Call the Midwife: A True Story of the East End in the 1950S

girl.”
     
    The baby’s face is blue and puckered, covered in mucus and blood. I check the heartbeat. Still normal. I observe the restitution of the head through one eighth of a circle. The presenting shoulder can now be delivered from under the pubic arch.
     
    Another contraction.
     
    “This is it Muriel, you can push now - hard.”
     
    I ease the presenting shoulder out with a forward and upward sweep. The other shoulder and arm follow, and the baby’s whole body slides out effortlessly.
     
    “It’s another little boy,” cried the mother. “Thanks be to God. Is he healthy, nurse?”
     
    Muriel was in tears of joy. “Oh, bless him. Here, let me have a look. ‘Ow, ’e’s loverly.”
     
    I am almost as overwhelmed as Muriel, the relief of a safe delivery is so powerful. I clamp the baby’s cord in two places, and cut between; I hold him by the ankles upside down to ensure no mucus is inhaled.
     
    He breathes. The baby is now a separate being.
     
    I wrap him in the towels given to me, and hand him to Muriel, who cradles him, coos over him, kisses him, calls him “beautiful, lovely, an angel”. Quite honestly, a baby covered in blood, still slightly blue, eyes screwed up, in the first few minutes after birth, is not an object of beauty. But the mother never sees him that way. To her, he is all perfection.
     
    My job is not done, however. The placenta must be delivered, and it must be delivered whole, with no pieces torn off and left behind in the uterus. If there are, the woman will be in serious trouble: infection, ongoing bleeding, perhaps even a massive haemorrhage, which can be fatal. It is perhaps the trickiest part of any delivery, to get the placenta out whole and intact.
     
    The uterine muscles, having succeeded in the massive task of delivering the baby, often seem to want to take a holiday. Frequently there are no further contractions for ten to fifteen minutes. This is nice for the mother, who only wants to lie back and cuddle her baby, indifferent to what is going on down below, but it can be an anxious time for the midwife. When contractions do start, they are frequently very weak. Successful delivery of the placenta is usually a question of careful timing, judgement and, most of all, experience.
     
    They say it takes seven years of practice to make a good midwife. I was only in my first year, alone, in the middle of the night, with this trusting woman and her family, and no telephone in the house.
     
    Please God, don’t let me make a mistake, I prayed.
     
    After clearing the worst of the mess from the bed, I lay Muriel on her back, on warm dry maternity pads, and cover her with a blanket. Her pulse and blood pressure are normal, and the baby lies quietly in her arms. All I have to do was to wait.
     
    I sit on a chair beside the bed, with my hand on the fundus in order to feel and assess. Sometimes the third stage can take twenty to thirty minutes. I muse over the importance of patience, and the possible disasters that can occur from a desire to hasten things. The fundus feels soft and broad, so the placenta is obviously still attached in the upper uterine segment. There are no contractions for a full ten minutes. The cord protrudes from the vagina, and it is my practice to clamp it just below the vulva, so that I can see when the cord lengthens - a sign of the placenta separating and descending into the lower uterine segment. But nothing is happening. It goes through my mind that reports you hear of taxi drivers or bus conductors safely delivering a baby never mention this. Any bus driver can deliver a baby in an emergency, but who would have the faintest idea of how to manage the third stage? I imagine that most uninformed people would want to pull on the cord, thinking that this would help expel the placenta, but it can lead to sheer disaster.
     
    Muriel is cooing and kissing her baby while her mother tidies up. The fire crackles. I sit quietly waiting, pondering.
     
    Why aren’t midwives the heroines of society that they should be? Why do they have such a low profile? They ought to be lauded to the skies, by everyone. But they are not. The responsibility they carry is immeasurable. Their skill and knowledge are matchless, yet they are completely taken for granted, and usually overlooked.
     
    All medical students in the 1950s were trained by midwives. They had classroom lectures from an obstetrician, certainly, but without clinical practice lectures are meaningless. So