The Midwife Trilogy (10 page)

Twenty-five years later, a shy young girl called Lady Diana Spencer became engaged to marry Prince Charles, heir to the throne. I saw several film clips of her arriving at various engagements. Each time when the car stopped, the front nearside door would open, and her bodyguard would step out and open the rear door for Lady Diana. Then he would stand, jaw thrust forward, legs slightly apart, and look coolly around him at the crowds, a mature Jack, still practising the skills he had acquired in childhood, looking after his lady.

ANTENATAL CLINIC

There must be aspects of every job that are disliked. I did not like antenatal work. In fact I would go so far as to say that I hated antenatal clinic, and dreaded the arrival of each Tuesday afternoon. It was not just the hard work - though that was hard enough. The midwives tried to organise the day-book so that we could finish our morning visits by twelve noon. We had an early lunch, and at one-thirty we started to set up the clinic in order to open the doors at 2 p.m. Then we worked through until we were finished, often as late as 6 or 7 p.m. After that, our evening visits began.

That did not bother me - hard work never did. What really got me, I think, was the sheer concentration of unwashed female flesh, the pulsating warmth and humidity, the endless chatter, and above all the smell. However much I bathed and changed afterwards, it was always a couple of days before I could get rid of the nauseating smells of vaginal discharge, urine, stale sweat, unwashed clothes. It all mingled into a hot, clinging vapour that penetrated my clothes, hair, skin - everything. Many times, during the routine antenatal clinics, I had to go out into the fresh air and lean over the rail by the door, heaving, forcing down the urge to be sick.

Yet we are all different, and I did not meet any other midwife who was affected in this way. If I mentioned it, the reaction was one of genuine surprise. “What smell?” or “Well, perhaps it got a bit hot.” So I didn’t make any further comments about my own reaction. I had to remind myself continuously of the huge importance of antenatal work, which had contributed so greatly to the drop in maternal deaths. Memory of the history of midwifery, and the endless sufferings of women in childbirth, kept me going when I was thinking, I just cannot bring myself to examine another woman.

Total neglect of women in pregnancy and childbirth had been the norm. Among many primitive societies, women menstruating or with child, or in labour or suckling the child, were regarded as unclean, polluted. The woman was isolated and frequently could not be touched, even by another woman. She had to go through the whole ordeal alone. Consequently only the fittest survived, and by the processes of mutation and adaptation, inherited abnormalities, such as disproportion in the size of the pelvis and the foetal head, died out of the race, particularly in remote parts of the world, and labour became easier.

In Western society, which we call civilisation, this did not occur, and a dozen or more complications, some of them deadly, were superimposed on the natural hazards: overcrowding, staphylococcal and streptococcal infection; infectious diseases such as cholera, scarlet fever, typhoid and tuberculosis; venereal disease; rickets; multiple and frequent childbirth; the dangers from infected water. If you add to all this the attitude of indifference and neglect that often surrounded childbirth it is not hard to understand how childbirth came to be known as “the curse of Eve”, and how women could often expect to die in order to bring forth new life.

The Midwives of St Raymund Nonnatus held their clinic in a church hall. The idea today of conducting a full-scale antenatal clinic in a converted old church hall is horrifying, and sanitary inspectors, public health inspectors, every inspector you can think of would be there condemning it. But in the 1950s it was by no means condemned, in fact the nuns were highly praised for the initiative and ingenuity they had shown in the conversion. No structural changes had been made, apart from the installation of a lavatory and running cold water. Hot water was obtained from an Ascot water heater fixed to the wall near the tap.

Heating was provided by a large coke fire in the middle of the hall. It was a black cast iron construction which had to be lit earlier in the morning by Fred, the boilerman. Such coke fires were very common in those days, and I have seen them even in hospital wards. (I recall one ward where it was the practice to sterilise our syringes and needles by boiling them in a saucepan placed on the stove). These stoves were very solid, flat topped, and you had to fill them by opening the circular lid and tipping the coke in from a coke-hod. It required quite a bit of muscle power. The stove was situated in the middle of the space, so that heat was radiated all around. The flue went straight up the middle, to the roof.

A few examination couches were available, with movable screens to provide privacy, and wooden desks with chairs, where we wrote up our notes. A long marble-topped surface stood near the sink, upon which we placed our instruments and other equipment. A gas jet stood on this surface, with a box of matches beside it. This single jet of flame was used continuously for boiling up the urine. I can smell it now, more than fifty years later!

The clinic, and those like it all over the country, may sound primitive today but it had saved countless thousands of lives of both mothers and babies. The Midwives’ clinic was the only one in the area until 1948, when a small maternity unit of eight beds was opened in Poplar Hospital. Prior to that, the hospital had no maternity unit even though Poplar was said to have a population of fifty thousand people per square mile. When the decision was taken after the war to open a hospital unit, no special provision was made. Quite simply, two small wards were allocated for maternity - one for lying-in, and the other for delivery, doubling-up as an antenatal clinic. This was inadequate, but it was better than nothing at all. Accommodation, equipment, technology, were not really important. What was important was the knowledge, skill and experience of the midwife.

Clinical examination was what I shrank from the most. It can’t be as bad as last week, I thought as we prepared to open the doors. I shuddered as I remembered it. Thank God I was wearing gloves, I thought. What would have happened if I had not?

She had been in my mind on and off for the whole of the past week. She had flounced into the clinic at about 6 p.m. in her hair curlers and slippers, a fag hanging from her lower lip, and with her were five children under seven. Her appointment had been for 3 p.m. I was clearing up after a not too stressful afternoon. Two of the other student midwives had left, and the third was still with her last patient. Of the Sisters, only Novice Ruth remained, (a “novice” in the religious life, not in midwifery). She asked me to see Lil Hoskin.

It was Lil’s first antenatal visit, even though she had had no periods for five months. This is going to take another half an hour, I sighed to myself as I got out the notes. I scanned through them: thirteenth pregnancy, ten live births; no history of infectious disease; no rheumatic fever or heart disease; no history of tuberculosis; some cystitis but no evidence of nephritis; mastitis after the third and seventh babies, but otherwise all babies breastfed.

Her previous notes gave me most of her obstetric history, but I needed to ask some questions about the present pregnancy.

“Have you had any bleeding?”

“Nope.”

“Any vaginal discharge?”

“A bit.”

What colour?”

“Mos’ly yellowish.”

“Any swelling of the ankles?”

“Nope.”

“Any breathlessness?”

“Nope.”

“Any vomiting?”

“A bit. Not much though.”

“Constipated?”

“Yep, not ’alf !”

“Are you sure you are pregnant? You haven’t been examined or tested.”

“I should know,” she said meaningfully, with a shriek of laughter.

The children by now were rushing around all over the place. The hall, being large and virtually empty, was like a great play area for them. I didn’t mind - no healthy child can resist a wide open space, and the urge to run is powerful if you are only five years old. But Lil thought she must exercise some show of authority. She grabbed a passing child by the arm and dragged him to her. She gave him a great blow across the side of the face and ear with a heavy hand, and screamed.

“Shut up and behave yourself, you li’l bleeder. And that goes for the lot of you and all.”

The child squealed with pain and the injustice of the blow. He retreated about ten yards from his mother, and screamed and stamped, until he could scarcely breathe. Then he paused, took a deep breath, and started all over again. The other children had stopped running around, and a couple started whimpering. A happy but noisy scene with five little children had been turned in an instant into a battlefield by this stupid woman. I hated her from that moment.

Novice Ruth came up to the child, and tried to comfort him, but he pushed her away, and lay on the floor kicking and screaming. Lil grinned and said to me: “Don’t mind him, he’ll get over it.” Then louder, to the child: “Shu’ yer face or yer’ll get another.”

I couldn’t bear it, so to prevent her doing any more harm, I told her that I must examine her urine, gave her a gallipot, and asked her to go into the lavatory to supply a sample for me. After that, I said, I would want to examine her, and would need her undressed below the waist, and lying on one of the couches.

Her slippers slapped across the wooden floor as she went. She came back giggling, and gave me the specimen, then flopped over to one of the couches. I ground my teeth. What has she got to giggle about, I thought. The child was still lying on the floor, but not screaming so much. The other children looked sullen, making no attempt to play.

I went to the work surface to test the urine. The litmus paper turned red, showing normal acidity. The urine was cloudy, and the specific gravity high. I wanted to test for sugar, and lit the gas jet. I half filled a test tube with urine, and added a couple of drops of Fehlings solution, and boiled the contents. No sugar was present. Lastly, I had to test for albumen by refilling the test tube with fresh urine, and boiling the upper half only. It did not turn white or thick, indicating that albumen urea was not present.

This took about five minutes to complete, during which time the child had stopped crying. He was sitting up and Novice Ruth was playing with him with a couple of balls, pushing them back and forth. Her refined, delicate features were offset by her white muslin veil which fell down as she leaned over. The child grabbed it and pulled. The other children laughed. They seemed happy again. No thanks to their rough and brutal mother, I thought as I went over to Lil, who was now lying on the couch.

She was fat, and her flabby skin was dirty and moist with perspiration. A dank, unwashed smell rose from her body. Have I got to touch her? I thought as I approached. I tried to remind myself that she and her husband and all the children probably lived in two or three rooms with no bath, or even hot water, but it did not dispel my feeling of revulsion. Had she not hit her child in that heartless manner, my feelings might have softened towards her.

I put on my surgical gloves, and covered her lower half with a sheet, because I wanted to examine her breasts. I asked her to pull up her jumper. She giggled, and wobbled around, pulling it up. The smell intensified as her armpits were exposed. Two large pendulous breasts flopped down either side of her, prominent veins coursing towards huge, near-black nipples. These veins were a reliable sign of pregnancy. A little fluid could be squeezed from the nipples. Just about diagnostic, I thought. I told her this.

She shrieked with laughter. “Told you so, didn’t I?”

I took her blood pressure at that point, and it was fairly high. She will need more rest, I thought, but I doubt if she will get it. The children had recovered their spirits, and were racing about once again.

I pulled her jumper down and uncovered her abdomen, which was large, the skin simply covered with stretch marks. The slightest pressure from my hand showed a fundus above the umbilicus.

“When was your last period?”

“Search me. Las’ year, I reckons.” She giggled, and her tummy flopped up and down.

“Have you felt any movements yet?”

“Nope.”

“I am going to listen for the baby’s heart beat.”

I reached for the pinard foetal stethoscope. This was a small metal, trumpet-shaped instrument, used by placing the larger end over the abdomen, and then pressing the ear against the flattened smaller end. Normally the steady thud of the heartbeat could be heard quite clearly. I listened at several points, but could hear nothing. I called Novice Ruth, as I felt I needed confirmation, and also an assessment of the duration of pregnancy. She couldn’t hear a heartbeat either, but thought that other signs indicated pregnancy. She asked me to do an internal examination to confirm it.

I had been expecting this, and dreading it. I asked Lil to draw her knees upwards and part her legs. As she did so, the odour of stale urine, vaginal discharge, and sweat wafted up to greet me. I struggled to control the nausea. I mustn’t be sick, was all I could think of at that moment. Tufts of pubic hair stuck up in clumps, matted together by sticky moisture and dirt. She might have crabs, I thought. Novice Ruth was watching me. Maybe she understood how I was feeling - the nuns were very sensitive, but they spoke little. I dampened a swab with which to clean the moist bluish vulva, and it was whilst I was cleaning her that I noticed that one side was very oedematous, swollen with fluid, whilst the other was not. I started to part the vulva with two fingers, and it was then that my finger encountered a hard, small lump on the oedematous side. I rubbed my finger over it several times. It was easily palpable; hard lumps in soft places make one think of cancer.