The Midwife Trilogy (41 page)

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 finally 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.

However, the baby was another matter. He hadn’t been weighed, but my guess of between one and a half and two pounds was accepted. They all said twenty-eight weeks was barely viable, and that a living baby of that gestation must have hospital treatment, with the latest technological equipment, and twenty-four hour expert nursing and medical care. They suggested that he should be transferred at once to Great Ormond Street Hospital for Sick Children. Len looked dubious, but when they told him that without such care the baby would die, he readily agreed.

We all went upstairs to the bedroom. I don’t know what these hospital doctors thought of having to squeeze past all the prams in the hallway and parting the washing flapping around their heads as they climbed the wooden stairs. Nor did I ask. But I smiled to myself.

Conchita was sleeping, the tiny baby lying on her chest. One hand was protectively over it, the other lay limp by her side. She was smiling, and her breathing, although shallow, was regular and less rapid. I approached the bed and felt her pulse. It was slightly stronger, and regular, but still rapid. I counted 120 per minute, which, though abnormal, was an improvement. Liz was cleaning up quietly and efficiently, and the whole scene was peaceful.

The baby looked even smaller now that the entire hand of the mother covered it. Only its head was visible. It did not really look as if it were alive, although its colour did not suggest death.

The registrar wanted to examine Conchita. I told him that I had not yet examined the placenta, as I had not had time between delivery and the arrival of the ambulance. We examined it together; it was very ragged. “Not hopeful,” he muttered, “and it all came out at once, you tell me? I must have a look at her.”

He pulled back the bedclothes to examine her abdomen and see the vaginal discharge. Conchita seemed quite unconscious and didn’t move as he palpated the uterus. Some blood rushed out.

“Another pad,” he said, and, to the houseman, “Draw me up 0.5 cc of ergometrine for injection.”

He sank the needle deep into her gluteus muscle, but she didn’t move. He covered her and said to Len: “I think part of the placenta has been left behind. She may have to go to hospital for a D and C. It would only be for a few days but we cannot risk a haemorrhage occurring at home. In her condition it would be very serious.”

I saw Len turn white and he had to grab the back of a chair to prevent himself from falling.

“However,” continued the registrar kindly, “it may not be necessary. The next five minutes will tell if the injection is going to be effective.”

He then took Conchita’s blood pressure.

“I can hear nothing,” he said, and the three doctors exchanged significant glances. Len groaned and had to sit down. His daughter put her hand on his shoulder, and he squeezed it.

We all waited. The registrar said, “There is no point in examining the baby. It is obviously alive, but we are none of us paediatricians. Examination must wait for the experts.”

He asked for the telephone, to ring Great Ormond Street Hospital, but there was no telephone in the house. He cursed silently under his breath and asked where he could find the nearest phone box. It was two hundred yards down the road, on the other side. The long-suffering houseman was dispatched out into the freezing fog and icy roads with a pocket full of pennies gleaned from us all, to ring the hospital and make the necessary arrangements.

We continued waiting. There was no sign of an abdominal contraction. Five minutes slipped by. The houseman returned to say that Great Ormond Street would send a paediatrician and a nurse with an incubator and special equipment to collect the baby at once, although the time of their arrival depended on visibility.

Another five minutes passed. There was steady vaginal bleeding, but no contractions.

“Draw up another 0.5cc,” the registrar said. “We must give it intra-venously. There is something in there that has to come out. If we can’t get it this way,” he said to Len, “we will have to take her back with us for a scrape. And if you value her life, you must agree to this.”

Len groaned, and nodded dumbly.

I clamped the upper arm and endeavoured to pump up a vein for injection, but nothing showed. Her blood pressure was so low that the venous return could not be found. The registrar tried, with a couple of stabs, to locate the vein and on the third attempt blood showed in the syringe. He emptied the 0.5cc into her vein, and I released the arm.

Within a minute Conchita winced in pain and moved her legs. A large quantity of fresh blood spurted from her vagina, and then, mercifully, several large, darker lumps. There was a pause, then a second contraction. The registrar grasped the fundus and pressed the uterus hard, downwards and backwards. More blood and placenta were evacuated.

All this time Conchita was inert, but I thought I saw her hand tighten over her baby.

“That might be it,” said the registrar, “but we must wait a bit longer to see.”

He was more relaxed now and started chatting with anyone who would listen about the excellent golf down at Greenwich and the house he was buying at Dulwich, and his holiday in Scotland.

Over the next ten minutes there was no further blood loss, and no more contractions. Thanks to modern obstetrics, the danger of post-partum haemorrhage had been overcome for Conchita. But she still looked very ill indeed. Her breathing and pulse were rapid, her blood pressure abnormally low, and her temperature high. She did not appear to be conscious, although as her eyes were now closed, she might have been asleep. Nonetheless, her hand was still firmly placed over the baby, and any attempt to remove it was resisted.

With difficulty Liz and I cleaned up the bed again, and the houseman was given the messy job of checking the bits of placenta against the larger piece that had first been delivered, and measuring the blood that we had managed to contain.

“Placenta seems to be all here, sir, and I measure one and a half pints of blood. Add to that about eight ounces lost in the bed, and you could say around two pints of blood loss.”

The registrar muttered to himself, then said aloud, “She really needs a transfusion. Her blood pressure is already low. Can we do it here?” he added, turning to the GP.

“Yes, I’ll take a sample now for cross-matching.”

I had wondered why the GP had remained all the while, when he could have left. Now it became clear to me. He anticipated having ongoing responsibility for Conchita if she was to be cared for at home, and he wanted full cognisance of the facts.

At that moment the ambulance arrived from Great Ormond Street to collect the baby.

A PREMATURE BABY

It was a thousand pities, I thought, from the point of view of the good gossips of Limehouse, that all this had been carried out in a London smog. Had it been a clear night, every move would have been witnessed and reported - a midwife, police, teams of doctors, ambulances, each with a police escort. Such a sensation would have kept the gossips in business for a year at least. As it was, not even the next-door neighbour would have been able to see the two ambulances parked outside the Warren house, and police coming and going throughout the night. Their only consolation might have been that the whole street was wakened by the blood-curdling screams that lasted for about twenty minutes.

The paraphernalia and personnel that emerged from the second ambulance was overwhelming. A doctor came hurrying past, carrying an incubator. Another followed with a ventilating machine. A nurse followed with a huge box. Two ambulance men and the policeman came last, each carrying oxygen cylinders. All this equipment had to be manoeuvred past the three coach prams and two ladders lining the hallway. The washing hanging overhead didn’t help, because it got caught up on the equipment and several small, dainty items, personal to the young ladies of the house were transported upstairs. The children, who had been in and out of bed all night, hung over the banisters, and hid in doorways, to get the full impact of the procession.

On reaching the bedroom, the medical staff entered whilst the policeman and the ambulance men were directed down to the kitchen to join their colleagues for tea. Nevertheless, the bedroom, of average size, now contained five doctors, two nurses, a midwife, and Len and Liz. There was equipment everywhere. My delivery instruments still covered the dresser. The obstetrician’s was on the chest of drawers. The paediatrician’s had to be left on the floor, whilst we hastily cleared space.

“I think we’ll push off, now,” said the registrar to his colleague.” I’m very glad to see you. The mother is to be nursed at home. Good luck with the baby.”

They left, but the GP remained.

The paediatrician looked at the baby and gasped.

“Think he’ll make it, sir?” asked the young doctor.

“We’ll have a damn good try,” said the paediatric registrar. “Fix up the oxygen, and the suction, and heat up the incubator.”

The team got busy.

The paediatrician leaned over Conchita to take the baby. You could not tell whether she was asleep or semi-conscious, but the muscles of her arm tightened, and she held the baby fast.

He said to Len, “Would you tell her to let me have the baby, please? I’ve got to examine him, before we can transport him.”

Len leaned over his wife and murmured to her, trying to loosen her hand. It tightened, and her other hand came up to cover the first.

“Liz, luv, you tell yer mum we’ve got to ’ave the baby, to take to hospital.”

He shook her gently, trying to waken her. Her eyes flickered, and opened a little.

Liz bent over her and spoke to her in Spanish. None of us could tell what she said. Conchita opened her eyes more, and tried to focus on the little creature lying on her chest.