Call the Midwife

by Jennifer Worth

  That night Conchita went into labour.

  The phone rang at about 11.30 p.m. I was called to the phone, as it was my case. I was aghast – firstly because of the premature labour, and secondly because of the weather conditions. How on earth was I to find my way to Limehouse? I was speaking to one of the elder sons, who briefly explained the circumstances. My first question was, “Have you called the doctor?” Yes, he had, but the doctor was out. “Well, you must keep on trying,” I said, “because your mother may be ill. If she was concussed, and her temperature dropped a lot, she may need medical treatment, quite apart from the pregnancy. Ring the doctor again now. He may have difficulty getting to you, but so will I.”

  I replaced the telephone, and looked out of the window. I couldn’t see a thing. Thick grey swirls of fog seemed to be circling the window panes, trying to get in. I shivered, as much with apprehension for Conchita’s awful plight as reluctance to go out at all. The sirens from the river boats, and those in the docks, moaned a hollow call.

  We had hardly been out of the house for three days, hoping and praying that no one would go into labour before the smog lifted. It was a situation I could not, should not, handle alone.

  I went up to the Sisters’ floor to call Sister Julienne. Nuns go to bed at about nine o’clock because they get up before 4 a.m. for the first Office of the day, so eleven-thirty would be the middle of the night for them. Nonetheless, with the first light tap on the door, Sister was awake.

  “Who is it?,” she called out.

  I said my name, and that Conchita Warren was in premature labour.

  “Wait a minute.”

  I waited thirty seconds, and Sister joined me in the corridor, shutting the door of her cell behind her. She was wearing a coarse brown wool dressing gown, and, amazingly, her veil. The question, does she go to bed in the thing? flashed through my mind. It must be damned uncomfortable.

  But there was no time to reflect upon the habit of a nun. I told her briefly the story that had been given to me over the telephone.

  She thought for a moment and said, “Limehouse is over three miles away. You might not get there. There is no point in me, or any of the midwives, coming with you, because two people can get lost just as easily as one. You must have a police escort. Go now and ring the police, and God be with you, my dear. I will pray for Conchita Warren and her unborn baby.”

  The knowledge that Sister Julienne would be praying for us had an extraordinary effect. All the tension and anxiety left me, and I felt calm and confident. I had learned to respect the power of prayer. What change had come over the headstrong young girl who, only a year earlier, had found the whole idea of prayer to be a joke?

  I spoke to the police and told them it was an emergency. I was told that the safest way to get there would be to walk, but the quickest would be by bicycle. The policeman said: “There is no point in sending a car, because you can’t see further than the bonnet, and we would have to have a man walking ahead. We will send a bicycle escort.”

  I said I would be ready within ten minutes. My delivery bag was already packed and ready. All my thoughts were with Conchita – I did not think that the baby was likely to survive at around twenty-eight weeks gestation. Finding the bicycle shed in the smog and loading up my bike was a tricky business, but I was at the front of Nonnatus House in less than ten minutes.

  Two policemen arrived shortly after on bicycles with very powerful lights, front and rear, which illuminated about two yards ahead. One rode ahead of me, and I was instructed to follow him. The other rode beside me, I being on the kerb side. Thus we progressed with surprising speed, because there was no other traffic around.

  Looking back over nearly half a century it seems absurd to be racing to an emergency labour on bicycles at about ten miles per hour. But even today I can think of no better way. What would be the advantage of the most powerful police car with nil visibility?

  We arrived at the Warren household in less than fifteen minutes. I could not have done it alone. The men said they would wait, in case I needed them further, and a couple of the Warren girls took them down to the kitchen for a cup of tea.

  I went upstairs to Conchita. She looked ghastly, deathly white, with bright pink splodges under her eyes. She moaned. I took her temperature, which was 103°F. At first I could not feel her pulse, but, on careful counting, I found it to be 120, and intermittent. Her blood pressure was barely perceptible. Her breathing was shallow and rapid, at around forty breaths per minute. I watched her in silence for a couple of minutes, as a contraction came on. It was powerful, and her features distorted in pain, a high-pitched groan emanating from her throat. Her eyes were open, but I don’t think she could see anyone.

  Len was cradling her in his arms. The suffering on his face was enough to break your heart. He was stroking her hair, and murmuring to her, neither of which she seemed to feel or hear. Liz was in the room.

  I enquired if the doctor had been called. He had, but was still out on a call. The call had been put through to another doctor, who was also out with a patient. All doctors worked terribly hard at these times. The London smogs were notorious killers.

  I said that we should arrange for a hospital admission as soon as possible.

  “Is she tha’ bad?” Len asked.

  It is astonishing how people do not see what they don’t want to see. To me it was obvious that Conchita could easily die, especially if complications arose from labour and delivery. But Len couldn’t see this.

  I went and spoke to the policemen. One said he would telephone the hospital. The other one undertook to try to find one of the local GPs and escort him to the house, if possible. How an ambulance would get there and back was an open question.

  I returned to Conchita, and started to lay out my delivery things. It was possible that I would be alone with a premature delivery, and a sick and possibly dying woman.

  Suddenly I remembered that Sister Julienne was praying for us. Again, the relief was overwhelming. All my fears vanished, and the calm certainty that all would be well flooded my mind and body. I remembered the words of Mother Julian of Norwich:

  “All shall be well, and all will be well

  and all manner of things shall be well.”

  I must have given a great sigh of relief, which Len picked up. He said, “You reckons as how she’ll be all right then, do you?”

  Should I tell him that Sister Julienne was praying for us? It seemed so silly, almost irrelevant. But I did; I felt I knew him well enough. He didn’t dismiss it.

  “Well, I reckons as ‘ow its goin’ to be all righ’, then, too.”

  His face was brighter than it had been since I entered the room.

  It would have been advisable to examine Conchita vaginally to see how far she was in labour, but I couldn’t get her into the right position. She wouldn’t allow Len or me to move her. Liz explained to her in Spanish what was required, but she didn’t understand or respond in any way. I could only assess the progress of labour from the strength and frequency of contractions, which were approximately every five minutes. I listened for the foetal heart, but couldn’t hear a thing.

  “Is the baby alive, then?” asked Len.

  I didn’t like to say a straight “No,” so I hedged my bets.

  “It’s unlikely. Remember your wife got very, very cold today, and has been unconscious. Now she has a fever. All this will affect the baby. I cannot hear a heartbeat.”

  One of the real problems of premature delivery at the stage of pregnancy Conchita had reached is that the foetus is often lying transversely across the uterus. A human baby ideally should be born head first. A breech delivery is possible, but difficult. A transverse or shoulder delivery is impossible. The head does not normally descend into the pelvis until after thirty-six weeks. A foetus of around twenty-eight weeks is quite large enough to block the cervix completely if contractions push it downwards in the transverse position. In that event, without surgical intervention, the death of the baby is inevi
table. I palpated the uterus trying to find out the baby’s position, but it was no use, I could not tell. A vaginal examination might have enlightened me, but there was no way that we could persuade Conchita to cooperate.

  All I could do was wait. The minutes between contractions ticked by slowly. They were coming every three minutes now. Her pulse was more rapid, 150 per minute; and her breathing seemed to be more shallow. Her blood pressure was quite imperceptible. I prayed for a knock on the door to announce the arrival of a doctor or the ambulance, but none came. The house was silent, save for the low moaning of Conchita as each contraction came and went.

  Inevitably the contractions became stronger, and it was then that Conchita began to scream. I have never in my life, before or since, heard such terrifying sounds. They came from the depths of her suffering body with a force and power that I would have thought impossible, given her fevered, debilitated state. She screamed on and on, wild terror in her unseeing eyes, the sound reverberating wave after wave against the walls and ceiling of the room. She clung to her husband, tore at him, until his face and chest and arms were bleeding. He tried to hold her, to comfort her, but she was quite beyond comfort.

  I felt helpless. I did not dare to give her an analgesic to lessen the pain and quieten her, because her pulse and blood pressure were so abnormal, and I knew that any drugs would probably kill her. I thought that if it was a normal delivery she had a chance of living; if it was a transverse presentation she would die, unless an ambulance were to arrive quickly. I could not get near her to feel the uterus, or even to hold a leg, as she was throwing herself around the bed with the strength of a wild animal in a trap.

  Poor Liz looked terrified. Len, with unconditional love, was still trying to hold her in his arms and console her. She sank her teeth into his hand with the strength of a bulldog, and hung on. He didn’t cry out, but winced with pain, sweat and tears falling from his forehead and eyes. He didn’t even try to force her jaw open or to pull away. With alarm, I thought that she would sever a tendon. Eventually she loosed the hand, and flung herself to the other side of the bed.

  Then, as suddenly as it had started, it was all over. She gave a terrible cry, and a massive push, and water, blood, foetus, placenta – everything – was delivered on to the bed sheets at once. She fell back exhausted.

  I could feel no pulse at all. Her breathing seemed to have stopped. But I could feel a flutter of a heartbeat, so I listened with my stethoscope. It was faint and irregular, but it was there. The foetus was blue, and looked quite dead. I snatched a large kidney dish from the dresser, scooped everything into it, and dumped it on the dresser.

  “Now we must quickly get her warm,” I said, “cleaned up and comfortable, if she is to stand a chance. You help me, Liz – clean warm sheets, a couple of hot water bottles. I will check the placenta in a minute to see if it is complete. If we can get her to drink something hot it will help. Hot water and honey would do; a teaspoon of brandy in it would be even better. The main thing is to treat the shock. And let us all hope and pray that the bleeding won’t get worse.”

  Len went out to issue some instructions, and to pacify the terrified family gathered around the door. Liz and I started to clean the dirty sheets and linen from under Conchita. Len soon returned with clean sheets and hot water bottles, and Liz and I started to make the inert body comfortable.

  Len must have gone over to the dresser. Liz and I had our backs to it, busy with Conchita. We heard a gasp.

  “It’s alive!”

  “What!” I cried.

  “It’s alive, I sez. Ve baby’s alive. It’s movin’.”

  I rushed over to the dresser, and looked at the gory mess in the kidney dish. It moved. The blood actually moved. My heart stood still. Then I saw the tiny creature in the pool of blood, and its leg moved.

  Oh, dear God, I could have drowned it! I thought.

  I lifted the tiny body out with one hand and tilted it upside down. It seemed to weigh nothing. I have held a new born puppy of about the same size. My head raced.

  “We must clamp and cut the cord quickly. Then we must get him warm.”

  It was a little boy.

  I felt desperately guilty. The cord should have been clamped five minutes earlier. If he dies now, it will be all my fault, I thought. I had discarded this tiny living soul to drown in a dish of blood and water. I should have looked more closely. I should have thought.

  But wallowing in self-reproach gets us nowhere. I clamped and cut the cord. I felt the fragile rib cage. He was breathing. He was a survivor. Len had warmed a small towel on a hot water bottle, and we wrapped him in the cloth. He moved his head and arms a little. All three of us were stunned by the life in the baby. None of us had seen a human child quite so tiny. A baby that is two months premature usually weighs about four pounds, and seems tiny enough. This baby was about one and a half pounds and looked like a tiny doll. His arms and legs were much smaller than my little finger, yet a miniscule nail completed each digit. His head was smaller than a ping-pong ball, and looked disproportionately large. His rib cage looked like fish-bones. He had tiny ears, and his nostrils were the size of a pin-head. I had never imagined that a baby of around twenty-eight weeks could be so lovely. I felt I ought to suck the mucus from his throat, but was terrified of hurting him. Anyway, when I got the catheter, it was far too large, and would never have gone into his mouth. To force a hosepipe into a normal baby’s mouth would have been just as inappropriate. So I just held him nearly upside down with one hand, and gently rubbed his back with one finger.

  I had no experience of caring for a premature baby, and did not know what to do. All my instincts told me that he must be kept warm and quiet, preferably in the dark, and with frequent feeding. No cot was ready. Where could we put him? Just then Conchita, who was lying quietly, spoke.

  “Niño. Mi niño. Dónde está mi niño?” (Baby. My baby. Where is my baby?)

  We looked at each other. We had all thought she was semi-conscious or asleep, but obviously she knew exactly what had happened, and wanted to see her baby.

  “We’ve gotta give ’im to ’er. Liz, you tell her he’s very little and we’ve gotta be very careful with him.”

  Liz spoke to her mother, who smiled slightly and sighed with weariness. Len took the baby from me and sat down beside his wife. He held the baby in one hand so that the child lay within her gaze. Her eyes had been vacant and unfocused for several moments and I don’t think she saw or understood at first; she had expected to take a full term baby into her arms. Liz spoke to her again, and I heard the words.

  “El niño es muy pequeño.” (The baby is very small.)

  Conchita struggled to adjust her vision to the minute scrap held in Len’s hand. You could almost see the struggle and the effort it cost her. Gradually she became aware, and with a sharp intake of breath put out a shaking hand to touch the child. She smiled, and murmured “Mi niño. Mi querido niño,” (my baby, my darling baby) and drifted off to sleep, her hand resting on Len’s hand and the baby.

  Just then, the Flying Squad arrived.

  THE FLYING SQUAD

  An Obstetric Flying Squad was provided by most big London hospitals, and I believe by all regional hospitals, as an emergency backup for domiciliary midwifery. The service must have saved thousands of lives, because before the 1940s, when no service existed, a midwife could find herself entirely alone with any obstetric emergency – such as a mal-presentation, haemorrhage, cord prolapse, or placenta previa – and all she could do would be to call in the local GP who might or might not be skilled in midwifery.

  It was the proud boast of the Flying Squad of the London Hospital that it could reach any obstetric emergency in twenty minutes. But that was reckoning without a London smog. When the policeman contacted the hospital about Conchita no ambulance had been available to bring the Flying Squad. The smog caused acute and deadly respiratory failure in thousands of old people each year, and every doctor and ambulance was out on these cases. When one final
ly did return to the depot, the driver, who had been working non-stop for sixteen hours, was sent off duty, and another had to be found. Even then, a policeman had to cycle in front of the ambulance to guide it – hence the delay of nearly three hours. However, a registrar, a houseman, and a nurse from the obstetrics department had been sent by the hospital.

  Everything happens at once, so they say, and within minutes a GP also arrived on foot. God bless him, I thought. He looked exhausted. He had been working all day and all night, and very likely most of the night before, yet he had the professionalism and the courtesy to apologise for being late.

  With so much medical know-how in the house, it was necessary to have a case conference to decide the best course of action for mother and baby. We went down to the kitchen for this, and I asked Len to accompany me. Liz was left with her mother and the baby. The two ambulance men and the policemen joined us too – they couldn’t be asked to sit outside in the cold, and there was nowhere else for them to sit in the house. Sue, one of the older girls, made tea all round.

  I gave my case history, and handed over the recorded notes. All doctors were agreed that mother and baby must be transferred to hospital at once. Len was alarmed.

  “Does she ‘ave to go? She won’t like it. She’s never been away from home before, she hasn’t. She’d be lost an’ frightened. I knows as ’ow she would. We can look after ’er. I’ll stop at home, an’ the girls can muck in an all, till she’s better.”

  The doctors looked at one another and sighed. Fear of hospital was commonplace. Among the older generation, it arose mainly from the fact that most of the hospital buildings were converted workhouses, which had been feared more than death itself. The doctors agreed that as Conchita was now safely delivered, if no post-natal complications arose, she probably could be treated at home. A course of antibiotics would clear the infection that was causing fever. The head injury, causing concussion and delirium, would heal with rest and quiet. They tried to point out that she would get more rest in hospital than at home, surrounded by children, but Len would have none of it, so they capitulated.