Hard Pushed

by Leah Hazard

  ‘Let’s begin at the beginning,’ I said to Olivia. ‘Is it OK if I squeeze onto the edge of your bed here?’ Olivia nodded her assent. Officially, sitting anywhere on a patient’s bed is a big Infection Control no-no: who knows what treacherous germs could be lurking on the navy-blue seat of your uniform trousers? However, many a postnatal midwife has sent her back into agonising spasms by leaning precariously over a bedside while attempting to crowbar a patient’s breast into her baby’s mouth. The goal is admirable, but the process bears more than a passing resemblance to the ‘stress positions’ notoriously used in modern-day torture; it is so much easier, and more companionable, to sit next to your patient. And so I perched a grateful buttock on the edge of Olivia’s bed and gently moved her baby into a safe, secure hold for breastfeeding.

  ‘Tummy to tummy, nose to nipple,’ I began, reciting the incantation drilled into every midwife at lactation workshops up and down the land. ‘Nice wide mouth, chin tucked under, that’s it, pop Rosie’s hands out of the way so she doesn’t push herself off the breast …’ I kept my smile fixed across my cheeks as Olivia fumbled gamely with her baby under her mother’s frosty gaze.

  Current trends in midwifery dictate that we’re supposed to be ‘hands-off’ when helping new mums breastfeed. If a midwife puts the baby to the breast herself, instead of allowing the process to happen spontaneously, this ‘interference’ is said to undermine the mother’s confidence. Videos in antenatal classes show newborn babies placed on their mum’s abdomen crawling miraculously up to the breast, then locating and latching onto the nipple with the accuracy of a chubby-cheeked guided missile. The reality is often somewhat different, leading women to spend tearful hours wondering why their little Jack or Jamal doesn’t do what the baby in the movie did, and leading midwives to spend those same hours sitting on their hands at the bedside, grinning away like demented Cheshire cats while fighting the overwhelming urge to grasp the poor child and latch it to the boob in one fell swoop. So it began with Olivia. I sat with her for half an hour, suggesting a little adjustment here or a tweak there, folding a pillow under her left arm and propping another two behind her shoulders, willing little Rosie to locate the nipple and delight in the rich, creamy colostrum that was trickling temptingly just out of reach, until finally, Rosie’s flailing attempts exhausted her so much that she fell asleep in her mother’s arms. Olivia sat back dejectedly on her throne of pillows, defeated.

  ‘I don’t know if this is going to work,’ Olivia said as Rosie’s head lolled heavily in her arms. ‘I just can’t seem to do it.’

  Olivia’s mother patted her arm. ‘There, there, darling. All the best things are worth waiting for,’ she replied, her voice dripping with saccharine sympathy. ‘I’m sure the nurse will be happy to spend the day helping you. What could possibly be more important than getting this right?’

  I bit my tongue so hard that I wondered whether blood would actually start to trickle down my chin and onto my uniform; the stains on my tunic would require some explanation to the ward sister at the midday huddle. Of course I was happy to help Olivia breastfeed if that was really what she wanted, and of course I knew that success was a definite possibility with the right amount of guidance. But this woman’s butter-wouldn’t-melt attitude was seriously beginning to grate on me, never mind her insistence on calling me ‘nurse’, which I was starting to think was intentional. Add to this the fact that the ward was heaving – we had been told to open up extra beds to accommodate a spike in deliveries, and my colleagues were already well into their morning workloads – and I was sure that with all the will in the world, I wouldn’t be able to give Olivia the kid-gloved time and effort that her mother was expecting.

  ‘Of course I’d be delighted to do everything I can to help you breastfeed,’ I intoned. ‘The best thing you can do now is keep little Rosie skin-to-skin, so she can smell all that delicious milk, and then if she does start looking for a feed again, she’ll be in the right place at the right time.’ This suggestion seemed to satisfy Olivia and her mother, and with a squeaky turn of my heel, I dashed off to begin my long-overdue drugs round.

  As the day went on, I did my best to return to Olivia as frequently as I could. Some of these bedside visits were spontaneous, and some were prompted by Olivia’s mother pressing the call button every time her granddaughter’s mouth drifted within close proximity of a nipple. Each time the buzzer went, I hurried through what I was doing – applying a pressure dressing to a leaky wound or taking out a cannula – and bustled along to Olivia’s bed space, only to find Rosie asleep or grizzling through her first poo or pushing her mother’s breast away with clenched, angry fists. At each visit, Olivia was on the brink of tears with ever-increasing frustration, while her mother marvelled at the fact that Rosie was not, shockingly enough, the world’s best breastfeeder. Each time this happened, I suggested subtle changes to Olivia’s positioning, becoming increasingly hands-on with every attempt until I finally took hold of the back of Rosie’s shoulders myself, brushed her lips across Olivia’s breast and moved her to the nipple with lightning speed when she finally opened her mouth wide enough to latch well. One suck, two sucks – and then Rosie grimaced, twisted her face away and fell asleep.

  Olivia’s mother observed these attempts with a knitted brow and a mouth that was pursed into a disapproving moue. ‘I mean, I don’t know what the issue is,’ she said as I answered the buzzer for the umpteenth time. It was nearly six o’clock, and the air was heavy with the mingled odour of sweaty women and hospital dinners. ‘Rosie’s such a darling little thing, but poor Livvy can’t seem to get the hang of it.’

  I looked at Olivia. She had barely moved from the bed all day: her glossy hair was now frizzed with the heat of the ward, her make-up had begun to slide down her bloodless cheeks and even her breasts appeared to droop languidly between the open lapels of her pink pyjamas. This was a woman on the brink of a breakdown, and in her arms – squalling, squawking, downright pissed off – was a very hungry baby.

  ‘Olivia,’ I began, hoping the tone of my voice was just frank enough to initiate some plain-talking between us. ‘What do you want to do?’

  ‘She wants to breastfeed, of course!’ replied her mother. I shot her a look: a cold, concentrated laser beam of midwife attitude. I didn’t want to enter into a debate with her about her daughter’s preferred feeding choices or the rights-or-wrongs of any of it. I knew that once I started, I wouldn’t be able to stop. Not only that, I would probably allow my carefully crafted mask of calmness to slip, so strongly did I feel about Olivia’s right to make her own decisions, and to deliver and feed her baby whatever the hell way she wanted to, or could.

  ‘Olivia,’ I repeated, ignoring her mother’s interjection. ‘What do you want to do? Whatever it is, I’ll do everything I can to help you, but it has to be your call.’

  Olivia looked up at me. Silently but steadily, streams of hot tears began to pour down her cheeks. There was no sobbing, no tearing of hair. She was too exhausted even for that. A long, futile labour, major abdominal surgery, three hours of sleep and the best part of a day’s worth of jamming her breasts into her baby’s angry, unyielding mouth had left Olivia completely and utterly spent.

  ‘I do want to breastfeed,’ she said, as the tears reached her jawline and trickled down her neck. ‘I know Rosie’s hungry. I’ve tried so hard. I just – I don’t know what to do.’

  I knelt down by Olivia, on the opposite side from her mother. ‘Hey,’ I said. ‘We’ll get this milk into your baby’s tummy. It’s OK if she’s not latching right now. The main thing is that she gets fed. Do you know about hand-expressing?’

  ‘You mean, milking myself? Like a cow?’

  ‘Well, yes and no …’ I replied. ‘It might be a bit too soon to get you on the breast pump, but I can show you how to express the milk yourself into a pot, and then we can give it to Rosie in a little syringe. It takes a bit of getting used to, but it doesn’t hurt.’ I began flipping through the breastfeeding bookle
t I had left with Olivia, looking for the relevant illustrations.

  On the other side of the bed, Olivia’s mother clutched at her pearls in disgust. ‘Really, now, there’s no need for that kind of thing, is there? It’s just so … crude.’

  ‘It’s the best way to keep the breasts stimulated for now,’ I said, looking her dead in the eye. And then, to Olivia, ‘Let’s have a go.’

  While Olivia’s mother held Rosie (and very pointedly averted her eyes from the bed), I leaned over Olivia and talked her through the basic steps of hand-expressing, showing her how to grasp a handful of breast tissue and with long, steady squeezes, drizzle her milk into a sterile gallipot. The longer I held that awkward position, the more my hips and the backs of my thighs began to ache, compounded by the stair-climbing I’d squeezed in during my lunch break, in service to the Fat Bastards Club. It was worth the effort, though: within minutes, Olivia had mastered the technique and was squeezing jets of colostrum with one hand into the little tub she held in the other.

  ‘Brilliant!’ I said, slowly standing upright and feeling every vertebra in my spine stiffen as I did so. It was now almost seven o’clock, time to catch up with the day’s documentation, write my part of the ward’s evening report and do a quick walk-round to check that none of my other patients had fallen ill, had a nervous breakdown or absconded before I clocked off for the day. ‘You’ve got loads of milk. Rosie’s going to have a three-course meal,’ I said as I tried to reverse discreetly out of the bed space. I took one last look as I backed away: Olivia, grappling bravely with her breasts as tears continued to slide down her face. Her mother, holding Rosie in a white-knuckled grip, pretending to study the abstract print of the curtain fabric while Olivia tried and tried to please them both. It was an image that returned to me as I drove home that evening, and again when I woke at two in the morning, unable to sleep. Olivia had stirred something in me, and as I lay there in the dark, counting the hours until the start of my third and final shift of the week, I shuddered with the memory of those early days of motherhood: the brain fog brought on by the relentless sleep deprivation and searing interludes of pain; the sudden and overwhelming rush of love for the baby, along with the dawning realisation that you will never, ever be able to do everything completely right for this child, no matter how hard you try. There is joy, yes, in that twilight haze of parenting, but underneath it all hums the guilt that drones at varying volumes through every woman’s journey: I first heard that hum years ago as I lay in the hospital bed nursing a baby and a wound, and I heard it still as I slept fitfully that night in between shifts, wondering if I had done enough for Olivia and whether I would find her better – or broken – in the morning.

  As it happened, when I drew back the curtain at the start of that third shift, I had to wonder whether the woman packing her bag with brisk efficiency was the same one who had nearly dissolved in a hot puddle of milk and tears the day before. Olivia was dressed, for one thing: the pink pyjamas had been replaced by a stylish jumper, skinny jeans and spotless white trainers. Her hair was slicked back in a high ponytail, and with a fresh shade of fuchsia lipstick, Olivia looked bright, healthy and put together. The scene was also notable for its lack of crying: at the bedside, Rosie lay serenely in her cot, wearing a lemon yellow sleepsuit with matching hat and mitts. What spoke loudest to me, though, was the empty chair in the corner: Olivia’s mother was absent.

  ‘Morning, Olivia!’ I called from the foot of the bed. Olivia paused her packing and when she turned to face me, I could see that her eyes were tired, but there was a gentle softness to her features that had been missing among the previous day’s dramas. ‘Getting ready to go home?’

  ‘Yes,’ she said, and smiled. ‘I finally managed to latch Rosie on overnight, and she’s fed a few times already this morning. She kind of came on and off a bit, but we’re getting there.’

  ‘That’s fantastic,’ I said. ‘I’m delighted for you. Sometimes it’s easier to get the hang of things when your— when nobody’s watching you.’

  Olivia gave a wry laugh as she folded a stack of muslins and pressed them into the large duffel bag that lay open in front of her on the bed. ‘You mean my mother. She’s driving back home this morning. According to her, Dad can’t even open his own Weetabix.’

  ‘Well,’ I ventured, ‘she’s quite a strong character.’

  ‘Don’t I know it. I did eighteen years of hard time in that house before I escaped to uni.’ Olivia sighed as she placed a folded jumper into the bag.

  ‘I guess mothers always want the best for their children,’ I said, and as the words came out of my mouth, I knew I would never have been so charitable to Olivia’s mother in person. There was something about that false, fixed grin that had made my bile rise. ‘She just wants you to do things exactly the way she did, I suppose.’

  ‘What do you mean?’

  ‘Well, to have a vaginal birth, and then to breastfeed.’

  Olivia tossed her ponytail back and laughed. ‘Oh, I was born by C-section too!’ she said. ‘And she bottle-fed me and my brothers. She always said her milk never came in. She’ll bore on about it for hours to anyone who asks.’

  I was, quite literally, gobsmacked. I stood there with my mouth hanging open as Olivia crammed more clothes into her bag. Just as I had felt an overwhelming desire to help Olivia and to protect her from what I saw as her mother’s overbearing passive-aggression, so I now felt a powerful and completely unexpected surge of sympathy – even sadness – for Olivia’s mother. Here was a woman whose own birth experiences didn’t go to her idealised plan, who tried and failed to breastfeed, who couldn’t – despite her best efforts – do things the ‘right’ way, and was still projecting her hopes and sorrows onto her daughter a generation down the line. It’s often said that women are their own worst enemies, a notion that can be confirmed by a single shift in a maternity hospital, where gossip and bullying often provide a bitter backing track to the overall thrum of kindness. Midwife to midwife, mother to daughter: the gift of our love is so often tainted by our own guilt and sadness. Like the Fat Bastards climbing the stairs in pairs, only to descend and start again, each generation of women tries its best to brave the heights of motherhood, only for their daughters to begin again at the bottom with nothing but their mothers’ dusty, weaving footprints as their guide.

  ‘Could you give me a hand with this?’ Olivia asked as she tugged at the zip on her bag, which was now stuffed to bursting. ‘If you hold it at this end …’

  I moved alongside her and as I grasped the bag where Olivia was pointing, I was met with my second surprise of the day. Inside, jammed into every available nook and cranny between jumpers, socks and Babygros, were at least a dozen bottles of ready-made formula. It wasn’t unusual for formula-feeding mums to ask for a couple of bottles ‘for the road’, but this was a bit excessive, especially for a woman who had spent the previous day working her nipples to the nub in the name of breastfeeding.

  ‘I’ll pull the zip if you can grab the side,’ Olivia suggested, oblivious to my discovery.

  As Olivia wrestled with the bag, I wrestled with my thoughts. It would have been easy to zip it all up and send Olivia on her way without comment – after all, she’d had enough ‘helpful’ hints from her mother – but the temptation was too strong.

  ‘Wow,’ I said. ‘That’s a lot of milk.’

  Olivia straightened up and looked me squarely in the eye. ‘Just in case,’ she said. Her gaze was firm – every bit as steely as her mother’s – as if silently daring me to reply.

  I tightened my grip, she grabbed the zip, and together we closed the bag.

  Notes on Triage

  ‘Triage, Midwife Hazard speaking, how can I help you?’

  ‘I think everyone in my office can smell my vagina.’

  ‘My husband left the heating on all night and now I’m really thirsty.’

  ‘I’m at the departure gate in the airport, can you tell the ground crew I’m fit to fly?’

 
‘If I go blonde, will it hurt my baby?’

  ‘If I put olive oil in my ear, will it hurt my baby?’

  ‘My baby hasn’t moved in the last twenty minutes.’

  ‘My baby hasn’t moved in three hours.’

  ‘My baby hasn’t moved since yesterday.’

  ‘I’m bleeding.’

  ‘I’m pushing.’

  ‘I can feel something coming out.’

  ‘The baby is here.’

  When I tell people that I’m a midwife, I tend to get one of two responses: 1) It must be so amazing to deliver babies all day long; and 2) it must be so nice to cuddle babies all day long. Yes, some lucky midwives on the postnatal ward do occasionally cuddle babies, although these rare, cosy moments are little recompense for the rest of the working day and the mountains of documentation required to get these newborns and their mothers out the door on the hallowed day of discharge. Births and baby cuddles apart, most midwives in the NHS are actually engaged in caring for women in the nine months leading up to delivery (and for up to six weeks afterwards). Early pregnancy units, outpatient clinics, day-care suites, antenatal wards – all are devoted to nurturing pregnancies safely from a tiny cluster of cells to a bawling bundle of joy. Anything and everything can and does go wrong during that ‘magical’ journey, and while Mrs Celeb is blooming on the cover of OK! magazine, showcasing her perfectly airbrushed bump in a birth pool made of Carrara marble and unicorn sparkles, most mere mortals are busy bleeding, aching, cramping, or generally stressing out in a pair of baggy maternity leggings passed down from Auntie Senga after she had her twins in 1997.

  Of course, while every woman is offered regular antenatal check-ups and postnatal visits, there’s an awful lot of bleeding/stressing/googling going on in between times. But fear not, the NHS in all of its wondrous foresight has gifted the women of Britain a repository for all of their out-of-hours hopes, dreams and worries: Maternity Triage (aptly named in a grim nod to the battlefield). It was here that I settled, having completed my clinical rotation through almost all of the different wards and areas in which you’ll find a midwife. When I first encountered the department, I was overwhelmed by its relentless pace and head-spinning variety, terrified by the seemingly endless drama. In time, though, this was the very quality that drew me back again and again and I eventually became acquainted with the full spectrum of dilemmas and disasters that can afflict the pregnant populace day or night. As I gained experience and confidence, the complex cases that had once brought me out in a cold sweat gradually became fascinating problems to be unravelled and solved as part of a dynamic team. The cocktail of clinical challenge, adrenaline and dark humour became intoxicating and addictive.