Farewell To The East End

been normal until that moment, but had now risen to an alarming 110 beats per minute.
    ‘If this goes on, the baby will be in serious distress,’ remarked Sister. ‘We must prepare for a twin birth at home. You will not be sent to hospital, Mavis. But Meg, you must go. I am not prepared to deliver the second baby with you in the room.’
    Meg rolled her eyes. ‘I told yer, didn’t I? It was an evil omen wiv the tea leaves. An’ ve cards. Vey’ll die. You mark my words.’
    Sister pushed her out of the room. Then she scrubbed up. She was calm and controlled.
    ‘There have been no contractions since the birth of the first baby. If the foetus is lying transversely this will help me. First I must make quite sure of the lie of the baby, and secondly ascertain whether or not the waters have broken. If the uterus is inert, and the membranes intact, it is usually possible to turn the baby to the correct position for delivery. I want you to monitor the foetal heart every few minutes, nurse.’
    Trixie listened and said the heartbeat remained at 140. Sister carried out a vaginal examination.
    ‘Yes. I can feel the amniotic sac bulging through the dilated os – splendid – but I cannot identify the presenting part. It is certainly not a head. It might be a breech, I suppose, but I cannot be sure. I’m not going to do too much … remember, that, nurse. Never try poking around too much in a twin birth. You might rupture the membranes, and if an arm or a shoulder is presenting and descends into the birth canal, you will then have an impacted foetus which cannot be delivered vaginally.’
    Sister withdrew her hand and removed her gloves.
    ‘I am going to attempt an external version – unless you want to do it, doctor?’
    The doctor shook his head.
    ‘It would be better if you did it, Sister.’
    Sister nodded.
    ‘What is the foetal heartbeat, nurse?’
    ‘One hundred and fifty; a little raised, Sister.’
    ‘Yes. Now Mavis, lie quite still and relax. You are not in any pain, are you?’
    ‘Nope.’
    ‘I have to turn your baby. I am going to exert a lot of pressure. I want you to breathe deeply all the time and concentrate on relaxing.’
    Mavis nodded and smiled. Since the threat of hospitalisation had been removed, she had been quite relaxed, and her pulse had dropped to a steady seventy-two beats per minute.
    ‘I want you to watch me carefully, nurse, so that you will know how to do it another time.’ Trixie fervently hoped that would never happen.
    ‘Here in the right iliac fossa is the head … feel it, nurse … I’m correct, am I not?’ Trixie nodded, though she could feel no identifiable head. ‘And over here is the breech … can you feel that?’
    Trixie nodded vaguely. ‘I think so, Sister.’
    ‘Good. Now what I cannot tell is whether the foetus is lying dorso-anterior or dorso-posterior. You said that you saw and felt a kick. Where? Point to the spot.’
    Trixie did so.
    ‘Hmmm – not much help. Now what I want to do is to flex the foetus into a ball as much as I can, which will enable me to turn it more readily.’
    Sister grasped what she had identified as the head and the breech and slowly closed her hands together.
    ‘Yes … it is moving … the foetus is definitely flexing. The head is closing towards the breech, and the back is curved under the fundus. Splendid! Feel it now, nurse. Can you feel the difference?’
    Trixie felt but could not truthfully say she noticed anything different. The doctor felt also and nodded approvingly.
    ‘You must have X-ray hands, Sister,’ he murmured.
    ‘I must turn the foetus now, and I want to turn it so that it follows its nose. About a quarter circle will be sufficient, and the head will be presenting. This is going to hurt, Mave, but only for a minute. I want you to relax as much as you can.’
    Sister Bernadette, the expert midwife, with the ball of her right thumb behind the head, and with the fingers of the left hand beneath the breech, firmly and slowly, her two hands working together, feeling her way, successfully achieved external cephalic version of the foetus. She turned the baby.
    ‘The head is now lying just above the pubic arch … can you feel it, nurse?’
    To her surprise, Trixie could and she nodded enthusiastically.
    ‘To ensure that it remains in that position I am going to ask you to hold it there … grasp it firmly … and hold the breech with the other hand. After version a foetus can slip back into its former position.