Hard Pushed

by Leah Hazard

  Hoisting my bag higher over my shoulder, I passed a low, squat sculpture of a pregnant woman by the building’s front entrance; her ovoid bump was sleek and gleaming even in the dark, her face expressionless as she watched me disappear through the revolving doors and onwards to the staff changing room.

  In some ways, this area of a maternity unit is a great equaliser: whereas the clichéd advice for calming one’s nerves at a big event is to ‘picture them all naked’, the changing room allows the panicked, novice midwife to see her new colleagues quite literally naked. That ward sister who barked at you and made you cry? She’s wearing day-of-the-week pants. The auxiliary who told you off for making a mess when you knotted your bin bags instead of tying them in the regulation ‘swan neck’? A luxuriant bikini line and a lacy thong that leaves little to the imagination. Standing amidst the lockers before that first shift, I looked at the women around me in various states of undress – all shapes and sizes, some with dimpled flesh, some sleek, some with immaculately coiffured and back-teased ponytails, some looking as though they’d been dragged through the proverbial hedge – and told myself, They’re just women, like you. They’re no different. They all had to start somewhere. It’s fine.

  My confidence was short-lived. As I sifted through the scrubs heaped in jumbled piles by the door, I realised that the only sizes available were XXL or XXXL. Now, whilst two children have certainly left their indelible marks on my body, I don’t need a uniform that could accommodate half the hospital’s staff in a single trouser leg. It was something of a miracle when I finally found a set that wasn’t ink- or bloodstained; I slipped the tent-like top over my head and pulled the trouser drawstring tight round my waist.

  A cluster of women was gathered in front of a mirror, chattering cheerfully in a misty cloud of deodorant and perfume. I stood at their backs and gazed at my reflection, looking every inch the clown I felt on the inside. The supersized trousers dragged on the floor, and the V-neck of my scrub top dipped low enough to give any inquisitive onlookers a glimpse of my greying ‘work’ bra. A clock above the mirror read 7.22 p.m.; my shift started at 7.30 p.m., so there was no delaying my shameful debut in this circus. I pinned my name badge to my chest – Student Midwife Hazard – and winced in anticipation of the inevitable jokes that my ‘dangerous’ name would attract throughout the rest of my new career. (Though, during the odd bout of sleep-deprived delirium in the years to come, I will admit to having answered patients’ buzzers by breezily pulling their curtains back and declaring, ‘Midwife Hazard, at your cervix!’)

  I tailed a group of midwives through the hospital’s labyrinthine interior and up in the lift until a tired ‘ding’ announced our arrival at the labour ward on the fourth floor. The lift spilled its chattering contents into a small foyer, where a wheelchair bearing a ‘WARD 68 – DO NOT REMOVE’ tag on its handles had been parked beneath a peeling trio of breastfeeding posters. The midwives turned right, moving in a throng of burbling gossip and hairspray through a set of double doors; I slipped in after them like a stowaway as the doors began to shut. Inside, cool light bounced off gleaming floors, and the air seemed thinner, somehow; a blend of disinfectant and the acrid tang of blood. I breathed deep and followed on to the ‘bunker’, a room so named because all plans for obstetric engagements originated in its cramped, windowless confines. One wall was covered in handwritten signs for shift swaps, union meetings and ‘70s tribute nights, while the opposite wall held two large whiteboards on which were scrawled the names of every patient in the department and a coded summary of each woman’s progress so far. At the start of each shift, midwives gather in the bunker and wait for the senior charge midwife – the labour ward ‘sister’ – to allocate patients. It’s a lottery that can determine whether the next twelve-and-a-quarter hours will be a soul-destroying slog that ends in the operating theatre or a joyful journey towards an easy, euphoric birth, with a grateful couple waving you off in floods of happy tears.

  Tonight’s sister was tall with a short shock of fiery red hair and a long beak of a nose. She peered down at her staff – nine midwives and one terrified student – then back at the board, mentally matching up staff to patients, before barking out the night’s orders.

  ‘Room three, para one at thirty-eight weeks, insulin-controlled Type One diabetic on a sliding scale, six centimetres, malposition … Luisa.’ The sister nodded to a midwife sitting by the door, who cursed just loudly enough for us all to hear and ducked out of the bunker towards room three.

  ‘Room Six, prim at term plus twelve, IOL for post-dates, high BMI, failed epidural, baby with a known VSD, two centimetres, on Syntocinon … Jenny.’ A young midwife with a tight, glossy ponytail stood up and tumbled through the door like a paratrooper hurling herself out of a plane into enemy territory.

  What was this language being spoken? You, dear reader, have the benefit of the glossary at the back of this book to guide you through the jargon – a quick browse and you could bluff your way through a basic ward round. For me, though – newly minted Student Midwife Hazard, quaking in her trainers – the sister’s orders fell on cloth ears. I could just about decipher the words ‘prim’ (first-timer, in obstetric shorthand) and ‘para one’ (mother of one), but the intervening tumult of abbreviations and complications was virtually incomprehensible. The three months of classroom theory that had preceded this placement had focused only on textbook ‘normal’: healthy women at full term with uncomplicated labours – in fact anything but the usual, as would quickly become clear.

  My heart pounded in my chest as the list went on, each patient more complex than the last: ‘Recovery, para three, post emergency section, 1.4 litre blood loss.’ ‘High dependency, para nought plus two, twins, day four, sepsis.’ ‘Room thirteen, stillbirth at twenty-eight weeks.’

  Was everyone in this hospital pathological? Did anyone actually come in, labour in a straightforward way for a few hours and push a baby out of their vagina without losing half their circulating blood volume or mainlining an industrial amount of drugs, or both? As the litany of obstructed labours and complications continued, I imagined myself walking back through the car park and driving home, where my husband would be getting my girls out of their baths, bouncy dark curls plastered to their cheeks, their skin soft and soap-smelling. I could stop this all now, I could tell them I had had a change of heart and they would still love me, just excited to have their mum home for bedtime.

  ‘And you are …?’ It took a moment to realise that the sister was talking to me. She peered down that impossibly long nose with a withering look that took me in from head to toe: my unfamiliar face, my rictus of naked fear, the ridiculous scrubs and the blindingly new shoes, their gleaming white soles yet to be christened by rainbow trickles of blood and liquor.

  ‘Student midwife,’ I squeaked. ‘I’m here for six weeks.’

  ‘Nobody told me you were coming. Bloody typical. What year are you?’

  ‘First,’ I said. Sister looked pained. This was clearly the wrong answer. She turned towards the whiteboard, scanning it for a patient who could bear the brunt of my hopeless inexperience.

  ‘Room four,’ she decided. ‘Para one, thirty-nine weeks and six days, spontaneous labour, fully dilated …’

  OK, maybe I can handle this, I thought to myself. A woman who’s had one baby already, just a day short of full term, who’s got herself into labour and all the way to being fully dilated without any drugs or intervention. With any luck, she’ll have delivered before I even get to the room. Maybe I would stay.

  ‘… and she’s got genital warts.’

  Ah. The punchline. Sister grinned at me beatifically and looked around the room to see which midwife would be unfortunate enough to be paired with me as my mentor. Her gaze landed on a colleague standing by the door who was as broad as she was tall; almost perfectly square-shaped, with a severe black bob framing her equally angular face and a full sleeve of Maori tattoos trailing down one of her sturdy arms. The smiley-face badge on this midwife
’s scrub top seemed at odds with her dour expression, which grew even colder when she realised she’d be in charge of me for the night.

  ‘Phyllis,’ Sister said to the midwife. ‘Take the student.’

  Phyllis took a dramatic pause to size me up. She sighed, beckoned to me with a sharp nod and headed down the corridor towards room four without looking back to check whether I was following. Although the temptation to flee was definitely as real as the muffled screams I could hear emanating from every room in the labour ward, some ingrained sense of responsibility (or masochism) propelled me down the corridor. Phyllis chapped the door of room four with quick, sharp blows. Turning to me with the laconic drawl of a jaded general about to lead his hopeless infantry into battle, she said, ‘Just do what I tell you.’

  I squinted as my eyes adjusted to the scene in front of me; the room was dark but the overhead examination lamp beamed its small, hot pool of light onto the bed. A woman hunched there on all fours, a mane of frizzy golden curls hanging down over her face, her hands white-knuckling the sides of the bed while a steady stream of straw-coloured fluid dripped onto the tangle of green sterile drapes wedged under her knees. At her side, the outgoing day-shift midwife looked up at Phyllis and me with exhausted gratitude, peeling off her gloves with a thwack. I braced myself for the verbal handover I had been taught to expect: a detailed description of the woman’s past medical history, her antenatal health, any allergies, her progress in labour and a plan of management. Instead, the midwife said simply, ‘She’s doing it,’ and left the room. I stared blankly at Phyllis, who accepted this pronouncement without question, and I had the creeping realisation that real midwifery bore very little resemblance to any theory I had learned. I was suddenly a foot soldier in an army of warrior women, caught in a campaign whose rules of engagement were beyond my comprehension.

  Phyllis and I stood at the end of the bed and surveyed the scene; she with an experienced eye, me with an embarrassed sense that I should be apologising to this stranger for staring at her vulva before we’d even made eye contact.

  ‘Get your gloves on,’ ordered Phyllis.

  I stared at her dumbly.

  ‘In there,’ she said, gesturing to a door, and looked at my hands. ‘Six and a halfs, I’m guessing.’

  Gloves, gloves, gloves, I chanted to myself, opening the cupboard to be met with an array of unidentifiable packets. What was this long plastic thing? And the whoosit with the wire coming out of it? And who could possibly get through all these sachets of lube? I tossed what was probably several hundred pounds’ worth of stock to one side and found a small pile of flat paper packets. I ripped one open and, yes – first success of my midwifery career – I had located gloves. While I congratulated myself, an ear-splitting scream came from over my shoulder.

  Phyllis was poised where I’d left her, head so close to this woman’s vagina that she could almost have used her nose to push the baby back in again. As it was, a thick strand of viscous red mucus dropped down between the woman’s knees, and Phyllis rested her gloved hands on the peach-sized patch of baby’s head that was advancing steadily with every contraction. Joining Phyllis at the business end of the bed, I flashed back to my younger self watching the Birth Video in Mr Katz’s classroom. The feeling of wonder was the same, but this view was real and very undeniably in the now – the woman’s body a riot of textures and shapes, and in the air the salty, coppery scent of sweaty pennies, of blood, of the sea. More of the head was there, with a fine down of blonde hair slicked by blood and goo, and yes, like a crown of miniature cauliflowers, genital warts covered the woman’s distended labia and bloomed in the creases of her groin. This was not how I expected my first birth as a student midwife to look, but it was overwhelming and wild and even beautiful, warts and all.

  ‘Put your hands on the head,’ hissed Phyllis. I shook myself out of my trance and slapped my gloves on. ‘On the head!’ she repeated with clear annoyance.

  I placed my hands on the very top of the baby’s head, gently flexing it as I had been taught, while keeping a watchful eye on the delicate skin that stretched around it, looking for paper-thin patches that could split into buttonhole tears, or worse. Phyllis placed her hands on mine, guiding me, adjusting the angle of flexion. The woman pushed again.

  ‘Small breaths,’ Phyllis called in a gentle, encouraging voice quite different from the one she had used to address me. ‘Just breathe it out,’ she said, but the surges were too powerful for the woman to control and the baby’s head came out in one slippery push, its eyes still closed, its pursed lips blowing mute, mucusy bubbles. In the pause before the next contraction, the baby’s head rotated smoothly towards me as its body completed the internal tilts and turns required to pass through the mother’s pelvis. It was my textbook in technicolour. It was perfect.

  The baby opened its eyes and gazed at me with a cool, level stare. You are here, it seemed to be saying. This is happening.

  Suddenly grounded, calm, I realised that, to some small extent, in my limited capacity, I did know what to do. I repositioned my hands, one under the baby’s chin and one at the nape of its neck, ready to guide the head and body down and out with the final contraction and, just as I had learned, the last knee-trembling wave sent the baby out in a slick, thrilling rush, first the anterior shoulder, then the posterior, then the body with its tiny arms and legs flailing wildly. My gloves held firm to the baby, Phyllis’s hands on my own, as we guided this new human out in one smooth curve. Amniotic fluid splashed onto our forearms as we looped the baby, still attached by its cord, under its mother’s legs, helping her to rise up onto her knees with her child clutched to her chest. The woman tossed back her hair and cried loud, racking sobs as her baby made its first tentative squeals. ‘Thank God,’ she said, gasping, then laughed. ‘I thought that would never end.’

  Phyllis sprang into a practised routine of efficiency, rubbing the baby briskly with towels, sweeping soiled drapes and pads into bins, boxing instruments and writing notes. I shadowed her clumsily around the room, no doubt more of a hindrance than a help. My mind reeled as my hands flapped at my sides; what I had just seen was too powerful, too monumental to be processed in a moment or two. It was a raw, bloody, towering triumph for this woman, but an everyday occurrence for Phyllis and the rest of the midwives toiling away in this strange factory of new life. As I pointlessly folded and re-folded a pile of blankets that had been warming under the lights of the Resuscitaire, Phyllis nudged my elbow and said, ‘The next one’s all yours. See one, do one.’

  And she was right. As I was to realise over the next three years, midwifery training takes no prisoners: learning happens quickly, ruthlessly and is quite literally hands-on. The expectation is that you will see your mentor do it once, then do it yourself the next time, whether it’s guiding a baby into the world or drawing blood, injecting drugs or scrubbing for an emergency Caesarean section when the baby’s heartbeat is in a downward spiral and your own pulse is going a million beats per minute and the phrase ‘sick with fear’ becomes vividly, sphincter-clenchingly real. Three years and seventy-five births later, after soldiering on through situations that were bloodier and more beautiful than I could ever have imagined, I qualified as a midwife, and my real education began.

  Notes on the Women Who ‘Shouldn’t’ be Pregnant

  ‘You shouldn’t be pregnant.’

  No midwife will ever say this to their patient, but more often than you might believe, there’s a midwife who’s thinking it. Sometimes the thought is rooted in personal prejudice, plain and simple. Bias and judgement are unavoidable – some might argue, essential – elements of being human, and midwives are hardly exempt from that condition. The drug abuser whose five other children have all been taken into care? There will be a midwife who thinks she shouldn’t be pregnant. The morbidly obese woman whose pregnancy is high-risk, whose Caesarean section requires superhuman feats of anaesthetic skill and whose postnatal care is dizzyingly complex? There will be a midwife who thinks this i
s a colossal waste of public funds and clinical efforts.

  And the forty-eight-year-old accountant whose green juices, yoga classes and half-marathons keep her in brilliantly rude health? Not even a boatload of kale smoothies could have prevented the multiple miscarriages that drove her to seek IVF abroad, then return to Britain for the safe gestation and delivery of her twins. Many a midwife will sigh and tut over this woman’s lengthy case notes, shaking her head as she reads about the expensive trips to the clinic in Madrid and the private scans and the dozen anxious phone calls to Triage for every spot and twinge. Later, in the cosy, windowless confines of the tea room, this midwife will lecture her colleagues at length about these women who ‘think it’s their God-given right to be pregnant’. Her colleagues will nod mutely as they race against the clock to bolt down mouthfuls of microwave meals; it’s a familiar debate, and few have the time or energy to engage. This midwife will then toss back the dregs of her tea, rinse her mug and return to the bedside. She will smile guilelessly as she straps the monitoring belts around her patient’s abdomen and she will tell this mother-to-be how wonderful it is that these twins have defied the odds and come into being. She will be kind and she will crack a dirty joke that makes the patient and her husband laugh. She will embrace them both warmly as they leave the unit, and no one but the other staff at the other bedsides will know how she really feels.