by Leah Hazard
Primigravida, or ‘prim’: A woman who is pregnant for the first time.
Prostin: A commonly used brand of hormone pessary, often inserted towards the back of the vagina in the first stage of induction of labour with the aim of softening, shortening and opening the cervix.
Pyrexia: Fever; a temperature above the upper limit of normal (roughly 37.5 degrees Celsius).
Query: In medical terminology, used as a prefix to a medical condition in order to denote a degree of uncertainty about the diagnosis. For example, ‘query cholestasis’ would indicate a tentative but unproven diagnosis of cholestasis.
Recovery: An area of the labour ward usually reserved for post-operative care; for example, a woman who has had a Caesarean section will usually spend several hours in Recovery before being transferred to a postnatal ward.
Rectal pressure: A sensation similar to the need for a bowel movement, caused by the fetus’s presenting part descending through the pelvis and putting pressure on the mother’s pelvic floor. This feeling often precedes or accompanies the urge to push.
Registrar, or ‘reg’: In the UK, a doctor who has completed two years of foundation training and is now at least two years into their period of specialist training. In British obstetrics and gynaecology, specialist training generally takes seven full-time years, after which the doctor is eligible to become a consultant.
Resuscitaire: A brand name for a large device or machine used for warming and resuscitation of babies at birth; usually allows for the administration of oxygen and suction, as well as the storage of other essential instruments and drugs used in neonatal resuscitation.
Rigours: Full-body shivers caused by the body’s attempts to regulate its temperature during serious infection or sepsis.
Ruptured ectopic: An ectopic pregnancy is one that occurs outside the main body of the uterus, typically in one of the Fallopian tubes; a ‘ruptured ectopic’ occurs when an ectopic pregnancy outgrows the structure in which it is contained. This frequently leads to life-threatening bleeding and requires immediate surgical attention.
Senior house officer, or ‘SHO’: An outdated but still commonly used term for a doctor who is either in their second year of foundation training (see Registrar), or in their first one or two years of specialist/GP training; the rank below a registrar.
Sepsis: A life-threatening complication of infection which can compromise the body’s vital organs and, ultimately, cause death. Sepsis continues to be one of the leading causes of maternal and neonatal death and, as such, is treated as an emergency.
Show: Also called the ‘mucus plug’; the thick, jelly-like substance which seals the cervix during pregnancy and is often expelled as labour begins and progresses.
Sliding scale: A carefully titrated system of administering glucose and insulin simultaneously via pump infusion to regulate the body’s blood-sugar level; often used for diabetic patients in labour.
Sonicaid: A brand name for a handheld device used to listen to the fetal heartbeat; see also Doppler.
Speculum: An instrument, usually plastic, used for holding the vaginal walls apart in order to visualise the vagina and cervix. This can be useful when trying, for instance, to determine the cause of bleeding, or the presence of amniotic fluid.
Spines: The shorthand term for ischial spines, bony prominences within the pelvis which are often used as landmarks to determine fetal descent in labour. For example, a fetus whose presenting part (usually the head) can be felt 2 centimetres below the mother’s ischial spines may be described as ‘spines plus two’.
SROM: Spontaneous rupture of membranes; when the mother’s ‘waters break’ on their own.
Stat: Immediately. From the Latin, statim.
Stillbirth: A baby born after twenty-four weeks of pregnancy which has not shown any signs of life at delivery.
Syntocinon: A brand name for a synthetic version of oxytocin, the hormone which causes the uterus to contract. Syntocinon is used for a number of reasons, including induction of labour and acceleration of a labour which has slowed or stalled.
Tachycardia: An abnormally fast heartbeat; in pregnant women, this is generally accepted to be a pulse above 100 beats per minute. In fetuses, over 160 beats per minute.
TENS: Transcutaneous electrical nerve stimulation; the term often used to describe a machine comprising a battery pack and electrode leads which are applied to the patient’s back with the aim of blocking pain signals in labour.
Term: Full gestation of pregnancy: forty weeks. A woman who is said to be at ‘term plus eight’ is eight days past her due date.
Third-degree tear: A childbirth-related tear involving one or both of the anal sphincter muscles as well as perineal skin and muscle, often described in layperson’s terms as ‘a tear that involves the back passage’. Third-degree tears are usually repaired in theatre by a doctor, with the patient under spinal or epidural anaesthetic.
Trial of forceps: An attempt to deliver a baby with the use of forceps where success is uncertain. A trial of forceps is almost always undertaken in the operating theatre: if the trial is unsuccessful, all of the necessary staff and instruments are immediately available to perform a Caesarean section.
Unbooked: Relating to a woman who has not yet accessed antenatal care within the local area. For example, an ‘unbooked labourer’ is a woman who is unknown to the local maternity service, but is now presenting in labour.
Ureters: Tubes which carry urine from the kidneys to the bladder.
Uterine activity: A term often used in clinical documentation to denote contractions. For example, ‘uterine activity 2 in 10’ describes an average frequency of two contractions in ten minutes.
Uterus: The womb; the organ in which the fetus grows.
Vagina: The fleshy internal passage which leads from the cervix to the exterior of the body.
Ventouse: Also known as a vacuum extractor; an alternative to forceps (see above). A suction cup which is applied to the fetus’s head, allowing traction (and, in certain circumstances, rotation) to be applied.
Vernix: The thick, pasty substance that protects the fetus’s skin in the womb and may still be found on the baby in varying quantites at the time of birth.
Vertex: An area on the top of a baby’s head which, in a normal vaginal birth, is usually the first part to descend or ‘present’.
Viable: Likely to survive. Current law states that fetuses of twenty-four weeks’ gestation or over are viable, although an increasing number of babies born before that time are surviving with the aid of advanced neonatal care.
VSD: Ventricular septal defect; a common congenital (present from birth) heart defect.
Vulva: The external female genitalia; often referred to incorrectly as the vagina.
… and a Note on Gender
Birth stays the same, but society changes. I recognise that some birthing parents do not self-identify as women and that an increasing number of midwives nowadays are men. However, in my (admittedly limited) experience, every mother and midwife I have encountered has self-identified as female, so I have referred to them here as such. It should go without saying that the hopes and aspirations I’ve expressed for the women in this book apply equally to all midwives and pregnant parents, regardless of label or gender.
Acknowledgements
To every agent and editor who welcomed this book in its most primitive form with unmitigated enthusiasm and warmth: thank you for showing me that my story was worth telling and for expressing your love and admiration for the work that midwives do. Each and every one of you is remembered and appreciated.
Thank you to Hayley Steed, agent extraordinaire and future chief executive of a global publishing empire; thank you for believing in me and my fellow midwives, for spreadsheeting my existence with breathtaking precision and for humouring my steady stream of dog photos. You deserve all the champagne, not just for birthdays and barbecues. And thank you to the whole Madeleine Milburn Agency team, for bearing with me as I blunder through the indus
try for the very first time and for having my back along the way.
Thank you to Sarah Rigby, my wonderful editor, for understanding from the outset where I wanted my story to go, and for guiding me with unflappable patience and skill. You’ve (almost) persuaded me that I’m an Author with a capital A and I’m proud to call you a Friend with a capital F. To Jocasta Hamilton and all at Hutchinson and Cornerstone: thank you for welcoming me to your world and for your total commitment to my work from that very first meeting. Special thanks to Laura Brooke, Elle Gibbons and Sarah Ridley for pushing hard and to Sasha Cox for being my first superfan.
Huge gratitude to Susan Roan and Gareth Reid for joining me in the journey from doula to midwife to author (and friend) and for being unwaveringly enthusiastic and supportive through it all.
My heartfelt thanks to midwife Erin Hutchings and obs/gynae consultant Adam Archibald for providing invaluable ‘insider’ feedback, which was gentle, thoughtful and so very much appreciated.
To every midwife who has mentored me, knowingly or unknowingly, from training right through to today: thank you for leading by strong, graceful, foul-mouthed, huge-hearted example. You have shown me how to be ‘with women’: a gift I can only pay forward. And to all of my colleagues in the extended NHS family – the doctors, auxiliaries, porters, domestics and clerical staff who have taught me, supported me and saved my bacon in ‘this place’ on countless occasions – thank you.
To the women who have allowed me to care for them in times of the greatest joy and the deepest pain, and to their families: there is no greater privilege. For your generosity of time and spirit, for your strength and your wit: a debt of gratitude and love. Midwives work hard, but the work of motherhood is so much harder.
To family on both sides of the Atlantic: thank you for your unstinting support. And finally, to my own little family: words aren’t enough. To my husband, Alan, who is my greatest fan and my own personal midwife: your love and your time are the greatest gifts of all. To my girls, the most amazing women I know: it’s all for you.
Leah Hazard is an actively 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 her 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.
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Published by Hutchinson 2019
Copyright © Leah Hazard, 2019
Jacket photography © Alamy Calligraphy © Ruth Rowland
Leah Hazard has asserted her right under the Copyright, Designs and Patents Act, 1988, to be identified as the author of this work.
First published in the United Kingdom in 2019 by Hutchinson
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A CIP catalogue record for this book is available from the British Library
ISBN 9781473563537