Farewell To The East End

by Jennifer Worth

  Two more contractions came and went. They are getting stronger and more regular, thought Chummy. I hope the crew can get something sorted out quickly, because I need to move her, and she has to be able to walk.

  The captain returned and said that the best cabin was ready. Kirsty sat up and heaved her great bulk off the bunk. With enormous difficulty she squeezed herself through the narrow doorway and along the gangways. Several men looked out of their cabins and patted her arms or shoulders. One man gave her a crucifix. They all looked anxious. The ship’s woman was not only well used, she was well thought of.

  The captain led them to a much larger cabin that was more appropriate in every way. Kirsty gave a cry when she saw it and embraced her father. He kissed her and turned to leave, but first he saluted Chummy in military fashion and bowed to her.

  When the door closed, Kirsty said, ‘This is the captain’s cabin. He’s so good to me, I tell you. What other captain would give up his cabin?’

  ‘Well, under the circumstances, and considering he might be the father of the baby, I think it’s the least he could do,’ retorted Chummy dryly.

  The captain’s desk and all other naval paraphernalia had been pushed to one side. A large folding bed had been placed in the middle of the cabin, covered with clean blankets and linen. Kirsty looked at it and said, ‘I didn’t know they had these nice things on board.’ A bowl was standing on a small table with jugs of hot water beside it, and soap and clean towels.

  Another contraction came, and Kirsty grabbed the edge of the desk and leaned over it. She was panting and sweating. When it passed, she grinned and said, ‘You must be right, nurse; this is more than green apples.’ She went over to the bed to lie down.

  ‘I still don’t know how it happened. I’m so careful. Do you think one of the boys didn’t put his rubber on, but told me he had?’

  ‘I don’t know. I haven’t any experience in your line of business,’ said Chummy truthfully, and they both laughed. A bond of female friendship and understanding was developing between them.

  Kirsty said, ‘You are nice. I’d like you to be my friend. I haven’t had any girl friends since I left school, and I miss them. It’s men, men, all the time. I never have the chance to talk to another woman. When I go ashore, which isn’t very often, I look at the other women in the streets and think, “I’d like to talk to you and see how you live.” But then it’s back to the ship and off to sea again.’

  ‘Do the lads ever talk to you?’ asked Chummy, who was beginning to sense loneliness.

  ‘Oh yes, some of them tell me all their troubles, they tell me about their wives and girl friends, and some tell me about their children. It’s nice to hear about their children – it makes me feel part of the family.’

  Secretly Chummy wondered if the compliment would be returned, but Kirsty was still speaking. ‘But I must say most of them just want to be quick and have done with it. I don’t mind, if that’s what they want, but it’s tiring, especially if I get ten or twelve who’ve only got half an hour before the next shift.’ She puffed at the memory. ‘You need some strength in my job, I can tell you. These men will be the death of me. Oooh, no, not again!’ She threw her body back in pain and cursed in Swedish.

  Chummy watched her carefully and made a note that contractions were now coming every seven minutes and lasting for approximately sixty seconds. She could feel the uterus firmly just above the pubic bone, but nothing higher, because abdominal fat occluded it. She longed to be able to hear the foetal heart and reassure herself that the baby was healthy, but it was impossible. She was going to make a vaginal examination. Perhaps that would reveal something. Suddenly she remembered the obligatory enema – that monstrous practice, sacred to midwifery – and abruptly forgot the idea. How absurd on a ship, and surrounded by men! She wrote in her notes: ‘Enema not given’.

  The pain passed, Kirsty relaxed with a sigh, and Chummy gave her a drink of water.

  ‘I’ve got to examine you internally,’ she said. ‘That means I have to put my fingers into your vagina to assess where the baby is lying, and how close to birth it is. Will you allow me to do that?’

  ‘Well, I’m used to that sort of thing, aren’t I? But not for the same reasons!’

  Chummy placed her delivery bag on the captain’s desk and opened it. She scrubbed up and extracted a sterile gown, mask and surgical gloves and put them on. While she was doing so, it occurred to her that Kirsty had probably contracted syphilis during her career. Chummy had no practical experience of venereal disease, but from her classroom work she remembered that syphilis can usually be diagnosed by the hard, rubbery chancre on the vulva, whilst gonorrhoea is manifested by profuse greenish-yellow vaginal discharge. She recalled the midwifery tutor saying that a syphilitic woman very seldom carries to full term, because the foetus usually dies within the first sixteen weeks. She also remembered the next part of the lecture: that in the event of the baby going to full term, it was likely to be stillborn and was frequently macerated. Chummy felt queasy at such an idea. A macerated stillbirth could leave a midwife feeling sick and depressed for days, or even weeks – let alone the effect it had on a mother.

  Chummy quickly put the thought from her. Another contraction was coming. She timed it to be seven minutes since the last one. Full dilation of the cervix was getting closer, and as she had been unable to assess the lie of the baby from external palpation, a vaginal assessment was imperative. When the contraction had passed, she said ‘Now I want you to draw your knees up, put your heels together and then let your legs fall apart.’

  Kirsty did this with great agility. Her lower limbs were surprisingly flexible. Her massive thighs not only flew apart, but her knees touched the bed on either side, revealing a vast, moist purple-red vulva. Chummy was a bit taken aback at the speed and efficiency with which the exercise was undertaken, and Kirsty must have seen her expression because she laughed. ‘You seem to forget I do this all the time,’ she said.

  Chummy examined the external vulva carefully. She could neither see nor feel syphilitic chancre, nor was there any evidence of a foul-smelling and profuse vaginal discharge. Against all the odds, it seemed that Kirsty did not have venereal disease. It must have been her father’s gifts of boxes of 500 rubbers at frequent intervals that had protected her. ‘Bully for the captain!’ thought Chummy.

  Chummy did as every good midwife would do. She prepared to place two fingers gently in the vagina, but without the slightest effort her whole hand slid in. ‘Great Scott! You could get a vegetable marrow in here,’ she thought.

  With easy access she could feel the cervix. It was three-quarters dilated, a head presenting, fairly well down, waters intact. She breathed a sigh of relief that the baby was lying in a good position for a normal delivery.

  Then she felt something very strange. At first she thought it was part of the soft, undulating vaginal wall. She moved it with her fingers. It was not part of the vaginal wall. ‘What on earth is it?’ she wondered. It was attached above, and seemed to be hanging freely beside the baby’s head. She palpated it with her fingers, and it moved a little. Chummy was feeling this strange thing and moving it about with her fingers, when she realized with horror that it was pulsating. She froze, and blind panic overtook her for the second time that night. She looked at her watch and saw that the thing was pulsating at 120 beats per minute. The pulsation was the baby’s heartbeat. The cord had prolapsed.

  Chummy said afterwards that in all her professional career she had never known a moment of such terror. She went shivery all over but could feel the sweat pouring out of her body. She withdrew her hand, and it was trembling. Then her whole body began to tremble. ‘What can I do? What should I do? Oh please, God, help me!’ She nearly sobbed aloud but controlled herself.

  ‘Everything all right?’ enquired Kirsty cheerfully.

  ‘Oh, yes, quite all right.’

  Chummy’s voice sounded far away and faint. She was thinking back to her midwifery lectures: ‘In the event of p
rolapse of the cord, an emergency Caesarean section is necessary.’ She looked around the cabin, with the hurricane lamp swinging from the beam; at the portholes, black against the night sky; at the jugs of hot water and towels so thoughtfully provided; at her equipment laid out on the captain’s desk, adequate for a normal birth, but no more. The ship moved in the wind, and she remembered her isolation and the impossibility of getting help. She trembled at her own inexperience and thought, ‘This baby will die.’

  Yet something else was stirring in her mind. The lecturer had not ended with ‘a Caesarean section is necessary’, but had continued. What else had the lecturer been saying? The pulsating cord, and the knowledge that a living baby depended on her for life, forced Chummy’s mind back to the classroom. ‘Raise the pelvis by instructing the mother to adopt the genu-pectoral position and sedate the mother. If the amniotic sac is unbroken it is sometimes possible to push the baby’s head back a little and move the cord out of the way.’

  Good midwifery is a combination of art, science, experience and instinct. It used to be said that it took seven years of practice to make a good midwife. Chummy had everything but experience. She possessed intuition and instinct in abundance. The amniotic sac was not yet broken. There might still be time to attempt the replacement of the cord. She must have a go. She could not sit and do nothing, knowing that the cord would be crushed as labour progressed, and that the baby would die.

  ‘Raise the pelvis’, the lecturer had said. Chummy looked at the massive thighs and buttocks of Kirsty, who probably weighed about thirty-five stone. A crane would be needed to raise her pelvis. The genu-pectoral position would be possible in a smaller woman, but Kirsty could no more roll over onto her front than a beached whale could. But only raising the pelvis would take pressure off the cord, and Chummy was resourceful. She remembered that a folding bed had been provided. If she folded up the legs at the head of the bed, but left the foot end standing, perhaps her patient could lie with her head and shoulders on the floor and her buttocks resting on the higher end of the bed. It was worth a try.

  She explained what she wanted to Kirsty. She did not say anything about the cord or the gravity of the situation, because there was no point in alarming her unnecessarily. She merely explained about the bed, as though it was the usual way to deliver a baby.

  With great difficulty Kirsty got to her feet, and Chummy crawled under the bed to collapse the legs so that the head dropped to the floor. That was easy; the difficult part would be getting Kirsty back onto it in the required position. The problem was solved by Kirsty. She calmly went to the raised end of the bed, sat on it, leaned backwards, then rolled her back down the bed. ‘I do this all the time,’ she said, splaying her legs apart.

  Pressure would now be off the cord, Chummy thought with satisfaction – gravity would pull the baby back into the uterus, allowing a little extra space for the cord. But the advantage would not last for long, because the inexorable process of uterine contractions would push the baby forward. Time was short, and running out. Contractions were already coming every six minutes.

  Chummy weighed in her mind whether or not to give pethidine to sedate her patient. It would relax her and might help when it came to replacing the cord. But on the other hand it would also sedate the foetus, and delivery was imminent. She decided against sedation. Kirsty seemed relaxed enough and would just have to bear the pain. The life and health of the baby were Chummy’s main concern, and pethidine in its bloodstream would be an additional hazard.

  A contraction was coming, and Kirsty groaned with pain. She threw her head around and tried to move her legs up to her body. ‘Whatever happens, don’t roll out of that position, Kirsty. It’s perfect,’ said Chummy.

  ‘I must try to replace the cord before the next contraction,’ she thought. The time between each would soon be only five minutes. The contraction passed, and Chummy said a quiet prayer for what she was about to do. She had never seen it done before and had received only one lecture on the subject, but it had to be enough, and with God’s help it would be.

  ‘I’m going to push you around a bit, Kirsty. Hook your knees over the edge of the bed, and hold on, so that you don’t slip backwards with the pressure.’

  Chummy slipped her gloved hand into the vagina. There was no perineal resistance, something she knew she could be thankful for. She felt the partly dilated cervix again, the forewaters protruding and the pulsation of the cord within. With her forefingers she felt around the baby’s head – there must be no pressure on the fontanelle, she thought, because that could kill the baby at once. Her fingers were placed ready to push when the ship moved, causing them to slip. She had to find the correct position a second time. When she thought her fingers were rightly placed she pushed hard, but the head did not move. She felt the sweat running down her face and neck. ‘It’s got to,’ she thought, ‘it’s got to go back.’ So she pushed again. This time the head retreated slightly but not enough for the cord to be replaced behind it.

  After the second unsuccessful attempt Chummy paused, trembling.

  ‘Pressure, that is the only thing I’ve got to help me, massive pressure, and God be with me that I do no harm.’

  Shaking all over, she leaned her head on the soft cushion of Kirsty’s enormous thigh, trying to think clearly. The wind groaned outside, and the ship moved in sympathy. Her fingers slipped, and she withdrew her hand. If the amniotic sac broke, that would be the end: nothing could save the baby. Only the fact that the cord was still floating freely in the amniotic fluid made replacement a possibility.

  Another contraction came. ‘Five or six minutes can’t have passed,’ she thought. ‘I can’t have spent all that time achieving nothing.’ She looked at her watch – it had been five minutes. Contractions were getting closer, and time was rapidly running out.

  She saw the uterus heave with the muscular pressure of the contraction, and a plan formed in her mind. Looking at the uterus, her instinct told her that, if she applied reverse pressure externally, and internal pressure on the baby’s head, she might be able to move it sufficiently to replace the cord. It was not a procedure that had been taught in the classroom, but something told her that it might work. With only five minutes, perhaps four, before the next contraction, she had to be successful, or the baby would surely die. The ship lurched as a great gust of wind hit the side, and Chummy prayed for calm during the next few minutes.

  When the contraction passed Chummy said, ‘Kirsty, I want you to listen carefully. Grip your knees over the edge of the bed again, and hold on. Just concentrate on holding your body still, because I am going to push hard, and you must not allow me to push you downwards.’

  ‘I’ll do my best, nurse. I have to be strong in my job. I don’t suppose you can push any harder than a fifteen-stone first mate. I’ll be all right.’

  Chummy took her at her word. She inverted her left hand over the upturned uterus, just above the pubic bone. Being able to insert her whole hand into the vagina was a huge advantage. She cupped the palm of her right hand over the baby’s head, stood up and took a deep breath.

  ‘Hold on, Kirsty, don’t let yourself slip. I’m going to push – now.’

  Chummy was tall and strong. She exerted massive downward pressure internally and externally. The baby shifted two or three inches from her internal hand, but still she kept up the external pressure on the uterus. When she felt it was enough, she relaxed.

  ‘That was hard! I don’t know if I’ve had it harder than that. But I didn’t move, did I?’ said Kirsty.

  Chummy did not reply. Her job was not done. She still had to replace the cord into the uterus. She felt for the cord, but it was not there. She stretched her finger inside the os and ran it around the rim, but could feel only the smooth, round surface of the baby’s head. The cord had disappeared. Internal fluid suction, caused by shifting the baby, must have withdrawn the slippery cord without any further action being required from the midwife.

  Chummy felt giddy with relief and
leaned her head on Kirsty’s capacious thigh. She giggled weakly.

  ‘It’s done, it’s done, thanks be to God! And thanks to you, Kirsty. You didn’t move. I couldn’t have done it without you.’

  ‘All in a day’s work,’ observed Kirsty casually.

  The whole operation had taken only about thirty seconds. But Chummy sat trembling with relief for another two or three minutes, until her more practical side took over. Now that the baby was safe, how was it to be delivered? All sorts of questions tumbled into her mind. Kirsty looked quite comfortable, but could a baby be delivered in an upside-down position? She wondered what the midwifery tutors would say about that! On the other hand, moving this massive female might be a problem. Kirsty had rolled down the slope of the bed, but would she be able to roll up? The third stage of labour, the delivery of the placenta, was vitally important, and Chummy was not confident about the mother expelling a placenta upside-down. Kirsty would have to be moved. Then the cord came into her mind. Reverse pressure had made it withdraw into the uterus, but if Kirsty stood up, as she would have to, would the downward pressure displace the cord and make it slip forward again? Chummy could not be sure, but it might. The risk was too great. Kirsty would have to remain in her present position.

  Chummy sat beside the labouring woman, listening to the wind and feeling the ship move beneath her. She was not really surprised by the extraordinary situation in which she found herself; after all she was going to be a missionary and she would have to be prepared for anything. She was a thoughtful, prayerful girl, and she thanked God she was being tested in this way.

  She pondered the ugly situation in which Kirsty had been placed. First abused, probably raped, when she was fourteen by her father, and then confined to a ship for the pleasure of all the men, including her father. Yet, Chummy reflected, she seemed happy and content. Perhaps, as she had known no other life, it all seemed quite natural to her. The men were obviously fond of her – their concern as she struggled down the gangway was evident – and she was not ill-treated. Common prostitutes, pushed onto the streets by pimps and beaten up if they protested, had a much worse life, she thought.