Jennifer Worth - Call The Midwife - A True Story Of The East End In The 1950S

The next day when I called, I was so pre-occupied with wondering how I could decline the offer of a cup of tea, that when the door opened, I stood staring awkwardly, stupidly, at Lil, who was not Lil. She looked a bit shorter and fatter, the same slippers, the same hair curlers, the same fag - but different.

A familiar screech of laughter revealed toothless gums. She poked me in the stomach. “Yer thinks I’m Lil, don’ yer? They all thinks that. I’m ’er mum. We looks like two peas, we does. Lil’s had a mis an’ gorn to ’ospital. Good riddance, I sez. She’s got enough with ten o’ them, an’ him in an’ out all the time.”

A few questions elicited the facts. Lil had felt ill shortly after I had left the previous day, and was later sick. She had lain down on the bed, and sent one of the children to fetch Gran. Contractions had started, and she was sick again. Then she must have become unconscious.

Gran said to me, “I’ll cope with a mis any time, but not a dead woman. No, sir.”

She’d called a doctor, and Lil was taken straight to The London Hospital. We later learned that a macerated foetus was extracted. It had probably been dead for three or four days.

It is hard to imagine today that until the last century no woman had any specialist obstetric care during pregnancy. The first time a woman would see a doctor or midwife was when she went into labour. Therefore, death and disaster, either for mother or child, or both, were commonplace. Such tragedies were looked upon as the will of God, whereas, in fact, they were the inevitable result of neglect and ignorance. Society ladies would have a doctor visiting them during pregnancy, but such visits were not antenatal care and would probably be more like social calls than anything else, because no doctor was trained in antenatal care.

The pioneer in this branch of obstetrics was a Dr J. W. Ballantyne of Edinburgh University. (Indeed some of the greatest discoveries and advances made in medicine seem to come from Edinburgh.) Ballantyne wrote a paper in 1900 deploring the abysmal state of antenatal pathology, and urging that a pre-maternity hospital was necessary. An anonymous gift of £1,000 allowed the first ever bed for antenatal care to be inaugurated, in 1901, at the Simpson Memorial Hospital. (Simpson, another Scot, developed anaesthetics.)

This was the first such bed in the civilised world. It is an incredible thought. Medicine was developing rapidly. The staphylococcus had been isolated; so had the tuberculous bacillus. The heart and circulation were understood. The functions of liver, kidneys, and lungs had been ascertained. Anaesthetics and surgery were advancing apace. But no one, it seems, thought that pre-maternity care might be necessary for the life and safety of a pregnant woman and her child.

It was ten years later, in 1911, before the first antenatal clinic was opened in Boston, USA. Another opened in Sydney, Australia, in 1912. Dr Ballantyne had to wait until 1915, fifteen years after his seminal paper, before he saw an antenatal clinic open in Edinburgh. He, and other far-sighted obstetricians, were faced with bitter opposition from colleagues and politicians who regarded antenatal care as a needless expenditure of public money and medical time.

At the same time the struggle by visionary and dedicated women was in progress to gain properly regulated training in the art of midwifery. If Dr Ballantyne was having a hard time, these women found it harder. You have to imagine what it was like to be on the receiving end of vicious antagonism: sneering, contempt, ridicule, slights about one’s intelligence, integrity and motives. In those days, women even ran the risk of dismissal for their opinions. And this treatment came from other women, as well as men. In fact, “in-fighting” between various schools of nurses who had some sort of training in midwifery was particularly nasty. One eminent lady - the matron of St Bartholomew’s Hospital - branded the aspiring midwives as “anachronisms, who would in the future be regarded as historical curiosities”.

The medical opposition seems to have arisen mainly from the fact that “women are striving to interfere too much in every department of life”. 2Obstetricians also doubted the female intellectual capacity to grasp the anatomy and physiology of childbirth, and suggested that they could not therefore be trained. But the root fear was - guess what? - you’ve got it, but no prizes for quickness: money. Most doctors charged a routine one guinea for a delivery. The word got around that trained midwives would undercut them by delivering babies for half a guinea! The knives were out.

In the 1860s the Council of Obstetrics estimated that, out of around 1,250,000 births annually in Britain, about 10 per cent were attended by a doctor. Some researchers put the figure as low as 3 per cent. Therefore, all the rest - well over one million women annually - were attended by women with no training, or by no one at all, other than a friend or relative. In the 1870s Florence Nightingale wrote Notes on Lying-in Infirmarie s, drawing attention to “the utter absence of any means of training in any existing institution”, saying “it is a farce or mockery to call women who attend childbirth, midwives. In France, Germany, and even Russia they consider it woman-slaughter to practice as we do. In these countries everything is regulated by Government - with us, by private enterprise.” The guinea earned by doctors for a delivery was a significant part of their income. The threat of being undercut by trained midwives had to be resisted. The fact that thousands of women and babies were dying annually for want of proper attention did not come into it.

However, the courageous, hard-working, dedicated women eventually won. In 1902 the Midwives Act was passed, and in 1903 the Central Midwives Board issued their first certificate to a trained midwife. Fifty years later I was proud to be a successor of these wonderful women, and to be able to offer my trained skills to the long-suffering, cheerful, resilient women of the London Docklands.

At the church hall, the antenatal clinic had been set up again. It was mid-winter, and the coke-stove was burning fiercely. It was well guarded on all four sides for the protection of the numerous little children running around. Lil had been in my mind on and off during the past fortnight - a curious mixture of revulsion and admiration. Whilst I admired the way she coped, I hoped I would not have to meet her again, at least not in the intimate patient/midwife relationship.

The pile of notes on the desk told me it would be a busy afternoon - no time to brood about Lil and her syphilis. There were seven piles of notes, with about ten folders in each pile. Another seven o’clock finish, if we were lucky.

I glanced at the top of the first pile, and saw the name Brenda, a woman of forty-six with rickets. She would be admitted to hospital for a Caesarean, and she was booked with the London Hospital in Whitechapel, but we were looking after her antenatally. At that moment she hobbled in, punctual to the minute for her two o’clock appointment. As I was at the desk, and the other staff were not available, I took her for examination and check-up.

My heart went out to little Brenda. Rickets showed itself in malformation of the bones. For centuries it was not known what caused the condition. It was thought, perhaps, to be inherited. The child was thought to be “puny” or “sickly” or even just lazy, as rachitic children always stand and walk very late. The bones are shortened and thickened at the ends, and bend under pressure. The spine is deformed, as many vertebrae are crushed. The sternum is bent, and therefore the ribcage is barrelled and frequently twisted in shape. The head is large and square shaped, with a jutting, flattened lower jaw. Frequently, the teeth drop out. As if these deformities were not enough, rachitic children always had a lower immunity to infection, and bronchitis, pneumonia and gastroenteritis constantly occurred.