by Leah Hazard
‘Star,’ I began. Her eyes were still tight, and she was breathing faster now, her shoulders visibly shaking as another surge began. Moss hung back at the opposite side of the pool, a look of helpless bewilderment on his face. ‘Star, your pulse and temperature are high, and your baby’s heartbeat is a lot faster than I’d like. I think it would be a really good idea to check where we’re at now. Let’s see if we can cool you down, maybe try some paracetamol to lower your temperature, maybe pop your baby on the continuous monitor to keep a closer eye on things.’ I flinched at hearing myself use the midwife’s verbal tic of trivialising interventions – ‘pop’ you on the monitor, ‘pop’ up on the bed, put a ‘wee’ clip on the baby’s head – but I was worried, and the luxuries of time and careful word choice had abandoned me.
‘Don’t fucking touch me,’ a voice growled. The tone was so brutal, so hateful, I had to do a double-take to confirm that it was Star who had spoken. Her face contorted as another contraction arrived hot on the heels of the last, and she threw back her head and moaned in raw, unmistakeable pain.
‘It’s OK, babe,’ Moss said, ‘you’re still the boss.’ He reached across the water towards Star, but she batted his hand away, and he retreated, shocked, into the shadows.
‘And you can fucking get to fuck as well,’ she spat, before another ripple of pain passed through her, and she clawed at her scarlet cheeks. I had often seen women become desperate, foul-mouthed and even aggressive during the ‘transition’ phase of labour that precedes active pushing. Patients swearing at me or at their partners was nothing new; sometimes, the sight of a woman losing it a bit can even be an encouraging sign that the contractions are strong, and birth will be imminent. A midwife would be churlish to take offence at this normal response; her skill lies in keeping calm while guiding the woman through her personal storm. This was something else, though; there was an undertone of bile to Star’s voice that caught me off-guard.
‘Star …’ I said again. ‘I want to keep you safe, and keep your baby safe, but I can only do that if you let me.’
‘Don’t touch me!’ she shouted, her eyes flying open. And then, just as quickly, she squeezed her eyes closed and curled into a ball in the middle of the pool, the water lapping around her shoulders as she began a frantic incantation. ‘Don’t touch me don’t touch me don’t touch me don’t touch me,’ she babbled, until the words melted together into a tumble of incoherence and gave way to a bone-splitting groan. Her hands searched for the side of the pool, and as she grasped the rim with claw-like, white-knuckled hands, I seized the opportunity to slide two fingers gently under her left wrist to re-check her pulse. It was 129 beats per minute now, I estimated, before she whipped her hand away and fixed me with a wild glare.
‘I told you not to fucking touch me!’ she roared.
‘Please, Star, I’m worried about you …’
‘You’re just like all the rest. I knew it! All you want is for me to lie on my back so you can stick your hand in me. And I’m not doing it.’ With a splash, she stood bolt upright in the pool, water running down her naked body in a hundred tiny rivers. Her enormous belly seemed to glisten and throb as she towered over Moss and me. ‘Well, guess what: it’s not happening,’ she screamed. ‘Because I’m out of here. I’m leaving. I’ll deliver this baby my fucking self if I have to, by the side of the fucking road. Gaaaaaggggh,’ she moaned, and doubled over with her hands on her knees as another contraction caused her bump to tighten and heave. I thought I could hear the telltale grunt of a push at the end of Star’s cry, but in the current state of stalemate, there was no way I could tell for sure whether she was entering the second, expulsive stage of labour. 23.46: Patient declines to be examined, I scribbled in the notes at my side. Patient states she wishes to leave the hospital. Distressed+++.
As the contraction eased, Star drew herself up again and heaved a leg over the side of the pool, splashing water onto my scrubs and across the floor. The other leg followed, and soon Star was lunging around the room, ricocheting off trolleys and walls as her rant continued.
‘I’m going to get my stuff and go before you lay another hand on me,’ she said, almost growling as she grabbed at the pile of overstuffed rucksacks in the corner of the room. ‘Just you fucking watch, ggggnnn,’ she groaned with a definite push in her voice. Moss watched, agog, lost for words.
I stood at one side of the bed, Star at the other. We were locked in a face-off. She clutched at the crisp white sheets, wide-eyed, flushed. I could feel my own cheeks burning and was suddenly aware of the heat of the room; clouds of steam billowed off the water in the pool and collected at the back of my neck in a clammy film. Even Star seemed to be radiating her own waves of angry heat, and as she stared me down, I tried desperately to match her energy with my own. I wanted only to help this woman, to do my job, to check a few things and make the best possible plan, but I could do nothing without her consent. Anything else would be assault – the very thing she was already convinced was about to happen to her. In my head, I was one of the good guys: sympathetic, open to any and all birth choices and behaviours, from the hippiest of home birthers to the divas who demanded their own private anaesthetist on speed-dial. Even on my toughest shifts, I was ready to give love to the women in my care. I could help them if they’d let me: it’s the tacit midwife–patient contract that keeps the wheels of the system spinning. In Star’s eyes, though, I was the enemy. There was no peace to be brokered, no love to be lost.
‘Star,’ I began. ‘I became a midwife to help women, not to hurt them.’
She snarled, unflinching, across the bed.
‘I’m a good person,’ I said, pleading now, and as those words hung in the humid air, I was aware how feeble, how wheedling and insincere I must sound. But I was tired, and scared, and even a little bit angry.
‘I’m on your team,’ I insisted. ‘Yes, there are midwives who would happily strap you up with every drip and wire you can think of. There are midwives who would examine you even if you were crying. But I’m not that midwife,’ I said, as much to myself as to Star. ‘I’m not the enemy.’
Before she could reply, another contraction gripped Star’s body. She roared so loudly that the walls of the room seemed to shake, and as she dipped her head and gripped desperate fistfuls of the sheets on the bed between us, I could see a sliver of a golden, fluid-filled balloon protruding between her legs: the amniotic sac, the baby’s watery home. My heart leapt. Star was close to delivering, although I could only guess at whether her baby would be in good condition when it came.
Star seemed to sense that something had changed. She looked up at me as the contraction died away; her eyes were softer, and her voice was different, smaller, child-like.
‘What was that?’ she asked.
‘It’s your bag of waters, Star. Your baby can’t be far away.’
Silently, she paced over to the pool and heaved herself back into the water with a splash. Moss and I drew closer; he stared in anticipation at the apex of Star’s legs while I started running the taps. Star might not let me touch her, but the least I could do was bring the pool back up to a safe temperature for birth.
23.50, I wrote. Amniotic sac visible. Patient returned to pool. Another push came, and another, and Star withdrew deeper and deeper into the inner space in her mind as the water in the pool clouded with a silent pop of straw-coloured amniotic fluid. 23.54, spontaneous rupture of membranes, clear liquor seen, I scribbled, and I reached over and pressed the buzzer for another midwife to be present for the delivery. This was common practice in my unit: one midwife for the mother and one for the baby, in case both needed urgent attention simultaneously. I had no idea who would appear at the door, but I was grateful to have an excuse to call for backup.
Star was on all fours with her head and arms resting against the side of the pool, her rump towards me, her legs open enough to reveal a slender patch of her baby’s head. It was crucial at this point that she listened to my guidance, and I began to speak as gentl
y as possible, bracing myself for the backlash.
‘It’s very important that you keep your bottom either completely above or completely below the water, Star,’ I said. ‘If the baby feels the cold air on its body while its head is submerged, it might gasp and breathe in the pool water.’
Silently, she lowered her bottom below the water’s surface.
Emboldened by her cooperation, I kept talking, my voice soft but steady: ‘Do what your body is telling you – push when you need to push, and when you feel all of your baby’s head stretching you open down below, just breathe.’
‘That’s it, babe,’ Moss added quietly, cautiously. ‘Breathe the baby out, just like we talked about.’
The water rippled as Star tossed her dreadlocks back in a smooth arc and girded herself for another contraction. This time, I could actually see the smooth diamond of her tailbone kicking out beneath her skin, a sure sign that the baby was moving through her pelvis. Star screamed and pushed, and as she did so, the door flew open against the wall with a bang and Mary Jane, the sister in charge, marched into the room.
‘What are you doing to this poor girl? I’ve never heard such a racket in my life.’ And then, under her voice, as the cloud of lavender and clary sage enveloped her, ‘Bloody hell, it smells like a whore’s drawers in here.’
‘Just having a baby, sister,’ I replied. As if on cue, Star reared up to a kneeling position, threw her head back, and with her lips pursed into a perfect ‘O’, she let out a long, low ‘hooooooooooo’ of breath. As she did so, her baby’s head slipped out from between her legs, eyes closed, rosebud lips pursed, skin still dusky in its last moments of suspended animation. 23.59, head delivered. Star looked down through the rippling water, saw what was there, and pushed. In a final burst of blood and liquor, her baby’s body shot out, tethered only by its long, spiralling cord. Star sank further into the pool as she reached down and brought the infant up onto her chest, its body warm below the surface, its eyes now wide and blinking in the shock of the air above. A discreet glance confirmed what I thought I had seen: Star had birthed a girl. 00.01, spontaneous vaginal delivery of live female. I began to write the next words, Cried at birth, automatically, then paused and set down my pen. The room was silent.
‘It’s purple,’ Moss said, a quiver of panic in his voice. ‘Why is it purple?’
The baby’s skin was mottled and dusky in places. It was a familiar sight to me, but understandably worrying to someone who might only ever have seen the impossibly rosy-cheeked newborns of TV and cinema lore.
‘Water babies take a bit longer to pink up,’ I said. This was true, but with my luck, I thought morosely, this will be the one baby that needs resuscitation. I’ll need to go through the frantic routine of inflation breaths and chest compressions that I last practised on a rubber doll six months ago, and God only knows what will happen next, and then Star’s idea of me as the Devil incarnate will be well and truly confirmed. As the reel of a million different catastrophic scenarios ran through my mind, the baby opened its mouth, blew a cluster of glossy bubbles, and cried. As she bawled, a slow bloom of pink began to spread outwards from her chest to her face and her limbs. Star and Moss began to cry as well: Star with hot, silent tears, Moss with loud, racking gasps of relief. She collapsed back into his body, the baby still clasped to her breast, and Moss enveloped them both in his long, sinewy arms. The circle was complete again; Moss, Star and their baby were one.
‘Well,’ Mary Jane said from behind me. ‘Looks like you have everything in order. Try and keep the noise down, Midwife Hazard,’ she said with a wry smile, and left the room.
I had been squatting by the side of the pool, but as the door slammed shut behind Mary Jane, I allowed relief and exhaustion to tip me back onto my heels. I sat on the floor, adrift in a mess of puddles and soggy towels, my scrubs soaked with water, steam and sweat, and I watched as Star and Moss welcomed this new life to the world.
‘Heyyy, baby Luna,’ Moss cooed, and Star covered the baby’s curled, wet hair with kisses.
‘Who’s my gorgeous girl,’ she murmured. ‘Who’s my gorgeous, gorgeous girl.’
Apart from the baby, the scene was almost identical to the one that had greeted me at the start of the night: the love in the room was as heady as the fragrant oils that still drifted in dappled slicks across the surface of the pool. I wondered whether Star’s outburst had even happened, or whether I had imagined its intensity, my emotions heightened by fatigue, my brain scrambled by too many hours of hard work and lost sleep. Mary Jane wouldn’t even be able to corroborate the story – Sod’s Law, she had arrived just as Luna slid smoothly into the pool, and she was probably already telling the rest of the staff how Midwife Hazard had been making her perfectly pleasant patient scream the house down for no good reason at all.
I dragged myself upright and shuffled over to the case notes that lay scattered across the worktop in the corner. I scanned the pages for any clues in Star’s history that might help explain her outburst. I had seen situations where previous trauma or abuse lay buried in a woman until the pain of labour brought memories vividly back to life – women who flinched with fear before I’d even touched them, or whose bodies went oddly limp, their numb gaze fixed on a distant point during every examination. I remembered Star’s accusation that I was ‘just like all the rest’, but as I read page after page of routine antenatal check-ups, there was nothing here out of the ordinary – or at least, nothing that had been disclosed. It was a mystery and, like so many women’s stories, it would remain so.
Luna’s cries had settled into contented gurgles and squeaks as she nuzzled into her mother’s breast. Star shook her head, looked up at me and blinked, as if suddenly remembering who I was. But instead of anger, there was only love in her eyes. Her pupils were huge; she was high on birth.
‘Hey,’ she called to me. ‘That was amazing. You were amazing.’
‘Actually, you were amazing,’ I replied. And I meant it.
Star brushed a stray dreadlock away from her face. ‘I wasn’t horrible to you, was I?’ she asked. Her face shone – she was beautiful – but as she struggled to meet my gaze, I thought I saw a shadow of self-doubt, maybe even of embarrassment, cloud her expression.
‘No,’ I said. ‘Of course not. You weren’t horrible at all.’
Notes on Death
Student midwives are drip-fed death by their mentors, like children duped by their mothers into swallowing sour medicine in between spoonfuls of sweet, milky rice. The knowledge of death, the awareness that it hovers around the edges of life, is a slow, creeping thing. There is no good way to learn that babies sometimes die, and that mothers sometimes leave the hospital empty-handed, and there is no right way to teach or to learn these lessons.
Towards the end of my first year as a student midwife, I had begun to find my place in the rhythms and routines of the labour ward. My clinical skills were still limited, and I still lived in constant fear of humiliating myself by some unintentional misstep or error, but there were things that I could do relatively well, and I embraced those tasks wholeheartedly. I could love-bomb a labouring woman with such fierce enthusiasm that I would start to believe I had known her for ever. I could catch a baby whose heartbeat was strong, and whose mother could push long and hard. I could also tidy up after a delivery with increasing efficiency, which was no mean feat considering the mess of blood, fluids, drapes, sheets and instruments that were often part of even the most straightforward birth.
I was knee-deep in one such clean-up at the end of an especially busy night shift. My mentor and I had been with a woman since the start of the night, and in spite of various complications along the way, the birth itself had gone smoothly. The new parents were delighted with their first baby, a nine-pound girl who had cried, peed, pooed and fed within moments of being born, as if to say, I’m here, I’m alive, I can do everything you expect of me.
Leaving the mother with her baby suckling comfortably at the breast, I staggered down the co
rridor with an instrument tray under one arm and a bag of dirty linen in each hand. The familiar sounds of labour and its aftermath came from each room as I passed; the ward had been quiet at the start of the evening, but it looked as if the place had filled up while I’d been busy with my patient. I trundled into the sluice – a walk-in cupboard ram-packed with every wipe, pad and spray one might need to erase the bloody debris of maternity – and heaved my linen bags into a trolley. I turned around, set the instrument tray on the worktop, and was about to wash my hands when I saw a small plastic jar in the corner.
I recognised the jar as one of the containers we used to send samples to the pathology department: bits of tissue, cysts or whatnot that required further analysis. Normally, I wouldn’t have given such a jar a second glance. The contents of these pots were usually unidentifiable fragments, abandoned momentarily by midwives too busy to label and send them straight away. There was no label on this specimen, and it had nothing to do with my patient; it shouldn’t have concerned me. But for some reason, I picked it up, held it to the light, turned it round in my hand. And it was a baby.
Well, I say baby, though technically it was a fetus, or what is clinically called ‘products of conception’ when delivered before twenty-four weeks’ gestation. For lack of a more nuanced name, though, I will call what I held in my hand a baby. To even the most inexperienced student midwife, the small, curled, wine-coloured creature within the jar looked like a baby – or something that was on its way to being a baby, and was perhaps very much a baby in the mind of the woman who had delivered it. I knew that such things happened in the hospital – labour was sometimes induced in women whose babies had already died inside them, or whose babies had such debilitating birth defects that they were, to use the industry parlance, ‘incompatible with life’. Until now, for the junior student still grappling with the basics, a veil had remained drawn over this dark corner of midwifery.
