‘I know Elsie took a girl in once to Greenwich – St. Alfreges Hospital, it was then. It was her first baby. I don’t know, Elsie told whoever was in charge what was going on. And Elsie wasn’t very happy about what happened. When Elsie took her in, they should have given her a caesarean, or whatever. But they didn’t, and the girlie died. It wasn’t the same day. If it was the same day, you might say, “Oh, midwife took her in too late” – but it wasn’t the same day. And Elsie said she should never have died. As far as I know, out of over 4,000 births, Elsie never had any maternal deaths.’
Births with potential risk factors
It would be wrong to suggest that midwives in pre-NHS days only dealt with straightforward cases at home. Midwives describe women with breeches, twins, triplets, and complicated medical and obstetric histories – all giving birth at home, usually with the midwife as the sole attendant. Margaret A. tells a story that would make today’s birth attendants shudder:
‘I had a girl once who had twins – boy twins. They were six or seven pounds each, and she was a fortnight overdue. Now that girl had had a placenta praevia [the placenta situated across the cervix – a situation that would be life-threatening for both mother and baby] three years previously for which she’d gone into our little local general cottage hospital here for a caesarean. And three years later she carried twins a fortnight overdue – and she was left at home to have them. One was a breech. It came out very easily. You know, I’ve sometimes gone cold when I think about it. No doctor there, just me.’
Many women with risk factors invariably refused to go into hospital – for example, those who had had many babies before. ‘Grand multipara’ [or grand multip] is the name given to a woman having her fifth, or subsequent baby, and today she would be advised not to opt for home birth on the grounds that there could be obstetric complications during labour. Midwives working 50 years ago seemed to take grand multiparas in their stride, as Mary T. bears witness:
‘I went with her when she [midwife Elsie Walkerdine] had that twenty-first baby in Deptford High Street. She woke me up this particular night and said, “I’m going out, Mary.” I said, “Oh, all right, Elsie, where are you going?” So she said, “Mrs B.” “Ooh,” I said, “I must come and see this one!” So I went and saw her twenty-first baby born. Of course, it took all the calorie out of her having all them babies. She looked very thin. But the birth was no bother.’
Esther S. will never forget attending a woman having her thirteenth baby:
‘We delivered the grand multips at home, then and you know – the funniest thing! I delivered a baby, the thirteenth baby, funnily enough, in Portsmouth, and you know when the placenta turns inside out, they call it the “Matthew Duncan” form of expulsion after some obstetrician who wrote about it years ago. And I said, “Oh, a Matthew Duncan!” And she said, “Oh, is that what I’ve got then?” So I said, “What do you mean?” She said, “Here’s you naming the baby – he’s Matthew Duncan. Oh, I like those names.” She called her baby that – it’s true! The thirteenth baby, so she had a game to know what she was going to call it, probably. So I named that baby Matthew Duncan [laughter]! Good, wasn’t it!’
Elizabeth C. was one of the many midwives who told us stories of women who refused to go into hospital:
‘We said to this woman, “You’ll have to go into hospital for X-ray and so on, you’re having twins”. She said, “I don’t want to.” Doctor says, “Well, you might die at home.” She says, “If I’m going to die, I’ll die at home.” And she didn’t die. It’s just as normal as having one, having two – a bit more risk of bleeding – but not much extra risk if gently handled.’
Unlike today, it was considered ‘normal’ to have breeches and twins at home. Nellie H. talked calmly of a twin birth that would shock midwives today, who are taught that twins must be delivered in hospital and that, in the interests of safety, the second twin must be born within 20 minutes of the first:
‘I did get one girl that had twins and she had one twin one night and the next twin 24 hours later. She was quite happy and she didn’t want to go into hospital – I knew she was all right. I knew the twins were situated well and that it would come when it was ready – so why worry? But now they shove them into hospital and half the time I think they die from overtreatment.’
Midwives such as Esther S. spoke with pride about the twin births they had attended at home:
‘I’ve had six sets of twins at home. I’ve had a wonderful association with them all. I’ve kept up with them, been to their weddings. Just been to one set of twins – their mum’s funeral. I used to get letters when they’d passed their 11 plus [exam] and all that business. “Dear Nurse, I thought you’d like to know that Robert has passed his 11 plus. I knew you were always interested in him.” Things like that – lovely. Ever so many weddings.’
Elsie B. remembers triplets being born at home:
‘We had one lot of triplets, I must say there was a doctor there. That was a woman who’d been into the nursing home for her first two babies and the next one she stayed at home. After that we couldn’t get her in! She had triplets and two sets of twins at home and she’d had the first two single births in the nursing home! No, you had all sorts of funny things happen …
‘There’s so much said about “the risk” and all the rest, that you frighten a lot of the people. There’s things that in the old days would never enter their minds that could happen to them. Well, they were happy. And you can think things will happen and then they will happen. There isn’t the patience these days.’
Elsie Walkerdine obviously did not consider it necessary to call out the doctor to a triplet birth, as her friend Mary T. remembers:
‘I remember when she had triplets down Hyde Street. She never called the doctor in till after. So he says, “Sister, you should have let me in on this” (that was Dr R-J. in Edward Street). So she says, “Why? What for?” She says, “There was nothing wrong. It was all straightforward. If I’d have called you in, I would have frightened the patient.” Three girls they were.’
Midwives spoke of caesarean sections as rarities in the first half of the century. Nowadays, the caesarean section rate in some London teaching hospitals is over 30 per cent with instrumental birth rates [forceps and vacuum extraction] approaching 20 per cent. So it is awe-inspiring to hear midwives like Bronwen H. talk of their work in the mid-1920s:
‘I only had to call a doctor to do forceps about four or five times and only one caesarean section in 200 births when I was on the district. I didn’t have to send anyone in. I always considered myself lucky.’
The only caesarean section that she was involved in was a home birth. Bronwen explained how, in 1926, she and the GP (who was later to become her husband) were called to a woman in labour who refused to go into hospital even though she needed a caesarean as the baby was too big to fit through her pelvis:
‘She wouldn’t go in! You see … it’s … it’s hard to explain. It’s difficult when you don’t know anything about the people. I mean, I’d only seen to her about once, you see. Didn’t know anything about her. She just couldn’t be persuaded to go in.
‘Of course, my husband, he was a bit nervous doing the caesarean in the house and thought, “Oh dear …” Anyway, I thought, “I wonder if she’ll be all right”. You know, the risk of infection – no antibiotics or anything in those days.
‘Anyway, we did it on the kitchen table and I arranged with the people downstairs that when the baby was born I’d bang on the floor with a broom so that they could come up and take care of the baby, you see. So anyway, we did the caesarean in this room, everything according to plan, and somebody came up and took the baby down. I said, “Keep it warm but not too near the fire and don’t leave it on the side.” So we finished off the mother and packed her up, and then I did the baby. Well, everything went according to plan. A beautiful boy about eight pounds! And you know, she was only about four foot, eleven [inches] tall.
‘Anyway, everything went
according to plan and in about a fortnight’s time the wound had healed and I found the baby wasn’t putting on weight. So I told her how to feed the baby and all that sort of thing. Well, in a day or two she had mastitis, then an abscess. Now we didn’t know much about that then. In those days it was lancing that was the thing, you see. Then the pus poured out.
‘Anyway, she got over that all right, so I attended her for a month and saw that she was all right and then I said, “Now I’m not coming any more, but I’ll call in a few days to see how you are.”
‘So I called in a few days and she and her husband had flown, with the baby. They hadn’t even paid the lady the rent. So anyway, about a couple of months after that, the police came to talk to me and my husband about them. Anyway, we discovered eventually that they’d moved to the Midlands from Wales and the reason the police came to see us was the police in the Midlands wanted to know all about them. Apparently, they took two rooms and then one day they said they were going to see about buying a house and would she look after the baby until they came back. So the lady of course looked after the baby and then the parents never turned up!
‘We discovered afterwards that he was somebody else’s husband … I felt very sorry for her really because she must have been in dreadful agony, I should think. I don’t know what happened to the baby – probably it was put out for adoption. We didn’t know, didn’t hear any more about it. Oh, it was very sad.’
One of the women we interviewed, Alice F. described having a timely caesarean section in 1937. She spoke with pride about the experience:
‘I went into hospital, and I had to wait and wait. Three times I went into false labour and that was horrific. I don’t know if you know labour pains? You do – well, they’re murder, aren’t they! And then, of course, they kept on putting needles in my botty to bring on the false labour – no painkillers. On the third attempt, I thought I was going to get the baby but I heard the doctor – he swore – he said, “This child is determined to come standing up …” Afterwards, as I told you, they reckoned there was a piece of bone right across and the baby couldn’t get out. And, of course, he was a big baby for little me. I’m not big now, but I was very slim when I got married. I only had a 19-inch waist.
‘And so the baby was born and I was all worried – “Was it perfect?” You know, and all that. Caesarean, of course. I’ve still got the wotsit down there. Well, he was beautiful. One mass of thick curly hair, black, bright blue eyes. The Sister was very, very pleased. She said “I’m very, very pleased about this birth because it’s so beautiful and clean.” She said “You must have drunk castor oil by the bottle.” And I had! ‘Cause we had a nurse there and she was rather strict, and she said, “If you don’t take this castor oil, I shall hold your nose and pour it down you.” I said, “You don’t have to, Nurse, I’ve been drinking it even before I came in here.” “Let me see you do it then.” And I drunk it right down. The Sister said to me “It was the most beautiful birth, I’m very, very pleased with it.”’
As with caesarean sections, the midwives spoke of forceps deliveries as rare and implied that people these days lack the skill of patience – ‘We waited for them [the babies] to come’. Elsie B. remembers:
‘I’m not saying we never did do them. Well, I didn’t, but you helped the doctor. Then they used to use a little chloroform on a mask. I’ve given chloroform on the mask numbers of times, when you got stuck like that. We did them at home because you didn’t have enough beds in hospitals to send all these people in there.’
Although the comparatively high number of instrumental deliveries today is being questioned, there is another side to the coin. In the past, without easy access to hospital facilities, many women laboured on until their babies died. The doctor and midwife then had the gory and disturbing job of dismembering the baby and crushing its skull in order to remove it vaginally. There was a high risk of infection and, in the days before antibiotics, many women died. Bronwen H. spoke with distress of being involved in such a birth in Wales:
‘In the beginning of September 1927 we had a case – a tiny little woman. She hadn’t booked anybody. One of my mothers that I was attending said to me, “Oh, Mrs H., she’s expecting, has she booked you, Nurse?” I said, “No.” “Well,” she said, “If I were you I should go and have a look at her”.
‘So being nosy, I went to have a look at her. And honestly, when I saw her I said, “Well, when is your baby due?” “Oh,” she said, “In about two weeks’ time.” I said, “Well, have you booked a nurse or a doctor?” “No,” she said, “I haven’t.” “Well,” I said, “I think you’d better book a doctor.”
‘So anyway I sent this note down to the doctor and in a day or two she started labour. But her membranes had ruptured some time before and the baby wouldn’t come through. So, anyway, the doctor came up and we had to do a craniotomy. But fortunately the baby had died because … Oh, I don’t know … it was a funny affair really. Husband was more or less a cripple and a mother’s boy and she, poor dear … Anyway, I attended her for about a month and she got on like a top. Not even a whisper of a temperature or anything. It was interesting but very upsetting.
‘But I think they were thrilled to think the baby hadn’t lived. They were glad it was dead because … well, they had to get married in the beginning. And there was all this fuss with the mother-in-law and oh, I don’t know … One doesn’t know half the things that go on with these people.
‘The funny part about it, a few years afterwards when I was married and had children of my own, I was driving along the road and I saw her pushing a pram with four little ones with her. One tiny little toddler hanging onto her … and the mother wasn’t much taller than the pram! And I thought, “Well, really!”’
A stillbirth at home
Esther S. spoke from personal experience about the lack of knowledge about appropriate support around stillbirths in pre-NHS days:
‘I lost my first baby. He was a fresh stillbirth. Of course, I was devastated. I was very shocked about it all – you can imagine, can’t you? You never forget these things – all the little details. I’d put out all the best clothes for my baby to air on the clothes horse. I had him dressed for burial in all those best clothes. In those days, they were disposed of in this horrible cardboard box – I used to have to go and get it myself later in my work – terrible isn’t it?
‘When I went back to work some time later, something happened that made me think, “These things are meant to be …” I had to go and do “nursings” [postnatal visits] in a new area – because of course I’d had to give up my old area when I got pregnant – and the first one I went to, that baby was exactly the same weight as my baby had been – five pounds – and he had exactly the same look – fair, he was a very fair child. So I thought, “That’s exactly what my baby would have looked like if he’d lived.” So I picked him up, cuddled him and cried over him. And then I thought, “Now I can do it.”
‘In those days, you see, they didn’t know about letting you hold them when they died, they just didn’t know. And I was so distraught and didn’t know to ask. It was devastating for my friend who was my midwife, too.
‘But I do think that with an experience like that, you’re better off at home. You haven’t got to come back into your home and enter it. You’re with people, you know. Nowadays, of course, they know much more about how to help people through it with the aftercare and counselling. But it’s a very traumatic thing. So is miscarriage. I had one of them after that before I had my two children. Those experiences are with you all your life.’
Premature births
Prior to the 1950s, babies born prematurely were usually cared for at home. Certainly, very small babies did survive without the use of incubators. They would have had carefully improvised circumstances, such as those described to us by Katherine L. and Margaret A., sisters who worked together in East Anglia in the 1940s:
‘Oh, we had a wonderful premature baby! One Sunday morning, we were just getting our
dinner. There was snow on the ground and along came a worried relative. “Nurse, can you come quickly, one of the girls has just had a baby?” He didn’t say what. He didn’t say how.
‘Well, round we went. And the poor little baby was ten weeks prem. and had been born in the latrine, the outside loo, down the bottom of the garden. She’d lived with her sister, who didn’t know she was pregnant. She was complaining of stomach-ache, poor Mary, so her sister gave her a whopping dose of castor oil – and poor Mary went and had it in the loo! And a neighbour came along – I’ll always remember it – and two men on either side of Mary manhandled her into the house and old Mrs Auger (the handywoman) came along holding the baby in her hands, up the garden path and up the stairs. It weighed about two and a half pounds and it was just like a plum to look at, wasn’t it. And the doctor said, “You can’t wish that on the matron (in the cottage hospital). Do what you can for it.”
‘And so we cleared a room downstairs and put a bed in it. We turned our house inside out, didn’t we, Kath? We loaned them all sorts of things: we loaned them a Moses basket, a bedside lamp, an electric blanket, two little electric pads that Dad had given us – everything we could think of! We came home and made premature baby clothes out of white lint and we reared that baby inside that room. We had great big notices on the door – “NO ADMITTANCE EXCEPT IN EMERGENCY”. And we were the only ones allowed in there and Mary, of course. Nobody was allowed to go in there without a mask on. They had to wash their hands and put a gown and a mask on.
‘The baby was too small to breastfeed, but Mary had masses of milk so we used to express the milk and feed the baby with a “Belcroy” – the “Belcroy” is like a very small glass tube. It has one big bulb on one end and a tiny little teat on the other and you put that little teat in the baby’s mouth and you press the bulb and it literally squirts it down the baby. It doesn’t have to work very hard to get it. We gave it a few tube feeds of breast milk, too.
The Midwife's Tale Page 21
