‘It means that you have registered for antenatal care and delivery of the baby, and for postnatal care.’
‘Oh.’
There was a long pause.
‘Well, I’m not sure what that means, but I think I’m in labour, and I was told to call you. Can you come? The pains are getting quite strong, an’ all.’
‘How often are they?’
‘Well. I don’t rightly know, I don’t have a clock, but quite often, and quite strong, and ... oh, there’s the click. The pennies are running out and I don’t have any more ... 144 Mellish Street, Isle of Dogs ...’
The phone went dead.
Ruth put on her habit and went to the office to search through the antenatal notes. She could find no Kathleen O’Brian. The woman must have booked elsewhere, but she would have to go to Mellish Street to see the woman and get the address of the correct midwifery service before she could refer her on. Ruth went to the shed and got out her bicycle. She was just about to cycle off, when she paused. Perhaps she ought to take her delivery bag. You never knew! She went back to the clinical room and fetched it.
The cold night air woke her up as she cycled through the quiet streets. She found Mellish Street without any trouble; it ran at right angles to the river. The houses were drab and tall, the street unlit, and she could see no house numbers. So she got off her bike and detached the lamp, shining it on the buildings in the hope that it would illuminate a number. It shone on number 20. She pedalled on, the cobbles making it a slow and painful ride.
Suddenly a female voice called out in the still night: ‘Is that the nurse?’
‘Yes, and I’m trying to find number 144.’
‘It’s me you are wantin’, me darlin’, and right glad I am to see you.’
The soft Irish accent was unmistakable, but the voice trailed away into a groan of pain, and the girl leaned against the wall, her head thrown back and her face contorted with agony. She suppressed the scream rising in her throat, giving a high strangulated sound, even though she pressed both hands to her mouth. The midwife took her body in both hands to support her – she was just a slip of a girl, barely more than eighteen, small and thin and heavily pregnant. The contraction was powerful and long, but eventually it subsided. The girl relaxed and laughed.
‘Oh, that was a nasty one. Me mammy didn’t ever tell me it could be as bad as that.’
‘You shouldn’t be standing out here in the street.’
‘I didn’t want you to miss the house.’
‘Well, someone else could have looked out for me.’
‘There is no one else.’
‘What! You mean you are alone here, in labour?’
‘What else could I be doing!’
‘Oh, never mind. We’ve got to get you to your bedroom before the next contraction comes on.’
‘I’ve got a room on the third floor, and I’m feelin’ fine now.’
Ruth removed her delivery bag from the bike, took the girl’s thin arm, and together they entered the house. It was completely dark inside, so she ran back to her bike to detach the cycle lamp. The torchlight illuminated the narrow stairway. They passed several closed doors, but there was not a sign of another human being. On the second-floor landing the girl started groaning and breathing heavily, doubled up with pain. Ruth was alarmed; it was possible that the girl was entering the second stage of labour. She took hold of the girl again to support her, and then suddenly felt a rush of warm fluid at her feet. The waters had broken.
‘Quickly,’ she said, ‘upstairs. Only one more flight. You have to get to your room. We can’t have the baby born on the landing.’
The contraction passed, and the girl smiled.
‘I can get there. Don’t trouble yourself, nursey. I feel fine now the pain’s gone.’
With surprising agility the girl mounted the stairs, followed by Ruth, and they entered a pitch-dark room, cold as a coffin. She looked around her and said cheerfully, ‘I’m so glad you brought a light with you, because the meter ran out, and I only had enough pennies either for the telephone or for the meter. I think it was the angels told me to use them for the telephone.’
The torch light revealed a bleak, barren room, devoid of any comfort. A rough wooden bedstead stood against one wall. A dirty, stained mattress and pillow lay on the worn-out springs. There were no sheets or pillow-cases; two grey army blankets were the only coverings. A small table and chair and a chest of drawers were the only other furniture in the room. There were no curtains, no rug or mat. An enamel bowl and a jug half full of cold water stood on the table. The electric meter was high on the wall near to the door. In those days the majority of houses and flats received gas and electricity through payment into a coin meter. When the coin ran out, the power supply cut off. Every midwife carried a shilling in her pocket, because meters running out were a constant hazard in our work. Ruth climbed onto the chair, inserted a shilling and turned the key. A dim electric light bulb hanging from the middle of the ceiling cast a gloomy light over the room, and now Ruth could see the girl more clearly. Her small face was delicately boned, and her mouth was beautifully shaped. Her eyes were cornflower blue, and her hair a glorious autumn brown. She sat on the edge of the bed, holding her stomach. Her eyes were laughing.
‘Trust a sailor! This is what happens to a girl when she trusts a sailor! What’s your name, nurse?’
‘Novice Ruth.’
‘Ruth. That’s me mam’s name. She always says ...’
‘Look here, Kathy, we haven’t got time to chatter. You can tell me what your mother says after your baby is born. It won’t be long now because I can see you are in advanced labour, and your waters have broken. Undress and get onto the bed. I must examine you. Where is your maternity pack?
‘What’s that? I don’t know.’
‘Every expectant mother is given a box for her home birth containing sheets to protect the mattress, cotton wool for the baby, sanitary towels, that sort of thing. Where are they? Have you got them?’
‘No.’
‘You should have been given a maternity pack. Who did you book with?’
‘I was just told to call you when I went into labour.’
‘You’ve told me that. But which clinic did you go to for antenatal care?’
‘None.’
‘None! You mean you have had no antenatal care?’
‘I didn’t tell anyone I was pregnant. Me mam and me grandma, they would have killed me, they would. Never trust a sailor, they always say. And I did, silly me, and now look at me.’
The girl cheerfully patted her stomach. But then her face changed. ‘It’s coming again ...’
She threw her head back as pain seared her body. Beads of sweat stood out on her forehead, and her whole expression seemed to be turning inwards as her mind and body focused on the tremendous force of the contraction.
There was no time to lose. Ruth took her stethoscope, gown, gloves and mask from the outer compartment of her delivery pack. She opened the box, and the sterile lid formed a tray on which she placed in readiness her kidney dishes, gallipots, sterile water, antiseptics, scissors, hypodermic syringe, needles, sterile cotton wool and gauze swabs, catheters and blunt forceps. She also carried chloral hydrate, potassium bromide, tincture of opium and pethidine for relief of pain. Cord clamps and cord dressings, powder for the baby and gentian violet or silver nitrate for sterilisation of the cord stump completed her equipment.
All her training and experience told her that a primigravida4 who had had no antenatal care should be transferred immediately to hospital. But to arrange this, she would have had to go down the road to a phone box, and birth was imminent. While she was gone the baby would probably be born. She looked at the thin, horsehair mattress on sagging springs. There were no sheets, no waterproofing, no brown paper, no absorbent pads. There was no cot, no baby clothes, nor any apparent provision for a baby. There was no fire, nor heating of any kind, and the room was cold. There was a jug of cold water, but she had no means
of heating it. The light was quite inadequate for delivery, and the only means of supplementing it was the bicycle lamp. But her midwife’s training had been strict and uncompromising; whatever the circumstances, she must improvise, and cope.
The contraction passed, and the girl sighed with relief.
‘Oh, that’s better. I feel all right when the pain has gone.’
‘I want to listen to your baby’s heartbeat, and then to examine you. I need to know how near you are to delivery. Would you lie down, please?’
She palpated the girl’s abdomen to determine which way the baby was lying. She listened for the heartbeat and heard it quite clearly. Satisfied that the baby was safe, she prepared to do a vaginal examination, saying as she gowned and gloved: ‘You don’t seem to be prepared for having a baby. There isn’t even a cot or baby clothes here.’
‘Well, I haven’t really been here long enough to get anything. I only came over from Ireland yesterday.’
‘What! You came on the ferry yesterday!’
‘Yes.’
‘But you might have gone into labour on the boat.’
‘I might have, but I didn’t. The angels must have been looking after me.’
‘When you got to Liverpool, how did you get to London?’
‘I got a lift with an overnight lorry driver.’
‘I can’t believe it! You might have had the baby on the lorry!’
‘The angels again.’ The girl shrugged cheerfully.
‘When did you arrive?’
‘This morning. I had been given this address and the landlord’s name. That was the only good thing my charming sailor-boy did for me.’
She looked around the room and smiled contentedly.
‘Just draw up your knees for me, please, and let your legs fall apart. I want to examine you internally. The waters have broken, and I want to feel how far you are dilated, and in what position the baby is lying.’
But there was no time for a vaginal examination. Another contraction was coming, and the girl winced in pain, throwing herself around the bed in an effort to escape it. The pain intensified as the uterine contraction became more fierce. Ruth admired the way the girl was coping with labour – she had already had a lot of physical exertion getting to London during the past twenty-four hours. She must have been tired and hungry, and there were no signs of food in the room. She had had no sedation or analgesic, yet she made no fuss nor complaint. The contraction became even more powerful, and suddenly Kathy spontaneously pulled her legs up, gave a prolonged grunt and pushed with all her strength. Ruth only got there just in time, pressing the palm of her hand firmly over the emerging head of the baby and holding it back to prevent an uncontrolled delivery.
‘Kathy, don’t push, not now, do not push. The baby mustn’t be born too quickly. Pant, my dear, quick breaths: in, out, in, out. Don’t push, just pant quickly, in, out, in, out.’
The girl did exactly as she was told, and Ruth breathed a sigh of relief as the contraction passed.
‘With the next contraction your baby will be born. I know you feel as though you want to push, but don’t, not until I tell you. I want the baby’s head to be born slowly. If you push too soon, it will come too fast. Do you understand me Kathy?’
The girl smiled weakly and nodded.
‘Is it possible for you to turn onto your left side to face the wall? It will make it easier for both of us.’
The girl nodded and turned over, and as she moved another contraction started.
Ruth was on her knees beside the low bed with its sagging mattress. The light was terrible, but she had no time to get her torch. The girl gave a low scream and buried her pretty face into the filthy pillow in order to stifle the sound. The baby’s head was emerging fast, too fast. Again Ruth held it back.
‘Don’t push, Kathy, just pant in and out quickly. Keep panting – like that. Good girl.’
As the contraction subsided she eased the pressure on the presenting part and allowed the head to slide out a little, until it crowned. The perineum was stretched, but was still holding it back.
‘Only one more contraction, and your baby will be born. Try not to push. Your stomach muscles are pushing hard enough. They don’t need any help. The baby will come anyway.’
Kathy nodded, but was unable to speak because another contraction came almost immediately. Ruth slowly edged the perineum around the broadest part of the baby’s head – ‘Now you can push, Kathy.’ The girl did so, and the head was born.
‘That is the hardest part over, my dear. There will be a minute of rest, then another contraction.’
Ruth watched the head move about ten degrees clockwise as it aligned with the rest of the body. Another contraction came quickly.
‘You can push now, Kathy – as hard as you like.’
Deftly she hooked her forefinger under the presenting shoulder. The baby’s whole body slid out easily, Ruth guiding it upwards between the mother’s legs, and over the pubic bone.
‘You can turn over now, Kathy, onto your back, and look at your baby. It’s a little boy.’
The girl rolled over and raised her head.
‘Oh, bless him. A sailor’s son. Isn’t he tiny, nurse?’
The baby was indeed tiny, smaller than Ruth had expected from her admittedly brief abdominal examination. From appearances, he seemed to weigh no more than four pounds. ‘No doubt due to malnutrition and overwork in the mother during pregnancy,’ she thought bitterly. It was not uncommon. She clamped the cord in two places, and cut between the clamps. The baby was now a separate being.
But where should she put him? There was no cot, no blankets, he was small, and the room was cold. He must be kept warm.
She pressed him firmly under his mother’s arm.
‘Keep him warm with your body. Haven’t you got anything I can wrap him in?’
The girl was contentedly cuddling her naked baby and paid no attention to what was being said. Ruth opened the chest of drawers. There was a towel in the top drawer. She opened the second drawer. There were a couple of jumpers in it. She opened the third drawer, which was empty. ‘This will have to do,’ she thought, taking up the towel and jumpers. They were all cold, but thankfully did not feel damp.
‘Just lift your head and shoulders a minute, will you, Kathy? I want to put these things under your body to warm them, before I wrap your baby in them.’
She pulled the dirty grey blankets over the girl and baby to keep them warm and sat on the chair beside the girl to await the third stage of labour. A few minutes passed. She placed her hand on the abdomen to assess progress. ‘Something’s not right here,’ she thought. The uterus felt hard and bulky, and a strong contraction was developing. Kathy grit her teeth and started to bear down. Ruth leaped into action.
‘There’s another baby coming! Don’t push, whatever you do, don’t push – just pant, like you did before.’
Kathy was tensing all her muscles, and the baby lying under her arm was in danger of being crushed. Ruth grabbed the towel and jumpers and pulled them sharply from under the girl’s body, then took the baby from her. She wrapped him up quickly, and put him in the top drawer of the chest.
She returned to the bedside, pulled back the blankets and saw the head of the second baby emerging. She was just in time to control a rapid delivery.
With a twin birth, if the lie of the second baby is in a normal head-down position, if the uterine activity is normal, and especially if the baby is small, the birth can be fairly quick, because the birth canal has stretched, and there will be little resistance. Two or three good strong contractions may be sufficient to complete the birth. Kathy’s second delivery was swift and easy, and within a few minutes the baby was lying on his mother’s abdomen. She stretched out a hand to touch him. Her voice sounded incredulous. ‘Another baby! It can’t be true.’
‘It is true, Kathy. You have another little boy.’
Kathy stroked his head. ‘Another little boy,’ she repeated vaguely. Her blue eyes were w
ide and dreamy, and her body was limp after the exertion. Her voice sounded far away.
‘Another little sailor boy. Oh, you poor wet little thing. And where’s your daddy, little sailor, where’s your daddy? He sailed away on the deep blue sea. Sailed far away.’
Ruth took Kathy’s pulse and blood pressure, which were slightly lowered, but not too much. She knew that she had been lucky in having no complications for which medical assistance, or at least another midwife, would have been necessary.
‘You are a healthy girl,’ she said aloud. “How did you get yourself into this pickle?’
Kathy smiled dreamily. “Oh, that sailor boy. His curling hair, his night-black eyes, and oh, his saucy smile! Somehow I knew he wouldn’t be true. Never trust a sailor, they said, and silly me, I did. Now I’ve got two little sailor boys. What’s me mammy going to say? And me grandma? She’s the one I’m frightened of. A real terror, she is. If you knew her, you’d be frightened too, nurse.’
Kathy sighed sleepily, and closed her eyes. ‘I feel so tired now,’ she murmured, and fell fast asleep.
Ruth had many practical duties to attend to, not least of which was to separate the baby from his mother – and she had only one set of cord clamps in her bag, which she had used for the first baby. So she cut a gauze swab in half, tied each piece firmly to the cord, and cut between the knots. ‘Always improvise, ’ her midwifery tutor had taught.
The baby was small, but looked perfectly formed and healthy. Ruth picked him up, and he whimpered. She held him upside down, and he cried lustily. ‘That’s what I like to hear,’ she thought, ‘cry some more, little baby. Your lungs are only small, and this is the best way of inflating them.’ The baby obliged by screaming. She nodded in satisfaction and laid him with his mother to keep him warm.
Then she began wondering what to do with him. Ideally both he and his brother should have been bathed, examined thoroughly, weighed and measured, and put into a clean cot near to a fire. But she had no hot water, no soap, no clean towels, and the room temperature was far too cold to expose his naked body. To wrap him up warm was the immediate challenge. She looked around the room for something – anything she might use. She saw a cupboard in the corner and opened it, hopefully, but all she found was a lot of broken mechanical equipment. Then she saw the clothes that Kathy had taken off – a skirt, a jumper and a thin, cheap jacket. ‘That will do,’ she thought, ‘better than nothing, anyway.’ The garments were still quite warm, so she wrapped the baby up in them, and tucked him into the second drawer. ‘Phew!’ she thought, ‘this has been a night. What next?’
Farewell To The East End Page 3