Farewell To The East End

there be another one inside? But no; the abdominal muscles and the uterus felt soft. Ruth breathed a sigh of relief, but at the same time reminded herself that labour was far from over. The third stage had to be completed, and she knew that this was frequently the most difficult and the most dangerous part of delivery. She leaned back in the chair and closed her eyes. Was this a dream? Could it really be happening? She had been out the night before, followed by a busy day, and had enjoyed very little sleep in the past twenty-four hours. She very nearly dozed off, but a warning bell sounded in her brain, and she jumped up and splashed her face with cold water from the enamel jug. The shock soon focused her mind again.
    About twenty minutes had been spent wrapping and settling the babies, during which time there had been no contractions. Something had to be done. Ruth picked up the torch and shone the beam of light into the bed. The mess was quite indescribable; a great pool of blood and amniotic fluid was seeping into the uncovered mattress – and she could do nothing about it. Normally a midwife would have covered the mattress with brown paper, absorbent sheets, a rubber sheet, and on top of that more absorbents, which could be changed frequently – but she had none of these. The mess would have to stay where it was. She shone the beam of light onto Kathy’s vulva. Three cords were showing. But how many placentae would she have to deal with? It could be as many as three, if the babies had developed from three separate ova. She did not know, and there was no way she could find out.
    Ruth knew the risk of post-partum infection and in other circumstances she would have removed all soiled padding from beneath Kathy, washed her, cleaned the vulva with antiseptic, replaced the bedding with clean absorbent sheets and covered her legs with more clean sheeting. She would also have scrubbed her hands thoroughly, and put on sterile gloves. But none of this was possible. She also knew that warmth was essential, because a woman sweats during labour, losing a lot of body heat, and can become cold and shivery. Yet there was only one thin army blanket available.
    She shone the torch despairingly around the empty room and saw her coat hanging on the back of the door. That would do. She took it off the hook and covered the girl with it for extra warmth. Kathy’s breathing was deep and regular, her pulse and blood pressure were on the low side, which was a good sign, and her colour was fine. There had been no contractions, and the uterus felt as it should feel.
    In those days the management of the third stage of labour was left entirely to nature, and midwives were taught not to meddle or interfere with the process which separates the placenta from the uterine wall and controls bleeding. Today an oxytocic drug may be injected immediately after the baby is born, and a powerful contraction develops, separating the placenta, so that the third stage is over in a few minutes. We did not have that advantage. Patience, experience, observation and masterly inactivity were our guides. We were taught that meddling with the uterus or attempting to hurry the third stage would usually give rise to partial separation of the placenta, causing haemorrhage. We were taught never, never to pull on the cord, and only to knead or massage the fundus after uterine contractions had already developed, and only then if it became absolutely necessary.
    Ruth sat quietly beside the bed, her left hand guarding the uterus, which she could clearly feel. The torchlight was growing fainter, so to save the battery she switched it off and sat in total darkness. Twenty-five minutes had passed with no sign of a contraction, and she was beginning to grow anxious. She might have to leave the girl alone while she summoned medical aid. But then she felt a distinct hardening of the uterus, and the fundus rose under her hand. Kathy moaned with pain and moved awkwardly.
    ‘This is it.’ Ruth stood up, switched on her torch and shook Kathy. ‘Wake up. I want you to push as hard as you can. Wake up and push down. Draw your knees up to your chest so that you can push as hard as possible, as though you were going to open your bowels – go on, push – harder.’
    Kathy did as she was told, and Ruth assessed from the feel of the uterus that the placenta had separated and was lying in the lower segment. The fundus had risen higher in the abdomen and was still hard and