I could see something coming, as the perineum expanded, but it did not look like a baby’s buttocks. It looked a purplish colour. Sister saw my questioning expression, and told me, “That is the prolapsed cord. It occurs quite commonly in a breech delivery, because the breech is an incomplete sphere, and the cord can easily slip down between the baby’s legs. As long as it is pulsating normally, there is nothing to worry about.”
The perineum continued to distend, and now I saw the baby’s buttocks quite clearly. Sister was kneeling on the floor between Betty’s legs because the bed was too low for her to stand. She was explaining everything in a low voice to me, “This is a left sacro-anterior position, which means the left buttock will be born first, from under the pubic bone.
“Now don’t push, Betty,” she continued, “I want this baby to come slowly. The slower the better.
“The baby’s legs will be curled up. I will want to rotate the baby to ensure the best position for delivery, but also the pull of gravity as the baby’s body hangs from the vulva will help to maintain flexion of the head. This will be important.”
The buttocks were born, and with infinite care Sister inserted a hand and hooked her fingers over the flexed legs.
“Don’t push, Betty, whatever you do,” said Sister Bernadette.
The legs slid out easily. It was a little girl. A long section of cord also slid out. It was pulsating quite vigorously - one could see it, there was no need to feel it.
“The baby is still fully attached to the placenta,” Sister said, “and its life blood is coming through the cord. Even though the body is half born, until the head is born, or, at any rate, until the nose and mouth are clear to breathe, the baby depends upon the placenta and this cord for life.”
I found it spooky that this tortuous, pulsating thing was absolutely essential to life, and said, “Shouldn’t we push it back?”
“Not necessary. Some midwives do, but I really think there is no advantage to be gained.”
Another contraction came, and with it the baby’s body slid out as far as the shoulders.
Towels had been placed over the screen by the fire to warm. Sister asked for one and wrapped it firmly around the baby’s body, saying as she did so, “The purpose of this is two-fold: firstly the baby must not be allowed to get cold. Most of her body is now exposed, and if the shock of cold air makes her gasp, she will inhale amniotic fluid, which could be fatal. Secondly, the towel gives me something to grip hold of. The baby is slippery, and I have to turn her another one quarter circle so that the occiput will be under the pubic bone. I will do this as I deliver the shoulders.”
With the next contraction, the left anterior shoulder impinged upon the pelvic floor, and Sister delivered it by hooking a finger under the arm, and at the same time rotating the body a little clockwise. The right shoulder was delivered in the same manner, and both baby’s arms were out. Only the head remained inside the mother.
“You have a little girl,” Sister said to Betty, “but from the size of her limbs I don’t think she is six weeks premature. I think you got your dates wrong. I want you, Betty, to push now with all your strength and really use every contraction for delivery of the baby’s head. Doctor may have to exert some supra-pubic pressure, but I would prefer it if you could push the head out by yourself.”
There had been no contractions for a full three minutes, and I was beginning to feel tense and anxious, but Sister was relaxed. The baby was supported by her hands, and then she let go completely, so that it was hanging quite unsupported. I gasped in horror.
“This is the correct thing to do,” Sister explained. “The weight of the baby’s body will gently pull the head down a little, and will increase the flexion of the head, which is what I want. About thirty seconds like this will be enough. It will not hurt the baby.”
Then she took hold of the baby again. I must say I felt relieved. A contraction came on.
“Now push, Betty, as hard as possible.”
Betty did, but the head did not descend any more. Sister and Dr Turner agreed that with the next contraction he would exert suprapubic pressure, and if that did not prove effective, a low forceps delivery of the head would be necessary.
Sister explained to me, “That is because the cord will be compressed between the head and the sacral bones. The baby is all right at the moment, but if it goes on for too long, that is more than a few minutes, there is a definite risk of asphyxia.”
I clenched my fingers with shock and anxiety, but Sister remained completely calm. Another contraction came, and the doctor placed his hands on Betty’s abdomen just above the pubic bone and pressed down firmly. Betty groaned with pain, but there was a definite movement of the head.
“I am going to use the Mauriceau-Smellie-Veit method of extraction of the head,” Sister explained to me. She was allowing the baby to hang unsupported again, and my heart was in my mouth.
“With the next contraction, all being well, we will have the airways clear, and the baby will be able to breathe. I will want my Sim’s vaginal speculum, so be ready to pass it when I need it.”
I looked to see where the Sim’s was on her delivery tray. My hands were trembling so much that for a ghastly moment I imagined I would knock the whole tray over, or pick up the Sim’s only to drop it on the floor.
Another contraction came on, and the doctor exerted the same pressure on Betty’s abdomen. Sister placed her right hand over the shoulders of the baby and the fingers of her left hand into the vagina. I could see her gently moving her fingers and feeling for something. The baby was resting on her forearm.
“I am trying to hook my index finger into the mouth of the baby, in order to maintain flexion of the head, so that the mouth and nose will be the first part of the head to encounter the air. It is not to exert pressure by pulling. If you ever use this method of delivery, nurse, remember that. If you try pulling, you risk dislocating the jaw.”
I felt sick with fear, and just hoped to God that I would never have to deliver a breech. I could see that she was manipulating the back of the skull with her right hand. She explained, “I am simply pushing upwards on the occipital protuberance of the skull to increase flexion. A little more pressure, please doctor, if you can, and I think I shall have the airways clear. That’s it. The Sim’s now, nurse, please.”
I had to grip my wrist with my other hand to stop it trembling. All I could think was, I mustn’t drop it, I mustn’t drop it. My relief when I handed it over was so great that I almost laughed.
But there was more to see.
The chin of the baby was now on the perineum and Sister carefully inserted the speculum into the vagina, pushing the posterior wall backwards, rather like using a shoe-horn, so that the baby’s nose and mouth were exposed. She asked for a swab, which I handed to her, and she wiped the baby’s nose and mouth free of mucus.
“Now she will be able to breath, and will no longer be dependent upon the placental blood supply.”
It was astonishing to hear a gasp, followed by a tiny cry. The baby’s face could not be seen, yet her voice could be heard.
“That’s what I like to hear,” said Sister. “Did you hear that, Betty?”
“Not ’alf. Is she all right, poor little thing? I reckons as how she’s goin’ through it as much as what I am.”
“Yes. Your baby’s quite safe now, and with the next contraction she will be born, I assure you. I think you have a torn perineum, but I can’t see it because it’s behind the speculum, nor can I do anything about it, because if I remove the speculum your baby will not be able to breathe.”
Another contraction was coming. ‘This is it,’ I thought with some relief. Delivery of the head had so far taken only twelve minutes, but it had seemed like an eternity to me.
The contraction was strong, and doctor was exerting considerable pressure. Sister drew the baby’s body downwards until the nose was level with the perineum, and then swiftly upwards over the mother’s abdomen. The movement took no more than t
wenty seconds, and the head was delivered. I nearly sobbed with relief.
The baby was blue.
Sister held her upside down by the ankles.
“This blue tinge is not serious,” she said. “It is to be expected. I must make quite sure that the airways are clear. When she starts to breathe strongly and regularly the colour will improve. Pass me the mucus catheter, will you, please?”
I was not trembling any more, so was able to do this without fear of dropping it.
Sister inverted the baby, and held her in her left arm. She then inserted the catheter into the baby’s mouth and sucked very gently at the other end to draw any fluid or mucus away. One could hear a bubbling sound as fluid entered the catheter. She then cleared each nostril in the same way. The baby gave two or three big gasps, and coughed, then cried. In fact she let out a tremendous scream. Her colour rapidly changed to pink.
“That’s a lovely noise,” observed Sister. “A few more screams like that will make me happy.”
The baby obliged, and screamed lustily.
The cord was clamped and cut, and the baby wrapped in warm dry towels and handed to Betty.
“Oh she’s lovely,” exclaimed Betty, “bless ’er li’l heart. She’s worth all the pain in the world.”
It’s a miracle, I thought. The mother literally forgets the agony she has been through the moment she holds her baby.
“It’s Christmas Day,” remarked Betty. “We must call her Carol.”
“That’s a lovely name,” said Sister. “Now we must get the placenta out, and I think you had better stay where you are because there is a tear, as I thought, and it will be easier for the doctor to stitch you up in this position.”
Doctor was drawing up a syringe and said to Sister: “I am going to give ergometrine now, to promote the expulsion of the placenta.”
She nodded.
I did not ask why. It was not normal practice to give ergometrine in those days, unless there was undue delay of the third stage, or severe bleeding, or an incomplete placenta. As I noted earlier, oxytocic drugs may be given routinely today, immediately after delivery of the baby.
Within a couple of minutes a contraction came on, and the placenta plopped out into the kidney dish held by the Sister.
“Right, I’ll hand over to you, doctor.” she said. You can take my place, now.”
This was easier said than done though. Sister tried to get up, but couldn’t. She gave a gasp of pain.
“My legs! I can’t feel them. I’ve got pins and needles.”
Not surprising, poor thing! She had been kneeling on the floor for over half an hour, in the same position, concentrating wholly on the work she was doing.
“I can’t move. You’ll have to help me, my legs have completely gone to sleep.”
The gallant doctor put his arms round her and pulled. She must have been a dead weight, because he made no impression. Ivy and I joined in, pushing and pulling. We were all laughing. Eventually we hoisted Sister to her feet, and got her stamping and moving her legs. Bit by bit the circulation and the nerve supply restored the function, and she was able to stand without help.
The doctor opened his suture case and scrubbed up again. He asked me to hold his torch, so that he had a direct light on to the tear. He anaesthetised the area with a local, and then examined it thoroughly.
“It’s not too bad, Betty,” he said. “I’ll soon have you stitched up, and it will have healed within a couple of weeks. I want to examine you internally, though, to make sure that the cervix is not torn also, because this can sometimes happen in a breech delivery.”
He inserted two fingers into the vagina and felt all around. He explained to me, “The breech is smaller in diameter than the head. Therefore the cervix may be sufficiently dilated to allow the passage of the breech, but not relatively open enough to allow the free passage of the head. This will obviously be one of the occasions when the cervix may tear. If that occurs, the mother will have to be transferred to hospital, because I do not have the facilities here to repair a cervix. However,” he continued in a confident voice, “you are lucky, Betty, there is nothing torn inside you. I just have to put a few stitches on the outside.” He selected his catgut and needle. He pulled the muscle together with forceps, and with a few circular movements of the wrist had made a neat repair. It only took a few minutes.
“There we are. That’s that. Now let’s get you back into bed, so you will be more comfortable.”
Meantime, Sister had been examining the baby. “She weighs five and a half pounds, Betty. Your little Carol is certainly not six weeks premature. She may be two weeks premature, but you must have been a month out with your dates. You must keep a better record next time.”
“Next time!” exclaimed Betty. “That’s a good ’un. There won’t be a next time. One breech delivery’s enough for me.”
The baby was out of danger, and the mother comfortable, and so Sister Bernadette and the doctor prepared to leave. I was left to clear up, bath the baby, and write up the notes. On her way downstairs, Sister had to shout through the crowd to get hold of Dave in order to tell him that he had a little daughter. Through the closed doors we in the delivery room heard the shouts of congratulations, and the strains of “For He’s a Jolly Good Fellow”.
“Who’s a jolly good fellah?” said Betty. “Dave? Well, I like the sauce!” She cuddled her baby happily, and laughed.
Dave came up at once. He looked flushed, and only slightly the worse for wear, but he was proud and happy. He took Betty in his arms. I had found many East End men to be barely articulate, but not Dave. He was not a wharf manager for nothing.
“Yer wonderful, Betty, and I’m proud on yer.” he said. “A Christmas babe’s a miracle, and I reckons as how we can’t forget this one’s birthday. I reckons we should call her Carol.”
He took the baby and then, with alarm, said: “Cor, aint she little! I think I might break her. You’d best have her back, Betty.”
Everyone laughed, as Carol had that moment given a little whimper and puckered her face.
I was aware that the sounds from downstairs had changed. The noise of the party had subsided, and we could all hear shuffling and whispers and giggles outside on the landing. Dave said to me: “They are all there, wanting to come and see the baby. When can they come, do you think?”
I could see no good reason why they should not do so; after all, this was not a hospital. So I said, “I will finish cleaning up with Ivy, and when I’m bathing the baby the children can come in. I’m sure they would like that. In the meantime I will need more hot water brought up.”
Jugs of hot water arrived, and Ivy and I quickly cleaned up Betty and got her ready for visitors. Then I placed a tin bath on a chair by the fire and prepared water at the right temperature for the baby. Ivy opened the door, and said, “You can come in, now, but you’ve got to be quiet and good. Anyone who’s naughty will be sent straight out.”
Clearly grandmother’s word was law with small children. I didn’t count the number who entered the room, but probably about twenty little ones filed silently in, with big, round, awestruck eyes. It was a good thing the bedroom was large. They stood around me, sat on the bed, stood on chairs, on the windowsill, anywhere, in order to see. I looked around me with delight, for I like children, and this was an enchanting experience. Ivy told them that the baby’s name was Carol.
The baby was lying on a towel on my knee, still wrapped in a flannel sheet. I took a damp swab and wiped her face, her ears, her eyes. She wriggled and licked her lips. A little voice said, “Oo, she’s got a li’l tongue, look.”
The baby’s head was messy with blood and mucus, so I said, “I’m going to wash her hair, now.”
A little boy on the windowsill said: “I don’t like gettin’ my hair washed.”
“Shut up, you!” said a little girl bossily.
“Shan’t. Shut up yourself, bossy-bum!”
“Oo, I aint. You wait ... ”
“Now then,” sa
id Ivy with menace in her voice, “one more word from either of you and you’ll both go out.”
Dead silence!
I said, “Well, I’m not going to use any soap, and it’s the soap in your eyes that is nasty.”
I held the baby face upwards in my left hand, with her head over the rim of the bath, gently splashed the water over her head, and wiped it with a swab. The main purpose was to get the blood off, and really only to make the baby look more presentable. Most of the vernix or mucus is best left on the skin as a protective covering. I dried her with the towel, and said to the boy on the windowsill, “Now, that wasn’t nasty, was it?”
He didn’t speak. He just looked at me solemnly, and shook his head.
I loosened the flannel sheet, and the baby lay naked on my knee. There was a united gasp, and several voices cried, “What’s that?”
“That is part of the cord,” I explained. “When Carol was in her mother’s tummy, she had a cord linking her to her mother. Now that she is born, we have cut it off, because she doesn’t need it any more. You all used to have a cord where your tummy button is.”
Several skirts were pulled up, or trousers down, and several tummy buttons were proudly shown to me.
I took the baby in my left hand, with her head resting on my forearm, and immersed her whole body in the water. She wriggled her tiny limbs, and kicked and splashed. All the children laughed, and wanted to join in.
Ivy said firmly, “Now mind what I says. No noise. You don’t want to frighten the baby.”
There was instant silence.
I patted the baby dry with a towel, and said, “Now we must put her clothes on.”
All the little girls wanted to help, of course. It was just like dressing a doll. But Ivy restrained them, saying they could dress Carol later, when she was a bit bigger. Suddenly, at that moment, there was a piercing scream from a little girl. “It’s Percy! It’s Percy! He’s come to see the baby. He knows, and he wants to say hello.”
Call The Midwife: A True Story Of The East End In The 1950S Page 12
