“All shall be well, and all will be well
and all manner of things shall be well.”
I must have given a great sigh of relief, which Len picked up. He said, “You reckons as how she’ll be all right then, do you?”
Should I tell him that Sister Julienne was praying for us? It seemed so silly, almost irrelevant. But I did; I felt I knew him well enough. He didn’t dismiss it.
“Well, I reckons as ’ow its goin’ to be all righ’, then, too.”
His face was brighter than it had been since I entered the room.
It would have been advisable to examine Conchita vaginally to see how far she was in labour, but I couldn’t get her into the right position. She wouldn’t allow Len or me to move her. Liz explained to her in Spanish what was required, but she didn’t understand or respond in any way. I could only assess the progress of labour from the strength and frequency of contractions, which were approximately every five minutes. I listened for the foetal heart, but couldn’t hear a thing.
“Is the baby alive, then?” asked Len.
I didn’t like to say a straight “No,” so I hedged my bets.
“It’s unlikely. Remember your wife got very, very cold today, and has been unconscious. Now she has a fever. All this will affect the baby. I cannot hear a heartbeat.”
One of the real problems of premature delivery at the stage of pregnancy Conchita had reached is that the foetus is often lying transversely across the uterus. A human baby ideally should be born head first. A breech delivery is possible, but difficult. A transverse or shoulder delivery is impossible. The head does not normally descend into the pelvis until after thirty-six weeks. A foetus of around twenty-eight weeks is quite large enough to block the cervix completely if contractions push it downwards in the transverse position. In that event, without surgical intervention, the death of the baby is inevitable. I palpated the uterus trying to find out the baby’s position, but it was no use, I could not tell. A vaginal examination might have enlightened me, but there was no way that we could persuade Conchita to cooperate.
All I could do was wait. The minutes between contractions ticked by slowly. They were coming every three minutes now. Her pulse was more rapid, 150 per minute; and her breathing seemed to be more shallow. Her blood pressure was quite imperceptible. I prayed for a knock on the door to announce the arrival of a doctor or the ambulance, but none came. The house was silent, save for the low moaning of Conchita as each contraction came and went.
Inevitably the contractions became stronger, and it was then that Conchita began to scream. I have never in my life, before or since, heard such terrifying sounds. They came from the depths of her suffering body with a force and power that I would have thought impossible, given her fevered, debilitated state. She screamed on and on, wild terror in her unseeing eyes, the sound reverberating wave after wave against the walls and ceiling of the room. She clung to her husband, tore at him, until his face and chest and arms were bleeding. He tried to hold her, to comfort her, but she was quite beyond comfort.
I felt helpless. I did not dare to give her an analgesic to lessen the pain and quieten her, because her pulse and blood pressure were so abnormal, and I knew that any drugs would probably kill her. I thought that if it was a normal delivery she had a chance of living; if it was a transverse presentation she would die, unless an ambulance were to arrive quickly. I could not get near her to feel the uterus, or even to hold a leg, as she was throwing herself around the bed with the strength of a wild animal in a trap.
Poor Liz looked terrified. Len, with unconditional love, was still trying to hold her in his arms and console her. She sank her teeth into his hand with the strength of a bulldog, and hung on. He didn’t cry out, but winced with pain, sweat and tears falling from his forehead and eyes. He didn’t even try to force her jaw open or to pull away. With alarm, I thought that she would sever a tendon. Eventually she loosed the hand, and flung herself to the other side of the bed.
Then, as suddenly as it had started, it was all over. She gave a terrible cry, and a massive push, and water, blood, foetus, placenta - everything - was delivered on to the bed sheets at once. She fell back exhausted.
I could feel no pulse at all. Her breathing seemed to have stopped. But I could feel a flutter of a heartbeat, so I listened with my stethoscope. It was faint and irregular, but it was there. The foetus was blue, and looked quite dead. I snatched a large kidney dish from the dresser, scooped everything into it, and dumped it on the dresser.
“Now we must quickly get her warm,” I said, “cleaned up and comfortable, if she is to stand a chance. You help me, Liz - clean warm sheets, a couple of hot water bottles. I will check the placenta in a minute to see if it is complete. If we can get her to drink something hot it will help. Hot water and honey would do; a teaspoon of brandy in it would be even better. The main thing is to treat the shock. And let us all hope and pray that the bleeding won’t get worse.”
Len went out to issue some instructions, and to pacify the terrified family gathered around the door. Liz and I started to clean the dirty sheets and linen from under Conchita. Len soon returned with clean sheets and hot water bottles, and Liz and I started to make the inert body comfortable.
Len must have gone over to the dresser. Liz and I had our backs to it, busy with Conchita. We heard a gasp.
“It’s alive!”
“What!” I cried.
“It’s alive, I sez. Ve baby’s alive. It’s movin’.”
I rushed over to the dresser, and looked at the gory mess in the kidney dish. It moved. The blood actually moved. My heart stood still. Then I saw the tiny creature in the pool of blood, and its leg moved.
Oh, dear God, I could have drowned it! I thought.
I lifted the tiny body out with one hand and tilted it upside down. It seemed to weigh nothing. I have held a new born puppy of about the same size. My head raced.
“We must clamp and cut the cord quickly. Then we must get him warm.”
It was a little boy.
I felt desperately guilty. The cord should have been clamped five minutes earlier. If he dies now, it will be all my fault, I thought. I had discarded this tiny living soul to drown in a dish of blood and water. I should have looked more closely. I should have thought.
But wallowing in self-reproach gets us nowhere. I clamped and cut the cord. I felt the fragile rib cage. He was breathing. He was a survivor. Len had warmed a small towel on a hot water bottle, and we wrapped him in the cloth. He moved his head and arms a little. All three of us were stunned by the life in the baby. None of us had seen a human child quite so tiny. A baby that is two months premature usually weighs about four pounds, and seems tiny enough. This baby was about one and a half pounds and looked like a tiny doll. His arms and legs were much smaller than my little finger, yet a miniscule nail completed each digit. His head was smaller than a ping-pong ball, and looked disproportionately large. His rib cage looked like fish-bones. He had tiny ears, and his nostrils were the size of a pin-head. I had never imagined that a baby of around twenty-eight weeks could be so lovely. I felt I ought to suck the mucus from his throat, but was terrified of hurting him. Anyway, when I got the catheter, it was far too large, and would never have gone into his mouth. To force a hosepipe into a normal baby’s mouth would have been just as inappropriate. So I just held him nearly upside down with one hand, and gently rubbed his back with one finger.
I had no experience of caring for a premature baby, and did not know what to do. All my instincts told me that he must be kept warm and quiet, preferably in the dark, and with frequent feeding. No cot was ready. Where could we put him? Just then Conchita, who was lying quietly, spoke.
“Niño. Mi nino. Donde está mi niño?” (Baby. My baby. Where is my baby?)
We looked at each other. We had all thought she was semi-conscious or asleep, but obviously she knew exactly what had happened, and wanted to see her baby.
“We’ve gotta give ’im to ’er. Liz, you te
ll her he’s very little and we’ve gotta be very careful with him.”
Liz spoke to her mother, who smiled slightly and sighed with weariness. Len took the baby from me and sat down beside his wife. He held the baby in one hand so that the child lay within her gaze. Her eyes had been vacant and unfocused for several moments and I don’t think she saw or understood at first; she had expected to take a full term baby into her arms. Liz spoke to her again, and I heard the words.
“El niño es muy pequeño.” (The baby is very small.)
Conchita struggled to adjust her vision to the minute scrap held in Len’s hand. You could almost see the struggle and the effort it cost her. Gradually she became aware, and with a sharp intake of breath put out a shaking hand to touch the child. She smiled, and murmured “Mi nino. Mi querido nino,” (my baby, my darling baby) and drifted off to sleep, her hand resting on Len’s hand and the baby.
Just then, the Flying Squad arrived.
THE FLYING SQUAD
An Obstetric Flying Squad was provided by most big London hospitals, and I believe by all regional hospitals, as an emergency backup for domiciliary midwifery. The service must have saved thousands of lives, because before the 1940s, when no service existed, a midwife could find herself entirely alone with any obstetric emergency - such as a mal-presentation, haemorrhage, cord prolapse, or placenta previa - and all she could do would be to call in the local GP who might or might not be skilled in midwifery.
It was the proud boast of the Flying Squad of the London Hospital that it could reach any obstetric emergency in twenty minutes. But that was reckoning without a London smog. When the policeman contacted the hospital about Conchita no ambulance had been available to bring the Flying Squad. The smog caused acute and deadly respiratory failure in thousands of old people each year, and every doctor and ambulance was out on these cases. When one finally did return to the depot, the driver, who had been working non-stop for sixteen hours, was sent off duty, and another had to be found. Even then, a policeman had to cycle in front of the ambulance to guide it - hence the delay of nearly three hours. However, a registrar, a houseman, and a nurse from the obstetrics department had been sent by the hospital.
Everything happens at once, so they say, and within minutes a GP also arrived on foot. God bless him, I thought. He looked exhausted. He had been working all day and all night, and very likely most of the night before, yet he had the professionalism and the courtesy to apologise for being late.
With so much medical know-how in the house, it was necessary to have a case conference to decide the best course of action for mother and baby. We went down to the kitchen for this, and I asked Len to accompany me. Liz was left with her mother and the baby. The two ambulance men and the policemen joined us too - they couldn’t be asked to sit outside in the cold, and there was nowhere else for them to sit in the house. Sue, one of the older girls, made tea all round.
I gave my case history, and handed over the recorded notes. All doctors were agreed that mother and baby must be transferred to hospital at once. Len was alarmed.
“Does she ’ave to go? She won’t like it. She’s never been away from home before, she hasn’t. She’d be lost an’ frightened. I knows as ’ow she would. We can look after ’er. I’ll stop at home, an’ the girls can muck in an all, till she’s better.”
The doctors looked at one another and sighed. Fear of hospital was commonplace. Among the older generation, it arose mainly from the fact that most of the hospital buildings were converted workhouses, which had been feared more than death itself. The doctors agreed that as Conchita was now safely delivered, if no post-natal complications arose, she probably could be treated at home. A course of antibiotics would clear the infection that was causing fever. The head injury, causing concussion and delirium, would heal with rest and quiet. They tried to point out that she would get more rest in hospital than at home, surrounded by children, but Len would have none of it, so they capitulated.
However, the baby was another matter. He hadn’t been weighed, but my guess of between one and a half and two pounds was accepted. They all said twenty-eight weeks was barely viable, and that a living baby of that gestation must have hospital treatment, with the latest technological equipment, and twenty-four hour expert nursing and medical care. They suggested that he should be transferred at once to Great Ormond Street Hospital for Sick Children. Len looked dubious, but when they told him that without such care the baby would die, he readily agreed.
We all went upstairs to the bedroom. I don’t know what these hospital doctors thought of having to squeeze past all the prams in the hallway and parting the washing flapping around their heads as they climbed the wooden stairs. Nor did I ask. But I smiled to myself.
Conchita was sleeping, the tiny baby lying on her chest. One hand was protectively over it, the other lay limp by her side. She was smiling, and her breathing, although shallow, was regular and less rapid. I approached the bed and felt her pulse. It was slightly stronger, and regular, but still rapid. I counted 120 per minute, which, though abnormal, was an improvement. Liz was cleaning up quietly and eèfficiently, and the whole scene was peaceful.
The baby looked even smaller now that the entire hand of the mother covered it. Only its head was visible. It did not really look as if it were alive, although its colour did not suggest death.
The registrar wanted to examine Conchita. I told him that I had not yet examined the placenta, as I had not had time between delivery and the arrival of the ambulance. We examined it together; it was very ragged. “Not hopeful,” he muttered, “and it all came out at once, you tell me? I must have a look at her.”
He pulled back the bedclothes to examine her abdomen and see the vaginal discharge. Conchita seemed quite unconscious and didn’t move as he palpated the uterus. Some blood rushed out.
“Another pad,” he said, and, to the houseman, “Draw me up 0.5 cc of ergometrine for injection.”
He sank the needle deep into her gluteus muscle, but she didn’t move. He covered her and said to Len: “I think part of the placenta has been left behind. She may have to go to hospital for a D and C. It would only be for a few days but we cannot risk a haemorrhage occurring at home. In her condition it would be very serious.”
I saw Len turn white and he had to grab the back of a chair to prevent himself from falling.
“However,” continued the registrar kindly, “it may not be necessary. The next five minutes will tell if the injection is going to be effective.”
He then took Conchita’s blood pressure.
“I can hear nothing,” he said, and the three doctors exchanged significant glances. Len groaned and had to sit down. His daughter put her hand on his shoulder, and he squeezed it.
We all waited. The registrar said, “There is no point in examining the baby. It is obviously alive, but we are none of us paediatricians. Examination must wait for the experts.”
He asked for the telephone, to ring Great Ormond Street Hospital, but there was no telephone in the house. He cursed silently under his breath and asked where he could find the nearest phone box. It was two hundred yards down the road, on the other side. The long-suffering houseman was dispatched out into the freezing fog and icy roads with a pocket full of pennies gleaned from us all, to ring the hospital and make the necessary arrangements.
We continued waiting. There was no sign of an abdominal contraction. Five minutes slipped by. The houseman returned to say that Great Ormond Street would send a paediatrician and a nurse with an incubator and special equipment to collect the baby at once, although the time of their arrival depended on visibility.
Another five minutes passed. There was steady vaginal bleeding, but no contractions.
“Draw up another 0.5cc,” the registrar said. “We must give it intra-venously. There is something in there that has to come out. If we can’t get it this way,” he said to Len, “we will have to take her back with us for a scrape. And if you value her life, you must agree to this.”
/> Len groaned, and nodded dumbly.
I clamped the upper arm and endeavoured to pump up a vein for injection, but nothing showed. Her blood pressure was so low that the venous return could not be found. The registrar tried, with a couple of stabs, to locate the vein and on the third attempt blood showed in the syringe. He emptied the 0.5cc into her vein, and I released the arm.
Within a minute Conchita winced in pain and moved her legs. A large quantity of fresh blood spurted from her vagina, and then, mercifully, several large, darker lumps. There was a pause, then a second contraction. The registrar grasped the fundus and pressed the uterus hard, downwards and backwards. More blood and placenta were evacuated.
All this time Conchita was inert, but I thought I saw her hand tighten over her baby.
“That might be it,” said the registrar, “but we must wait a bit longer to see.”
He was more relaxed now and started chatting with anyone who would listen about the excellent golf down at Greenwich and the house he was buying at Dulwich, and his holiday in Scotland.
Over the next ten minutes there was no further blood loss, and no more contractions. Thanks to modern obstetrics, the danger of post-partum haemorrhage had been overcome for Conchita. But she still looked very ill indeed. Her breathing and pulse were rapid, her blood pressure abnormally low, and her temperature high. She did not appear to be conscious, although as her eyes were now closed, she might have been asleep. Nonetheless, her hand was still firmly placed over the baby, and any attempt to remove it was resisted.
With difficulty Liz and I cleaned up the bed again, and the houseman was given the messy job of checking the bits of placenta against the larger piece that had first been delivered, and measuring the blood that we had managed to contain.
“Placenta seems to be all here, sir, and I measure one and a half pints of blood. Add to that about eight ounces lost in the bed, and you could say around two pints of blood loss.”
Call The Midwife: A True Story Of The East End In The 1950S Page 31