Hard Pushed

by Leah Hazard

  There are, of course, exceptions to that depressing rule. Sometimes Cinderella does go to the ball and sometimes it is still possible for the postnatal ward to provide the kind of cocoon that women deserve. Every once in a great while, when the stars are aligned, and the birth rate slows to a manageable stride and the wards themselves seem to breathe an audible sigh of relief, it looks a little bit like this:

  You arrive just after midnight, your wheelchair gliding down darkened corridors, past dimly lit bays of sleeping women and their infants, until you reach – you can hardly believe your eyes – a private room. The bedside lamp is turned to the wall, casting a soft, cosy glow over the bed, with its crisp white sheets turned back invitingly, and the waiting cot sits nearby, its drawers fully stocked with fluffy towels and miniature clouds of cotton wool. On the far wall, a window looks out onto the darkness beyond the hospital, city lights twinkling faintly in the distance, and you are overwhelmed by a rush of gratitude for this warm, safe place, this little pod which seems to have been magicked up especially for this moment, for you and the adorable, sweetly scented baby in your arms. ‘Welcome to the ward,’ says a gentle voice behind you, and as you rise slowly out of the wheelchair, child still clutched to your chest, you turn to see the smiling, blue-tunicked postnatal midwife who will be your guardian angel for the night. She moves to help you lay your baby gently in the cot, cradling his head with the lightest touch, and as she does so, you catch her warm scent of perfume and sweet tea. You don’t know it, but your midwife has had one of those rare nights when she’s had only a handful of patients and she’s been able to stop a while at each bedside, chatting and soothing with an unpushed ease that makes her heart sing. She’s even had a proper break, instead of the usual rushed tea-and-biscuit over a pile of case notes: tonight, she’s had a chance to sit in the office with the other night staff, admiring the photos of this one’s grandchildren, stifling laughter at that one’s filthy jokes, and taking time to pick all of the coffee creams from the boxes of chocolates left by the day shift’s discharged patients. By the time you’ve arrived on the ward, she’s been reminded of a feeling she hasn’t had in a long while: the feeling that she’s actually good at her job when she gets the time and the space to do it properly, and that it’s about so, so much more than healthy babies alone.

  Olivia: Mother Knows Best

  It was my first of three day shifts on the postnatal ward, and by the time it came to the afternoon drugs round, the Fat Bastards Club had already taken its toll. As I heaved the trolley full of medicines from room to room, my legs seemed to trail heavily behind me, trainers dragging along the linoleum floor in protest.

  Terri, one of the ward’s auxiliaries, had started the club at the end of the summer. Shocked by the sudden expanse of her waistline after consuming slightly more than her fair share of barbequed meats and beer-garden tipples, Terri had sat at the desk at 2 a.m. one night and opened a fresh spiral-bound notepad with a flourish. Fat Bastards Club, she had written at the top of the first page and, underneath it, her own credentials in proud print: Terri, 13 stone 6 pounds, September 4. Within the week, she had persuaded every other staff member in the ward to add their names and weights to the list and devised an on-the-job fitness routine which we were all instructed, in no uncertain terms, to follow. Whenever we had a break or a rare quiet spell on the ward, we were to climb up and down the hospital’s five flights of stairs at least three times. Between making beds and doing the tea round, Terri took great delight in checking on her colleagues’ progress. You could be in the drug prep room, tapping the bubbles out of a syringe of antibiotics, and Terri’s grinning face would appear around the door frame.

  ‘You been doing your stairs?’ she would ask, and if the answer was anything but a resounding yes, she would put a black mark next to your name in the Fat Bastards Club notebook and personally corral you into a stair-climbing session. At first, there were a few resistant folk – those who had tried to ‘be good’ over the summer or who were already diehard members of Slimming World, Weight Watchers or one of the many diet clubs that midwives seem to flock to with varying degrees of success – but we all followed Terri’s orders in the end. Not only was she a five-foot-one, thirteen-stone whirlwind of persuasion, but as midwives, we seemed to take naturally to the futile routine of climbing the stairs to the storerooms on the top floor, only to climb back down and start again. We were already accustomed to working ourselves into a state of semi-comatose exhaustion every day, only to return in the morning and repeat the process with a completely fresh batch of patients. For every catheter emptied, there was another bag waiting to be filled up with pungent, postnatal urine; for every woman discharged, there were five more waiting to be admitted. Thus, as early autumn cast a subtle chill over the hospital, it became the norm to find midwives marching in pairs up and down the stairs at two o’clock in the morning, or half past four in the afternoon, or whenever the shift’s workload had eased up enough for us to do our duty as repentant Fat Bastards.

  Terri came to find me that day as I was returning the drugs trolley to its home, safely tethered to a locked shackle on the wall of the prep room. My drawstring trousers had only needed a little loosening after the indulgence of the summer holidays, but I had been doing the stairs with unquestioning obedience on every shift.

  ‘Done them already today,’ I said to Terri when she appeared in the doorway, before she even had the chance to question me. ‘My legs are agony.’

  ‘Good girl,’ Terri replied, approvingly. ‘But I’ve just come to tell you that the hospital coordinator’s been on the phone. She wants to put someone into room eight – prim, emergency section, coming up on a bed. I’ll clear a space.’ She disappeared for a moment before popping her face back round the doorway. ‘Weigh-in tomorrow, by the way. The girls in Outpatients are going to let us borrow their scales.’ She grinned and darted off again, battered Reeboks squeaking towards room eight as she went.

  I began to assemble the bits and pieces I would need for my admission: a jug of fresh water, a clean cot, a small metal stand on which to hang the catheter bag that any post-Caesarean patient was bound to have. I paused next to the stacks of leaflets by the filing cabinet in the staff base: there was one set for breastfeeders and another for bottle-feeders, but I didn’t know which ones this new mother would need. It was a cardinal sin to give a bottle-feeder the breastfeeding pamphlets (this gaffe would confirm any midwife’s status as a fully fledged member of the mythical, much-maligned ‘Breastfeeding Gestapo’, thus stirring the patient into a frenzy of guilt or anger) and it was virtually a sackable offence to give the bottle-feeding booklets to a breastfeeder, so keen was our ward on the promotion of the Boob for any mother minded to try it.

  When she was wheeled onto the ward twenty minutes later, Olivia was little more than a frazzled husk tucked among a tangle of sheets and drips; she had laboured for nearly thirty-six hours and reached full dilatation, only for her baby (who was now crying lustily in her arms) to become distressed and in need of immediate delivery. Her face was milky pale and her strawberry-blonde hair lay in limp strands across her pillow. She barely had the energy to lift her head and peer at the noisy bundle in her arms. A bag of IV fluids trickled into a cannula on Olivia’s left hand, a coil of catheter tubing snaked round her legs in a golden snarl at the bottom of the bed, and a quick peek under the sheets revealed a wodge of hastily folded bed mats jammed between her legs to soak up her postnatal bleeding. In short, Olivia was typical of so many of the patients who arrived on the ward, and she reminded me very much of my younger self after the birth of my first daughter. I had been so zonked by blood loss and fatigue that when my cannula finally fell out on day four, I begged the midwives to put it back in so that I could keep mainlining the morphine that had been keeping me in a comfortably numb fog since delivery. To this day, I have never met another woman who actually wanted her IV replaced; most patients are delighted to be rid of that niggly little tube in their vein.

  ‘
Welcome to the ward,’ I said, bustling around Olivia, doing my usual sequence of baseline observations. Her husband Paul attempted to shuffle out of my way as I moved alongside the bed, but between the bedside cabinet, the chair, Olivia’s suitcases, the cot and the bed itself, there was barely enough space for all of us within the curtained bay. Paul and I blushed and murmured awkward apologies as we danced around each other, and through it all, the baby screamed an increasingly urgent crescendo.

  ‘Should I feed her, do you think?’ Olivia asked weakly. ‘She had something downstairs, but it wasn’t much.’

  The baby’s face was beetroot with rage and hunger; it was time for the million-dollar question. ‘Are you breast- or bottle-feeding?’ I asked breezily, hoping my tone was neutral enough not to betray any bias. It’s one of the most loaded questions a midwife can ask her patient, right up there with ‘What are your thoughts about pain relief?’ and ‘Do you smoke?’ As someone who formula-fed one baby after a painful, guilt-ridden struggle with breastfeeding, then breastfed another child for over two years with almost unbelievable ease, I have no personal agenda other than a desire to facilitate whatever choice a woman wants to make. Yes, current evidence confirms that the breast is undeniably best for the health of both mother and baby, but a woman’s preference – and whether it really is ‘best’ for her and her child – is influenced by a myriad of factors, not all of them tangible or easily explained, and many of which will remain unknown to her midwife. I’ve never been one to enter into this debate with a patient who, more often than not, has made up her mind many months before she arrives in my care. Woman chooses, baby’s belly is full. No questions asked, no judgement made. Job done.

  Olivia peered up at Paul, who was now wedged beside the head of the bed. It was a look I recognised well: both a question and a request for forgiveness.

  ‘Well, we were going to breastfeed –’ my teeth clenched at the ‘we’; much as parenting can be a joint enterprise, lactation is pretty exclusively a female occupation – ‘but I’m just so tired, I think I’ll give her a bottle,’ Olivia said, sighing. She lifted up her free, non-cannulated hand to stroke her baby’s cheek and then looked up at me, adding apologetically, ‘If it’s OK with you.’

  I smiled down at her from my position at the foot of the bed. ‘Whatever you want to do is fine by me,’ I said. Olivia looked surprised, and then relieved. Even her shoulders seemed to drop incrementally; her whole body had been bracing itself for my disapproval. It saddened me to think that Olivia had prepared herself for a battle, even after everything else her battered body had been through, but again, this was a response I knew well.

  ‘Thanks,’ Paul added. He pushed a stray hair back from Olivia’s chalk-white face. ‘It’s just that I work on the rigs and I’ve already been off for two weeks, so I have to head up to Aberdeen tomorrow morning, and then back out. Olivia’s mum will be here to help, but we need to do whatever’s easiest.’ He squeezed Olivia’s arm. ‘I had no idea that birth could be like that – all those hours of labour, and then major surgery. I think I’m still in shock.’

  ‘You and me both, pal,’ Olivia replied.

  I nodded in sympathy. ‘What kind of milk would you like?’ I asked, and then listed the three brands of formula we had on the ward. ‘I can’t really say which one is best, it’s up to you.’

  ‘Surprise me,’ Olivia said, as she busied herself with adjusting the pink woolly hat on her baby’s head, and just like that, her choice was made. I hurried off to the room where the formula was kept, rather disingenuously, in a cupboard labelled Breastfeeding Supplies, and returned with the first bottle of milk I had seen on the shelf. By this time, Paul was sitting in the chair at Olivia’s bedside with the baby in his arms; he took the bottle from me and the baby’s cries settled almost instantly into grateful snuffles as he nudged the teat between her lips. Outside the curtain, the usual crowd of evening visitors had begun to file noisily into the ward, but Olivia was oblivious: exhaustion swept over her in a wave. As her baby slurped and gurgled happily at her side, Olivia’s eyes drooped shut, her jaw slackened and her body sank into a deep, dreamless sleep.

  My own sleep that night was a restless one. All of the characters in the ward’s daily dramas came to life as my mind digested the shift – their roles swapped to absurd effect and their dialogue twisted into an incomprehensible babble. In my dreams, midwives ran down endless corridors towards some far-off emergency, and no matter how many times I consulted the folded to-do list in my tunic pocket, my dream-self spent the night fretting over missed medications, crying babies and patients whose call buttons set off loud, clanging alarm bells instead of the usual droning buzz.

  By the time I arrived on the ward the next day, I was little more than a sleepwalker in uniform. As I attempted to fix my bed-blasted hair in the mirror of the staff toilets, I reflected that I must have woken up, dressed, had breakfast and driven myself to the hospital, but I could barely remember any of it. Nerys, another midwife on the day shift, recognised my Groundhog Day glaze when she came into the room: ‘Same old shit, different shovel,’ she said, squeezing my arm. Our reflections grinned ruefully back at us in the mirror.

  The day’s first coffee began to drip its jittery energy into my veins as I walked the ward, checking on the patients I knew and introducing myself to those who had been admitted overnight. As I came to Olivia’s room, I could hear her speaking in low, urgent conversation with another woman whose voice I didn’t recognise.

  ‘Just let me try it like this, Mum,’ Olivia was saying.

  ‘I don’t think you’re doing it right, dear. If you just move your hands a hair’s breadth this way …’

  There was the sound of a minor scuffle, and a baby’s frustrated yowl.

  ‘Mum, just let me …’

  ‘If you’d only let me help, Olivia. You’ve always been a bit ham-fisted.’

  The voices stopped as soon as I drew back the curtain to find Olivia and her mother frozen in a furious, mute tableau, like squabbling toddlers caught fighting over a coveted toy; only in this case, the object of their tug-of-war was a baby who was very much alive, furiously darting its tongue around in hungry protest. To my surprise, the baby was scrabbling at Olivia’s bare breasts; her pink flannelette pyjama top lay wide open and tiny globules of milk hung from each of her nipples. This was a stark contrast to her mother, whose sudden, fixed grin at my arrival was as steely as the grey, kirby-gripped bun on the top of her head, and whose own pink cashmere cardigan was tightly buttoned right up to the string of pearls around her neck.

  ‘Ah, there she is,’ said Olivia’s mother, cooing in mock delight, clasping her hands together. ‘The wonderful nurse that my daughter’s been telling me all about.’

  ‘Midwife, actually,’ I said, matching her tone. I had the measure of this woman. I flashed her a smile, quick but every bit as steely as her own, and turned to her daughter. ‘How are you this morning, Olivia?’ I asked, pointedly.

  Olivia returned a wan smile and hoisted the baby, who had been dressed in a blush-pink Babygro and matching hat, closer to her chest. ‘I’m fine, thanks,’ she said. ‘My mum’s spending the day with me because Paul’s headed back to work.’

  ‘Only the day, mind you,’ her mother chimed. ‘I can’t leave Olivia’s father for too long, nurse. You know what these men are like when left to their own devices.’ She gave a conspiratorial wink. ‘He hardly knows the microwave from the Hoover, poor thing. My fault, of course. I do spoil him terribly.’

  I gave her another fleeting smile and turned back to Olivia. ‘How was your night?’

  ‘Well, I was pretty sore,’ she began, ‘so I think I was up for most of it …’

  ‘Yes, well, that’s the way with these Caesars,’ Olivia’s mother added, using the antiquated shorthand for a Caesarean section. ‘So much harder than giving birth the right way.’ I raised an eyebrow and Olivia’s cheeks blushed scarlet as she looked down at her baby in silent rage, but her mother ploughed on. ‘But Livvy
’s going to do the right thing now, aren’t you, darling? So from here on, we’re breastfeeding.’

  By this point, both of my eyebrows were raised, and in spite of my desire to remain unruffled under the scrutiny of Olivia’s mother, I could barely conceal my surprise. ‘We’re … you’re breastfeeding?’ I asked Olivia, trying to keep my voice steady.

  She raised her head and tossed her hair over her shoulder. It had been brushed to a fine gloss, I noticed, and Olivia had even put on some lipstick and blusher, no doubt in an attempt to make herself ‘presentable’ for her esteemed visitor.

  ‘Yes, I’m breastfeeding,’ she confirmed. ‘Mum’s been … helping me. But I can’t get Rosie to latch,’ she said, looking down again at the baby who was now pawing at her breast with increasingly frantic desperation. ‘I don’t know what I’m doing wrong.’

  ‘That’s fine,’ I said. Olivia’s mother sat back with a satisfied smile. This was a scenario I had encountered many times: a new mother whose baby has already feasted on numerous bottles of formula deciding after a day, or sometimes two or three, that she would like to breastfeed; sometimes it is a genuinely autonomous decision, but more often than not, the choice is influenced by well-meaning but insidiously passive-aggressive comments from visiting friends and family. It is difficult, but not impossible, to breastfeed after the first day or two of lactation have been missed: babies can still squeeze into that precious window of opportunity when their mother’s milk-producing hormones are at their highest, but it takes persistence, a commitment to frequent feeding attempts and a willingness to forgo anything resembling normal sleeping patterns until the process is well established. Watching Olivia’s baby grasping furious handfuls of her mother’s pyjamas, her mouth rooting wildly from left to right but missing the nipple on every pass, I knew we had a long day ahead of us.