Read Farewell to the East End Online
Authors: Jennifer Worth
Farewell to the East End (5 page)
‘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 wide 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?’
What happened next was more than she, or anyone else for that matter, could have imagined in their wildest dreams.
Ruth sat down once more on the chair beside the mother, to await the third stage of labour. She had time to reflect on the situation. After a twin birth the uterine muscles are stretched and tired and can take up to half an hour to contract again for the expulsion of the placenta. Kathy lay sleeping, her fragile yet strong young body exhausted from a twin birth, and soothed by the blessed relief from pain. Ruth sat beside her and leaned her head on the wall. She glanced at her watch. What had happened to the time? Less than an hour had passed since she had got out of bed to answer the telephone. She tried to recall the sequence of events: the cycle ride through the night, the girl standing out in the street, the race to get upstairs, the waters breaking on the landing, and the birth of one baby, then two. It had been like a speeded-up film. What did time mean, anyway? There were some who said that time does not exist, others who said that past, present and future are one and the same. What did anyone know about time? Least of all herself. And Kathy was sleeping, blissfully sleeping.
Ruth placed her hand on the fundus of the uterus to assess progress of the third stage and stiffened with shock. The uterus still felt full, hard and bulky. ‘There’s something wrong here,’ she thought, ‘this doesn’t feel like a placenta.’
She carefully palpated the abdomen. ‘It’s definitely not a placenta. It can’t be ... It’s not possible ...’
She picked up her foetal stethoscope, applied it to the abdomen in several places and heard a rapid, regular heartbeat. Her mouth went dry, and she had to sit down again. Another baby! Undiagnosed triplets, no antenatal care, no assistance available, and apparently no one else in the building to summon help. She shivered as much from shock and fear as from the cold. Thoughts were racing through her mind. Would the delivery be normal? She had been lucky twice, but the third baby might be lying in any position. He might be a transverse lie, or a shoulder or a brow presentation ... or anything. She palpated the abdomen but could not feel a head or a breech. The foetal heartbeat was a steady 150 beats per minute, which was undoubtedly high, but might be normal for a third baby. She had never delivered triplets, nor even seen a triple birth. She felt numb with fear. Would he be healthy, like the others? There might be breathing problems, or other life-threatening difficulties derived from immature internal organs. Perhaps the placenta might come away first, leaving the baby with no maternal blood supply, or the cord might prolapse. She didn’t know if there would be one, two or three placentae. She couldn’t see inside, and she could not tell from external palpation.
Nearly half an hour had passed since the second birth, and there was no contraction. Kathy still slept quietly, but Ruth was trembling with anxiety. ‘If this is uterine inertia, it is a serious condition, and the baby will die. Dare I risk leaving Kathy alone for ten or fifteen minutes while I go to a telephone to call the hospital?’ she asked herself. She dithered. Should I? Shouldn’t I? Which course of action would be the least dangerous?
The situation resolved itself. In her sleep Kathy groaned in pain, and in the same instant there was a click from the electric meter and the light went out. The room was in total darkness. Ruth knew the bicycle torch was on the chest of drawers, but in trying to locate it she knocked it onto the floor, and then had to crawl around trying to find it. She could hear Kathy groaning and straining and pushing, but there was nothing she could do until she had light. She found the torch and switched it on. Kathy now lay calm and apparently asleep. Ruth went over to the bed and pulled back the blankets. A baby lay in a pool of blood, between his mother’s legs. She propped the torch on the end of the bed and picked up the baby. He was small, like the other two, but seemed perfectly formed, and even gave a little cry. She held him upside down, and he cried more loudly. ‘This is a miracle,’ Ruth thought. She cut another gauze swab into two pieces and ligated the cord, then cut the baby free from his mother. She lay him on his mother’s abdomen and covered them both to keep them warm. There was no other clothing available in the room, so she took one of the grey army blankets off the mother, cut it into pieces, wrapped a piece round the baby, and tucked him into the bottom drawer. The other pieces of blanket she tucked under and around all three babies to ensure that they were warm. Then she closed, or rather nearly closed, the drawers to keep out any draughts.
Meanwhile, Kathy was sound asleep, her body exhausted. Ruth sat beside her and tentatively palpated the uterus – would there be another one inside? But no; the abdominal muscles and the uterus felt soft. Ruth breathed a sigh of relief, but at the same time reminded herself that labour was far from over. The third stage had to be completed, and she knew that this was frequently the most difficult and the most dangerous part of delivery. She leaned back in the chair and closed her eyes. Was this a dream? Could it really be happening? She had been out the night before, followed by a busy day, and had enjoyed very little sleep in the past twenty-four hours. She very nearly dozed off, but a warning bell sounded in her brain, and she jumped up and splashed her face with cold water from the enamel jug. The shock soon focused her mind again.
About twenty minutes had been spent wrapping and settling the babies, during which time there had been no contractions. Something had to be done. Ruth picked up the torch and shone the beam of light into the bed. The mess was quite indescribable; a great pool of blood and amniotic fluid was seeping into the uncovered mattress – and she could do nothing about it. Normally a midwife would have covered the mattress with brown paper, absorbent sheets, a rubber sheet, and on top of that more absorbents, which could be changed frequently – but she had none of these. The mess would have to stay where it was. She shone the beam of light onto Kathy’s vulva. Three cords were showing. But how many placentae would she have to deal with? It could be as many as three, if the babies had developed from three separate ova. She did not know, and there was no way she could find out.
Ruth knew the risk of post-partum infection and in other circumstances she would have removed all soiled padding from beneath Kathy, washed her, cleaned the vulva with antiseptic, replaced the bedding with clean absorbent sheets and covered her legs with more clean sheeting. She would also have scrubbed her hands thoroughly, and put on sterile gloves. But none of this was possible. She also knew that warmth was essential, because a woman sweats during labour, losing a lot of body heat, and can become cold and shivery. Yet there was only one thin army blanket available.
She shone the torch despairingly around the empty room and saw her coat hanging on the back of the door. That would do. She took it off the hook and covered the girl with it for extra warmth. Kathy’s breathing was deep and regular, her pulse and blood pressure were on the low side, which was a good sign, and her colour was fine. There had been no contractions, and the uterus felt as it should feel.
In those days the management of the third stage of labour was left entirely to nature, and midwives were taught not to meddle or interfere with the process which separates the placenta from the uterine wall and controls bleeding. Today an oxytocic drug may be injected immediately after the baby is born, and a powerful contraction develops, separating the placenta, so that the third stage is over in a few minutes. We did not have that advantage. Patience, experience, observation and masterly inactivity were our guides. We were taught that meddling with the uterus or attempting to hurry the third stage would usually give rise to partial separation of the placenta, causing haemorrhage. We were taught never, never to pull on the cord, and only to knead or massage the fundus after uterine contractions had already developed, and only then if it became absolutely necessary.
Ruth sat quietly beside the bed, her left hand guarding the uterus, which she could clearly feel. The torchlight was growing fainter, so to save the battery she switched it off and sat in total darkness. Twenty-five minutes had passed with no sign of a contraction, and she was beginning to grow anxious. She might have to leave the girl alone while she summoned medical aid. But then she felt a distinct hardening of the uterus, and the fundus rose under her hand. Kathy moaned with pain and moved awkwardly.
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