He knows every detail of what happened as he tells me about his first flight. Vitória.
An Internist and Intensivist at Santa Maria, Nuno Gaibino earned the status of delivering a baby every year outside of a hospital context.
He started doing VMER (Medical Vehicle for Emergency and Resuscitation) in September 2018 and little did he know that a few months later, his Christmas Eve would have a special meaning in store for him. Unexpectedly, he would deliver his first baby. Named Vitória, this baby would be his first "godchild", born by his hands, on that cold night next to Beatriz Ângelo Hospital. Vitória did not want to wait to enter the hospital and so the story of childbirth began for Nuno Gaibino.
It was a photograph published on 6 April that reminded us once again of the reason for his passion for emergency medicine. The story repeated itself with the same characteristics, only changing the final address. This time, to tell of baby Maria Luísa's first flight.
The photographs of a delicate baby in a pink wool bonnet were viewed on the official networks, after all, living between firm ground and the abyss, Nuno knows that he doesn't always get lost.
It was after a call for help from the Fire Department of Beato and Penha de França, calling a VMER car, that Nuno Gaibino and the nurse Tiago Duarte flew out to reach their destination. Working at Santa Maria, Nuno Gaibino was called to leave as soon as possible, while the firefighters, the mother and the father of the baby, who would be born, waited for help near the Santa Apolónia station, near a small tunnel.
It was at the moment when the firefighter were passing all the information, requesting support from VMER that, from the CODU Central Station, that a minimal observation of the mother was requested in order to understand if the baby's head was already coming out. "It was at this point that the firefighter saw the back of the head of the baby, the labour was developing too fast", recalls Nuno Gaibino.
He thus anticipated the scenario to nurse Tiago, "we have to go as quickly as possible because we are going to deliver a baby, or else it will be over by the time we arrive".
Perhaps was not the ideal speed expected to keep the team safe, but from Santa Maria to Santa Apolónia the VMER of Nuno and Tiago took only 5 minutes.
While they were on the road and until they arrived at the scene, the information they had was that of a pregnant woman about to have her second child and at 36 weeks gestation had started contractions every 10 minutes. They also knew that until the arrival of the firefighters the waters hadn’t broken. The situation was apparently under control, but the picture changed in a very short period of time, the waters broke suddenly and the contractions came every minute. "It is very rare for a labour to progress so quickly", he explains.
The reality of childbirth is usually different, from the moment the mother has the first contractions, she can go quietly to the hospital, and it is expected to take some time to reach the moment of birth. It is therefore not considered the top priority of Emergency Medicine when a pregnant woman goes into labour. But there are exceptions and once more, labour was imminent. "In fact, there is the beginning of labour, that is, contractions at less than every four minutes, then the waters break, or not, and all of this with a period of evolution."
As soon as they arrived on the scene, Nuno Gaibino had warned Tiago Duarte to bring the delivery kit, the monitor for the mother and the breathing and respiratory equipment for the mother and the baby, as they could encounter several scenarios. Haemorrhage of the mother or foetal complication could be two of the possible scenarios. Nuno Gaibino was surprised that, when he got into the ambulance, the first thing he was told was to "close the door, because it was cold". Inside that small space was a firefighter calming the father and his colleague with a child in her hands. The umbilical cord was still attached to the mother and the baby had been wrapped in a large compress for about 1-2 minutes. After the cord was cut, mother and baby were checked. It was such a small space for so many elements and with no resemblance to a delivery block, the only support bed for Maria Luísa was improvised on an ambulance bench. Although it was not a common birth, due to the inherent risks that occur when performed outside the hospital institution, the situation was stable. An instinctive teamwork to those with much training, Tiago took care of the mother and Nuno observed the baby. The loss of temperature was a major concern for Nuno, "it was fundamental to see the suction capacity, the muscle tone, the vigorous response and if she cried or not, as well as the perfusion (warm extremities) of the baby. Everything was fine, but in fact she had lost some temperature".
A cold temperature that must also help the doctor keeping a cool head when immediately assumes the leadership of a team he does not know. Everyone was now called to work. The first was the father, it was necessary to look for the bag of clothes from Maria Luísa's first day of life, get the bonnet and put it urgently on the baby’s head. "Babies lose about 40% of their temperature through their head, so the first thing to do, even before cleaning, is to immediately protect that part of the body." Only then the secretions of the amniotic fluid from the nose and mouth, always present in the newborn baby, were sucked out. This explains why, as soon as they are born, newborn babies must be under an illumination that keeps them stable in terms of their body temperature. And if, on the one hand, the ambulance does not offer the same conditions as a delivery room, on the other, Nuno Gaibino's speciality is Internal and Intensive Medicine, not Obstetrics or Paediatrics. "I don't normally deal with newborn children in my day-to-day work, but there came the same situation again this year," Nuno Gaibino tells me laughing.
From his previous years, in which he helped other babies to be born outside the hospital context and while in the VMER, this year the paradigm changed considerably, as he now takes on the role of the greatest responsibility of all: being a father. "But dealing with babies is always the situation where you can't go wrong in anything, because as it is not a daily activity, we follow everything according to the rules, we strictly follow the protocols, because the stress level is so high that there is not the slightest improvisation."
Once the initial emergency had calmed down, Nuno Gaibino called Santa Maria Hospital, where the mother was already being monitored, and asked for clinical support, as they were about to arrive with another family member in their arms. However, the evaluation required to be rigorous, as the baby was 36 weeks old and had been born outside the appropriate place. At the door of the hospital some of the best clinicians in their areas were waiting, an Obstetrics team, to treat the mother, a Neonatology team, and a Paediatric Intensive Care team, for Maria Luísa. "We were welcomed at the entrance to the Emergency Room as if we were living a scene from one of the best American medical series."
On arrival at the hospital and after general care, the mother was already in the second stage of labour, the moment of expulsion of the placenta, while Maria Luísa was already showing evident breastfeeding reflexes.
It was 25 minutes of intense adrenaline, which lasted from the time the VMER was called until they arrived in Santa Maria.
As for the adrenaline, the levels lowed after the 25 minutes, allowing the heart rate to drop, but only disappeared the following day.
"We changed the course of something that might not have gone so well", he tells me with the same expression of duty and a mixture of magic and respect for the profession. In the life of this VMER team and in the medical career of Nuno Gaibino there are many stories to tell and some of them do not end well.
But we will talk about them one day, because these are also the stories that make the real life.
Today we tell only of the first flights. That of Nuno Gaibino, who helps to maintain the life of the one who receives it for the very first time in a first flight.