‘Nurse Bradburrry,’ she would say in her stiff brogue. ‘Recite for me the mechanisms for a left occipito-anterior presentation.’
I would rise, step into the aisle to the left of my desk, smooth the hard white canvas of my nurse’s skirt, fold my hands in front of me, look directly ahead, and respond to the instructor.
‘Thank you, Miss Helms. The mechanisms for the left occipito-anterior delivery are . . .’ And so it went – right occipito-anterior, frank breech, footling breech, left occipito-posterior. We recited, repeated, and tapped the words into our skulls as if by mallet and awl.
By the time I could roll out the answers like that, I’d been at Highlands General Hospital in Scotland for almost eight months. I’d completed my preparation for midwifery training: a one-year intensive course in nursing in Saint Louis, Missouri, followed by six months of probationary nursing at Highlands. Of course, the six months had seemed more like an advanced form of hazing than a probation. When I first got to Scotland and the cabbie let me off at the dark medieval door of the hospital, he rolled his eyes and looked at me as if I were condemned.
A ‘matron’ greeted me. ‘Block 37,’ she said, jangling her keys. ‘Follow me.’ She led me to a cell fitted with a sink, four hangers and a beige clay jar, meant for warming my feet. I looked at the iron bedstead, undoubtedly left over from the early days of the maternity hospital at Highlands. I’d read about those beds.
Throughout history most babies were born at home. Maternity hospitals were first started for homeless women and were really extensions of poorhouses. . . . These first maternity hospitals were convenient centers for medical students to learn and practice obstetrics, but infections were rampant, as doctors conveyed bacteria on their hands from one patient to another, and many babies and mothers died. They were possibly the most dangerous places in which women could possibly give birth.*
I crawled into the bed every night, bidding sweet dreams to all the women who had died of septicemia in it, and then, in the mornings, I would apply myself to perfecting my use of the sterile trolley. As far as I could tell, the sterile trolley was the one overriding ritual of nursing in the United Kingdom.
One did not nurse without the sterile trolley. Suppose for example, one wished to apply a Band-Aid to a patient’s wound. One would pull out the trolley and fall upon it with a scrub brush and a noxious-smelling foam. Once one had scrubbed the trolley, one draped it. Once one draped it, one could set out one’s bowl. Then one could set out another and another. The bowls were followed by scissors, gauze, syringes, needles, clamps, calculator, butterfly nets, tubs of margarine, and I cannot remember what else, except for the Band-Aid. Once this procedure had been observed, one could apply the Band-Aid. Needless to say, if one touched anything while one was setting up one’s trolley, if one broke the sterile field, one started over again – ‘straightaway’.
Each day I took my maidenly trolley into the male urology ward, where the sun didn’t shine. I must elaborate. The sun didn’t shine for five months. It was a filthy, smelly and dingy place. Every few days, they dragged a cold mop down the center aisle, leaving wax curled up like old men’s toenails in the corners of the rooms and under the beds. They never washed the windows, as far as I could tell, and there were no screens, so when the days grew warmer, the flies came in and settled on the patients’ wounds.
The men lay in bed after bed – ten down one side, nine back up the other. Nineteen iron beds and 19 iron grates. I gave 19 sick men – victims of strokes, men with cancer crawling from the inside out – baths every day. There wasn’t one shower for the entire ward. They each peed for me in glass urinals, which I placed in a wooden cart and pulled, rattling, behind me. Then I tested the nineteen samples and scrubbed the urinals clean.
I learnt a new nursing vocabulary, one made up of singularly revolting words. For example, an IV was no longer called an IV; it was to be called a ‘drip’. Gastric suction was called – I do not invent – a ‘suck’. Which made the treatment for gastric distress a ‘drip and suck’.
The rain and wind blew directly down off the Highlands and rattled the window of my room each day for that entire time. The other students ignored me, and my energy, generously inspired though it was, dwindled. Fortunately, in June, five months after my arrival, they announced that I would be granted my licence as a nurse in the United Kingdom, and that after a summer holiday in America, I could begin midwifery training. I’d made it to the good part.
By the time I returned to Glasgow in the fall, I had read and reread Maggie Myles’s Textbook for Midwives so many times that I knew her words backwards and forwards and I ached to talk about what I’d learnt, to challenge and question. I found, to my great frustration, that there was to be none of it. Not only did the system discourage inquiry, the students themselves seemed to resent it. When I’d mention something about what we’d learnt to one of my classmates, I’d be dismissed with a look of annoyance. Finally, I realized that the typical student at Highlands was there because it gave her a chance for a promotion at home, or maybe a chance to get to America; she was unlikely to have much interest in midwifery itself. It was best to go about one’s work dull-eyed and perfunctory.
Since I couldn’t find someone with whom to share my enthusiasm, I retreated into myself. I ran every day, and on holidays I rode the bus to the Highlands, and while reviewing the positions a baby could take in the birth canal – left occipito, right occipito – I walked endless miles through heather. I pictured every turn, every bump on the road in the birth passage. I imagined changes in pressure and the way they would feel to the baby’s head and shoulders passing by. I imagined the mother’s muscles weaving supple, powerful slings to help her child out. I would come back to the library from my walks and search for answers to questions I’d discovered while making imaginary deliveries.
I went to class and recited my lessons. I tried to eat well. I hung around the delivery room. I read Maggie Myles again. Like the woman whose baby I would deliver, I roamed restlessly in the last weeks before my first baby.
Finally, they called me to meet the woman. Her long, angular face reached at least a half a head higher than her husband’s. She had a bristly thatch of hair on her chin, uneven brows, big bones and dark blotches on her skin. Her eyes bulged slightly, and later, when she pulled in her breath during contractions, her cheeks sank into graceful hollows, as if they’d been carved by a slow-running waterfall. Her legs were ribbed with strength. I thought Janet was very beautiful.
She’d put on a freshly starched and ironed smock to wear to the hospital and since she was very nervous, she held tightly to her husband’s arm. He stayed with her throughout. ‘It’s our first, you know,’ he said, patting her hand. In his shirt pocket were two three-by-five cards: the first one had the choices of the baby’s names; on the second, Janet had written the names and phone numbers of all the relatives he was to call. He pulled the cards out and showed them to me.
As her labor progressed and the contractions increased, she began to whistle through them; she’d be talking, then she’d slow down, roll up and over and perch on her right elbow, suck in her breath and whistle a few bars of a tune I couldn’t make out. She was a determined girl. I don’t think she had the faintest idea she was whistling.
Her husband let her pull on him, tug at him and dig her fingernails into his palm. Once or twice towards the end she said she couldn’t go on, that it couldn’t be done, but he’d stroke her hair and tell her softly, ‘Don’t look now, gal, but you are already doing it.’
When she got to the point where she wanted to push, we moved her to the delivery room and before long she was at the last of it.
I watched the top of the head coming towards me in laps, moving forward during a contraction, then dropping back. I had studied it so much, I could feel the mechanism of the birth canal – the rhythm of turning, burrowing, climbing, clenching and easing – as the baby secured his path. I longed to put my hand on Janet’s belly to assure myself that the way I knew it felt was the way it felt.
She gripped the sides of her cot. I massaged the perineum. The head crowned. I touched the tips of my fingers to the creamy scalp and felt the pulse. Time stopped and I stopped and my hands joined with the baby’s head. The baby’s face crept out from under its mother’s covering of skin. As the head came, my fingers eased along the cheeks almost as if a groove had been worn there to guide me. My fingers slid beneath the chin. The world turned then, one time and one time only on the axis made by the baby’s head and body. Then the baby floated out into my hands.
Janet whistled ever so lightly and beneath my mask I smiled, because from the moment I touched the child’s head I knew I had been born to be a midwife.
*Sheila Kitzinger, The Complete Book of Pregnancy and Childbirth (Alfred A. Knopf)