THE BOTTOM DROPPED OUT OF PIGS 8 page

“Of course not Fred,” we all chorused. “What happened?”

“Well, they charged me, din’t they, but the magistrate, he lets me off wiv a fine, like, because I ’ad three kids. He was a good bloke, he was, the

magistrate, but he says I would go to prison if I does it again, kids or no kids. So I never done it no more.”

His most recent economic adventure had been in toffee apples, and very successful it was, too. Dolly made the toffee mixture in the little kitchen, while Fred purchased crates of cheap apples from Covent Garden. All that was needed was a stick to put the apple on, dip it in the toffee, and in no time at all rows of toffee apples were lined up on the draining board. Fred couldn’t imagine why he hadn’t thought of it before. It was a winner. One-hundred per cent profit margin and assured sales with the large number of children around. He foresaw a rosy future with

unlimited sales and profits.

A week or two later, it was clear that something had gone wrong from the silence of the small figure crouched down by the stove, manipulating the flue. No cheerful greeting, no chat, no tuneless whistle - just a heavy silence. He wouldn’t even respond to our questions.

Eventually Chummy left the table and went over to him.

“Come on, Fred. What’s up? Perhaps we can help. And even if we can’t, you will feel better if you tell us.” She touched his shoulder with her huge hand.

Fred turned and looked up. His north-east eye drooped, and a little

moisture glinted in the south-west. His voice was husky as he spoke.

“Fevvers. Quail’s fevvers. Tha’s wha’s up. Someone complained fevvers was stuck to me toffee apples. So food safety boffins come an’ examined ’em an’ said fevvers an’ bits of fevvers was stuck to all me toffee apples, an’ I was endangerin’ public ’ealth.”

Apparently the health inspector had asked at once to see where the toffee apples were made, and when shown the kitchen, in which the quails were regularly slaughtered and plucked, had immediately ordered that both occupations be discontinued, on pain of prosecution. So great was the disaster to Fred’s economy that it seemed nothing

could be said to comfort him. Chummy was so kind, and assured him that something else would turn up, something better, but he was not reassured, and it was a glum breakfast that morning. He had lost face, and it hurt.

But Fred’s triumph was yet to come.

A CHRISTMAS

BABY

Betty Smith’s baby was due in early February. As she dashed happily around all December, preparing Christmas for her husband and six children, her parents and in-laws, grandparents on both sides, brothers, sisters and their children, uncles and aunts, and a very ancient great-grandmother, none of the family dreamed that the baby would be born on Christmas Day.

Dave was a wharf manager in the West India Docks. He was in his thirties, clever, competent and he knew his job

inside out. He was greatly valued by the Port of London Authority, and he earned a good wage. In consequence, the family was able to live in one of the large Victorian houses just off Commercial Road. Betty never ceased to thank her lucky stars that she had married Dave just after the war, and was able to leave the tenements, with the cramped living conditions and minimal sanitation. She loved her big, roomy house, and that is why she had always been glad to have the family descend on her for Christmas. The children loved it. With about twenty-five little cousins coming from all over Poplar, Stepney, Bow, and Canning Town, they were going to have a high old time.

Uncle Alf was Father Christmas The house was at the bottom of an incline, and Uncle Alf had a home-made sleigh on wheels. This was taken to the top of the street, loaded with a sack of presents, and at a given signal, pushed off. The children did not know how it was done. All that they saw was Father Christmas trundling gently towards them, with no apparent means of propulsion, and stopping at their house. They were in an ecstasy of delight.

But this year, things were to be rather different. Instead of Father Christmas on a sleigh, a midwife arrived on a bicycle. Instead of a sack full of presents, a baby came, naked and crying.

My Christmas was also very

different. For the first time in my life I began to understand that Christmas is a religious festival, and not just an occasion for overeating and drinking. It had all begun in late November with something that I was told was Advent. This meant nothing to me, but for the nuns it meant a time of preparation. Most people prepare for Christmas as Betty had done, buying food, drinks, presents and treats. The nuns prepared rather differently, with prayer and meditation.

The religious life is a hidden life, so I would not see or hear what was going on, but as the four weeks of Advent progressed, I began to feel intuitively that something was in the air. I couldn’t put my finger on it, but as

children pick up a feeling of excitement from their parents, so I “caught” from the Sisters a real feeling of calm, peace and joyful expectancy, which I found to be strangely disturbing and unwelcome.

It came to a head on Christmas Eve when I returned late from my evening visits. Sister Julienne was around, and said to me, “Come with me to the Chapel, Jennifer, we put up the crib today.”

Not wishing to be rude by saying I would rather not, I followed her. The chapel was unlit, except for two candles placed by the crib. Sister Julienne kneeled at the altar rail to pray. Then she said to me, “Our blessed Saviour was born on this day.”

I remember looking at the small plaster figures and the straw and things, and thinking, how on earth can an intelligent and well-informed woman take all this seriously? Is she trying to be funny?

I think I murmured something polite about it being very peaceful, and we parted. However, I was not at peace within myself. Something was nagging at me that I was trying to resist. Was it then or was it later that the thought came to me: if God really does exist, and is not just a myth, it must have consequence for the whole of life. It was not a comfortable thought.

For many years I had attended a Christmas midnight Mass somewhere,

not for religious reasons, but for the drama and beauty of the ceremony. I was not fussy about denomination. When I was living in Paris, I had been in the habit of attending the Russian Orthodox Church in Rue Darue, for the beauty o the singing. The Christmas mass from 11 p.m. to about 2 a.m. counts as one of the greatest musical experiences of my life. The liturgy, sung by the Russian bass voice of the cantor, rising in quarter-tones, has never left my inner ear, even though more than fifty years have passed.

The Sisters and lay staff attended All Saints Church, East India Dock Road for midnight Mass. I was astonished to find the church absolutely packed. Strong, tough dockers, hard-bitten casual

labourers, giggling teenagers in their winkle-pickers, whole families carrying babies, small children, all were there. The crowd was enormous. All Saints is a large Victorian church, and it must have held five hundred people that night. The service was as I had expected - impressive, beautiful, dramatic, but devoid of any spiritual content as far as I was concerned. I wondered why. Why was it the whole meaning of life for these good Sisters, yet just a piece of well executed theatre for me?

We were having lunch around the big table on Christmas Day when the telephone rang. Everyone groaned. We had hoped for a day of rest. The nurse who answered it came back to say that

Dave Smith was reporting that his wife seemed to be in labour. The groan turned into a gasp of anxiety.

Sister Bernadette jumped up with the words, “I’ll go and talk to him.” She came back a few minutes later, and said, “It sounds as though it is labour. At thirty-four weeks this is unfortunate. I have informed Dr Turner, and he will come at once if we need him. Who is on call today?”

I was.

We prepared to go out together. I was a student at the time, and was always accompanied by a trained midwife. From the first moment I had watched Sister Bernadette at work, I knew that she was a gifted midwife. Her

knowledge and skill were balanced by her intuition and sensitivity. I would have entrusted my life to her hands, without the slightest hesitation.

Together we left the cosy warmth of an excellent Christmas dinner, and fetched a delivery pack and our midwifery bags from the sterilising room. The pack was a large box, containing pads, sheets, waterproof paper, and so on, which was usually taken to the house a week before the expected delivery. The blue bag contained our instruments and drugs. We fitted them both to our bicycles, and pushed out into a cold windless day.

I had never known London to be so quiet. Nothing seemed to stir, except for

two midwives cycling silently along the deserted road. Normally the East India Dock Road is dense with heavy goods lorries going to and from the docks, but on that day the broad thoroughfare looked majestic and beautiful in its solitary silence. Nothing moved on the river or in the docks. Not a sound, but the occasional cry of a seagull. The stillness of the great heart of London was unforgettable.

We arrived at the house, and Dave let us in. Through the window we had seen a big Christmas tree, a fire, and a room crowded with people. About a dozen little faces of curious children were pressed to the window pane as we arrived.

Dave said, “Betty’s upstairs. I didn’t see no cause to send them home, and she don’t want it. She likes a bit of noise, says it will help her.”

The sound of lusty singing “Old MacDonald Had a Farm” came from the front room, accompanied by an out-of-tune piano. Full vocal justice was given to the animal noises by various uncles, expert in being the horse, the pig, the cow, the duck. The children screamed with laughter, and shouted for more.

We went upstairs to Betty’s room, where the peace and silence contrasted with the noise and clamour below. A fire had been lit and was burning brightly. Hardly any time had been given to Betty’s mother to prepare a delivery

room, but she had worked miracles. Surfaces had been cleaned, extra linen provided, hot water was available, even the cot had been prepared. Betty’s first words were, “This is a turn up for the books, eh, Sister?”

She was a cheerful, down-to-earth sort of woman, who took everything in her stride. No doubt she had the same confidence in Sister Bernadette that I had.

I opened the delivery pack, and covered the bed with brown waterproof paper, then the draw sheets and maternity pads. We gowned and scrubbed up, and Sister examined her. The waters had broken an hour earlier. I saw intense concentration on Sister’s

face, and then a look of grave concern. She said nothing for a few moments as she slowly took off her gloves, then said gently:

“Betty, your baby seems to be a breech presentation. That means the bottom is coming first, instead of the head. This is a perfectly normal way for the baby to lie until about thirty-five weeks, but then the baby usually turns, and the head is presented first. Your baby has not turned. Now, whilst thousands of babies are born quite safely in breech, there is a greater risk than a head presentation. Perhaps you should consider a hospital delivery.”

Betty’s reaction was immediate and dogmatic. “No. No hospital. I’ll be OK

with you, Sister. All me babies have been delivered by the Nonnatuns and born in this room, and I don’t want nothing else. What do you say, mum?”

Her mother agreed, and recalled that her ninth had been a breech, and that her neighbour Glad had had no less than four, arse first.

Sister said, “Very well then, we will do our best, but I am going to ask Dr Turner to come.” Then to me: “Would you go and ring him, nurse?”

In spite of his comparative affluence, Dave did not have a telephone. There would have been no point, because none of his friends or relatives had a phone, so no one would ever have rung them. The public phone

box was sufficient for their needs. As I went downstairs, a stream of shouting children in paper hats, faces alight with excitement rushed past me. A voice from downstairs called out:

“Everyone hide. I’ll count twenty, then I’m coming to find you. One, two, three, four ... ”

The children rushed higher in the house, screaming and pushing, hiding in cupboards, behind curtains, anywhere. By the time I got to the front door, all was quiet except: “Seventeen, eighteen, nineteen - cummin’.”

I went out into the cold of the deserted street to find the telephone box. Dr Turner was a general practitioner who not only had a surgery in the East

End, but also lived there with his wife and children. He was utterly dedicated to his work and his practice, and it seemed to me that he was always on call. Like most GPs of his generation he was a first-class midwife, with a knowledge and skill gained from the experience of his wide ranging practice.

He was expecting my call. I told him the facts. He said, “Thank you, nurse. I will come directly.” I imagined his wife sighing, “even on Christmas Day you have to go out.”

Back in the house, hide and seek was still going on. The noise was terrific as children were found. As I entered the door, a cheery faced man passed me carrying a crate of empty beer

bottles.

“How about joining me for one, then, nurse?” he said. “You and Sister and all. Oops, does she drink, do you think?”

I assured him that the Sisters did drink, but not on duty, and that for the same reason, I would not do so either. A paper streamer shot past my ear, blown by an invisible figure behind a door.

“Oh, sorry, nurse. I thought it was our Pol.”

I unravelled the pink and orange thing from my uniform, and went upstairs.

Betty’s room was wonderfully quiet and peaceful. The thick old walls and heavy wooden door insulated the

sounds and Betty looked calm and content. Sister Bernadette was writing up her notes, and Betty’s mother, Ivy, was sitting in a corner knitting. The click of the knitting needles, and the crackle of the fire were all that could be heard.

Sister explained to me that she would not give Betty a sedative, because it might affect the baby. She said it was difficult to tell how long the first stage of labour would last, and at present the foetal heart beat was quite normal.

Dr Turner arrived, looking as though there was nothing in the world he would rather do on Christmas Day than attend a breech delivery. He and Sister conferred, and he examined Betty thoroughly. I expected him to do another

vaginal examination, but he did not: he accepted Sister’s diagnosis without question. He told Betty that she and her baby seemed very well, and that he would come back at 5 p.m. unless we called him earlier.

We sat down to wait. Much of a midwife’s work involves intense, often dramatic activity, but this is balanced by long periods of waiting quietly. Sister sat down and took out her breviary in order to say the office of the day. The nuns lived by the monastic rules of the six offices of the day: lauds; tierce; sext; none; vespers; compline and Holy Communion each morning. In a contemplative community, the offices together occupy about five hours of

prayer time. For a working community this is impracticable, so, in the early days of their vocation, the Midwives of St Raymund Nonnatus had had a shortened version devised for them. Thus they were able to maintain their professed religious life, and work full-time as nurses and midwives.

The sight of this fair young face in the firelight, reading the ancient prayers, turning the pages quietly and reverently, her lips moving as she read, was deeply affecting. I sat watching her and marvelled at the depth of a vocation that could make such a pretty young woman renounce life, with all its fun and opportunities, for a religious life bound by the vows of poverty, chastity, and

obedience. I could understand the vocation to nursing and midwifery, which to me were fascinating both as a study and a practice, but the calling to a religious life was quite beyond my comprehension.

Betty groaned as a contraction came on. Sister smiled, got up and went over to her. She returned to her breviary, and all that could be heard in the room was the tick of a big clock and the click of Ivy’s knitting needles. Beyond the door the sounds of the party continued, but within the room all was calm and prayerful.

I sat in the firelight, and allowed my mind to wander backwards. I had spent many Christmases in hospitals.

Contrary to what one might think, it was a happy time. Fifty years ago, hospitals were very much more personal than they are today. The nursing hierarchy was formidable but at least everyone knew or was acquainted with everyone else. Patients stayed in hospital for much longer and, as nurses worked sixty hours per week, we really got to know our patients as people. At Christmas, everyone let their hair down, and even the most draconian old Ward Sister, after a few sherries, would be giggling with the student nurses. It was all rather like schoolgirl fun, but it was good humoured, and the aim was to give a happy time to the patients, many of whom had horrible diseases.

My most abiding Christmas memory was the carol singing on Christmas Eve. Led by Matron, all the nursing staff would go through the wards by candlelight, singing. For someone in a hospital bed it must have been a lovely sight. There may have been over one hundred nurses, twenty or more doctors, and fifty or more ancillary staff. The nurses wore full uniform, and we turned our cloaks inside out showing the scarlet lining. We all carried candles. We walked through each darkened ward, usually containing thirty beds, singing the age-old story of Christmas. All this has long since gone from hospitals, and the memory of it is all that remains, but it was very beautiful, and I know that many

patients shed tears of emotion.

A BREECH

DELIVERY

The time ticked quietly by. The sounds of “Aye, aye, aye, conga” came from below. They went round and round the sitting room, then the noise got louder and louder as the snake of people started coming up the stairs. They were all shouting at the tops of their voices, and stamping in unison. Sister thought the noise might bother Betty, but she said, “No, no, Sister. I likes to hear it. I wouldn’t want this house to be quiet, not on Christmas day, like.”

Sister smiled. The last few contractions had seemed stronger and

were closer together. She got up, and examined Betty, and said to me, “I think you had better go and call Dr Turner if you please, nurse.”

It was four o’clock when I rang him, and Dr Turner arrived within a quarter of an hour. I was excited. This was my first breech delivery. Betty was beginning to feel the urge to push.

Sister Bernadette said to her, “You must try very hard not to push at first, dear. Breathe deeply, and try to relax, but not to push.”

We gowned, masked and scrubbed up again. Doctor looked at Sister Bernadette, and said, “You take this delivery, Sister. I’ll be here if you need me.”

He obviously had complete confidence in her.

She nodded, and told Betty that she wanted her to remain on her back, with her buttocks over the end of the bed, and she asked me and Ivy to hold a leg each. I was learning, and so Sister explained everything that she did clearly and carefully.

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.”

Date: 2016-04-22; view: 551