‘Don’t push, Kathy, just pant in and out quickly. Keep panting – like that. Good girl.’
As the contraction subsided she eased the pressure on the presenting part and allowed the head to slide out a little, until it crowned. The perineum was stretched, but was still holding it back.
‘Only one more contraction, and your baby will be born. Try not to push. Your stomach muscles are pushing hard enough. They don’t need any help. The baby will come anyway.’
Kathy nodded, but was unable to speak because another contraction came almost immediately. Ruth slowly edged the perineum around the broadest part of the baby’s head – ‘Now you can push, Kathy.’ The girl did so, and the head was born.
‘That is the hardest part over, my dear. There will be a minute of rest, then another contraction.’
Ruth watched the head move about ten degrees clockwise as it aligned with the rest of the body. Another contraction came quickly.
‘You can push now, Kathy – as hard as you like.’
Deftly she hooked her forefinger under the presenting shoulder. The baby’s whole body slid out easily, Ruth guiding it upwards between the mother’s legs, and over the pubic bone.
‘You can turn over now, Kathy, onto your back, and look at your baby. It’s a little boy.’
The girl rolled over and raised her head.
‘Oh, bless him. A sailor’s son. Isn’t he tiny, nurse?’
The baby was indeed tiny, smaller than Ruth had expected from her admittedly brief abdominal examination. From appearances, he seemed to weigh no more than four pounds. ‘No doubt due to malnutrition and overwork in the mother during pregnancy,’ she thought bitterly. It was not uncommon. She clamped the cord in two places, and cut between the clamps. The baby was now a separate being.
But where should she put him? There was no cot, no blankets, he was small, and the room was cold. He must be kept warm.
She pressed him firmly under his mother’s arm.
‘Keep him warm with your body. Haven’t you got anything I can wrap him in?’
The girl was contentedly cuddling her naked baby and paid no attention to what was being said. Ruth opened the chest of drawers. There was a towel in the top drawer. She opened the second drawer. There were a couple of jumpers in it. She opened the third drawer, which was empty. ‘This will have to do,’ she thought, taking up the towel and jumpers. They were all cold, but thankfully did not feel damp.
‘Just lift your head and shoulders a minute, will you, Kathy? I want to put these things under your body to warm them, before I wrap your baby in them.’
She pulled the dirty grey blankets over the girl and baby to keep them warm and sat on the chair beside the girl to await the third stage of labour. A few minutes passed. She placed her hand on the abdomen to assess progress. ‘Something’s not right here,’ she thought. The uterus felt hard and bulky, and a strong contraction was developing. Kathy grit her teeth and started to bear down. Ruth leaped into action.
‘There’s another baby coming! Don’t push, whatever you do, don’t push – just pant, like you did before.’
Kathy was tensing all her muscles, and the baby lying under her arm was in danger of being crushed. Ruth grabbed the towel and jumpers and pulled them sharply from under the girl’s body, then took the baby from her. She wrapped him up quickly, and put him in the top drawer of the chest.
She returned to the bedside, pulled back the blankets and saw the head of the second baby emerging. She was just in time to control a rapid delivery.
With a twin birth, if the lie of the second baby is in a normal head-down position, if the uterine activity is normal, and especially if the baby is small, the birth can be fairly quick, because the birth canal has stretched, and there will be little resistance. Two or three good strong contractions may be sufficient to complete the birth. Kathy’s second delivery was swift and easy, and within a few minutes the baby was lying on his mother’s abdomen. She stretched out a hand to touch him. Her voice sounded incredulous. ‘Another baby! It can’t be true.’
‘It is true, Kathy. You have another little boy.’
Kathy stroked his head. ‘Another little boy,’ she repeated vaguely. Her blue eyes were wide and dreamy, and her body was limp after the exertion. Her voice sounded far away.
‘Another little sailor boy. Oh, you poor wet little thing. And where’s your daddy, little sailor, where’s your daddy? He sailed away on the deep blue sea. Sailed far away.’
Ruth took Kathy’s pulse and blood pressure, which were slightly lowered, but not too much. She knew that she had been lucky in having no complications for which medical assistance, or at least another midwife, would have been necessary.
‘You are a healthy girl,’ she said aloud. “How did you get yourself into this pickle?’
Kathy smiled dreamily. “Oh, that sailor boy. His curling hair, his night-black eyes, and oh, his saucy smile! Somehow I knew he wouldn’t be true. Never trust a sailor, they said, and silly me, I did. Now I’ve got two little sailor boys. What’s me mammy going to say? And me grandma? She’s the one I’m frightened of. A real terror, she is. If you knew her, you’d be frightened too, nurse.’
Kathy sighed sleepily, and closed her eyes. ‘I feel so tired now,’ she murmured, and fell fast asleep.
Ruth had many practical duties to attend to, not least of which was to separate the baby from his mother – and she had only one set of cord clamps in her bag, which she had used for the first baby. So she cut a gauze swab in half, tied each piece firmly to the cord, and cut between the knots. ‘Always improvise, ’ her midwifery tutor had taught.
The baby was small, but looked perfectly formed and healthy. Ruth picked him up, and he whimpered. She held him upside down, and he cried lustily. ‘That’s what I like to hear,’ she thought, ‘cry some more, little baby. Your lungs are only small, and this is the best way of inflating them.’ The baby obliged by screaming. She nodded in satisfaction and laid him with his mother to keep him warm.
Then she began wondering what to do with him. Ideally both he and his brother should have been bathed, examined thoroughly, weighed and measured, and put into a clean cot near to a fire. But she had no hot water, no soap, no clean towels, and the room temperature was far too cold to expose his naked body. To wrap him up warm was the immediate challenge. She looked around the room for something – anything she might use. She saw a cupboard in the corner and opened it, hopefully, but all she found was a lot of broken mechanical equipment. Then she saw the clothes that Kathy had taken off – a skirt, a jumper and a thin, cheap jacket. ‘That will do,’ she thought, ‘better than nothing, anyway.’ The garments were still quite warm, so she wrapped the baby up in them, and tucked him into the second drawer. ‘Phew!’ she thought, ‘this has been a night. What next?’
What happened next was more than she, or anyone else for that matter, could have imagined in their wildest dreams.
Ruth sat down once more on the chair beside the mother, to await the third stage of labour. She had time to reflect on the situation. After a twin birth the uterine muscles are stretched and tired and can take up to half an hour to contract again for the expulsion of the placenta. Kathy lay sleeping, her fragile yet strong young body exhausted from a twin birth, and soothed by the blessed relief from pain. Ruth sat beside her and leaned her head on the wall. She glanced at her watch. What had happened to the time? Less than an hour had passed since she had got out of bed to answer the telephone. She tried to recall the sequence of events: the cycle ride through the night, the girl standing out in the street, the race to get upstairs, the waters breaking on the landing, and the birth of one baby, then two. It had been like a speeded-up film. What did time mean, anyway? There were some who said that time does not exist, others who said that past, present and future are one and the same. What did anyone know about time? Least of all herself. And Kathy was sleeping, blissfully sleeping.