by Leah Hazard
I approached the table hesitantly. How could I possibly help during this procedure? I had the basic knowledge to understand what was being done, but handling a laparoscope was completely beyond my remit.
‘Hurry up now,’ she said, and nodded to the space next to her at the table. As directed, I stood beside her and assumed the standard pose of the student midwife: frozen with terror. The patient lay in front of us: green-draped, eyes closed, hair spread out on the black vinyl of the table, tongue lolling beside the airway tubing that was keeping her alive while the anaesthetic suspended her body in a shroud of sleep.
Dr Munn nodded towards the screen. ‘Let’s have a look around,’ she said, as casually as if she were inviting me into her home. ‘See what we can find.’ My panic subsided rapidly when I realised that, far from expecting me to operate the camera, Dr Munn was about to give me a guided tour of human anatomy. While the procedure itself had been quick, with the doctor moving the instruments deftly from one area to the next, now she worked slowly and demonstratively for my benefit, and as if by magic, the screen revealed an easily identifiable wedge of smooth tissue.
‘Her liver,’ Dr Munn commented. And then, another leisurely sweep, and a bundle of fleshy rope. ‘Her intestine.’ Sweep again; the movement was almost balletic. ‘Her uterus, and the fallopian tubes. These are ligaments,’ she said, pointing to taut, fleshy cords, ‘and these are the ureters.’ And so on. My eyes were riveted to the screen. As I stood there sweating under the theatre lights, the clock on the wall ticking towards 3 p.m., I marvelled at the madness of the moment. With only my scrubs as my passport, I had been invited on a journey through the internal geography of a stranger’s body, the fleshy, throbbing landmarks both exotic and familiar. There was little difference between me and the people milling around the hospital café on the other side of the theatre walls in their T-shirts and jeans – and my clinical knowledge at this point was only marginally superior to theirs – but in the simple act of donning a uniform, I had been welcomed into what felt like medicine’s inner sanctum.
A few years after that afternoon in theatre, I completed my training and was allowed to collect the cornflower-blue uniform of a registered midwife from a stuffy storeroom in the basement of another nearby hospital. By this time, I had caught seventy-six babies, looked after countless more women, and was slightly less mystified by the workings of the human body, but midwifery was no less magical to me than it had been on the first day of my training. If anything, my pride at slipping on the blue uniform for the first time was magnified a hundredfold from the buzz I had felt when I had received the student’s grey tunic. Once again, there was the overwhelming joy and disbelief at finally ‘looking the part’, but this time, there was also delight in being the part.
As my clinical practice progressed in the first few years after I qualified, I wore the blue uniform in clinics, wards and busy treatment rooms aplenty. The chest became frayed where I pinned my name badge and fob watch day after night after day; the knees of the trousers became baggy from kneeling behind women as they squatted out their babies and from bending beside a bed to help latch a fractious baby to its mother’s breast. Not every patient was delighted to see me – one labourer spat a crumbling tooth in my direction when I didn’t get her diamorphine quite as quickly as she would have liked – but there was no denying that wherever I was, the uniform marked me out as someone who had earned her stripes. Even when women were doubled in pain, or rigid with fear, there was an understanding that this midwife was on their side.
I may not have had the dress of my dreams, with its starched collars and silver-buckled belt, but the uniform was my way of telling the world that I was there to serve. There was only one instance where the uniform had the opposite effect; marking me out as a threat; even as the enemy. And no polished shoes could put a shine on the darkness of that experience. Suddenly my passport to respectability was gone: I was stateless, pointless, nothing more than a woman telling another woman to put her faith, and her life, in my hands.
Star: Meeting the Enemy
I arrived at work knowing that everyone hated me.
It wasn’t my imagination; I had read it in a newspaper.
I was sitting at my kitchen table, bolting down a bowl of leftover chilli in an attempt to fill my belly before what would undoubtedly be a busy night shift in the labour ward. I had been struggling with a stomach bug, and my guts churned audibly as I shovelled the food into my mouth, contemplating the grim possibilities of what the night might bring. I’d been doing a few extra shifts in the labour ward to bulk out my pay cheque, and in spite of my best efforts, my last few patients had ended up in theatre. One for a crash section (with the patient calling the staff all the bloody bastards under the sun right up until her last moment of consciousness); one for a trial of forceps that had morphed into a Caesarean (but only after the doctor realised that he had used his huge silver salad spoons to rotate the baby from a favourable fit to a hopeless malposition, instead of the other way around); and one for a postpartum haemorrhage that had resulted in the patient’s womb being removed as a last-ditch, desperate attempt to stop the bleeding at source. In short, I had had a few rough days at the office, and I was in need of some light relief.
As my stomach heaved in protest against the food I was forcing inside, I flicked through a newspaper that my husband had left before taking the girls to their evening ballet and hockey practices. (Another mark of my ‘failure’ as a shift-working mother: I’d been at the hospital so much that my children had stopped asking me if I could drive them to their various classes and clubs, knowing full well that the answer would always be a guilt-stricken no.) I scanned the day’s headlines, hoping to come across a bit of good news to cheer me up, or even a fluff piece about a panda being born or a cat rescued from a well.
My eyes were drawn, though, to an article about the maternity services. Apparently, a recent survey had revealed a large jump in the numbers of women who reported feeling abandoned, neglected and ignored in labour. The author wrote of women who had been sent away from their local Triage unit in agonising pain, having been told that their distress was an over-reaction to the niggles of early labour. Some of these women had gone on to deliver at home or in roadside lay-bys, while other women (who had managed to achieve admission to the wards) spoke with sadness about their experiences of begging fruitlessly for painkillers as their contractions increased. Some had been left alone while they bled; others ruefully recalled the midwives who had mocked their distress. The comments ranged from the wistful – ‘I wish things had been different’ – to the outraged, with one woman going as far as to call all midwives ‘a bunch of cruel, twisted gatekeepers’.
So there it was. In spite of the hundreds of hours of exhausting toil, in spite of the fact that so many of the midwives I knew had sacrificed their time, their sleep, their physical and mental health, and their most precious personal relationships in the name of their career, we were hated. I knew first-hand the difficulty of assessing a labourer in the knowledge that there were no beds for her anywhere in the hospital, regardless of the result of my examination. I knew what it was like to have to send a woman home, assuring her through gritted teeth that ‘a couple of paracetamol and a hot bath will see you through the next few hours’. I knew how it felt to bounce around an antenatal ward like a demented pogo stick in midwife’s clothing, trying in vain to care for six different patients at once, apologising to one about the shortage of birth balls, assuring another that I would get her diamorphine as soon as my other, equally manic colleague was free to check it with me, and placating the rest with rushed words of comfort and a rictus grin.
I had missed birthday parties and school concerts. I had reduced my relationship with my husband to a mumbled ‘hello’ when I tumbled into bed after a night shift as he was getting up to make the children’s packed lunches. I had dragged myself into the hospital with heavy colds and dodgy tummies that I’d probably picked up – guess where – in the hospital, a kind of presenteei
sm fuelled only by copious amounts of coffee and a deep-seated fear of letting my colleagues down. All this was true, but still we were hated, and here in front of me was the undeniable proof.
I pushed away the half-eaten chilli, along with the newspaper and the pint of Diet Coke I had poured in an attempt to mainline some caffeine before my shift. It was 6.45 p.m., and cruel, twisted gatekeeper or not, I was a midwife with a job to do; somewhere on the other side of the city was a woman who was waiting for my care. I bundled my bags and myself into the car and drove through the balmy June evening, passing families picnicking in the park and beautiful young things flirting in the sun outside cafés and bars. I wondered – not for the first time, or the last – why I was rushing to spend twelve and a quarter hours shut in a windowless room with a stranger, instead of relaxing with my husband and a chilled glass of wine in the garden. Even as I contemplated this parallel universe, where I had a normal job and did normal things, my brain drove me to the hospital on autopilot. As I pulled into the car park, I prayed only for an easy night with a pleasant patient who might enjoy my company (and, ideally, not end up flat on her back in theatre while a doctor raked clot after clot from her exhausted, atonic uterus).
An hour later, it seemed as though my prayers may have been answered. The nightly lottery in the labour suite’s bunker had allocated me a low-risk, twenty-six-year-old woman who was already eight centimetres dilated with her first baby. As I entered her room, I could feel the tension drain from my body. The atmosphere was almost soporifically relaxing; the lights were dimmed, Ibiza-style chill-out music thrummed softly from the stereo in the corner, and the air was heavy with the scent of lavender and clary sage. This was one of the hospital’s few rooms with a birth pool, and my patient was making full use of the large oval tub. She reclined against the side, eyes closed, smiling with Buddha-like serenity as her tumble of purple-tipped dreadlocks dipped and swirled in the water lapping at her cleavage. She was unabashedly naked, and her long, lean body was covered in elaborate tattoos of flowering vines and branches; her ears pierced with a glittering array of studs, safety pins and coloured discs. Behind her knelt a man who was very clearly her ‘other half’ on every level, so closely did his appearance and energy match hers. He had a dreadlocked topknot, a solemn face, and equally bedazzled ears; the tangle of scuffed silver chains around his neck jangled softly as he leaned over his lady and massaged her shoulders with strong, spindly fingers. As he moved, she swayed gently in the water, sending ripples across the surface of the pool. They were one, they were in the Zone. This would be easy.
I didn’t recognise the young midwife who was scribbling some final notes at the worktop in the corner. She was part of the influx of newly qualified girls required to fill the gaps left by an exodus of burnt-out, hacked-off senior staff who had run for the hills. This one looked like she was barely out of school, with a button nose and a downy softness to her cheeks that only added to the impression of youth. She finished her writing and stared at the notes in consternation.
‘I hope I haven’t forgotten anything,’ she said apologetically as she went to leave the room. ‘Anyway, they’re lovely. Star and Moss. You’ll have a good night.’ She smiled, and left.
Star’s head lolled onto her chest and she began to inhale deeply through her nose, blowing back out across the water with a long, low sigh. As a contraction rolled through her body, Moss’s fingers travelled down Star’s arms, and he grasped her firmly, steadying her with his grip, until the pain eased off and her breath softened again.
‘All good, babe, all good,’ he murmured as her body relaxed and his fingers resumed their hypnotic knead and pull. She opened her eyes for the first time and lifted her face to Moss; they beamed at each other, and he planted a soft kiss on her forehead. If they knew that I was in the room, they weren’t showing it.
I crept over to the pool and knelt beside it. ‘Hey,’ I ventured.
Star and Moss looked over to me, seeming to register my presence for the first time.
‘Hey,’ they both replied in distant, blissed-out voices. Star squinted as she realised I was a different person from the midwife who’d been with them all day.
‘Are you going to catch my baby?’ she asked.
I smiled. ‘Hopefully, you’ll catch your own baby. If you deliver in the pool, that’s pretty much how it happens. I’ll be hands-off if all goes well.’
‘Cool,’ Star said, beaming. ‘Very cool.’ She closed her eyes again and leaned back into Moss’s embrace.
‘It looks like these contractions are nice and strong,’ I said.
‘We’d prefer to call them surges,’ Moss said as his fingers worked the knots at Star’s vine-strewn shoulders. ‘We’re Hypnobirthing. We’re going to breathe this baby out, aren’t we, babe?’
Star smiled, eyes still closed, and she began a soft, low hum as another ‘surge’ rumbled across her belly. It had been ages since I’d had a low-risk, or ‘Green Pathway’, patient, and I was so ready for this cosmically relaxed couple; they were just doing their thing. Prior to becoming a midwife, I had been lucky enough to attend a few home births as a spectator and supporter. The vibe in the labour room that night took me straight back to those early experiences, when birth was a celebration, yes, but also simply another event in the life of the family: babies arriving in pools, or baths, or in candlelit nests of cushions and quilts, with friends and siblings crying happy tears over tea and home-baked cakes. The heady fug of essential oils was both exotic and familiar, and I could feel myself drift easily into the mood that Star and Moss had already created, oblivious to the alarms and emergencies of the labour ward outside the door.
When the surge had passed, I asked Star if I could listen to her baby and check her vital signs. She murmured her consent, draping one arm over the edge of the pool so I could strap on the Velcro cuff, and bobbing her belly helpfully to the water’s surface to allow me to listen in. I pressed my handheld Doppler to her bump and found the baby’s heartbeat just above her pubic bone; the sound was steady and clear, and at 140 beats per minute, it sat reassuringly in the middle of the normal range.
19.52, I wrote in Star’s labour and birth notes, picking up where the day-shift midwife had left off. Observations normal, Star breathing through uterine activity 3 in 10 minutes, moderate to strong on palpation. Plan: low-risk care, intermittent auscultation of the fetal heart, vaginal examination at 23.30 if no signs of imminent delivery, or sooner if indicated. So far, so good, I thought as I slipped my pen back into my pocket and admired the harmonious scene in front of me.
We passed the next few hours in this way, settling into an easy rhythm. I lingered by the side of the tub, doing my checks and observations as silently and unobtrusively as possible in between Star’s surges, then retreated as soon as I heard her breath deepen and saw Moss’s grip tighten on her arms. Now and again, she would change position, stretching her legs out in front of her, or drifting onto all fours while Moss scooped handfuls of warm water over the rising-sun tattoo that covered her lower back. I could see strands of blood-streaked mucus or ‘show’ drifting around her ankles as she shifted in the water. This was a good omen: a sign that the neck of the womb was loosening, releasing the plug that had sealed it for the last forty-one weeks. Star was unaware as I scooped these jelly-like strands away and topped up the pool with fresh water; she swayed and rocked through her surges, eyes closed, swimming through an inner cosmos where even Moss couldn’t join her.
22.58, I wrote in the notes at my side. Patient coping well, enjoying benefit of pool and support of partner Moss. Uterine activity now 4 in 10 minutes. Copious show visible per vaginam.
At first, there were only subtle signs that the mood had shifted. Star begin to flinch and squirm under Moss’s touch. Instead of allowing him to hold her through her surges, she drifted towards the middle of the pool, unreachable, an island. Her dreadlocks fanned around her as she breathed and heaved through ever more powerful contractions. Moss sat back on his heels by t
he side of the tub and continued his chant of ‘Well done, babe, all good, babe,’ as each surge passed. Star responded with only the hint of a smile, then stopped responding completely, then grimaced when he spoke, his words a hollow echo to the pain that was now tearing through her body. It had been over four hours since Star had been examined by the day-shift midwife, and although I didn’t want to interrupt her flow, instinct and protocol both told me that it would be wise to know whether her cervix was continuing to open and labour was progressing.
‘Star,’ I said, in between contractions, ‘I’m going to check your pulse, temperature and blood pressure, and then if it’s OK with you, I’d like to do a gentle internal examination. It’s been a while since you were checked, and it’s really helpful to know whether things are moving on. I’ll be as quick as I can, and then if everything’s all right, we can keep on doing what we’re doing.’
She opened her eyes enough to peer at me through narrow slits. Her cheeks were flushed, and wispy hairs had worked themselves loose from her dreadlocks and lay plastered by sweat to her forehead. ‘Will I have to leave the pool?’ she asked. Her voice was reedy and ragged from hours of heavy breathing.
‘I’ll do these observations first – you can stay where you are – but then yes, you’ll have to get out for a little while. It’s really hard to do an accurate examination under water, but being up and about could do you some good anyway. We might even get you along to the toilet; emptying your bladder could give the baby’s head more room to come down.’
She pressed her eyes shut while I bustled about her with my blood-pressure machine and my thermometer, hurrying to do my bits and pieces before the next contraction came. Her blood pressure was fine, but her pulse was elevated at 123 beats per minute, and her temperature was 38.1 degrees Celsius, well above the upper limit of normal. As I pressed my Doppler to her belly, her baby’s heartbeat raced loudly in response: 178 beats per minute, with no sign of easing up. I frowned as I jotted down my observations, water from my hands dripping onto the page like teardrops: 23.34: Maternal tachycardia and pyrexia noted; fetal tachycardia with reduced beat-to-beat variability. Either Star was overheating in the pool, or her labour was showing signs of obstruction, or she was brewing an infection, or any combination of the three. None of it was good for her baby, and whatever was going on, I needed to get a few things done.
