by Leah Hazard
I stood there under the bright fluorescent lights of the sluice, sweating in my oversized scrubs, holding the jar in my hand. It felt like finding an abandoned suitcase in the middle of an airport, or someone’s child wandering alone along the side of a motorway. The panic, the confusion, the irrational but uncontrollable surge of furtive guilt – you’ve done nothing wrong, but you know you are in possession of something, of someone, that is definitely not yours.
A midwife passed by the door, walking briskly towards the storeroom. I didn’t recognise her, but I held out the jar in my hand and called, ‘Who does this belong to?’ She looked back over her shoulder, shrugged and walked on.
Another minute passed under the lights, clutching the jar. My mentor would be expecting me back in the room, but I couldn’t let this go without knowing at least whose it was. I’m not sure what I expected to do with that knowledge, or what difference it was going to make, but suddenly this baby and I were complicit in something, and I needed to know that it had an owner, a story, a mother.
The sister in charge of the labour suite that night came down the corridor from the other direction.
‘Excuse me,’ I said from the doorway. I held out the jar.
Sister looked at me dispassionately.
‘Whose baby is this?’ I asked.
She looked at me, then at the jar, then at me again. She was not impressed by my curiosity: to her mind, the situation didn’t involve me and explaining it would only serve to delay her from attending to the ward’s more pressing duties. I could see her composing some comment to that effect and then deciding that she couldn’t even be bothered to say it. ‘Probably room five’s,’ she replied, and carried on down the corridor.
And that was it. There were no words of reassurance, no balm for the monstrous uncertainty of the moment. I would never know who ‘room five’ was, or why she had delivered this tiny thing on that particular night, or whether anyone ever came back to label the jar, or to send it. The how and the why of it all remained a mystery, but I did learn one of the labour ward’s most important lessons that night: that death is the twin of life, and the midwife delivers them both.
My second taste of this bitter medicine came a couple of years later, towards the very end of my training. By this time, I was proficient in more than tidying up and making the tea. I was trusted to look after most labouring women on my own, with my mentors hovering at the desk or even attending to other patients, while I found my own way through the challenges and changing rhythms of each shift. I could deal with diabetics on complex ‘sliding scale’ drips of glucose and insulin; I could match up the scraps of a ravaged perineum and stitch them back together with reasonable proficiency. I had even begun to tackle my nemesis, my clinical black spot: scrubbing for a Caesarean section with its dizzying array of instruments, swabs and drapes, each of which had to be organised and accounted for with exacting precision.
I was well past the forty deliveries required for professional qualification by the time the summer of my third year rolled around. It was light when I left the house at 6.45 a.m. for my day shifts; I was starting to bounce through the hospital doors with a spring in my step, my initial terror at entering the building not completely gone, but now more like a pesky but harmless dog, teeth nipping at my heels every now and again. I took that morning’s first assignment in the bunker with eager anticipation: a healthy woman in labour with her second baby. Ideal.
By the afternoon, I had enjoyed hours of unadulterated midwifery pleasure: my role had been that of enthusiastic spectator, cheerleader and guide, with very little intervention required. The baby had more or less delivered itself, as they sometimes do – a long-awaited boy and a brother for the five-year-old who was waiting at home with her grandparents and a box set of Peppa Pig DVDs. Within an hour, the proud father had dressed his boy in a miniature version of his favourite football strip, with matching socks, mitts and hat, and the mother was reclining serenely on a tangle of sheets and towels.
There was a soft knock at the door. I glanced at the clock: almost five o’clock; maybe someone was letting me out for an early tea break.
‘Be right back,’ I said to my patient, who barely looked up as she snuggled her boy to her chest while the baby’s dad rattled off a flurry of photos on his phone.
The corridor was cold and bright in comparison to the dim heat of the birthing room, and I blinked at the sight of Farah, one of the labour ward’s most senior midwives. Farah and I had worked a handful of shifts together during my second year of training. She had been firm but kind, guiding me through a bit of tricky suturing and a few terrifying trips to theatre, but I had hardly seen her since then, and I wondered why she was waiting outside my room with a bundle of baby cardigans under her arm. The knee-jerk response of the student flashed through my mind: I’ve done something wrong, I thought. That’s it, I’m rumbled, and they’ve sent Farah to give me my marching papers.
‘I’ve just had a thirty-eight-week loss,’ she said without warning or preamble.
‘Oh,’ I said, suddenly wrong-footed, cotton-mouthed. Was this a test?
‘I know you haven’t had much of a chance to do the losses yet, but it’s your final placement, and … would you like to come and see him?’ Her eyes softened with gentle concern, and she shifted the cardigans from one arm to the other. The elation of my patient having birthed her child moments before drained from my body; my legs felt leaden, my feet glued to the polished linoleum floor. Every student knew that by their third year they should at least have had some fleeting contact with the tragic but constant stream of women who passed through the labour suite bearing babies that had already died in utero. We knew that at some point we would be the sole carer for a woman to whom this had happened, and we also knew that it would be best to learn this heartbreaking role while still guided and sheltered by our mentors. We simultaneously dreaded and anticipated the day when we would cross this final frontier of midwifery but, for me, time and circumstance hadn’t allowed for it yet. Farah’s offer wasn’t morbid or voyeuristic – it was a bittersweet favour, a tacit admission that here was an opportunity for me to face death, albeit briefly, under her wing.
The door to the blandly named ‘Preparation Room’ could only be opened by certain staff, and I hung back as Farah tapped her badge against the keypad. The door opened, and then closed behind us with a dull thud of finality as Farah and I huddled together in a room that was no bigger than a linen cupboard. My arms tingled with goosebumps; the room was freezing, fit for its sombre purpose. Farah edged forward and set the cardigans down on the worktop next to a cot I hadn’t seen before. She peered inside and smoothed down the soft white blankets that were just visible over the cot’s tall sides.
‘He’s beautiful,’ she said.
Taking a deep breath, I edged closer to her and looked into the cot at the baby who lay within it, his head and body swaddled neatly. He was beautiful. His broad forehead was porcelain-smooth; a hundred dark eyelashes rested gently on full, round cheeks. Only his lips told the story of his arrival; they were tightly furled and purple, like the petals of a budding black tulip.
Farah placed a warm hand on my arm, but the room only seemed to grow colder.
There was nothing, and everything, to say about this boy.
‘He is beautiful,’ I whispered. I thought then of my girls; they would be getting ready for dinner, helping their father set the table, arguing over whose turn it was to take the bins out. Both had been silent at birth for a few awful moments; but then the moments had passed, and they had cried. This boy was suspended in that quiet void; crystalline, perfect, but silent. I wasn’t sure I could ever be in that moment with a woman, but Farah was gently edging me towards it.
‘Thank you,’ I said to her. It seemed wrong, but right, to say so.
I left Farah in the room as she prepared to unwrap and dress the boy at his parents’ request, and I went back along the corridor to the room where I had left my beaming new mother. Only minutes had
passed, and when I opened the door and stepped back into the room’s warm, damp haze, she barely registered my return. Her boy was squealing for milk and she laughed and pulled him close, teasing his lips with a bottle. His mouth found the teat and he locked on, slurping noisily as the milk dribbled over his chin and down his neck. I smiled as he guzzled the sweetness, and his mother looked up and smiled back at me. She couldn’t have known where I had gone – how I had passed through shade just as her baby’s arrival had brought love and light – and that was as it should have been.
The Sound
There is a sound a woman makes when she is told that her baby has died.
It is a sound that no one should ever have to make, or hear, but the midwife comes to know it well.
The sound is both human, and not. The mouth opens, but no words come out. There is only the sound: the shriek of gulls dashing shells against a jagged shore, the roar of a landslide, the groan of an iceberg as it calves, casting its mute, white offspring into the impossibly black and bottomless sea.
The sound is both powerless and powerful. In that moment, when a woman finds herself set adrift, spinning through the void, she receives the terrible knowledge that the natural order of things is a lie, and gravity an illusion. From that moment on, nothing is right, or fair. The sound the woman makes is the only thing that tethers her to the earth, and like the love she already has for the baby whose eyes will never open, the sound is strong, fierce and without end.
The sound echoes around the pale green walls of whichever windowless room the woman is in when she is told. It reverberates through the long, low-ceilinged corridors of the hospital, and ripples over the car park, and across the dual carriageway where the rush-hour traffic is gathered to listen, and out along the creeping arteries that cross the town or city.
The sound lingers, just there at the edges of the day. It hums through these words, along the page, to your fingertips, to you.
She came because she’d had a bit of a bleed. Just a few spots on her pants when she woke up. Then a little heavier when she checked again in the toilets at work, and then a clot. She would have come sooner, but she’d already had twelve days off work that year with one thing and another, and she knew her boss would have a fit if she told him she needed to leave in the middle of a busy lunch service for what he called ‘another bloody check-up’. So she left it until she had bussed the last table, and swept the coins of the last lousy tip into the pockets of her apron, and then she came.
Or maybe she came because she hadn’t felt the baby move since the night before. She googled what to do and she tried everything from every website and forum: a pint of cold water, loud music, a bar of chocolate, a coffee. Later, after the hospital, when she got home and began endlessly to think about why, she would feel particularly guilty about the coffee, even though her boyfriend told her not to be daft, it had nothing do to with anything she’d done.
Or maybe she came because she just knew something wasn’t right. She hated phoning the hospital. She had phoned them with every ache and twinge, and the last midwife she spoke to had given her the distinct impression that she was wasting valuable time, but the thing was, her sister had had a stillbirth the previous year and she couldn’t get that out of her mind. So she phoned. And she came. And something wasn’t right.
Perhaps it was her first baby. Or her third. Maybe she’d already had two losses, or four, or none. She had longed for this baby, she had re-mortgaged her house for that fourth cycle of IVF, and finally it seemed to have worked, and there she was at thirty-seven weeks, so close. She had done everything right, read all the books, had finally allowed her partner to assemble the cot and the pram only the night before. Even after everything – after it was all over, and they had broken the cot one night into a pile of sticks – the pram still sat in the damp darkness of the porch, like a hunchbacked skeleton among the boots and bags.
Or perhaps she hadn’t wanted the baby, barely knew the baby’s dad, had thought long and hard about a termination but her mum had promised her that it would be OK, that she would help, that they would do it together. Afterwards, after everything, she blamed herself. She blamed her mum. She didn’t know what to think.
She was tall with blonde hair. She was short, stout, a smoker, a drinker. A yoga enthusiast, a red-headed vegan. She was your cousin, your friend, the girl you knew at school, your desk-mate. She was that woman you used to see on the train every morning who looked pregnant, until one day she didn’t.
She sat in the waiting room quite calmly. It was a busy day; there was a high-risk antenatal clinic in Outpatients that afternoon, and the consultant seemed to be sending every other woman along to Triage for further investigations. There were labourers, too: first-timers pacing the floor, clutching their TENS machines, shooting anxious glances at the staff behind the desk; and women who’d done it all before, shuttling back and forth from the toilets, trailing amniotic fluid behind them, looking at the clock on the wall and wondering if Gran and Grandpa would be willing to keep the kids another night.
She sat in the middle of this scene: still, silent, patient. She picked up a copy of Take a Break from the low table in front of her, thumbed through it, exchanged it for a Staff Newsletter, read a two-page spread about the new paediatric dialysis unit without taking any of it in. The labourers got taken ahead of her; this was only right, she thought. This visit was only a precaution. She tried to remember when she had last shaved her legs, regretted rescheduling her bikini wax, had a little argument in her head over whether to have pizza or salad for dinner. At the edge of her consciousness was a low ache – where? – somewhere at the bottom of her stomach, no, across her pelvis, even a bit uncomfortable along her thighs. Maybe it actually wasn’t fair that the others were seen before her. Maybe it had been a little too long. She looked over at the desk.
I saw her as I came out of the treatment area, glanced at her case notes long enough to read her name, and called her in.
She was in bed two. Or bed five. Or bed six. She sat back on the bed and smiled.
‘Should I take my shoes off?’ she asked.
‘Entirely up to you,’ I replied, also smiling. ‘Whatever makes you comfortable.’
She swung her feet up onto the bed. She wore black zippered boots, or wedges, or slippers.
‘What brings you here today?’ I asked.
And she told me, and she smiled as she told me, and I smiled as I listened, and as I listened, I reached for the fetal monitor and squirted a daub of jelly onto the transducer.
‘Let’s have a little listen in to this baby,’ I suggested. My voice was confident and casual. ‘See what the wee one is up to.’
It was then that I saw the fear flicker across her face, like a fox darting through a garden at night. There, then gone. My smile may have wavered.
‘Please don’t worry if it takes me a few minutes to find your baby,’ I said, reaching for a familiar script. ‘Sometimes these rascals are tucked round a corner, or behind the placenta, and it can make them that bit harder to listen to.’
She gave a tight little nod in response to my tight little smile.
I placed the transducer against the bottom left corner of her abdomen; I don’t know why I always start there, but I do, and usually the monitor’s initial rustle of jelly on skin gives way to the thump, thump, thump of the fetal heart. Usually that’s how it goes.
She craned her neck to see the monitor’s display panel on the wall next to the bed, but there were only green and orange dashes on the screen, no numbers, and there was only static, no rhythm. I swept the transducer across her bump, firmly, steadily, a detectorist scanning for treasure on a windswept beach. I went to the curve of her hip on the right side, then up along her flank, then across the taut frame of her ribcage, then back down to where I started. I placed the transducer just above her pubic arch, I angled it this way and that. I dug. I swept. I pushed and I smiled.
She had stopped looking at the monitor now, and was looking only at me.
‘What’s happening?’ she said.
‘I’m sorry …’ I began. No, I couldn’t say it yet. I was sure I was only a moment away from getting it, if I just tried this angle again, if I just used a little more jelly. ‘Just give me a minute.’ My voice was bright and brittle.
She knew. She was looking at me, and she was listening to the syncopated heartbeats of all the other babies in all the other beds on the other side of that curtain, and she saw me for a liar. I swept and prodded in vain, but there was no foot or elbow prodding me in return, only stillness, only silence.
‘I’m sorry.’ This time, now, it had to be said. ‘I can’t find your baby’s heartbeat.’
She looked at me. Everything stopped.
And then, the sound.
Afterwards, after everything, the midwife carries the sound like a stone. The weight of it is always with her, and sometimes she reaches for it willingly, turning it over, feeling its heft and smoothness, fingers searching its surface for a meaning. Every time she hears the sound, she adds another stone, each one a slightly different size and shape, until the weight is almost too much to bear – and she has built a little cairn in her heart.
Notes on Obstructed Labour
There are only so many times you can push before your body refuses. At first, when the cervix has reached full dilatation, circling the baby’s head like a crown, the womb does the pushing all by itself: the muscle fibres contract, their action becoming expulsive, hurling this new life ever closer to the outside world without any conscious thought or effort on the mother’s behalf. It is involuntary, automatic, primal and unstoppable. The body wants to push, and it pushes.