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

She had not been pleased to fall pregnant again, in fact she was furious, but like most women who have a baby late in life, she was besotted with the little thing when he arrived, and cooed over him all the time. The flat was hung with nappies all over the place - there were no disposable nappies in those days - and a pram further reduced the living space in the crowded room.

Edith was up and doing. It was her tenth day after delivery. We kept mothers in bed for a long time after delivery in those days - ten to fourteen days known as the “lying-in” period. Medically speaking, this was not good practice, as it is far better for a woman to get moving as soon as possible, thus reducing the risk of complications such as thrombosis. But this was not known back then, and it had been traditional to keep women in bed after a birth. The great advantage was that it gave the woman a proper, and well-earned, rest. Other people had to do all the household chores, and for a brief period, she could lead a life of idleness. She needed to gather her strength, because once she was on her feet again, everything would devolve to her. When you consider the physical effort required to carry all the shopping up those stairs: coal and wood in the winter, paraffin for stoves, or rubbish carried down to the dustbins in the courtyard; if you consider the fact that to take the baby out, the pram had to be bumped down the stairs, one step at a time, and then bumped up again to get home, often loaded with groceries, as well as the baby, you might begin to understand how tough those women had to be. Almost every time you entered the tenements, you would see a woman bumping a big pram up or down. If they lived at the top, this would mean about seventy steps each way. The prams had big wheels, which made it possible, and were well sprung, which bounced the baby around. The babies loved it, and laughed and shrieked with glee. It was also dangerous if the steps were slippery, because the whole weight of the pram had to be controlled by the handle, and if the mother missed her footing or something happened and she let go, the pram and baby would go cascading down the length of the steps. I always helped when I saw a woman with a pram by taking the other end, therefore half the weight, which was considerable. The whole weight, for a woman alone, must have been tremendous.

Edith was in a grubby dressing gown, down-trodden slippers and hair curlers. She was simultaneously feeding her baby and smoking. The radio was blaring out pop music. She looked perfectly happy. In fact she looked a better colour, and younger than she had a couple of months earlier. The rest had obviously done her good.

“Hello, luvvy. Come on in. How about a nice cup of tea?”

I explained that I had other calls to make and declined the tea. I was able to see how feeding was going. The baby was sucking voraciously, but it struck me that Edith’s thin little breasts probably did not contain much milk. However, it was far better for her to continue than to put the baby on to formula milk straight away, so I said nothing. If the baby fails to gain weight, or shows real signs of hunger, we can talk about it then, I thought. It was our practice to visit each day post-natally for a minimum of fourteen days, so we saw a lot of each patient.

It became the fashion about that time to put babies on to formula milk, and to suggest to the mother that this would be best for the baby. The Midwives of St Raymund Nonnatus did not go down this path, however, and all our patients were advised and helped to breastfeed for as long as possible. A fortnight of rest in bed helped to facilitate this, as the mother was not tiring herself by rushing around, and all her physical resources could go into producing milk for the baby.

As I glanced around the crowded room, the minimal kitchen area, and the general lack of facilities, it flashed through my mind that bottle-feeding would be the worst thing for the baby. Where on earth would Edith keep bottles, and tins of formula milk? How would she sterilise them? Would she bother to? Or even bother to keep them clean, never mind sterilising? There was no refrigerator, and I could well imagine bottles of half-consumed milk left lying around the place, to be given a second or third time to the baby, with no thought to the fact that bacteria quickly builds up in milk that has been left to go cold, and then warmed up again. No, breastfeeding would be much safer, even if there was not quite enough milk.

I remember lectures during my Part I midwifery training about the advantages of bottle-feeding, which sounded very convincing. When I first came to work with the Nonnatus Midwives, I thought them very old fashioned in always recommending breastfeeding. I had not taken into account the social conditions in which the Sisters worked. The lecturers were not dealing with real life. They were dealing with classroom situations and ideal young mothers who existed only in the imagination, from educated middle-class backgrounds, women who would remember all the rules, and do everything they were told to do. These classroom pundits were remote from silly young girls who would get the formula mixed up, get the measurements wrong, fail to boil the water, be unable to sterilise the bottles or the teats, fail to wash the bottles. Such theorists could not even imagine a half-empty bottle being left for twenty-four hours, then given to the baby, nor envisage a bottle rolling across the floor, picking up cat hairs, or any other dirt. Our lecturers never mentioned to us the possibility of anything else being added to the formula, such as sugar, honey, rice, treacle, condensed milk, semolina, alcohol, aspirin, Horlicks, Ovaltine. Perhaps such a possibility had never come the way of the writers of these textbooks. But they had been encountered often enough by the Nonnatus nuns.

Edith and her baby looked quite happy, so I did not disturb them, but said we would call the next day to weigh the baby, and to examine her.

I had another visit to make, to Molly Pearce, a girl of nineteen who was expecting her third baby and who had not turned up at the antenatal clinic for the last three months. As she was very near to full term, we needed to assess her.

There was noise coming from inside the door as I approached. It sounded like a row. I’ve always hated any sort of row or scene, and instinctively shrank away. But I had a job to do, so I knocked on the door. Instantly there was silence inside. It lasted a couple of minutes, and the silence seemed more menacing than the noise. I knocked again. Still silence, then a bolt pulled back, and a key turned - it was one of the few times I had known a door to be locked in the East End.

The unshaven face of a surly looking man stared suspiciously at me through a crack in the door. Then he swore obscenely, and spat on the floor at my feet, and made off down the balcony towards the staircase. The girl came towards me. She looked hot and flushed, and was panting slightly. “Good riddance,” she shouted down the balcony, and kicked the doorpost.

She looked about nine months pregnant, and it occurred to me that rows of that sort could put her into labour, especially if violence was involved. But I had no evidence of that, as yet. I asked if I could examine her, as she had not been to antenatal clinic. She reluctantly agreed, and let me into the flat.

The stench inside was overpowering. It was a foul mixture of sweat, urine, faeces, cigarettes, alcohol, paraffin, stale food, sour milk, and unwashed clothes. Obviously Molly was a real slattern. The vast majority of women that I met had a true pride in themselves and their homes, and worked desperately hard. But not Molly. She had no such home-making instincts.

She led me into the bedroom, which was dark. The bed was filthy. There was no bed linen, just the bare mattress and pillows. Some grey army surplus blankets lay on the bed and a wooden cot stood in the corner. This is no place for a delivery, I thought to myself. It had been assessed as adequate by a midwife some months earlier, but quite obviously the domestic conditions had deteriorated since that time. I would have to report back to the Sisters.