Farewell To The East End

second time that night. She looked at her watch and saw that the thing was pulsating at 120 beats per minute. The pulsation was the baby’s heartbeat. The cord had prolapsed.
    Chummy said afterwards that in all her professional career she had never known a moment of such terror. She went shivery all over but could feel the sweat pouring out of her body. She withdrew her hand, and it was trembling. Then her whole body began to tremble. ‘What can I do? What should I do? Oh please, God, help me!’ She nearly sobbed aloud but controlled herself.
    ‘Everything all right?’ enquired Kirsty cheerfully.
    ‘Oh, yes, quite all right.’
    Chummy’s voice sounded far away and faint. She was thinking back to her midwifery lectures: ‘In the event of prolapse of the cord, an emergency Caesarean section is necessary.’ She looked around the cabin, with the hurricane lamp swinging from the beam; at the portholes, black against the night sky; at the jugs of hot water and towels so thoughtfully provided; at her equipment laid out on the captain’s desk, adequate for a normal birth, but no more. The ship moved in the wind, and she remembered her isolation and the impossibility of getting help. She trembled at her own inexperience and thought, ‘This baby will die.’
    Yet something else was stirring in her mind. The lecturer had not ended with ‘a Caesarean section is necessary’, but had continued. What else had the lecturer been saying? The pulsating cord, and the knowledge that a living baby depended on her for life, forced Chummy’s mind back to the classroom. ‘Raise the pelvis by instructing the mother to adopt the genu-pectoral position and sedate the mother. If the amniotic sac is unbroken it is sometimes possible to push the baby’s head back a little and move the cord out of the way.’
    Good midwifery is a combination of art, science, experience and instinct. It used to be said that it took seven years of practice to make a good midwife. Chummy had everything but experience. She possessed intuition and instinct in abundance. The amniotic sac was not yet broken. There might still be time to attempt the replacement of the cord. She must have a go. She could not sit and do nothing, knowing that the cord would be crushed as labour progressed, and that the baby would die.
    ‘Raise the pelvis’, the lecturer had said. Chummy looked at the massive thighs and buttocks of Kirsty, who probably weighed about thirty-five stone. A crane would be needed to raise her pelvis. The genu-pectoral position would be possible in a smaller woman, but Kirsty could no more roll over onto her front than a beached whale could. But only raising the pelvis would take pressure off the cord, and Chummy was resourceful. She remembered that a folding bed had been provided. If she folded up the legs at the head of the bed, but left the foot end standing, perhaps her patient could lie with her head and shoulders on the floor and her buttocks resting on the higher end of the bed. It was worth a try.
    She explained what she wanted to Kirsty. She did not say anything about the cord or the gravity of the situation, because there was no point in alarming her unnecessarily. She merely explained about the bed, as though it was the usual way to deliver a baby.
    With great difficulty Kirsty got to her feet, and Chummy crawled under the bed to collapse the legs so that the head dropped to the floor. That was easy; the difficult part would be getting Kirsty back onto it in the required position. The problem was solved by Kirsty. She calmly went to the raised end of the bed, sat on it, leaned backwards, then rolled her back down the bed. ‘I do this all the time,’ she said, splaying her legs apart.
    Pressure would now be off the cord, Chummy thought with satisfaction – gravity would pull the baby back into the uterus, allowing a little extra space for the cord. But the advantage would not last for long, because the inexorable process of uterine contractions would push the baby forward. Time was short, and running out. Contractions were already coming every six minutes.
    Chummy weighed in her mind whether or not to give pethidine to sedate her patient. It would relax her and might help when it came to replacing the cord. But on the other hand it would also sedate the foetus, and delivery was imminent. She decided against sedation. Kirsty seemed relaxed enough and would just have to bear the pain. The life and health of the baby were Chummy’s main