The Midwife's Tale

by Billie Hunter

  All the midwives described the virtue of getting women to walk around in labour, a practice also encouraged by 95-year-old handywoman, Mrs G:

  ‘Oh yes, we got the long labours that went on and on. Some of them were nearly a week. Well, you couldn’t do nothing. Just tell ‘em to walk about and that’s it. Some people say, “Lay on the bed”. But then the baby goes to sleep, doesn’t it, so the mother’s got to go all through that again. We used to stay with them when it started. The woman needed to know there was somebody else there.

  ‘We used to get an orange. Squeeze half into a glass, then a dessert-spoonful of castor oil, then squeeze the other half of the orange on top so they wouldn’t taste the oil. That would get them going. Then they would want to go to the toilet and if the baby was there, really well down as well, you see, it was lovely, it was not much problem.

  ‘If there was something in the way, the baby wouldn’t come. We used to call it “the shutter”. It had to be lifted, you see. Until the shutter was lifted, the baby wouldn’t come. You’d use your finger, see, and you had to lift it like inside. [Presumably, Mrs G. is describing lifting back a lip of cervix over the baby’s head.]

  ‘When they were in real labour, they used to lay on their backs in a certain way and we used to press on their stomach, on the top of their stomach. We used to tip our hands down like that and hold the baby down a bit.’

  Midwife Esther S. remembered the increased pain she experienced when being forced to lie down during one of her own labours and how that gave her insight into the benefits of what is now called ‘mobilising in labour’.

  ‘We kept them moving around in labour, never went to bed until the last minute. They almost had them [the babies] standing up sometimes – “Come on love, on the bed. No, you can’t really stay like that [moving around]”. It was lovely because they were free. There weren’t all this tied down thing [reference to modern monitoring equipment]. When I went to have one of mine, I had to go into hospital for an emergency and they wouldn’t let me get off the bed! I said, “This is terrible. This is murder to me.” Terrible! Stuck where you are! Dreadful! Oh no, no, no, you want to move. Of course you do. Nature needs you to move. You let them have the freedom of what she’s wanted. You got as tired as they were; you walked miles when you had deliveries!’

  There were times when midwives could not walk miles, since they sometimes arrived at labours exhausted from lack of sleep. Several women told stories about ‘looking after the poor midwife’. Edie M., whose babies were born in the 1920s, recalls:

  ‘I called the midwife out on the Sunday. Cropped hair, proper, like a sergeant major. “Oh you naughty girl,” she said, “Calling me out at this time. Oh, I’m ever so sorry. I’ve got a terrible head.” So I said, “Lie on the couch.” “Ooh,” she says, “Ain’t it hard?!” I said, “Well, lay on the bed.” So I put a pillow from the top to the bottom and said, “Lay there.” And this big woman, she got on and got down. I said, “I’ll make you a nice cup of tea.” So I’m in strong labour and I’m running around! So eventually, I says, “I’m afraid you’ll have to get off. I’ve got to push this out!” Had to get her off to get on meself!’

  Margaret A. describes a similar situation, but from the midwife’s point of view:

  ‘If we were at all able to stay with them in labour we did. I well remember a girl we had down the road here. She was in labour overnight. The husband came up to the house with a pair of her pants. He said, “Ere Nurse, what’s that?” “That’s a show,” I said. So he said, “Well, you better come then.” So off I went. And when I got there she wasn’t doing much, but obviously she’d had a show, and I thought, “Oh well, its her sixth so I’ll stay.” I gave her pot. brom. chloral and she went into a sound sleep. I got on the bed with her and I expect I dozed off as well. Slept all night. About 7 o’clock in the morning she suddenly sat up in bed and said, “God, it’s coming, Nurse!” D’you know, I didn’t have time to put on me gown and me mask and me gloves! She just had it like that, slept all night and then just had it! And I had a night’s rest on the bed beside her!’

  The pot. brom. chloral [potassium bromide chloral, or chloral hydrate] referred to by Margaret A. was a mild sedative – the only analgesic used by midwives. Even though the early gas-and-air machines (Minnitt Machines) were introduced in 1936, few midwives used them since they were too heavy and bulky to carry on foot or bicycle. Chloroform was still used occasionally at difficult births, such as forceps, when the doctor had been called. Edie B. elaborates:

  ‘We used to give them horrible stuff called chloral hydrate, which used to immediately make them sick. It was no good. That was the only concession we had to pain relief then.

  ‘There was one little phase where we had horrible little chloroform capsules. I don’t know if anyone’s told you about those? Little capsules filled with chloroform and you had a lint mask and you just squeezed one of these capsules onto the lint and put it over the patient’s face every time a pain came. However, they soon stopped it because I think they found it not very successful – and a bit dangerous. [It could be fatal.] The women did begin to get a bit of relief from it, but they didn’t think it was a wise thing to do, to continue with that. And, of course, when the Minnitt machine came in, that was a terrible great help … But most of the ones at home didn’t want anything anyway. They moved around. They weren’t restricted.’

  Elizabeth C.’s response to our discussion on coping with pain in labour was to emphasise the importance of continuity of care, a topical issue in midwifery today. She described accurately the release of endorphins (the body’s natural opiates) in undisturbed labour, which surprised us because this process was not written about until the early 1980s.5

  ‘I’m sure it’s really important to know the person who’s going to look after you in labour. I’ve never had a baby, of course, but I’m sure it’s very comforting to have someone that you know and that knows you and sort of knows your temperament, knows what you can take and what you can’t. And having a home back up, too. Knowing the midwife, it’s better than dope or something because it’s a normal thing, you see.

  ‘I think myself that the system has a certain amount of sedative in itself that it releases at a time like that. I’m sure it has, because I’ve seen people that just looked as if they were half sozzled – and they didn’t have anything! Just looked like somebody “gone” – and they hadn’t had any dope.

  ‘I think the body does release something into the system. If it’s not interfered with by giving dope, it will work. But I think when you interfere, it won’t work then.’

  Elsie B.’s tip for coping with long labours was, ‘Keep them all busy and happy’. She gave this example:

  ‘One thing that happened. I think she was a primip [first baby]. All the house was very anxious and all the rest of it. So they said, “What could they do?” So I said, “Oh, well, keep quiet and let her go. Sit down and have a game of cards, or do something.” When I went back and had a look in, there they all were most religiously playing cards! It worked!’

  The birth

  Like all the women we interviewed, Sissy S. spoke vividly about each of the births of her children in the 1920s and 1930s. She remembered details as if they had happened yesterday:

  ‘You was always told to lie on your left side and “Steady, steady … that’s right – now bear down, slowly … slowly … now the next pain is going to be very hard …” (“Ooh no, the first one was bad enough!”) For the head to come into the world, that was painful enough, but then you had the shoulders. After that, you might as well say it’s all over. I never tore with any of my babies. Not even the one that was 12lbs. I never had a doctor to me – because if it was a tear, you had to have a doctor to you.’

  The midwives all talked with pride about their skills in preventing tears. Elsie K. explains:

  ‘We were taught to deliver, not just catch the baby. We were taught to guard the perineum. And it was a disgrace to get a tear. We were taught to do i
t properly and carefully. I know when I was a staff midwife, I was getting tears sometimes when I was delivering, so I said to the senior Sister, “I want to watch you deliver and see what it is I’m doing wrong.” And I was really hurrying the head out a bit too much. I watched her, you see, and realised that I must be very much slower than I was. It’s all patience in midwifery.’

  Elizabeth C. explains further:

  ‘You didn’t have to rush things, you see. Time was not of any great consequence. You didn’t rush. Your time was your own. You might be up all night but it was your time.’

  By contrast, we heard many descriptions of handywomen getting women to bear down long before the uterus was ready to expel the baby (a potentially harmful practice). Handywoman Mrs G. certainly expressed a sense of urgency to ‘get the baby out’. She often implied that if the baby was not coming, it must be the woman’s fault:

  ‘And then the head comes through – that’s if they lift the shutter. Of course, if the shutter don’t lift, well it’s no good is it? It’s like if a person cut yer tongue out. If you cut yer tongue out, you can’t talk. That’s true, isn’t it? You had to let the baby’s head come through and then you held the baby’s head, and then you say, “Well how long have you got, mate? You gonna lay there all the time? Come on, get cracking!” Then we used to massage the woman’s stomach, just give her a press down again. “Come on, don’t lark about with me, that’s it …”

  ‘There was one woman; I used to laugh about her. I used to go to her and she had four girls. And all her babies, believe it or not, they were born hand first! So I always used to shake their hands and say, “You are polite, shaking hands first!” They was born with their hand up alongside their heads, you see. You wouldn’t know what to do, would you? ‘Cause there’s nothing you can do. If you try to push their hand back, you might break their shoulder. All her babies came like that – but I used to say they was polite!

  ‘No, the women weren’t always lying down, I’ve had babies drop in my apron [laughter]! There used to be a lady lived opposite me at Number 3 and she never had no labour. She used to be cleaning her windows. She used to be on the chair, cleaning her windows, and a boy come up to my door and he says, “Lady over there wants you.” And I looked out and I’d say, “All right lad.” You know, take me apron and that and go over. And perhaps I’d just have the chance, maybe, to get her sitting on the chair. Soon as she sat on the chair, the baby come – didn’t want it in there no more!

  ‘It’s surprising though. Some people don’t have labour. It’s very rare. They have the bearing down but they don’t have no other pains. She had two little girls; both come like that. Mysterious, isn’t it? But you could go home sooner! It’s good for the midwife as well as the woman!’

  The midwives we spoke to were all much more rigid than Mrs G. in their attitude towards the position in which women gave birth. While principles of what is now called ‘active birth’ were applied in the first stage of labour, it seems that all midwives insisted that the woman got onto the bed in second stage.6 They were very directive about the position for the birth in order to carry out what they saw as a most vital midwifery skill – ‘the protection of the perineum’:

  ‘We delivered them in the left lateral [on the left side]. You could support the patient’s leg around your neck, you see – you sort of made your hands tight together, flexed the head and let it crawl out slowly, very, very slowly. You had the odd skin nicks but you didn’t have a lot of what I would call torn perineums.’ [Elizabeth C.]

  When the first edition of this book was published episiotomies (cutting the women’s vagina to speed up the birth of the baby and prevent natural tearing) were still common procedures in most hospitals. This horrified midwives like Elsie B.:

  ‘I don’t think they’re doing so many now, but there used to be all these episiotomies! And the whole thing that we trained for was to protect the perineum, not to split it. And the people used not to have half the trouble afterwards that they do today. Once you do one of those awful things, you’ve had it for next time. And you know, you used not to get the trouble with the babies that they say you’ll get if you don’t do them. I think they’re going to die out probably.’

  The baby at birth

  Midwives working without oxygen and resuscitation equipment would resort to all sorts of methods to encourage babies to breath. These ranged from the standard practice of holding the baby by its feet to that of dunking it in an ice-cold water butt to shock it into existence. Margaret A. describes the methods she used:

  ‘On occasions, I’ve had to use mouth-to-mouth resuscitation, not very often. But with a baby that won’t breathe you take hold of its feet and pat the bottoms of its feet – or another thing, too – blow in the centre of their stomachs like that – oooh – right in the centre of their tummies. And you often hear them go, “aaaagh” [breathes in] if you do that. Not a wide blow, a thin blow right in the middle of their tummies. And I did have a doctor who would light a cigarette and blow cigarette smoke in the baby’s face – oh, but I don’t like that. It probably irritates the mucous membrane. I wouldn’t do it – but then I don’t smoke!’

  Where artificial rupturing of the membranes is not done routinely, occasionally babies are born ‘in the caul’, as Esther S. describes:

  ‘Where the membranes haven’t ruptured, you’ve got to watch ‘cause if it does happen like that (a quick delivery – it could happen, you see), of course you have to whip it off. I had just a few. I got one off – oh, it was such a feature in the home. It was laid out and they tried to dry it. It was going to be given to someone in the family who was a sailor so that he would never drown. He’d go to sea and he’d be safe! In the war, every seaman tried to get one. If you carried one in your wallet, you wouldn’t drown! Only a yarn, of course! But it was quite fun that!’

  The delivery of the placenta

  ‘After they’d seen to the baby, the nurse always said, “Now, go steady and just bear down gradually”. After you’d relaxed a little while after having your baby, then you’d bear down, they’d get the placenta out, and then they’d clamp it [the cord]. My afterbirth was always brought out before the cord was cut.’

  The fact that Sissy S. remembers accurate details about the final part of labour [the third stage] is indicative of an age where women saw expelling the placenta as being part of the process of giving birth. Today, as the baby is being born, most women are routinely given an injection of an oxytocic drug to make the uterus contract strongly. Their attendant then pulls out the placenta and membranes for them, having clamped and cut the cord. Therefore, for most women, the process of giving birth stops at the baby; the rest is accomplished by the midwife.

  Controversy over the effects of intervening in the third stage of labour continues. Many midwives complain that they have no experience of physiological (natural) third stage. It is, therefore, all the more interesting to hear the following midwives talk about what they did in the third stage of labour. Much of what they recommend is to be found in contemporary literature on the subject:

  ‘I was taught to expel the placenta by fundal pressure [pressing on the top of the uterus], but as I got older, I used to leave the mother to do her own third stage, and I found it very much easier. You get them relaxed and then the third stage is never very much trouble – unless, of course, there’s bleeding, and then you’d use Ergometrine. At first, we used liquid ergot and then later on we could give the injection. Retained placentas were very rare. I can’t think of more than a dozen times in 2,002 births, and then very few of those had to go into hospital for manual removal. That was very rare. We clamped and cut the cord after it stopped pulsating. We were taught that a certain amount of useful blood was given to the baby until the cord stops pulsating, so I always kept it that way.’ [Mary W]

  ‘Well, we just waited for it unless they were bleeding badly. We just went on waiting and then, well, we just used to catch it when it came out. It wasn’t any bother. We’d encourage t
he mother, saying, “Push with each pain, dear”, but it didn’t seem to cause any bother at all. Some took longer than others. If she was tight with it or got all excited, then it was sometimes a bit longer because she wasn’t co-operating properly, but if the mother listened and did what she was told, it usually came out quite quickly – usually in five or ten minutes, but sometimes longer, often an hour. You’d transfer if it hadn’t come after, say, twelve hours or so. You’d put it in a pail and check it over and then the husband would burn it down the garden.’ [Nellie H.]

  ‘You just waited – you just kept your hand there to control and then when you found that the placenta was free, you just – down and out and that was it. I found that more midwives and doctors in the G.P. unit had retained placentas than ever I did – because they gave Syntometrine and then you’ve got to get it out quick before it’s trapped. I don’t like that at all. It’s such a different way of delivering – and the speed you lot have to work at! No, I like my own old way. Usually, you had the placenta by 20 minutes – a little “show” and then you thought, “Ah, that means it’s separating – good!”

  ‘We used to feed the roses with the placenta – lovely! Now they take them away, don’t they? Or we’d burn them in the house. Sometimes we used to whip one out – a nice healthy one and take it home and dig it in the garden – ever so good for roses. But normally you wrapped it up in newspaper. It was quite a feature in the home. They all had coal fires you see – it was lovely for delivery, a little coal fire – and we used to put them on there and then we used to count how many times it popped. If it pops three times, there’s another baby will come! I had one cord that was 47 inches long and once the cord was wrapped round the baby’s neck five times – it was a complete collar. How it survived I’ll never know.’ [Esther S.]