‘The daughter, Nellie, must have been about twelve, just old enough to resent me taking over. One night my father-in-law said to me, “Edie, would you mind if Nellie takes over? She’s upset about you burning things.” “Not a bit,” I said.
‘I moved back to Islington to a much nicer, bigger room and my father-in-law used to bring the children over to see me but then he got ill with cancer and they were all put in a home and that all broke up … Looking back it was a horrible life. At that time I used to always accept it because we knew no other way. We never knew carpets or fridges.’
Edie’s descriptions of her living situation are in stark contrast to those of Vera W., a middle-class woman of similar age:
‘I had a dear little bungalow in the 1930s. It was lovely, leading down to the sea front, very nice, very easy to run. There was electricity and I had a nice little gas stove. Oh yes, yes, yes. I can remember putting the nappies into a steel bucket – it would be a steel bucket – onto the gas stove to boil. And of course, we had a bathroom. Yes, yes, oh, it was quite modern in those ways.’
The midwives we talked with had vivid memories of homes they had visited in this period. Some were sympathetic to the problems of poverty and inadequate housing. Elizabeth C., a working-class woman and district midwife for many years in Battersea, recalls:
‘Most homes I went to were sort of working-class. You know, homes where they looked for their clothes in the morning to see if the rats had taken them down under the floorboards. And you daren’t go out to the toilet or anything in the night time cause there’d be rats in it. That was after the war, too, not long ago. Somebody once said that all the babies in London on district are delivered onto the News of the World – I says “They are not!” Anyway, the News of the World is sterile ink; printed paper is sterilised with the ink mixture.
‘If they hadn’t got things, well, you raked round and found them. Often you came home and took your own sheets off the bed because they hadn’t got any.’
Elsie K., working in Derby in the 1930s, also remembered the dirt and bugs in the homes she visited:
‘The conditions were very bad. Filthy, some of the back streets. They’ve all been demolished now. Very bad. If there was time, we used to wipe over the tops of the furniture before we laid our things out, but sometimes there was only just time to catch the baby and that was all – it never seemed to do any harm. They were used to their own germs. We used to put our coats down on newspaper to try and keep the bugs and whatnot off them.’
In this and the preceding chapters, we have portrayed working conditions of both handywomen and midwives in the first half of the twentieth century. Then and now, there is abundant evidence that maternal and infant mortality and morbidity are directly related to poverty and its trappings of lack of education, frequent pregnancies, overwork, poor living conditions and poor nutrition.5, 6 Overall, there have been vast improvements in living and working standards since the days described by Edie M. in this chapter, with an ensuing improvement in mortality statistics. However, infant deaths are still more common in working-class households: poverty still causes hardship, ill health and bereavement for childbearing women in Britain today.
10
The Experience of Birth: women and midwives tell their stories
‘You had all sorts of funny things happen …’
In pre-NHS days, most births took place at home. Either a midwife, a handywoman or maybe a doctor would be present (or perhaps even a combination of all three).1 Mollie T., a retired midwifery tutor who worked on the district in Bermondsey in the 1940s, explains what she thinks were the reasons that women had their babies at home:
‘Thinking of the poverty – and people were so poor – I was thinking of the reasons why people stayed at home. In the lower social group, I don’t think it was anything emotional at all as we now know it. They hadn’t got night clothes and although hospitals issued them they didn’t want it known. They also had communal washing things at home – one face flannel, one toothbrush – and they didn’t want to show that one up either. They had to stay at home because husband would drink or gamble or bring another woman home, children wouldn’t be fed, there was no home-help service, they wanted to go back to work. This still happens – in certain parts of the country with early transfers, you’d be best to check the strawberry fields before calling at home. The other thing was – and still is again now – that the husband couldn’t afford to take time off work for fear of losing his job.
‘I think the middle classes at about the same time were unable to afford a nursing home and couldn’t visualise themselves mixing in hospitals. In many of the public hospitals, the maternity ward was in fact the workhouse and nobody wanted that. In fact, the care there was often superior to the nursing homes if they did but know it. These middle classes had a very great personal insecurity for they’d been brought up in the bosom of the family and went from that to marriage and had never really been on their own. To be separated was quite devastating. This was an aspect of hospital care that I found repeated over the years even in general nursing.
‘Some of the upper classes would have been to boarding school and so were much more resilient and self-reliant. They had no desire to be contaminated by mixing with the lower classes. They would employ a private monthly nurse and as a pupil I did get one or two gilt-edged deliveries in a rather fashionable part of the town because the woman got on rather quickly and then the monthly nurse took over. When we were called in an emergency, they were often surprised to find we were clean and quite educated; and later welcomed us back as visitors.’
By the late 1940s, the home birth rate had decreased to about 50 per cent and many people were beginning to see hospital birth as superior.2 Midwife Elizabeth C. notes:
‘Nowadays, most women have their babies in hospital whether they like it or not, don’t they? You nearly have to fight to have your baby at home. Before, you nearly had to fight to get into hospital. Just after the war, I had one young chap, he was blazing mad. He said, “If I hadn’t bothered getting married and we’d just had a baby, my wife would have got into hospital.” He said, “Just because we’re married she has to have it at home.”’
In pre-NHS days, most middle-class women who could afford to pay the fees opted for giving birth in private hospitals or nursing homes. Otherwise, hospital beds were reserved only for women who were considered ‘at risk’ obstetrically. The cost of such beds would be subsidised by either the local authority, charitable institutions or insurance schemes. Giving birth in hospital certainly did not mean that women received better care, either physically or emotionally. Hannah H. remembers the birth of her first daughter in London in 1928:
‘It was a long labour; it was all night and a part of a day. They just put you in a room and let you be done with it. They used to say, “Don’t bear down, bear down, do this, do that”. They didn’t used to take you into the labour room till the waters broke. But if your waters broke early and you were still not getting the baby, you stayed in the labour room anyway. And it was very bad – I think they used forceps for her because she was bruised each side of her head when I had her. Nobody with me, only the nurse sitting there. She said, “Oh, the next one won’t be so bad.” I didn’t have any painkillers, I don’t even think I had a smeller [chloroform or ether], did I? Didn’t have anything to smell. Maybe I did, but I don’t remember; it was so long ago.’
In both home and hospital settings, births were essentially ‘natural’: women usually laboured without painkillers or medical intervention. Midwives were only allowed to give very mild painkillers and sedatives, such as potassium bromide and chloral hydrate. From 1936, they were allowed to use ‘gas and air’ machines, which provided mild pain relief during labour. However, strong analgesics such as chloroform were only used by doctors.3
The ‘natural’ births of pre-NHS days were a far cry from ‘natural childbirth’ as it is thought of today. Women usually knew little about their bodies, which would make the proce
ss of giving birth very frightening. Birth was viewed as an extremely painful event and there was no expectation of it being an emotionally fulfilling experience. This attitude was true for all the women who we interviewed, including the midwives. Ruby C. remembers giving birth to her first baby in Belfast in October 1918:
‘Oh God, I thought, this is the end of the world. I kept praying all the time. “Oh, this is terrible, I’ll never get through this.” And the doctor – oh, he was lovely – he kept stroking me – “You’ll be all right, dear, no, don’t you worry”. He was a bit easy-going, you know. Ay, he stroked my head – “It’s going to be all right, dear, and you’ll forget about this in a very short time”. And it’s true, childbirth, you do forget, don’t you? I think it’s nature’s way, or you’d never have any more!’
Births were very much ‘managed’ by the helpers present, with the midwives and doctors disinfecting and sterilising and generally attempting to create a mini-hospital within the home. ‘Delivering’ was the key word: the woman was ‘delivered’ of her baby by the birth attendant whose job was to organise everything and to tell the woman exactly what to do. Today in Britain, a ‘woman centred’ concept of choice and empowerment for women in childbirth has been enshrined in government policy documents since 1992,4 but attitudes such as those described by Ruby C. still prevail:
‘You weren’t allowed to walk around. I was walking around and the doctor came like and “Oh, get into bed, get into bed!” You weren’t allowed to have a baby like you’d want to have it. I think this new method’s the best where they’re allowed to sit up or stand up, or run around [laughs] with the baby hanging out! Oh Lord, sounds a bit ridiculous! But they made you lie down on the old iron bed. They bossed you around. Oh, it was “Agony Ivy” [laughs]!’
Poverty and birth
In the 1930s, the unemployment level was between 20 and 25 per cent. It was estimated that one third of the population was suffering from serious dietary deficiencies, and one half was too poor to afford an adequate diet.5
Edie M.’s third baby had cerebral palsy. She spent a lifetime wondering if her poor diet could have been a contributing factor to his disability:
‘David was born later in life, weren’t he? It was 1935 and I would have been 33 years old. I was still living in one room but this time over in my sister’s house in Dulwich. Fine healthy chap, picture of a boy but he’s spastic. I’ve often wondered what caused it. I’ve got a funny feeling his trouble could have been down to my diet …
‘I was under a clinic in Southampton Street in Peckham and you went down there to have a check up every now and then. I was down there for me usual. I was lying on the table and I heard the man that was doing the talking to these students saying, “Now, this is what we would call a poor patient.” I jumped up and he said, “I don’t mean in clothes or money, I mean in feeding.” I was lying there with no clothes on so it had nothing to do with me outside clothes. It must have showed on me body. “You have plenty of pudding and two veg. and potatoes, do you?” he says. “Yeah …,” I says. “Ah, but you don’t get a lot of fruit, do you?” “No, never have fruit, we can’t afford it”.
‘But they got it wrong ‘cause they said I would go another month. No, listen to this bit. I had that check up that day at the clinic and I went home. That night I went to bed and I began to get pain. I thought, “I’ve got a cold in my tummy. I’ve only been to the clinic today and they said I’ve got another month to go”. Later, they said, “But you’ve had a family, you must have known you were in labour.” But I said, “I didn’t”. They told me I had another month to go and I didn’t want to make meself look silly’.
‘I had a different thing in that birth that I never had before. I sat about, wrapped in a blanket, losing water. We had burst pipes in the house and the joke in the house was, “The only one who’s got any water is Edie!”
‘Suddenly I said, “Alec, quick, go down and get Em” (that’s my sister). I said, “I think the baby’s coming.” He jumped out of bed and she sent him off to get the nurses. I was walking about and I said, “Oh I think it’s coming Em!” She said, “Well, get on the bed.” So I did and the baby shot out and she just covered me over. “Lay still,” she says, “Won’t be a minute.” You see, nothing was done for that baby. She didn’t handle nothing. Us sisters were like that. If it had been her, I would have probably covered her over rather than touch the baby. Perhaps today, with a little bit more knowledge I might have done something …
‘I lay there, ten minutes, quarter of an hour – I don’t know the time, you lose count – then Alec came back with the nurse. Well, whether it happened then, while he was lying there or whether it was because he was a month beforehand I don’t know …
‘Of course, it could have been something else. I went to put my head in the oven one night [during the pregnancy]. My husband had been out all night and was drunk again and I was having another baby. Well, I was half gassed and then pulled out, opened all the windows, hysterical …
‘The consultant, a big man, said, “Extreme worry or too quick a birth”, but I can’t think that worry done it because I had a friend that had a terrific lot of worry and she had a fine baby. I’ve often wondered …
‘When I think what’s going to happen to my David, I have to try and block it out. “Now stop it, Edie, stop it.” David says, “I hope you live to be a hundred, Mum.” I says, “I hope so, love. Let’s do our best.”’
It is impossible to tell which of the factors outlined by Edie might have been responsible for David’s cerebral palsy but her story highlights the fact that in those days, working-class women often went into labour undernourished, tired and anxious. For those with children, another baby often meant more stress on top of an already intolerable situation. Apart from the physical hazards of bearing many children, women also faced the enormous worry of another mouth to feed, another body to clothe and another potential source of bereavement.
High infant and child mortality rates meant that women could not afford to be sentimental about their children. Molly and Lily, two sisters who grew up on Tyneside in the 1920s, discuss this:
Lily: ‘Death and poverty and hunger were just accepted. There wasn’t a lot of sentimentality around. I can’t ever remember seeing Auntie Jane or anybody weeping or wailing [about their babies’ deaths]. But whether they wept in private? Perhaps they did in private but it was never outwardly.’
Molly: ‘No, no, I can’t ever remember my mum hugging me. I can’t ever remember her putting her arms around me – never. I mean, she had so many. I don’t know – never kissed you, did she? I can’t remember any of them around there showing affection. It was considered a ‘display’, a silly thing; you didn’t do that sort of thing, you just didn’t do it. I think it’s sort of brushed off on Lily and I. We don’t kiss much. We were brought up not to show affection. I think it’s a shame, a great shame.’
Lily: ‘But I don’t think she loved us any the less for it. She was a good mother, she really was.”
Mortality
Whether a woman was poor or well off, each birth brought with it the potential threat of death for both the baby and the mother. Although infant mortality rates fell steadily throughout the 1930s, neonatal mortality (deaths within the first four weeks of life) did not.6 Maternal mortality actually rose, so that about 3,000 women died every year in England and Wales from childbearing or related conditions. Morbidity rates (deterioration in women’s health as a result of pregnancy and birth) were also appallingly high. For example, in 1931, it was estimated that at least 60,000 women – ten per cent of all mothers – were more or less ‘crippled’ as the result of childbearing.7
Handywomen working in the early 1900s would have been all too familiar with women dying in childbirth. Mrs G., however, did not wish to be drawn into discussion on the subject:
‘Of course, I’ve seen them die. I’ve seen them die with the baby half out and half in. Couldn’t stay that way, could it, so you had to bring it away and that
was it. Well, you expect that sort of thing, don’t you? You got to take it as it happens. Sometimes the women died of exhaustion, you see, because they’re frightened. They’re frightened to bear down in case it’s going to split something. You can understand it really. But I don’t think so many dies in childbirth as what they makes out.’
Midwives working on the district rarely saw women die because, on the whole, they would transfer to hospital any women with severe problems. Esther S.’s only experience of a maternal death on the district was clearly a death due to a complicated hospital birth:
‘I did have one woman who died. It wasn’t my delivery. One of those that came out from St. Mary’s. She’d had twins that died. She was very toxic [suffering from septicaemia] when she came home and I wasn’t at all happy with her. Unfortunately, I had an older doctor who didn’t respond. She was an embolism in the end. I reported it in the morning and the doctor thought it was a form of pleurisy bronchitis. I went again in the evening and told my supervisor I was concerned about this patient … and the next morning she was dead; she just died.
‘No other maternal deaths. Of course, we got stillborns but only very rarely fresh stillborns. Mine all died from abnormalities. But you don’t think along these lines, do you. You must think on perfect lines.’
Mary T. remembers her friend, Elsie Walkerdine, transferring a women in labour who subsequently died:
The Midwife's Tale Page 20