Handywoman Mrs G., had obviously received some instruction about the third stage of labour from her mother, who was a trained midwife practising at the turn of the century:
‘When the baby’s out, you wipe its eyes and mouth, put your finger in its mouth and with the cotton wool bring out all the blood – otherwise it would have swallowed the blood and choked. And then, before the afterbirth comes, you have to time the blood pressure; you hold the cord and then you have to count the beats. It’s OK. So then you hold it about four inches away from the baby and then you double it like this and then hold it like that for a while. You’d double it over and then tie it with flax in those days. But you don’t cut in that loop; you cut the other end of the cord. Yes, that’s before the afterbirth comes out.
‘What happened if the afterbirth didn’t come? Well, it had to come, didn’t it. And if it didn’t, you had to force it. Well, you’d press on the stomach, say, “Come on, go to the toilet, onto the can – not the front, the back”. And in those days you used to fix towels to the bottom of the bed, you know, twisted towels. And you used to put the towel in her hands and say, “Now hold that, and when you feel a pain, think your horse is going to have a jump and PULL!” And that helps you see, it forces it down and there you are.
‘When you get the afterbirth you have to see there’s none broken off. If there’s a bit broken off, then you have to find it in the blood as it comes out, otherwise it mortifies and then there’s trouble. That’s it, that’s how it goes on. It’s a lot of rigmarole really, isn’t it? All these things. I think it’s very interesting work.’
Coping with emergencies
Elsie B., who spent all her working life in rural Devon starting in the 1930s, describes the isolation that many of the midwives had to cope with while carrying out their professional duties:
‘When you were in some of the country areas you often had 30 miles to go to a consultant hospital. I think you had to know what you were doing as much then as you have to today – maybe more so? We only had the odd case of haemorrhage and we did have Ergometrine, which was a great thing. One case in particular I remember and that was a very severe haemorrhage. We hadn’t a doctor booked and the woman made a mistake. You see, it was difficult to get case histories always. Well, half of these things you didn’t think about … What she failed to tell us was that, if ever she cut herself, she bled badly. You see, they didn’t realise things and you had no idea …
‘Well, I was five miles from a doctor and another two miles from a telephone. Anyway the husband was very good and he went to the telephone, but unfortunately you had to rouse the post-office people. And they didn’t want to get up! The doctor was mad about that. You had to do compression to stop the bleeding. The woman was all right afterwards and the baby was all right. It took quite a number of weeks for her to pull up. That was the worst one I did, the only one really, and I must say I was very lucky. We didn’t have much trouble with the babies either.’
Mollie T. describes methods of dealing with haemorrhage that were being used in South-east London in the late 1940s:
‘In my first period of training we used to give retention enemas of sweet coffee in cases of haemorrhage and shock [an alternative to intravenous re-hydration, given by the rectum]. There was still a reluctance to give blood due to many more reactions with inadequate cross matching, so we always had these large Winchesters [glass jars] of what looked like black treacle. We gave a retention enema of about six ounces of this very viscid material. The sugar and caffeine were easily absorbed [through the blood supply in the rectum] … I never saw it kill anyone and they all got better with it!
‘The thing that worried me as a pupil midwife was that at that time, it was absolutely forbidden to give an oxytocic [a drug to make the uterus contract firmly] with the placenta in situ, and I don’t know how you were supposed to stop any bleeding because you weren’t supposed to interfere with the uterus when the placenta was inside either. I thought the only thing left to do was to pray on those occasions [laughs]!
‘The other thing we used a lot up till late 1950 was intravenous acacia gum – a tacky, viscid solution – and it was prepared under protest and with great difficulty by the pharmacy. It was instead of plasma, and it was always available. Unlike plasma, it didn’t go off and was very stable. It was the choice of a particular group of consultant obstetricians. Acacia gum certainly saved some lives. The idea was that if the district midwife called a doctor, somebody who took the call at the hospital would get the doctor on his bicycle with appropriate bags, and the Morphia from the drugs cupboard, and a bottle of acacia gum solution in his pocket because that would keep the vein or circulating system from collapsing – the viscosity of it, I mean. So that would keep things going until the flying squads [emergency units that came out from the hospital with staff and equipment to help the midwife in dealing with an emergency at home] got there. The flying squads sometimes were heavily in demand with so many more home confinements.’
In urban areas where there were medical training schools, the midwife who called out a doctor in an emergency could not guarantee that the doctor would have any more expertise than she had. Mollie T. describes the procedure for calling the doctor in an emergency and her anxieties about the reliability of such a system of back up:
‘In relation to calling for medical aid, I have looked out an excerpt from an old medical journal (1926), and here’s a poem in “dog Latin”, which translates: “The Clerks” – that was the medical students – “were refreshing themselves with wine when a messenger came running quickly from the house. He said, ‘There’s a case of a mother labouring’. The man came from City Road with a red drum.”
‘Well, that was a little red token that was given to patients when they booked, to send in an emergency, and the midwife would send it if she wanted a doctor. You see, many of them – the midwives – didn’t read or write, and the husband was often drunk, but you could get him staggering along with a token, even if you couldn’t get him doing much else! The discs were originally wooden and later on, the ones I saw were Bakelite.
‘It was definitely an anxiety for me as a pupil that I couldn’t believe that if I sent for the doctor I would get the help I needed. One of the consultants told me that as a medical student he was sent out to look after a woman in tenements in Liverpool Road, and he’d never seen a delivery at all, though he’d had a few lectures. He sat beside the women – he was a nice chap – he was holding her hand and reading his textbook in the other and he got to the part about a full bladder holding up proceedings and she seemed to be making heavy weather of it, so he passed a catheter and the baby shot out!
‘So you see, it was no better training for doctors than it was for midwives. In fact, it was worse for the doctors because it was fairly common around the time I was a pupil for a midwife to be much more aware of the procedures, like how to put forceps on the head. She might well show the doctor how to do that and then show him how to carry out the traction, and she was probably skilled in breech delivery.
‘I remember I was in a situation in hospital where a houseman was the only doctor available for a breech delivery – all the nobs were in theatre – and I would perhaps have overruled him and done it myself, except that he was a nice fellow. He had got to start some time, so I talked him through by teaching the pupils, saying, “In a moment you’ll see the doctor do so and so …” We proceeded very nicely through this because he was a calm, sensible, competent fellow.
‘Five years ago, I met up with him somewhere and he said, “There’s one thing I remember was having to do a breech delivery and I really didn’t know anything about it, and I don’t know what I would have done if you hadn’t taught the students.” I didn’t have the heart to say, “That’s why I did it”. But he was still just as nice as ever.’
Midwives are trained to deal with emergencies, and there will always be the rare, life-threatening situations where they find themselves coping alone. Such experiences are never forgo
tten, as Nellie H. explains:
‘I will never forget this one night. This girl was bleeding badly [immediately after the birth] and I’d sent for the doctor, but he hadn’t arrived because he was with another case. I could see that if I didn’t do something she was going to bleed to death [the placenta had partially separated and needed to be removed so that the uterus could clamp down on the blood vessels and seal them off]. So I just scrubbed up, put on some gloves and peeled the placenta out. I mean I know you’re not supposed to do that, but she’d have died. The doctor was ever so complimentary, but I was scared stiff. When he arrived, he said to the woman who was there, “Take Nurse down and make her a strong cup of tea.” I was hanging over the balcony, absolutely flabbergasted by what I’d done! Ah well, at least I know I’ve saved one life!’
Although a breech birth at home would be considered an emergency nowadays, in pre-NHS days, such births were considered normal. All the midwives who spoke with us were skilled at delivering breech babies at home. Mary W. explains:
‘When I was training pupils in the 1950s and 1960s, one thing that amazed me was that these pupils were never taught how to conduct a breech delivery. I mean, you know, how ever careful you are, how ever good your antenatal care, a breech can be missed. You can be landed with a breech delivery at home. These girls hadn’t a clue about a breech delivery. It’s a skill that you acquire. When I trained, you were taught that a breech was just another presentation and you had to cope with it. It’s a shame these skills are being lost.’
Edie B.’s face lit up with delight on hearing that one of the authors [Billie] had been a ‘breech baby’, and her hands followed an imaginary and familiar set of manoeuvres as she enthused about breech births:
‘Oh, I used to love delivering breeches. The breech births are easy. Beautiful! You normally got the buttocks presenting and coming down so you just put your hand up and release a little foot and bring it out, a little twist and a little twist and release the other arm. Give it a little push and out the head comes. Beautiful. Perfect! And we never used to have problems with them.’
The postnatal period
‘After she had the baby, she wasn’t allowed up for ten days and then she just put her feet out of the bed and dangled them. They lay flat for three days in hospital. We had a lot of “white legs”, you know, DVTs [obstruction in the veins of the legs by the formation of blood clots]. They died from it you know.’
Here, midwife Mary W. describes the risks of the well-meaning but rigid policy adopted in the first half of the twentieth century – that of ‘confining’ women to bed for at least ten days. Ivy D. explained why she obeyed this rule:
‘They said if I didn’t all my insides would drop out and I didn’t want that, did I. Still, it gave you a rest, but when the ten days were up you were expected to get up and do everything. His food had to be on the table, everything back to normal.’
The ten-day ruling meant a lot of extra work for the district midwife. Mary W. remembers:
‘We went in to swab them and to make the beds. Occasionally the mother would make the bed, but it was very rare. “Nurse” was given 30 shillings to do this, she was getting paid! So yes, you swabbed them and then bathed the baby – that was for eight days – and on the tenth day you showed them how to bathe the baby and they could then do it themselves. But it was very hard work.’
Caring for mother and baby in the immediate postnatal period was hard work indeed if midwives followed instructions such as those laid down in Alice Gregory’s 1923 midwifery textbook:
‘In order to refresh memories, I add the proper ritual for an ordinary morning visit – with no complications:
1. Ask at door for kettle and slop pail.
2. Remove cloak and leave outside bedroom. Roll up sleeves to elbow.
3. Open your bag, and the drawer holding napkins.
4. Wash, domestically, in cold water.
5. Give thermometer, open wool bag, mix lotions, per-chloride of mercury, 1–1,000-quart basin, Lysol in a second bowl, place these on a chair near bed.
6. Take and record pulse, temperature, respirations, look at tongue, ask if bowels are open, and other questions.
7. Remove binder, fold it up and place on pillow.
8. Put patient on clean chamber, with pillow in small of back.
9. Place paper receiver under bed.
10. Scrub and disinfect (two minutes’ scrub, rinse, one minute soak, longer for lacerations, time by clock).
11. Take wool from wool bag and close its mouth, put swabs in Lysol, one or two in perchloride of mercury solution and some in mouth of bag for breasts.
12. Soak hands again, push back clothes with elbow, lather with soap and Lysol and stream down with that, then with perchloride of mercury. (The opening should be cleansed first and then covered with thin wet swab while the rest is lathered. Do not separate labia unless there are abrasions. These must be irrigated with either boracic or saline solution, or sterilised water, from sterilised bottle).
13. Remove chamber with left hand, and tilt patient onto side with right elbow.
14. Finish bathing from back, apply napkin, turn patient on back.
15. Scrub hands again, empty and refill basin.
16. Remove sheets and nightgown.
17. Soak hands in perchloride of mercury.
18. Wash and dry breasts with clean wool – cover with clean napkin.
19. Wash in the ordinary way face, hands, arms, abdomen and back.
20. Roll in binder, replace nightgown.
21. Rub uterus for five minutes, measure, adjust binder.
22. Do hair, cut nails if necessary.
23. Make bed, transferring patient to other side if possible.
24. Pin mother’s flannel and towel together.
25. Scrub and soak hands one minute.
26. Wash infant before fire, beginning with eyes and mouth. Powder must be warm (not hot) and dry.
27. Empty basin, wash soap dish, leave nail brush in empty lotion bowl.
28. Rinse out chamber with perchloride of mercury, using breast swabs.
29. Empty pail, remove soiled linen, burn swabs.
30. Give full instructions to last till next visit. (All linen should be folded neatly and placed together as soon as it is taken from bed of patient. Feet should be washed once a week, and toe nails cut. The visit should last about one hour to one hour and a quarter, unless breasts have to be relieved or a catheter passed, when it maybe longer.)’7
Such a routine is a far cry from the work of contemporary community midwives. Today, though, women are not ‘confined’ to bed and are encouraged to be active immediately following birth in order to avoid the risk of deep-vein thrombosis.
Midwives undoubtedly meant well in their strict efforts to keep women resting in bed for ten days and were only too aware of how hard women had to work once they got up. Alice Gregory’s book again:
‘The working man is extremely uncomfortable as to his meals and home life generally, as long as his wife is in bed, and will hail with joy the moment she gets up as the moment when he may hope to return to his average level of comfort. Nothing but the most authoritative order from the doctor or midwife will ever keep the working woman in bed after the tenth day, and if she is once up she has got to work hard – don’t make any mistake about that, whatever lies are told to the contrary.’8
Edie B. described the rigid routine imposed on women ‘confined’ in hospitals. [In the present day, when most women in Britain leave hospital within a couple of days of giving birth, it is worth noting that a similar routine was still in operation when one of the authors [Nicky] had her first baby in hospital in the late 1960s]:
‘They weren’t allowed up for ten days. For the first two days after delivery, they were not allowed more than a cup of Bovril and toast for lunch – oh dear, the restriction on food! I’ve always thought they needed a jolly good feed after all that hard work. But no, “Bovril and toast!” I can’t think what the reasoning was
, unless they’d got their anatomy mixed up and thought that the baby came from the stomach and the stomach needed a rest [laughter]! Breakfast, of course, was porridge. On the third day, they were allowed fish for two days. Until the fourth day, they were not allowed a proper meal. I think many of the fathers used to bring in pork pies and things at night, you know! On the fifth day, they were given a blanket bath – that was blanket bath day. On the ninth day, they could get up. On the eleventh or twelfth days, they could go to the toilet. On the thirteenth day, they were allowed to see their babies bathed. We taught them how to bath baby. On the fourteenth day, they went home. The babies were in the nursery at night and by the mothers during the day. And they were fed rigidly every four hours, whether they cried or not.’
On the whole, midwives actively discouraged the practice of babies being in the bed with the mother. However, Katherine L. described a situation where commonsense overrode the prevailing ‘rules’:
‘Did the babies sleep in the mother’s bed? – No, well, I hope not, though I’m not going to say never because on one or two occasions when the weather was very cold and the babies were suckling like the twins we had at the top of Windmill Hill – a very, very cold flat. They’d done their level best to get it warm, but those twins suffered from – in the old days it wasn’t called hypothermia, it was called “lardacious disease”. Now there’s a nice word for you – “lardacious”. Because the babies looked like lard, they said. Never seen it in print, but I heard the doctor call it that. So anyway, we put them in the mother’s bed to keep them warm – but on the whole it didn’t happen.’
Josephine M. thought that the practice of keeping babies in the bed was prevalent in the East End of London for good reasons:
The Midwife's Tale Page 24