by Leah Hazard
I moved swiftly across the floor and put an arm around Crystal’s shoulders, shuffling her back towards the bed. ‘Let’s get you lying down on your side,’ I said, taking care over every word, hoping my voice wouldn’t betray the panic that had fluttered in my chest. ‘You can tell me what happened, and then we’ll get some help.’
‘I was just opening the windows,’ she said as I eased her down onto the mattress. I drew the blue thermal blanket up under Crystal’s chin; the cheap waffle-weave flickered with static, as it always did, and we both flinched. ‘I was going to have a cheeky fag – you know, just the one – and I went to open the last window, and …’
‘And it started coming out?’
Crystal nodded in reply.
‘And does anything feel different now? Are you sore?’
‘Aye, nurse,’ she said. ‘I feel like I need to do a giant jobbie, but it’s not coming.’
Double shit. Rectal pressure is often a sign that there’s a baby sitting right down on your bowel, which is next door to your vagina, which for a twenty-three-week baby is a one-way route to trouble. I looked down at the fob watch pinned to my chest; ten minutes to seven. 18.50, I noted to myself. Copious Grade Two meconium draining per vaginam. And then, out loud, to Crystal, ‘Listen to me. You need to stay right here. Stay warm. I’m going to go and get the other midwife, and …’
At this, her eyes grew wide. ‘But my baby! What are they going to do to my baby?’
The honest answer was, I didn’t know. Crystal looked smaller than ever; her fear had made her recede into the pillows, diminishing her with every passing second. As words whirled and faltered in my head, I instinctively reached out to sweep the thick cloud of hair away from her face. These gestures – the drawing of the blanket, the reaching out – were automatic, had been practised many times with my own children in my own home. The curl of a small body under a quilt, the quiver of a frightened lip – these images triggered a response in me that required no thought or explanation. Comfort: this was what the mother in me had learned to provide long before midwifery had even entered my life, and this was the only thing I could reliably offer to Crystal at the moment when her world began to shatter.
‘I’m going to let the labour ward know that they’ll be seeing us soon,’ I said, my face close to Crystal’s, speaking as slowly and clearly as my nerves would allow. ‘If anything exciting happens, press your buzzer.’
Before I could be drawn into any further discussion or delay, I turned on my heel and raced back towards the desk, where June was finishing her day’s documentation.
‘The PPROM’s leaking meconium, and she’s got rectal pressure.’
June’s head whipped up; her eyes narrowed to jet-black beads. ‘What time do you call this for an emergency? There’s an ice-cold G&T waiting for me at home and there’s no way I’m staying late for the third bloody time this week.’
I sighed, and looked again at my fob watch. It was now eight minutes to seven, but every minute was critical, even during that foggy window at the end of a shift when the staff are still physically present but have mentally checked out, already planning their dinner (and ‘purely medicinal’ drinks) while they perform the last ministrations of the day.
‘I know, June,’ I said. ‘I’m sorry.’
In unison, we each picked up a telephone.
‘I’ll call labour suite, you call the paeds.’
I could hear June telling the emergency paediatric staff the bare bones of Crystal’s story. ‘Of course we’ve let labour ward know,’ June said, looking pointedly at me. The labour ward line was still ringing out. ‘We’re getting her up as soon as we can.’
Nobody was answering my call. Anything could be happening; there could be six emergencies going on at once, the staff could all be in theatre, the day-shift sister could be squeezing in a late break, kicking off her shoes and curling up with a steaming mug of tea while the night-shift sister surveyed the whiteboard in the bunker. My thoughts turned to the Resuscitaire at the back of the ward – I imagined Crystal’s scrawny baby gasping and flailing under the heat lamp as I scrambled in vain for a mouthpiece tiny enough to administer vital oxygen, and then I imagined myself losing my job for even attempting to resuscitate a twenty-three-weeker, and then I imagined how I would never forgive myself if I hadn’t even tried. In my relatively short career, I already knew midwives who had been investigated, suspended or sanctioned for less; the spectre of disciplinary action hovers at the edges of every midwife’s thoughts, taunting her most loudly in her weakest, darkest moments. The images in my mind grew more nightmarish with every unanswered ring of the phone. I could hear Crystal sobbing from her room. Pick up, pick up, pick up.
‘Labour ward sister,’ came a tired voice down the line.
I nearly collapsed with relief. ‘I’m on my way with a twenty-three and three PPROM, draining meconium, feeling rectal pressure. Paeds are aware.’ I slammed the phone down, not waiting for an answer.
June was already at Crystal’s bedside, where a pool of cloudy, algal fluid had begun to seep through Crystal’s pyjama bottoms and was spreading ominously over the sheets. She kicked up the footbrake at the bottom of the frame and we heaved the bed with Crystal on it out of the room, through the ward’s doors and out towards the lifts. June punched the lift button so hard I thought she would break it, while Crystal continued to wail.
‘Will they save my baby, nurse? Will they keep my baby alive? What will I aaaaaagggh …’ and she curled into a ball with a long, low grunt. June and I eyeballed each other across the bed as the lift finally creaked open. The journey up seemed to take hours, Crystal’s cries echoing around the metal box as it lurched and ground to a halt. The second the doors opened onto the top-floor foyer, we were already hurling the bed out, arms and shoulders aching, weaving through a cluster of day-shift staff who were making an early exit down the adjacent stairwell. ‘Excuse us, coming through,’ we called as we went. When you’re transferring a patient in an emergency, people always seem to move out of your way in painful slow-motion, with an almost comical lack of urgency, scarcely raising an eyebrow as you bounce the bed off corners and walls at breakneck speed.
Finally, the labour ward. June and I tapped our badges frantically off the keypad at its entrance and the double doors swung to the sides. The night-shift sister was waiting for us, along with two paediatricians and Soraya, whose dark eyes were blazing from beneath her hijab. Every face glared at me with an unmistakeable, unspoken message: It’s Your Fault. I knew it wasn’t – I had as much control over Crystal’s cervix as I do over global stock markets or El Niño – but in that moment, it felt as though I was the worst midwife ever, the bearer of bad news, of crisis and complication, of patients with misbehaving uteruses, inconveniently timed contractions, of cervixes that decide to spring open when they should be rosebud-tight. The staff glared at me with silent rage, as if I had presented them with a steaming turd, not a terrified child who was about to become a mother to a small, skinny thing that might or might not live beyond its first few desperate gasps. At the increasingly frequent times when the sheer volume of patients outstrips the number of available beds and midwives, the criteria for admission to the labour ward – that mecca of maternity – become impossibly (and often cruelly) narrow. Women who are contracting frequently but coping well may be dismissed by the notorious sister who expects all labourers to be – to use her charming expression – ‘rolling around like a beast’. In busy spells, uncomfortable pretermers can be viewed with suspicion until their tightenings are convincingly agonising, and woe betide the midwife who arrives at the labour ward doors at short notice, murmuring sweet nothings to her panicking patient even though she knows full well that there’s no room at the inn. I had encountered this hostile reception many times, but it never got any easier to accept or to hide from the women who thought they’d finally found – and earned – a place of comfort and safety.
Crystal might have been scared, but she wasn’t blind, and she qu
ickly clocked the expressions of those who had met her at the door. She rose up on the bed, flung her arms around my waist and cried, ‘What will they do? Will they save my baby? Is it too soon?’
Crystal’s hair had billowed back onto her face; again, I smoothed it away, and this time she tilted her cheek almost imperceptibly towards my palm, leaning into whatever last fragments of love I could offer. I had no answers to her questions and, even if I had, there was no time to give them. Midwives soon learn that it’s never a good idea to tell patients that everything will be OK, because the truth is that it might not be. Nature is cruel. The homespun wisdom that ‘babies come when they’re ready’ is a lie: babies come when they’re ready, and also when they’re not, and sometimes it’s OK, but sometimes it really, really isn’t. Hard experience teaches the midwife that only a fool would promise a happy ending every time.
Soraya grabbed the foot of the bed, the labour ward sister grabbed the top, and I felt Crystal’s arms slip away from my waist as they launched her towards the first available room. The double doors swung shut and I stood in the foyer, alone. I could hear the laughter of midwives down the stairs as they continued their evening exodus. ‘I told him to stop wasting his time,’ said a voice, and there was a chorus of gravelly cackles followed by the slam of a fire door, and then silence.
It was seven twenty-eight. June had trotted back towards the lift as soon as we had dispatched Crystal, and I knew she would be down in the ward already, expecting me to return and hand over the rest of my patients to the night staff, reporting on this one’s incoordinate contractions and that one’s penicillin allergy. I couldn’t face it. I felt as if one of my own children had been rushed to theatre, grabbing onto my heartstrings as she went; I could almost feel them pinging and snapping in my chest. I didn’t know if Crystal’s baby would survive, or even if the paediatric team would attempt what was casually referred to as ‘heroics’: intubation, cannulation, drugs and every possible intervention that might give a baby a chance of surviving for an hour, a day or even longer. So much depended on whether Crystal’s estimated due date was even correct to begin with – was she really just twenty-three weeks and three days, or five days or six? And on whether her baby came out in vigorous condition, and on whether the attending staff decided to stride boldly into the no-man’s land of the twenty-three-weeker or if they chose to hang back among the clear, comforting black-and-white guidelines of the law.
My head began to throb as I travelled down to the ground floor, trying (and failing) to avoid my haggard reflection in the lift’s mirrored interior. I let myself into the changing room, put my coat on over my uniform and slipped out of a side door into the car park. As I fumbled for my car keys, I felt a piece of thick paper in my pocket. I pulled it out. Two ducks hugging, with hearts above their heads. Mrs Bhatti’s card. I moved into a pool of light cast by one of the street lamps and peered down. Quack you very much, it read. Then, in my own handwriting, Thank you so much for all of your hard work.
The words were mine, the thought was Mrs Bhatti’s. Hot tears slid down my cheeks. I wasn’t due back at the hospital for another four days; four days of doing normal things, being Mum, making packed lunches and cooking dinners, and marking my day by dog walks and loads of laundry, shuttling from washer to drier instead of from bed to bed. Four days of wondering about Crystal and her baby – that small, scrawny sketch of a human. I slipped the card back into my pocket and began to search through the darkness for my car.
Notes on Paper Pants and Broken Dreams
The postnatal ward is a place where dreams are made and broken. You arrive on the ward with your precious cargo swaddled in layers of blankets like a mewling, cottony burrito. You’ve waited nine months to meet little Oliver or Maya or Mohammed or Kate, and in spite of the fact that your baby bears all of the less attractive hallmarks of labour (a remarkably cone-shaped head daubed with poo, blood or vernix – or a fragrant mixture of all three), you are 100 per cent convinced that this child is the Most Beautiful Cherub Ever to Grace the Planet. Your labour ward midwife shows you to your bed space – perhaps pushing you on a wheelchair with two suitcases and seven poly bags draped over its handles or birling you into position on an almost unmanoeuvrable bed whose brakes were last serviced in 1972, whanging you off every corner and doorway en route. (‘Learner driver!’ she laughs by way of an apology as you try to make yourself as compact and un-whangable as possible.) She gives you one last hug, tells you how amazing you are and chirps, ‘See you in two years!’ – which makes your perineum sting just thinking about it – before leaving you in the care of your postnatal midwife. Prior to your appearance on the ward, this woman with the strained smile and drooping ponytail has already done four discharges and two admissions, missed a break and now been asked to look after the mother of preterm twins in room eight whose babies are both on three-hourly observations and IV antibiotics. The exhaustion is written on her face as she checks your vital signs and hands you a sheaf of booklets about an overwhelming array of topics ranging from the prevention of cot death to car seats to breastfeeding and beyond, as well as a chart you are instructed to complete (black pen only, please) every time your little cherub feeds, vomits or graces its nappy with a slug of sticky poo. Unfortunately, you have arrived on the ward on a particularly busy afternoon. And although your midwife would genuinely love to help you feed your baby (now hungry, and thus transformed from a cooing angel to a screaming child of Satan), she is quickly interrupted by: 1) Patient A, who has been ‘nipping out for fresh air’ all day but suddenly seems to have lost the use of her limbs and wants the midwife to pick her used sanitary pads up off the floor; 2) Patient B, whose thumb appears to have become welded to her call button; and 3) Patient C’s husband, who finds it completely unacceptable that the staff are too busy to reheat his wife’s Happy Meal, and reminds the midwife in no uncertain terms that he is a Very Important Person with Impressive Medical Credentials. (NB: a quick flick through Patient C’s case notes reveals that Mr C is, in actual fact, the assistant manager of a dental surgery.)
Your midwife smiles weakly at you before excusing herself to see to these urgent demands, promising over her shoulder that she’ll be back before you know it. You smile lopsidedly in return as her stooped figure disappears behind the blue paper curtain and you pray that you have been charming enough during that brief interaction for your midwife to understand that you’re actually a very nice person, and you know how busy she is, and you really, really hope that when you do finally muster the nerve to press your own call button, she will respond with speed and goodwill and maybe, just maybe, an extra packet of those cheap shortbread biscuits that you only ever seem to get in hospitals. On the other side of the ward, your midwife notices that one of her patients is bleeding a little too much and as she reaches for the emergency buzzer she has a fleeting thought of you, and a pang of guilt, knowing that she probably won’t be able to get to your bedside again until this haemorrhage and the teatime drugs round and visiting time are over.
Outside your room, a trolley rumbles by on squeaking wheels, followed by a pungent waft of – could it be fish pie? Dinner has arrived somewhere on the ward, but finding it would be hard with legs still dense from the epidural you begged for early that morning. (Did you offer the handsome young anaesthetist some pretty creative favours in return for a denser block? It’s a distinct possibility and you blush at the memory.) Your stomach grumbles and you gingerly shift the weight of your baby from one arm to the other, leaving you with a free hand to rummage under the sheets for your buzzer, which you’ve now decided to press, just this once, very lightly, so as not to be a nuisance. As your hand grasps wildly under the bedsheets, it brushes against the vast paper pants that the labour ward midwife hoisted valiantly up your legs a few short hours ago and you remember the advice given to you in soothing tones by your mother last week at your baby shower, which now seems like it happened to another woman, in another life.
‘Don’t worry if things don’t go
the way you planned, dear,’ she had said. ‘At the end of the day, the only thing that matters is a healthy baby.’
This, of course, is a truism. The whole point of reproduction, biologically speaking, is to create healthy offspring. However, a baby’s journey to wellbeing doesn’t stop at delivery. In order to forge a cast-iron bond between mother and child, nature drugs women who have just given birth with a hormone that makes them feel warm and fuzzy, blissed out, loved up – the same hormone that started labour in the first place, that’s felt in the very first flashes of love and, in one super-condensed, mind-bending burst, in the throes of orgasm. Love, lust and contractions: all brought to you by none other than our sponsor, oxytocin.
By rights, then, the postnatal ward should be a shrine to oxytocin, a laid-back love shack where mother and baby can gaze at each other gooey-eyed for hours, with noise and distractions kept to a bare minimum. Unfortunately, as new mothers come to realise on so many levels, reality doesn’t always match up to the ideal. Postnatal care is often referred to as the ‘Cinderella’ sector of maternity services because, like the princess whose ball gown turns to rags at the stroke of midnight, much of the idealism and joy of a woman’s journey frequently seems to evaporate once the actual birth is over and done with. The mythical ‘glow’ of pregnancy is replaced by the nitty-gritty of throbbing ladyparts, leaking breasts and dirty nappies. Put Cinderella in an understaffed, underfunded maternity hospital, where she is one of many women whose silks have turned to sackcloth, and you begin to get the picture. The fairy dust of oxytocin is still there, scattered in tiny, sparkling clumps over bedpans and breast pumps, but it’s no match for the hulking, grinding gears of the maternity machine.
