The Midwife: A Memoir of Birth, Joy, and Hard Times (10 page)

 

Throughout history, and until after the end of the Second World War in 1945, most babies were born at home. Then the drive for hospital delivery started, and it was so successful that by 1975 only one per cent of babies were born at home. The district midwife became very nearly an extinct species.

The fashion, or trend, is reversing slightly today, and the home birth rate is around two per cent. Perhaps this is because hospital delivery presents new and totally unexpected risks for mother and baby, and people are getting wise to this fact.

Sally came to us because she believed her mother more than she believed the doctor, who had advised hospital for her first baby.

Her mother had said, “Nark ’im. You go to the Nonnatuns, luvvy. They’ll see yer right.”

Gran had stepped in, too, with a wealth of ancient folklore, and hair-raising stories about the lying-in infirmaries, which used to be feared more than death itself by women.

In vain the doctor tried to convince Sally that modern hospitals were not like the old infirmaries, but he was no match for Mum and Gran, so he retired from the ring, and Sally booked with the Midwives of St Raymund Nonnatus.

We saw patients antenatally once a month for the first six months, then fortnightly for six weeks, followed by weekly check-ups for the last six weeks of pregnancy. All went well with Sally for the first seven months. She was a pretty little twenty-year-old, and she and her husband occupied two rooms in her mother’s house. She was a telephonist, and her mum, who attended every antenatal visit, was proud of her.

I sat down with her, and went through her notes. Her blood pressure had been quite normal for the first six months. On the previous visit it had been slightly raised. I was concerned to find the BP even higher when I took it. I asked her to go to the scales, and found that she had gained five pounds weight in a fortnight. Warning bells were beginning to ring in my head.

I told Sally that I would like to examine her, and followed her over to the couch. By so doing, I was able to see that her ankles were swollen. A diagnosis was taking shape in my mind. She lay on the couch and I was able to feel, quite certainly, pitting oedema up to the knees - not very pronounced, but palpable to experienced fingers. Water retention - that would account for the weight gain. I examined the rest of her body for oedema, but could find none.

“Are you still getting any sickness?” I asked.

“No.”

“Any stomach pains?”

“No.”

“Any headaches?”

“Well, yes, now that you mention it, I have. But I puts it down to working on the phones.”

“When do you give up work?”

“I gave up las’ week.”

“And are you still getting headaches?”

“Well, yes, I am that, but Mum says not to worry. It’s normal.”

I glanced sideways at the mother, Enid, who was beaming and nodding wisely. Thank God the girl had come to antenatal clinic. Mum is not always right!

“Stay there, would you, Sally? I want to test your urine. Have you brought a specimen?”

She had, and Enid produced it after rummaging around in her voluminous handbag.

I went over to the Bunsen burner, which was on the marble slab, and lit it. The urine was quite clear and looked normal as I poured a little into the test tube. I held the upper half of the glass vial over the flame. As it heated the urine turned white, whilst the urine in the lower half of the tube, which was unheated, remained clear.

Albumen urea. A diagnosis of pre-eclampsia. I stood quite still for a moment, thinking.

It is strange how you forget things, even momentous things in life. I had forgotten Margaret, but as I stood by the sink looking at that test tube, Margaret and the whole of my first and only horrifying experience of eclampsia flooded into my mind.

Margaret was twenty, and must have been very beautiful, though I never saw her beauty. I saw dozens of photographs of her though, which her adoring and heartbroken husband, David, showed me. All photographs were black and white in those days. They had a particular charm, created by the effects of light and shadow. In some of the photos, Margaret’s intelligence and sensitivity claimed your attention, in others her laughing, puckish humour made you want to share the joke. In others, her huge, clear eyes looked fearlessly into the future, and in all of the snaps, her soft brown hair hung curling over her shoulders. One memorable photo was of a laughing young girl standing in a swimsuit beside the sea in Devon, with the spray from the waves leaping up the cliff face, and the wind blowing through her hair. The balance of her body on her long, slim legs and the angle of the shadows from the setting sun made an exquisite photo, by any standards. She looked like the sort of girl I would want to know - but I never did, except through David. She was a musician, a violinist, but I never heard her play.

All these photos David showed me during the two days of watching. When I first met him I’d assumed he must be her father. But no, he was her husband and lover, and worshipped the very ground beneath her feet. He was a scientist, and looked a very reserved, controlled, unapproachable sort of man, perhaps even cold and unemotional. But still waters run deep, and over those two long days the intensity of his passion and pain nearly split the hospital apart. Sometimes he was talking to her, sometimes to himself, occasionally to the staff. Sometimes he muttered prayers, or a few words forced out through sobbing tears. From these fragments, and the case history, I pieced together their story. There was nothing of the cold remote scientist about David.

They had met at a music club, at which Margaret was performing. He couldn’t take his eyes off her. All through the interval, and the social afterwards, he followed her every movement with his eyes. He thought he might speak to her, but stammered and couldn’t get the words out. He couldn’t understand why; he was an articulate man. He did not know what was happening to him. She continued laughing and talking with other people while he retreated to a corner, scarcely able to breathe for the beating of his heart.

In the following days and weeks, he couldn’t get her out of his head. Still he didn’t understand. He thought it was the music that had affected him so deeply. He felt restless and ill at ease and his comfortable bachelor habits afforded him no comfort. Then he bumped into her in a Lyons Corner House, and amazingly she remembered him, though he couldn’t think why. They had lunch together, and this time, far from being tongue-tied, he couldn’t stop talking. In fact they talked for hours. They had a thousand things to say to each other, and he had never felt so relaxed and happy with anyone in all his forty-nine years of fairly solitary life. He thought, She can’t possibly be interested in a dried-up old fogey like me, smelling of formaldehyde and surgical spirits. But she was. Perhaps she saw the integrity, the spiritual strength and the depths of untapped emotion in that quiet man. She was his first and only love, and he lavished on her all the passion of youth, with the tenderness and consideration of maturity.

Afterwards he said to me, “I am just thankful that I knew her at all. If we had not met, or if we had met and just passed each other by, all the great literature of the world, all the poets, all the great love stories would have been meaningless to me. You cannot understand what you have not experienced.”

They had been married for six months, and she was six months pregnant, when she was admitted to the antenatal ward of the City of London Maternity Hospital where I was working. According to her antenatal records, Margaret had been in perfect health throughout the pregnancy. She had been seen at the clinic two days earlier, and everything had been quite normal - weight, pulse, blood pressure, urine sample, no sickness - nothing that would indicate what was to come.

On the day of admission she had awoken early, and was sick, which was unusual as morning sickness had passed about eight weeks earlier. She returned to the bedroom, saying there were spots in front of her eyes. David was concerned, but she said she would lie down again. It was a bit of a headache, and would go if she had another sleep. So off he went to work, saying he would telephone at eleven o’clock, to see how she felt. The telephone rang and rang. He imagined he could hear it echoing through the empty house. She might be out, of course, having woken up refreshed, but a premonition told him to go home.

He found her unconscious on the bedroom floor, with blood smeared all around her mouth, across her cheek, and in her hair. His first thought was that there had been a burglary, during which she had been attacked, but the total absence of any signs of a break-in, and the apparent depth of unconsciousness, the stertorous breathing, the bounding heartbeat that he could feel through her night dress, told him that something serious had happened.

The hospital sent an ambulance straight away, in response to his frantic phone call. A doctor came also, as the implications of David’s description were very grave. Margaret was sedated with morphine before the ambulance men were allowed to move her.

We were told to prepare a side-ward to receive a possible case of eclampsia. It was during my first six months of midwifery training, and the ward sister showed me and another student how this should be done. The bed was pushed against the wall, with pillows stuffed down the crack. The head of the bed was padded with more pillows and secured tightly with sheets. Oxygen was brought in: a mouth wedge and airway tube were in readiness, also suction apparatus. The window was covered with a dark cloth to black out most of the light.

Margaret was deeply unconscious on admission. Her blood pressure was so high that the systolic was over 200 and diastolic 190. Her temperature was 104 degrees Fahrenheit and her pulse was 140. A catheter specimen of urine was obtained and tested. So heavy was the deposit of albumen that upon boiling the urine turned solid like the white of an egg. There was no doubt of the diagnosis.

Eclampsia was, and still is, a rare and mysterious condition of pregnancy, with no known cause. Usually there are warning signs before onset known as pre-eclampsia, which responds to treatment, but if untreated may progress to eclampsia. Rarely, very rarely, it occurs with no warning in a perfectly healthy woman, and in the space of a few hours it can develop to convulsion stage. When this stage is reached, the pregnancy is unstable, and the foetus unlikely to survive. The only treatment is immediate delivery of the baby by Caesarean section.

Theatre had been alerted and was ready to receive Margaret. The baby was dead on delivery, and Margaret returned to the ward. She never regained consciousness. She was kept under heavy sedation in a darkened room, but even then she had repeated convulsions that were terrifying to see. A slight twitching was followed by vigorous contractions of all the muscles of the body. Her whole body became rigid, and the muscular spasm bent her body backwards, so that for about twenty seconds only her head and heels rested on the bed. Respiration ceased, and she became blue with asphyxia. Quite quickly, the rigidity passed, followed by violent convulsive movements and spasms of all her limbs. It was hard to keep her from hurling herself on to the floor, and quite impossible to keep a tongue wedge in place. With the violent movements of the jaw she bit her tongue to pieces. She salivated profusely, and foamed at the mouth, which mingled with the blood from her lacerated tongue. Her face was congested and horribly distorted. Then the convulsion subsided, and a deep coma would follow, lasting for an hour or so and followed by another convulsion.

These terrible fits occured repeatedly for a little over thirty-six hours, and on the evening of the second day, she died in her husband’s arms.

All this flooded into my mind in the few seconds that I stood at the sink, looking at the sample of Sally’s urine. David. What had happened to that poor man? He had staggered out of the hospital half blind, half mad, dumb with shock and grief. Sadly, in nursing, and particularly in hospital nursing, you meet people during some of the most profound moments in their lives, and then they are gone from you for ever. There was no way that David would be hanging around the maternity hospital where his wife had died, just to reassure the nurses. And equally, hospital staff could not go chasing after him to find out how he was coping. I remembered with gratitude what he said to me just after she died, and the words of some great writer (I cannot recall who), came to mind:

There was no time to mope. I had to see Sister and report on Sally’s condition.

Sister Bernadette was in charge on that day. She listened to my report, looked at the urine sample, and said, “There may be contamination from a vaginal discharge, so we will take a catheter specimen of urine. Could you just get things ready for catheterisation, please, while I go over to Sally and examine her.”