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

Looking back over nearly half a century it seems absurd to be racing to an emergency labour on bicycles at about ten miles per hour. But even today I can think of no better way. What would be the advantage of the most powerful police car with nil visibility?

We arrived at the Warren household in less than fifteen minutes. I could not have done it alone. The men said they would wait, in case I needed them further, and a couple of the Warren girls took them down to the kitchen for a cup of tea.

I went upstairs to Conchita. She looked ghastly, deathly white, with bright pink splodges under her eyes. She moaned. I took her temperature, which was 103°F. At first I could not feel her pulse, but, on careful counting, I found it to be 120, and intermittent. Her blood pressure was barely perceptible. Her breathing was shallow and rapid, at around forty breaths per minute. I watched her in silence for a couple of minutes, as a contraction came on. It was powerful, and her features distorted in pain, a high-pitched groan emanating from her throat. Her eyes were open, but I don’t think she could see anyone.

Len was cradling her in his arms. The suffering on his face was enough to break your heart. He was stroking her hair, and murmuring to her, neither of which she seemed to feel or hear. Liz was in the room.

I enquired if the doctor had been called. He had, but was still out on a call. The call had been put through to another doctor, who was also out with a patient. All doctors worked terribly hard at these times. The London smogs were notorious killers.

I said that we should arrange for a hospital admission as soon as possible.

“Is she tha’ bad?” Len asked.

It is astonishing how people do not see what they don’t want to see. To me it was obvious that Conchita could easily die, especially if complications arose from labour and delivery. But Len couldn’t see this.

I went and spoke to the policemen. One said he would telephone the hospital. The other one undertook to try to find one of the local GPs and escort him to the house, if possible. How an ambulance would get there and back was an open question.

I returned to Conchita, and started to lay out my delivery things. It was possible that I would be alone with a premature delivery, and a sick and possibly dying woman.

Suddenly I remembered that Sister Julienne was praying for us. Again, the relief was overwhelming. All my fears vanished, and the calm certainty that all would be well flooded my mind and body. I remembered the words of Mother Julian of Norwich:

“All shall be well, and all will be well

and all manner of things shall be well.”

I must have given a great sigh of relief, which Len picked up. He said, “You reckons as how she’ll be all right then, do you?”

Should I tell him that Sister Julienne was praying for us? It seemed so silly, almost irrelevant. But I did; I felt I knew him well enough. He didn’t dismiss it.

“Well, I reckons as ’ow its goin’ to be all righ’, then, too.”

His face was brighter than it had been since I entered the room.

It would have been advisable to examine Conchita vaginally to see how far she was in labour, but I couldn’t get her into the right position. She wouldn’t allow Len or me to move her. Liz explained to her in Spanish what was required, but she didn’t understand or respond in any way. I could only assess the progress of labour from the strength and frequency of contractions, which were approximately every five minutes. I listened for the foetal heart, but couldn’t hear a thing.

“Is the baby alive, then?” asked Len.

I didn’t like to say a straight “No,” so I hedged my bets.

“It’s unlikely. Remember your wife got very, very cold today, and has been unconscious. Now she has a fever. All this will affect the baby. I cannot hear a heartbeat.”

One of the real problems of premature delivery at the stage of pregnancy Conchita had reached is that the foetus is often lying transversely across the uterus. A human baby ideally should be born head first. A breech delivery is possible, but difficult. A transverse or shoulder delivery is impossible. The head does not normally descend into the pelvis until after thirty-six weeks. A foetus of around twenty-eight weeks is quite large enough to block the cervix completely if contractions push it downwards in the transverse position. In that event, without surgical intervention, the death of the baby is inevitable. I palpated the uterus trying to find out the baby’s position, but it was no use, I could not tell. A vaginal examination might have enlightened me, but there was no way that we could persuade Conchita to cooperate.

All I could do was wait. The minutes between contractions ticked by slowly. They were coming every three minutes now. Her pulse was more rapid, 150 per minute; and her breathing seemed to be more shallow. Her blood pressure was quite imperceptible. I prayed for a knock on the door to announce the arrival of a doctor or the ambulance, but none came. The house was silent, save for the low moaning of Conchita as each contraction came and went.

Inevitably the contractions became stronger, and it was then that Conchita began to scream. I have never in my life, before or since, heard such terrifying sounds. They came from the depths of her suffering body with a force and power that I would have thought impossible, given her fevered, debilitated state. She screamed on and on, wild terror in her unseeing eyes, the sound reverberating wave after wave against the walls and ceiling of the room. She clung to her husband, tore at him, until his face and chest and arms were bleeding. He tried to hold her, to comfort her, but she was quite beyond comfort.

I felt helpless. I did not dare to give her an analgesic to lessen the pain and quieten her, because her pulse and blood pressure were so abnormal, and I knew that any drugs would probably kill her. I thought that if it was a normal delivery she had a chance of living; if it was a transverse presentation she would die, unless an ambulance were to arrive quickly. I could not get near her to feel the uterus, or even to hold a leg, as she was throwing herself around the bed with the strength of a wild animal in a trap.

Poor Liz looked terrified. Len, with unconditional love, was still trying to hold her in his arms and console her. She sank her teeth into his hand with the strength of a bulldog, and hung on. He didn’t cry out, but winced with pain, sweat and tears falling from his forehead and eyes. He didn’t even try to force her jaw open or to pull away. With alarm, I thought that she would sever a tendon. Eventually she loosed the hand, and flung herself to the other side of the bed.

Then, as suddenly as it had started, it was all over. She gave a terrible cry, and a massive push, and water, blood, foetus, placenta - everything - was delivered on to the bed sheets at once. She fell back exhausted.

I could feel no pulse at all. Her breathing seemed to have stopped. But I could feel a flutter of a heartbeat, so I listened with my stethoscope. It was faint and irregular, but it was there. The foetus was blue, and looked quite dead. I snatched a large kidney dish from the dresser, scooped everything into it, and dumped it on the dresser.

“Now we must quickly get her warm,” I said, “cleaned up and comfortable, if she is to stand a chance. You help me, Liz - clean warm sheets, a couple of hot water bottles. I will check the placenta in a minute to see if it is complete. If we can get her to drink something hot it will help. Hot water and honey would do; a teaspoon of brandy in it would be even better. The main thing is to treat the shock. And let us all hope and pray that the bleeding won’t get worse.”

Len went out to issue some instructions, and to pacify the terrified family gathered around the door. Liz and I started to clean the dirty sheets and linen from under Conchita. Len soon returned with clean sheets and hot water bottles, and Liz and I started to make the inert body comfortable.