I was a medical student the first time I saw a baby born. I’d been told about all the folding and unfolding and twisting and turning a baby does to get out of its mother.
The reality is much more exciting.
A tuft of hair emerges and retracts, and then emerges some more, to slowly become the head of a new little person. There’s the amazing — bizarre — moment when a woman has two heads. After that, the face of the little person turns, as the shoulders naturally get into position for delivery.
So-called normal deliveries don’t feel normal at all. They’re extraordinary miracles, following on the design and function of women’s bodies: the shape of the female pelvis, and the working of the uterus.
Women, too, are very often the ones directing the proceedings. That first midwife I watched, did a one-finger delivery, easing the baby’s second shoulder out with the subtlest of gestures, helping a greasy flabby monster out onto the mother’s belly, and gently rubbing the tiny clenched feet until we could all hear and see the pink flush of a noisy new human life.
What a privilege to witness this!
I got myself involved in many more deliveries than the student checklist said was necessary. When the midwives saw I was more help than hindrance, I was gradually allowed to take on more challenging cases.
Jade, a fifteen year old, was surely more child than woman. She had no partner or mother or even any friends with her. She was defensively hostile, when I asked about her birth plan. “What do you mean?” she said. “I just want it over as quickly as possible.”
“You could ask for things you might want”, I said, encouragingly. “I could deliver your baby onto your belly? If you’d like that? So you’d be the first person to really touch him.”
“Definitely not”, she glared at me. “ I don’t want anything on my belly. Ever”.
As I sat with her, she gradually loosened up. Talked to me about her school friends. Wrinkled her nose about breastfeeding: “Ugh! That’d be vile”. We even sighed together over the young man who had turned out to be much less trustworthy than he said he would be. “I don’t want him around”, she told me fiercely. “Even if he changes his mind.”
It was really surprising, at least for me, to see how well Jade did during her labour.
She got more determined than hostile as we went on. But she kept reminding me: “Don’t you forget. I don’t want anything on my belly. Ever!”
So I can’t explain what happened when I did the actual delivery. As I took the shoulders of her baby upwards, Jade and I looked directly at one another.
And then I put her baby straight onto her belly.
I was still looking at her, as she looked down. After the longest possible moment, she slowly pulled her baby upwards towards her breast. She kept on looking right into his wide-awake eyes as he rooted around for her nipple.
After a while she broke off to look at me. She was smiling: “How did you know? How did you know I’d changed my mind?”
“I dunno,” I almost laughed. “I just did.” And we grinned at each other, before she went back to loving her baby.
Of course, most deliveries, even if they’re so-called normal, are not as picture-perfect as Jade’s. I sat for five hours rubbing Yvette’s back when she was labouring with a dead baby inside her. She’d already had two miscarriages and had been so hopeful for this pregnancy. The only time her husband rang, she motioned for me to stay in the room. Her voice went up at least an octave as she squeaked: “I’m fine”.
This time it was me as well as the mother who wanted to have it all over as quickly as possible.
When a baby is stillborn, his or her skin, lips, eyes, and even internal organs can be affected. Like your fingers if you’re in the bath for too long, it gets worse the longer you wait.
The technical word is ‘macerated’, and I couldn’t get it out of my head.
Eventually, Yvette’s baby started to arrive and a senior midwife came in to help.
It’s completely different pushing for a live baby and a dead one. Yvette knew this better than me or the midwife.
When he was delivered, Yvette’s baby had the all the fingers and toes you might possibly want.
But he was somehow more anthropoid and less animal than a live baby.
I wrapped him up in a blanket. Arranged him in a Moses basket to show his best side — his least-bad side — and took him to sit with his mum. She asked me to stay with them. And then to take him away.
Later on, after I’d qualified as a doctor, I did a rotation in Obstetrics. I didn’t see any normal deliveries there.
The miracles were totally different.
When the heart of Sharlene’s baby kept slowing down, everyone agreed she needed an emergency Caesarean. Her birth plan, though, had her hearing her baby’s first cry. “I want to enjoy it,” she begged. The senior surgeon, Mrs Patel, agreed to a spinal anaesthetic so Sharlene could be awake. But then when Mrs Patel opened the uterus, the baby’s head was firmly stuck right down in Sharlene’s pelvis.
Mrs Patel sign-languaged me to push upwards in Sharlene’s vagina. But nothing was going anywhere, regardless of how hard I pushed and how hard the surgeon pulled.
Mrs Patel and I didn’t think about how babies like this used to die.
We just got on with trying to sort it out.
And the baby was — eventually — unwound from his mother’s pelvis.
Sharlene might have enjoyed it when her baby first cried. But Mrs Patel and I didn’t even notice. Because just before, the bleeding had started.
Not a little bleed, but torrential, from multiple sites.
Directed by yet more sign-language, I started pressing down on some of the bleeders while Mrs Patel took over with the others.
The scrub-nurse had to sign-language us to keep the growing pile of blood-soaked swabs out of Sharlene’s view.
Sharlene groaned. She said: “You’re squashing me. You’re squashing my belly!
She started hiccoughing — literally spilling her guts out of her abdomen.
Women used to die in situations like this.
I didn’t think about how sometimes they still do. I pressed down even harder. I thought: ‘Yeah, I’m squashing you. We’re trying to save your life.’
I could see Mrs Patel thinking about an emergency hysterectomy — the last resort if you really can’t control the bleeding.
This is when surgeons earn their money.
And Mrs Patel did just that, sorting it all out so Sharlene’s only grumbles were how long she’d had to wait to hold her baby.
When I transferred over to Paediatrics. I got back to seeing babies being born normally. After all, a Paediatrician is called whenever a baby is even four weeks early.
Frances was one of the most formidable of the midwives, but she and I got on well. “Come on”, she’d say to me. “Give a hand here”.
Really, she wanted my hips. She’d get the women to put their feet up on her and my hips, and we’d all physically labour together. This might be old-fashioned — it is old-fashioned — but if Frances and I were working together we could pretty much guarantee you a vaginal delivery. No forceps or anything like that. And a perfect perineum, with no tearing or stitches down below to mess up your first few days with your new baby. I got back to enjoying the miracle of new life.
The only problem I had with labouring women and new mums, was when they asked about my own children. Frances was childless — or was it child-free? — but she had delivered thousands of babies. She knew to avoid this question, and how to do that.
I always ended up admitting I hadn’t had any babies myself.
The women who seconds before were partners with me, who couldn’t thank me enough for all I had done, their eyes immediately changed. They were more than surprised. Sometimes they looked outraged. Betrayed, even.
“But you must have children!” I was often told. The more of a miracle I had just perpetrated, the more difficult and splendid my work, the more these new mothers seemed to think that I might somehow have forgotten some kids playing happily at home.
The ‘kindest’ women decided I must have a traumatic back-story of infertility. “I’m so sorry”, they said, eyes brimming with compassion.
One in five women in the UK are now childless — or is it childfree?
But the new mums I kept on meeting somehow couldn’t conceive I might have chosen other ways to be a real woman.