by Leah Hazard
Contents
Author’s Note
Where It Begins
Notes on Bowling Balls, and Other Birth Stories
Student Midwife Hazard: She’s Doing It
Notes on the Women Who ‘Shouldn’t’ be Pregnant
Eleanor: Defying the Odds
Notes on Children Having Children
Crystal: Twenty-three Weeks and Three Days
Notes on Paper Pants and Broken Dreams
Olivia: Mother Knows Best
Notes on Triage
Hawa: Word Medicine and the Pee Baby
Notes on Getting It Wrong
Tina: Flu Season and Fear
Notes on Being from Somewhere Else
Pei Hsuan: I Have Carried This Story
Notes on Baby Brain
Jaspreet: Too Many Hours in the Day
Notes on the Uniform
Star: Meeting the Enemy
Notes on Death
The Sound
Notes on Obstructed Labour
Leaving My Post
Going Home, and Finding the Way Back
The Cavalry
Glossary
Acknowledgements
About the Author
Leah Hazard is a serving NHS midwife. Having studied at Harvard, she left a career in television to pursue her lifelong interest in women’s health after the birth of her first daughter. She soon began working as a doula, supporting women in pregnancy and attending numerous births in homes and hospitals across the country. The birth of Leah’s second daughter prompted Leah to make the leap into midwifery. Since qualifying, she has worked in a variety of clinical areas within the NHS maternity services, including antenatal clinics, triage units and labour wards.
‘There must be those among whom we can sit down and weep and still be counted as warriors.’
Adrienne Rich
Author’s Note
The events described in this book are based on my life, experiences and recollections. To preserve patient confidentiality and the privacy of colleagues, names, places and all identifying features have been changed. The stories told are not based on any one specific patient or individual; rather, they are a selection of composite characters drawing from my various experiences. Any similarities are purely coincidental.
Where It Begins
Another night, another vagina.
It’s not unusual for me to spend the night between a stranger’s legs. Sometimes two or three strangers in the space of twelve hours. Tonight is a bit different, though. It’s 3.42 a.m. and things aren’t going to plan. Sitting in point-blank range of this particular vagina feels like staring down the barrel of a gun. Birth is inherently risky, a kind of physiological Russian roulette, but every midwife prays that she’ll dodge the bullet.
‘I can’t do it,’ wails a disembodied voice. At the same time, a slick patch of dark hair looms into view in front of me. ‘You are doing it, and you will do it,’ I call up to the voice. I glance quickly at the clock on the wall and then say quietly, to myself, 03.44, vertex visible. I will need to write a detailed report of all of these times and events later, when the blood-stained paper drapes have been bagged and tagged, a tray of tea and biscuits sits on the window sill and the baby has arrived safely. If the baby arrives safely.
Another contraction powers through the woman in front of me; her open legs judder and shake; the small circle of hair becomes negligibly wider as the baby’s head is nudged a millimetre closer to the outside world. 03.46, I note silently. Vertex advancing. ‘For fuck’s sake,’ comes the voice from the top of the bed. ‘Make it stop. Pull it out, cut it out, I don’t fucking care any more.’ So much effort for so little progress. Beads of sweat are dripping down the bridge of my nose now; the room is dark apart from one spotlight blazing a single white beam between my patient’s legs. My hands are gloved and sterile; unable to touch anything but the woman in front of me. I let the sweat trickle down my nose, my chin, the back of my neck.
‘That perineum’s tight,’ says another voice, from over my shoulder this time. Mary, the midwife who answered my buzzer for help with the birth, is looking on. ‘It’s not stretching out,’ she says, echoing my own unspoken fears as another contraction shakes the woman’s body and the top of the baby’s head pushes in vain against this thick band of skin.
Tick, tick, tick … tick … tick. Mary and I tense in unison as the monitor picking up the baby’s heartbeat slows, becoming irregular, sounding a familiar warning. 03.49, audible deceleration to 96 beats per minute. This is the drumroll we dread.
‘Your baby’s getting a bit tired,’ I say cautiously to the woman on the bed.
‘That makes two of us,’ retorts the voice, ragged and weary now.
A smaller contraction nudges the baby’s head; again, the taut skin holds it back.
‘You’re going to have to do an episiotomy,’ whispers Mary. I glance over at the tray of instruments just within reach on the metal trolley to my right. Cord clamps, water, cotton wool, sanitary pads. A small, stubby pair of scissors for cutting the cord and another, longer pair of scissors with short, straight blades, for cutting through skin and muscle. Recently, the hospital changed suppliers and, coincidentally or not, most of the scissors in these trays have been blunt. Cheaper, blunter: the staff could have T-shirts made with this slogan, I muse, as the fetal monitor’s rhythm stutters and slows. My tired mind veers back to the situation at hand, and I resume the documentation in my head. 15.51, I think, and then draw an imaginary line through my mental note. My brain is clearly wishing it were a day shift. 03.51, I start again. Fetal heart 108 bpm, decels persist. Preparing for episiotomy.
‘We might have to make a wee cut,’ I call brightly to the voice at the top of the bed. ‘Just to help this baby out.’ So many things in midwifery are ‘wee’ – a wee cut, a wee tear, a wee bleed, the latter used to describe anything from a trickle to a torrent. Euphemisms are one of our many small mercies: we learn early on to downplay and dissemble. The brutality of birth is often self-evident; there is little need to elaborate.
The monitor continues its erratic backbeat, the baby’s pulse now sitting at seventy-four beats per minute – roughly half of what it should be – and it’s not coming back up to a reasonable baseline in between contractions. Mary passes me the scissors. A glass bottle of lidocaine catches the light at the edge of the trolley, but the baby’s heartbeat is slowing, and there may not be time to inject the local anaesthetic.
‘Fuck, fuck, fuck.’ A voice. I’m no longer sure if it’s the patient’s or the one in my own head. Hand quivering with nerves and caffeine, I loop two fingers just inside the band of skin, creating a pocket between skin and baby where I know I can cut. Technical term: a mediolateral episiotomy. Reality: a deep bite into tender tissue at the angle of eight o’clock, an outrageous insult to the pelvic floor, but an instantaneous way to ease a baby’s troubled passage. I hate doing this. I hate cutting women, I hate the pain this will cause them for days, if not weeks, to come, and I hate knowing that in about half an hour’s time, all going well, I will have to repair my own handiwork. Just when the patient begins to relax, lying back with her baby scrabbling happily on her chest, I will have to find a second wind and begin round two. Scrub up, gown up, new instruments, curved needle and spooled suture poised in mid-air to fix the damage done.
I raise my scissors. An almighty wave surges through the woman and the baby’s head lunges forward. ‘Jesus, Mary and aaaaaaaaaah,’ roars a voice. Please let these scissors be sharp, says the quieter, but no less urgent, voice in my head. Please let this baby come. Please let it be OK. And finally, the urgent, daily prayer of midwives everywhere: Please let me keep my job and not be struck off when something horrible happens and please, please, please let my bladder hold fo
r at least another hour until this is over and done with.
It’s not even 4 a.m. yet. I’ve been awake for almost twenty-four hours. Scissors meet flesh. How did I get here?
Notes on Bowling Balls, and Other Birth Stories
I learned about childbirth from Mike Katz, second-place winner of Mr. Olympia 1976 (Over 200-pound Division), and holder of other such illustrious titles as Mr. Insurance City (ninth place, 1963), Mr. Universe Tall (third place, 1973) and Mr. America Tall & Overall (fourth place, 1970). Mike Katz – or Mr Katz, as he was known to me during my high-school years – was a veteran bodybuilder, teacher and ice hockey coach with a record-busting 60-inch chest in his prime and hulking biceps so large that he had to strut the school corridors with his arms held at a jaunty distance from his torso.
Weightlifting and muscle mass may not have been on my radar, but all students were required to take ‘health’ class, which was taught by – guess who – Mr Katz. Most sessions were based around the school’s collection of educational films – cautionary tales that covered a range of topics from drink driving to ‘sex ed’.
The real pièce de résistance, however, was the Birth Video. When the big moment arrived, Mr Katz stood at the front of the class, solemnly aimed the remote control at the VCR, and with very little indication of the labour that must have gone before, the Birth Video whirred into life. The screen flickered and the static cleared to reveal a close-up shot of a baby’s head crowning between a woman’s outstretched and stirruped legs. There were screams, there was some blood and there was the baby’s head, getting bigger and bigger as it distended this poor woman’s vulva to seemingly impossible dimensions. Boys shifted in their seats, unsure whether to feel disgusted or aroused by this rare close-up of unadorned ladygarden. Girls crossed their legs and winced but couldn’t look away. Was this our future? How would we do it? When would the screaming stop? And there, holding forth at the front of the class with dancing eyes and an incredulous grin, was Mr Katz.
‘Would you look at the size of that, kids!’ he exclaimed. ‘It’s like a freaking bowling ball.’
Mr Katz may have been an unlikely guru of obstetric knowledge, but something else about the Birth Video stayed with me for years. In spite of the film’s brutal aesthetic, I couldn’t help sharing some of Mr Katz’s sense of awe. A truth had been revealed to me: birth is amazing. Sometimes violent, sometimes shocking, but amazing. How a head that size can fit through a slender sleeve of vagina is the kind of conundrum that can’t help but puzzle and fascinate even the most cynical observer. But the real fascination for sixteen-year-old me was the question of whether women could ‘do’ birth in other ways? Sitting, standing, even smiling, laughing? What was happening to the rest of that woman in the video – to her face, her heart, her mind – above that cropped shot of a disembodied vulva?
The next years went by with only the most fleeting thought of the mysteries of childbirth until finally, as a newlywed at the age of twenty-five, I began to find the notion of having a baby with my straight-talking, ginger-bearded Scottish husband irresistibly attractive. When that notion materialised into two blue lines on a pregnancy test, I embraced maternity with all of the gusto I had previously used to avoid it. I read the books, I scoured the Internet and, like a dutiful little mother-to-be, I attended my first antenatal – or ‘Parentcraft’ – classes.
‘Parentcraft’ makes it sound like a quaintly artisanal activity, something you might find in the prospectus of a community arts centre today, next to beekeeping, basket weaving, latte-making and the like. The reality was a bit different. Our destination: a windowless room in the basement of the local maternity hospital full of equally clueless, wide-eyed couples. Just as I had done all those years ago in Mr Katz’s classroom, I sat down and waited for the Wisdom to be imparted.
For the next hour and a half, an older midwife with cropped silver hair and mischievously sparkling eyes held forth with great enthusiasm, gesticulating wildly at the anatomical illustrations displayed on easels at the front of the room. The uterus was depicted in scarlet red, the bladder was blue and the vagina a delicately ribbed rose, the whole reproductive system curled in on itself like some exotically whorled sea creature. The heat in the room became foggily tropical as the lesson continued and, this being winter in Scotland, everyone’s wet woollens began to take on the distinct aroma of damp dog. A battery of fetal kicks sent a wave of nausea up my throat and my vision tunnelled as I started to slide down the chair. I was clearly Not Cut Out for This. Panic and doubt followed the nausea and shame – if I couldn’t even handle Parentcraft, how would I cope with labour, birth and the inevitable bowling-ball moment?
Between them, my daughters’ births ended up running the gamut of obstetric experience: one emergency Caesarean section after a long, obstructed labour, and one home birth so unexpectedly quick that my husband had caught the baby before the midwife even arrived. How could two births have been so different? It felt like the only common denominator was a baby, but each event had brought me to the edge of my body and mind’s capabilities. Even with the benefit of hindsight, Parentcraft and personal experience, I was still stumped. How did it happen? How could billions of women follow infinitely different journeys to the same destination? Was there a way to make more of these journeys joyful and fulfilling, and could those skills be taught, or learned? And if so, did I even have what it took to learn those dark arts – me, with my almost total lack of practical skills, my catastrophic lack of hand–eye coordination and my quasi-comical shortage of common sense? The questions planted by the Birth Video all those years ago had become urgent, real and compelling. I was finding my current job in television less fulfilling with each passing day and had flirted with the idea of retraining for a while, but until recently, my reluctance to go back to school had overshadowed my interest in midwifery. As my girls began to grow up and a new career seemed increasingly plausible, the balance tipped. I started to think that maybe, just maybe, there existed a parallel universe in which I could be that midwife who helped women get through pregnancy and birth with dignity (and pelvic floor) intact.
The interview process for my local midwifery course was a combination of practical skill and intense psychological pressure (which, I would later realise, was excellent preparation for midwifery it self). Two lecturers ushered me into an office and asked me a range of relatively standard questions, the answers to which I gave with ease; it was enjoyable to ramble on about autonomy, advocacy and empowerment to such a receptive audience. A doddle, I thought, as the women nodded encouragingly. What was all the fuss about?
Then the tone of the interview changed dramatically. I had been warned about the dreaded Maths Test, but nothing could prepare me for the bolt of pure, unadulterated fear that shot through my heart as the interviewers sat me down at a small desk in the corner of the room. On the top was a sheet of maths problems designed to mimic the kinds of calculations a midwife might encounter in her daily work. I should make it clear at this point that arithmetic has never been my strong point. I could barely work out the tip for a meal and, even now, every drug calculation brings me out in a cold sweat. I find myself double- and triple-checking, especially at the end of a night shift, when simple sums might as well be Nobel-level astrophysics.
Nevertheless, I drew a deep breath, put pen to paper, and smiled as if I began every day with a refreshing round of algebraic equations. Lesson number one to the novice midwife: midwifery is one part skill, umpteen parts Ballsing It Out. To this day, I’m convinced that my admission to the midwifery course had less to do with my numeracy skills and more to do with my ability to do sums under scrutiny for twenty minutes without actually soiling my pants.
Student Midwife Hazard: She’s Doing It
My first placement in the hospital’s labour ward began with a night shift. I drove into the hospital car park, switched the engine off and sat clutching the steering wheel, rigid with fear, staring at the building in front of me. The sky was moonless, but the maternity un
it’s windows cast a yellow glow on the clusters of bathrobed smokers huddling outside, and the building itself appeared to hum with the frantic energy of a giant, oestrogen-driven generator. I shivered and chewed the inside of my cheek as I watched shadowy figures dart across windows on every floor, some trailing oversized balloons, some rushing to answer distant call bells.
Of course, my first shift in the hospital had been preceded by hours of rigorous preparation. No, I had not been revising the mechanisms of childbirth by poring over my notes from the last few weeks, nor had I been simulating delivery manoeuvres with a doll and pelvis. But I had taken a monumentally long time doing my make-up, hoping that every last sweep of blusher and flick of eyeliner could somehow conceal the underlying layer of abject terror. I had done all-nighters in the past, but none of them had required me to save a life, or repair ravaged flesh. I couldn’t see how I would pull off these seemingly superhuman feats without divine intervention or the aid of substances that I could only imagine might be frowned upon by my mentors.
(Intervening experience has taught me that a startling number of health-care professionals are only too happy to throw themselves headlong into the vortex of substance abuse, using whatever means necessary to counteract the permanent state of jet lag induced by shift work and emotional exhaustion.)
Although I am now an expert at self-medicating with entirely legal uppers (coffee) and downers (a glass or several of gum-numbingly cold white wine) depending on where I am in my working week, I had anticipated my first night shift in a state of panicked confusion. How would I stay awake? When would I eat? What would I eat? I knew I should be getting three breaks in my twelve-and-a-quarter-hour shift, but does one eat breakfast at 10 p.m., lunch at 1 a.m. and dinner at 6 a.m., or the complete opposite? During the preceding week, I had spent hours packing a huge bag with a variety of neatly clip-locked tubs full of meals and snacks that could suit any combination or permutation of appetite and time. Anyone watching me lug my cargo of energy bars, fried rice, fruit salads and Frazzles across the hospital car park that evening would surely have thought that I was heading to a prolonged stay as an inpatient rather than a single shift as a student.