by Leah Hazard
‘I want an epidural,’ came the muffled reply. With a massive effort, Eleanor reared back onto her knees, then heaved herself round so that she was sitting up in the bed once again. Strands of her hair were plastered against her forehead and her cheeks were flushed beneath their freckled tan. ‘If I get an epidural, will I still have to feel pain?’
‘Well,’ I said, ‘it’s useful to be able to feel something down below when you get to the pushing stage of your labour, but we can try to tweak the dose to give you some sensation when the time comes. With a really effective epidural, you won’t feel anything from the waist down.’
‘No change there then,’ Eleanor drawled, looking sideways at Liz, who gasped in mock outrage, and Eleanor threw her head back, unleashing another throaty laugh. This time, Liz joined in, chuckling with a delight that was free, easy and a joy to behold. Fatima was right, I thought. We’ll have a good night.
And so it went. Another midwife came to relieve me for my first short break of the shift and by the time I’d bolted down a slice of banana loaf and a cup of strong, muddy coffee and returned to the room, the anaesthetist had been and gone. The monitor was picking up much stronger contractions now, about four in every ten minutes, and the epidural was running through its own little pump at the bedside, pushing a small but powerful trickle of anaesthetic into a tiny space in Eleanor’s spine. Eleanor looked relaxed, and as the muscles in her face softened, so Liz also settled back into the chair, tucking her feet beneath her. The clock on the wall had just clicked past midnight. It was this baby’s birthday.
I rolled a big pink birth ball out of its hiding place in the adjoining stockroom and placed it by the bedside, where I could comfortably bounce the hours away while the jungle juice did its thing. Eleanor’s epidural was flawlessly effective; I placed a hand gently on her abdomen and could feel taut waves of pressure rolling across her bump, but she was none the wiser, snoring gently, slack-jawed, as a glassy bead of saliva slid down her chin. In a way, she had been right: watching women sleep can be simultaneously tedious and challenging, especially when you are duty-bound to stay awake and alert for the slightest glitch in the baby’s heartbeat. My coping strategies for this particular challenge are two-fold: first of all, the aforementioned coffee. Secondly, I break my night into fifteen-minute intervals. In fifteen minutes, I think, I will document the fetal heartbeat. In another fifteen minutes, I will check the patient’s ‘pressure areas’ – her knees, her hips, and so on – and document this action by ticking the relevant boxes on the ‘Skin Surveillance’ form, one of the many gaily coloured but undeniably onerous pieces of paperwork required in our hospital during the care of a labouring woman. Fifteen minutes after that, I will rearrange the packs in the top left-hand cupboard by order of size and then arrange the needles by colour, and then shuffle them all and start again.
It was 05.47 when the baby’s pulse, which had been sitting squarely in the ‘safe zone’ of between 110 and 160 beats per minute, began to edge its way downwards. I had been sliding slowly off the birth ball as exhaustion set in, but when I heard that warning skip and lurch in between beats, I sat upright, the ball squeaking beneath me. Fetal heart 95 bpm. OK, it was coming up again. Slowly, but coming up. Good recovery to baseline, I wrote. Observing carefully. I ran my hands through my hair and gave myself a bit of a slap around the chops. (Did I mention that a bit of light masochism is Coping Strategy Number Three?) Eleanor and Liz were still sleeping and the first glow of sunrise was beginning to illuminate the frosted-glass window at the back of Liz’s chair. Boom. Boom boom. Boom. 86 beats per minute. I stood up and the ball rolled silently away across the floor. Boom. 82 beats per minute. Here we go. I could hear somebody screaming in one of the other labour rooms. Too bad. I lunged towards the emergency buzzer – and pulled it.
‘Eleanor,’ I called, shaking her shoulder. She opened her eyes woozily and rubbed her nose with the back of her hand. Itchy nose: a little-known side effect of epidurals and the least of Eleanor’s problems at that moment. ‘Eleanor, I need you to try to roll onto your left side. It’s a better position for getting oxygenated blood to the baby. I’ll help you.’
Turning Eleanor was easier said than done as the epidural had made her more or less a dead weight from the waist down and her legs swung heavily from her hips as I hauled her over. Just as I managed to roll her onto her side, the door opened and Caroline, the labour suite sister for the night, came to the bedside.
‘What do we have here?’ she said as she looked from Eleanor to me to the monitor. And then, sharply, ‘I’ll get the reg.’ Before she had even turned around, Missy, the night’s registrar, was there. A strikingly tall woman with cropped peroxide hair and an earful of silver studs and bars, Missy was hardly the standard-bearer for the NHS uniform policy, but her piercings had – funnily enough – never interfered with her clinical judgement. Dr Walker present for review, I wrote with relief. Sitting alone in a room with a dodgy CTG is a very lonely thing; it was good to have backup.
‘Eleanor, I’m Missy, the doctor on call tonight,’ said the registrar, barely taking her eyes from the numbers on the monitor’s screen. ‘I’m going to examine you. We need to know whether you’re about to deliver vaginally or whether we need to take you to theatre.’ Liz, who had just awoken to find the room full of strangers, looked at Eleanor with undisguised terror. Eleanor, in turn, looked pleadingly at me, searching my face for clues or reassurance. I felt her distress keenly but was also preoccupied with finding the right gloves and packs for Missy; there was no time for light banter or, for that matter, any hesitation whatsoever.
Missy sat side-saddle on the bed, eyes narrowed and fixed on an invisible point on the wall as her fingers probed under Eleanor’s sheet.
‘You’re fully dilated,’ she said tersely to Eleanor, and then, to me, ‘Vertex at spines plus two.’ The baby’s head was well down in the pelvis. ‘Set up for a ventouse. We should be able to do this in the room, but if not, we’ll head to theatre for a trial of forceps.’
‘She’s going to use a suction cup,’ I explained to Eleanor as I heaved her feet into the stirrups she’d been playing with a few hours before. ‘The doctor will pull, but you’ll still need to push.’ There wasn’t time to say much more. Caroline had wheeled in one of the emergency trolleys with the ventouse and its accoutrements. Missy was gloving up in the corner. A paediatrician (or ‘paed’, as they are often called) had been paged and was hanging back by the Resuscitaire; a baby with a non-reassuring trace can surprise everyone by coming out crying or it can confirm its hours of compromise by sliding out slack-limbed and unresponsive, requiring urgent intervention that can range from a few puffs of oxygen to intubation and full-on life support. The paed remained in the shadows, waiting, poised for disaster.
Meanwhile, I hunched over Eleanor’s feet, flames of pain licking down my back as I unclipped the entire bottom of the bed from its hinges and heaved it onto the floor, leaving Eleanor in a kind of stirruped throne that would allow the doctor to get right in between her legs. I grimaced as my spine burned, but my body’s labour was insignificant in that moment; there would be time for rest and relief when this job was done.
Beat. Beat beat. This baby needed to come, this baby whose existence defied the laws of science, this baby with a far-away father and two adoring mothers, one of whom, at another time, might not be alive – this baby that was hovering in the hazy limbo between one world and the next. We were all willing it to make that last leap through impossibility, to squeeze through those few remaining millimetres and greet us with a cry. Missy was on a stool between Eleanor’s legs; she reached in and applied the ventouse cup to the baby’s head, a sliver of which had slid into view with the last contraction. 06.03, I scribbled. Vertex visible. Ventouse applied. ‘When the next one comes,’ Missy commanded, ‘push hard.’
I stood at Eleanor’s side, my hand on her abdomen so that I could tell her when her next contraction was beginning. Her epidural block was still dense; she had none o
f the ferocious, involuntary urge to push that women often have at this stage. As I felt the familiar tension building at the top of Eleanor’s bump, like a balloon being inflated in one slow, steady breath beneath my fingertips, I turned to her, locking her eyes to mine and said simply, ‘Now.’
Eleanor tucked her chin down onto her chest, drew a deep breath and pushed as long and hard as she could, squeezing the rumpled sheets with one hand and Liz’s skinny wrist with the other. As her breath became ragged, she opened her eyes and looked hopefully across her bump at Missy. ‘Anything?’
‘Slowly,’ Missy said, her eyes still fixed between Eleanor’s legs. With every push, Missy would need to give an equal pull. ‘Go again.’
The hormone drip was running at 60 millilitres per hour, its highest safe level, and as it pulsed into Eleanor’s veins, a mighty surge rolled through her abdomen. ‘Again, Eleanor!’ I called to her. Her eyes were closed once more, and she pushed. There was silence in the room; a still fissure in time.
And then came a gurgle, like a spring bubbling up suddenly from the soil, and then a gasp and then a cry. In a slippery flash of pink, with hardly a pause between head, shoulders and body, the baby rocketed out into Missy’s hands, and then into mine. I passed this wet, screaming thing onto Eleanor’s chest, and the paed started rubbing it with a warm towel, and Caroline was laughing, and Eleanor and Liz were looking at each other, crying, aghast, amazed. I lifted an edge of the towel and then one of the baby’s tiny, wrinkle-toed feet. ‘It’s a boy,’ I said. ‘Happy birthday, baby.’ 06.07, I noted silently. Ventouse delivery of live male infant, cried at birth.
Eleanor broke her gaze from Liz and looked down at their boy, seeing him for the first time, taking in every inch of his slick, fat little body: his shoulders, daubed with vernix; his downy blonde hair, still wet with streaks of liquor that smelled of rock pools and bracken. This was the woman who should never have been pregnant, whose love was still named in whispers, whose wife was a walking miracle of modern medicine, whose baby was a dazzling feat of reproductive science. Eleanor kissed the top of her baby boy’s head, and she smiled.
Notes on Children Having Children
‘Lock her up. It’s the only contraception you can trust’.
This was the advice ruefully given to me by Bridget, a woman whose fifteen-year-old daughter, Shannon, had just arrived at the hospital in early labour. I knelt by the bed and watched Shannon writhe with the fresh horror of each contraction as it rippled through her size-zero frame, every surge seeming to catch her by surprise. Could this one possibly hurt as much as the last? her face seemed to say. Will it ever stop? Yes, was the answer. And also, blessedly, yes. Her labour was fast, as often seems to be the case for the youngest mothers, and two hours later she gave birth to her own little girl, clutching Bridget’s hand the whole time and crying for her mum even as the baby latched onto her breast.
Many reports in recent years have highlighted the increasing number of older women having babies: ‘elderly primigravidas’, as medics cruelly used to call them, conjuring images of fetuses springing forth from dusty, wrinkled wombs. Although there’s no denying that the average age of the pregnant population is climbing slowly skywards, there are also still thousands of women giving birth every year who are, well, children. Some, like Shannon, conceive after only their second or third fumbling attempt at sex. Others, Shannon’s age or younger, make up a small but growing group whose bulging bellies are the by-products of trafficking and abuse.
Whatever the context, looking after such young women has always struck me as a unique challenge. On the one hand, as the mother of two girls, teenagers send my protective impulses into overdrive and my urge to shield them from pain, upset and the multiple cruelties that the world inflicts on women becomes almost irrationally strong, even if some of these girls are already more streetwise and battle-hardened than I will ever be. On the other hand, the very examinations and procedures that I need to perform in order to do my job can become deeply uncomfortable where young girls are involved. How do you explain a vaginal examination to a fourteen-year-old who’s never had a smear test or more than a handful of periods, and who’s certainly never been touched ‘down there’ by someone she could trust? Does it feel right to inject pain-relieving diamorphine – which, to be blunt, is simply medical-grade heroin – into the skinny thigh of a teenager whose body is the same size and shape as your child’s, even if she’s begging and screaming for you to ‘just give me the jag already’? When children have children, the midwife needs to ask herself a hundred tricky questions and, even after countless Shannons, there are no easy answers.
Crystal: Twenty-three Weeks and Three Days
I was in the middle of writing myself a thank-you card when Crystal arrived on the ward. Lest you think I’m some kind of egomaniac who needs to write herself a congratulatory note every time she empties a bedpan, please allow me to explain.
I was sitting by the bedside of Mrs Bhatti, a Bangladeshi woman who was thirty-seven weeks pregnant with her fifth child, and who was about to be discharged from the ward following a two-week admission with a kidney infection. Although I was just filling a staff shortfall that day and had never met this particular patient before that morning’s handover, I was lucky enough to bear the full force of her gratitude. She was packing up when I drew back her curtain, attempting to fit fourteen days’ worth of pyjamas, toiletries and assorted packs of fragrant snacks into a large zebra-print suitcase. Wearing a lime-green Adidas hoodie over a brilliant orange shalwar kameez, Mrs Bhatti almost appeared to glow as she moved around the bed, an effect which was only heightened when she turned to greet me with a broad, gap-toothed smile.
‘Good morning, dear,’ she said, clutching one of my hands with both of hers. Her grip was surprisingly strong, her hands warm and dry around mine. ‘You help me now,’ she commanded brightly.
‘I’d love to help you, Mrs Bhatti,’ I said, ‘but I actually just need to give you your discharge paperwork, and then you can go home to your family. Is somebody coming to collect you?’
She drew close to me and put her palms on my cheeks, her eyebrows furrowing into a solid black line as the smile fell from her face. ‘You help me now,’ she repeated, more urgently this time.
I laughed nervously, wondering what kind of assistance this woman could need so desperately. Was she still in pain? Or in their keen focus on treating her illness, had the ward staff overlooked some kind of terrible personal predicament? I began to do a mental inventory of the many and varied disasters that women had disclosed to me over the years during hushed bedside chats such as this, before Mrs Bhatti’s vice-like grip on my chin brought me back into the moment.
‘You help me now.’
‘Yes,’ I intoned, bracing myself stoically for whatever chilling secrets she might be about to share. ‘I will help you now. Tell me what you need, Mrs Bhatti.’
‘You write thank-you card,’ she said. Her face creased back into that brilliant smile, and she released me, clapping her hands with delight and chuckling mischievously as I blushed at my misguided concern. She didn’t need saving; she’d seen the earnest do-gooder in me and called my bluff to great effect.
‘Ooooh,’ I said, laughing breezily as if I’d been in on the joke all along. ‘Of course. Yes. I’ll help you write a card. Who is it for?’
Mrs Bhatti rummaged through a pile of magazines at the foot of the bed and brought forth a card with a cartoonish picture of two ducks hugging on the front, their wings wrapped tightly around each other, tiny red love hearts dancing above their beaks. She passed me the card, opened it and pointed to the inscription: Quack you very much. ‘It is a card for staff,’ she said. ‘For you.’
‘For me? But I’m only working here today to cover a staff shortage. All the other midwives have been looking after you for two weeks. It’s very kind, but …’ Mrs Bhatti’s hand clasped my shoulder and pressed me down into the chair at her bedside in one swift motion. At five foot nothing, she hardly towere
d over me, but her presence was powerful.
‘You write the card, dear. You say thank you.’
‘You want me to write a thank-you card … to me?’
‘My English is not good, dear. What shall we say? You write now,’ she said, and pointed again to the card, and then to the selection of pens in my tunic pocket.
So I sat dutifully with a pen poised in mid-air, searching for the words that would adequately express my overwhelming gratitude to myself. Mrs Bhatti grinned and nodded her approval as I put pen to paper.
‘Dear Leah,’ I said out loud as I wrote, ‘thank you so much for all of your hard work,’ and sensing that she was expecting a little more than a casual one-liner, I drew a smiley face, a love heart, and three kisses below. I tucked the card into its envelope and passed it to Mrs Bhatti, who then passed it back to me and gestured for me to open it. To complete the pantomime, I slipped open the envelope as if I had no idea of its contents, took an appropriate amount of time to read the inscription and tried to look suitably surprised, touched and humbled.
‘Thank you, Mrs Bhatti.’
‘Thank you, dear.’
‘Thanks so much.’
‘Thank you, dear.’
She put her arms around me and drew me in to her soft little body and, in return, I patted her gently between the small, bony wings of her shoulder blades, the way one might comfort an elderly aunt who couldn’t remember where she’d put her specs. As she squeezed me even tighter, I relaxed into her embrace, morning sunshine spilling over us from her bedside window. I felt that I could quite happily stay there for the rest of my shift, thanking and being thanked, breathing in the warm, sweet scent of Mrs Bhatti’s hair.
