to hospital, but the last thing Lissy needed to hear was her brother panicking. Luckily, telling him that Lissy could hear every word was enough to shut down much of a response, other than to promise to track Niall down and meet them in Truro. It took Ella and Lissy just over thirty minutes to get there, with Dan and Niall arriving a further forty minutes behind them.

‘Is she okay?’ Niall and Dan spoke in unison when they met Ella at the maternity ward.

‘Lissy’s fine.’ Painting on a smile, she decided not to tell either of them just yet that by the time they’d reached the hospital, Lissy had said she felt as though someone was trying to smash her skull from the inside out. Thankfully, the team in Truro had taken Ella at her word and Lissy had been rushed straight in for further checks. Her blood pressure was dangerously high and the consultant had confirmed they’d probably need to consider an early delivery, but he was confident they had enough time to try other treatments first. ‘They’re going to give her some medication and monitor her blood pressure for the next forty-eight hours to see if they can bring it down.’

‘Do you think that’s what they should be doing for her?’ Dan was looking to Ella for reassurance, and she nodded.

‘If it works, it’ll give the baby a bit more time to be ready. But even if the medication doesn’t do what they’re hoping, at thirty-four weeks it’s much safer to deliver the baby than take any unnecessary risks.’

‘What’s the medication supposed to do?’ Niall was stepping from foot to foot, as if he was finding it impossible to stand still. It was hardly surprising, given that his wife and unborn child were being treated for something that meant he could have lost them both.

‘Lissy’s being given some antihypertensive meds to lower her blood pressure and they’ve administered some corticosteroids to help develop the baby’s lungs, in case they do need to deliver early.’ Ella swallowed, hugging little Bailey to her side. She wasn’t going to mention the anticonvulsants Lissy had been prescribed. Talking about the risk of seizures wouldn’t do anything to help Niall or Dan stay calm.

‘Wouldn’t it be safer just to deliver the baby?’ Dan looked ready to insist on that course of action himself, his blue eyes clouding over, and Ella laughed for the first time since she’d realised how serious the situation with Lissy was.

‘Has Dr Google been at work again?’

‘When Niall was driving us over, I may have googled pre-eclampsia.’ Dan gave her a sheepish look, knowing only too well what she thought about relying on Google for medical advice. ‘Delivering the baby sounds like the quickest way to cure it.’

At any other time Ella might have teased him for thinking he was suddenly an expert, but it was obvious how worried he was for Lissy and what he needed right now was reassurance. ‘It’s definitely the quickest way, but the doctors also need to make sure the baby is as ready for delivery as possible. If they can reduce Lissy’s blood pressure enough with the medication to buy some time to help the baby’s lung development along a bit, it’s better to hold off for a while longer. But don’t worry, they’re monitoring her all the time and if they think they need to deliver the baby, they will.’

‘Okay then, I think we should trust that they know what they’re doing. Can I see her?’ Niall was still moving from foot to foot as he stood facing Ella.

‘They said they’d let me know as soon as we can go in.’

‘Thank you for everything you’ve done.’ Niall put a hand on Ella’s shoulder and dropped a kiss on to his son’s head. ‘It was such a relief knowing she was with you and in the best possible hands.’

‘My thoughts exactly.’ Dan put his arm around Ella, placing his hand just below where Bailey was resting on her hip. ‘I think we’d both have been freaking out a lot more otherwise.’

Ella had been about to answer, when a hospital midwife popped her head around the door. ‘You can come through now. Although I’m afraid I’m going to have to insist on a maximum of two visitors at a time, because Lissy needs as much rest as possible.’

‘It’s fine.’ Ella nodded. ‘I can stay in the visitor’s room with Bailey; I need to give him his dinner anyway.’

‘Are you sure?’ Dan dropped his arm as he turned to look at her.

‘Absolutely. Go and see Lissy and tell her not to worry about anything.’

‘What would I do without you? You’re amazing.’ Dan kissed her forehead and turned to follow his brother-in-law through the double doors.

Ella was determined to make sure there was as little as possible for Lissy to worry about and she knew, without even asking, that it was what Dan would want too. It would mean making some calls she’d never have dreamed she’d need to make, but sometimes even the most important day of your life had to take second place.