Kathy did as she was told, and Ruth assessed from the feel of the uterus that the placenta had separated and was lying in the lower segment. The fundus had risen higher in the abdomen and was still hard and firm.
‘Now relax, Kathy. Put your legs down and breathe in and out deeply. Relax as much as you can. I am going to press on your tummy. It will be uncomfortable, but it won’t hurt.’
Using the fundus as a piston, and with firm but gentle pressure, she pressed her left hand in a downward and backwards direction. Her right hand took hold of the cords and lifted the emerging placenta from the vault of the vagina. Two cords were attached. One remained hanging from the vagina, indicating that one placenta remained in utero.
At this point Ruth massaged and kneaded the fundus vigorously, and another contraction developed. ‘Start pushing again, Kathy, like you did before. We have to get this out with this contraction.’
‘What’s going on?’ moaned poor Kathy.
‘I’ll tell you later. Just push with all your strength.’ Kathy did so, and a few seconds later the other placenta slid out onto the mattress.
A huge gory mass of placentae lay on the bed. Ruth scooped them up into kidney dishes and placed them on the table. She had not the slightest chance of examining them, because the torchlight was dim and growing dimmer by the minute as the battery failed.
Kathy was wide awake now. ‘What’s been happening?’ she asked. ‘I’ve got twins. Where are they?’ She looked around her.
‘No. You’re wrong. You’ve got triplets, and they are in the chest of drawers.’
‘Triplets! You mean three babies?’
‘Yes.’
‘How?’
‘Well, you were exhausted and fell asleep after the second baby was born, so the third baby must have slid out with hardly any pain worth speaking of. Not enough to wake you up, anyway. I didn’t see it, because the meter had run out, and I’d dropped my torch.’
‘And I’ve got three babies?’
‘Yes. Three little boys.’
Kathy leaned back with an incredulous sigh.
‘Holy Mary, Mother of God – what’s me mam going to say? Oh be-Jesus, illegitimate triplets. Trust a sailor!’
Ruth cleared up and returned to the convent, where arrangements were made for Kathy and the babies to be admitted to the London Hospital. The girl had no one to look after her, and she was quite unable to look after the babies in the room where she was lodging. She had no money, no clothing, no heating, no food even, and the babies were small and vulnerable.
We did not find out what happened to them after they left hospital. If the sailor could not be traced and persuaded to marry Kathy and support his children, the prospects for them were bleak. Returning to the family in Ireland would have been the best thing, but in rural Ireland in the 1950s poverty and the shame of illegitimacy drove many families to reject their grandchildren. Places in a children’s nursery in London would have been offered, with access for the mother, but she would have had to live separately and support herself. It is unlikely that she would ever have earned enough money to have the boys with her and to support them. Adoption would have been possible, if Kathy had agreed, but the chances of anyone wanting to adopt all three babies were slender, so the boys would probably have been separated and would have grown up not knowing they had brothers.
Whilst I cannot record a happy ending, Kathy was buoyant, cheerful and resourceful, and we cannot be sure that life treated her harshly. It might have been quite the opposite. So often in medicine we see and become deeply involved with people at the most intimate and dramatic time of their lives. But then, like ships, they pass in the night; they are gone and we see them no more.
CYNTHIA
I was cycling back to the convent after a morning’s work, weaving my way in and out of the lorries on the East India Dock Road, singing to myself as I pedalled the old Raleigh, which was as heavy as lead with two of its three gears not working, and perfecting my no-hands-steer-with-knees-and-bodyweight technique, when I saw Cynthia ahead of me. She was cycling more slowly than me, and her bike was wobbling about on the road. I called out, ‘Hi, there!’ as I drew level; but my high spirits quickly changed to concern. She was crying.
‘What’s up? Oh, Cynthia dear, what’s happened?’
She looked round, tears streaming down her face. A lorry screeched past, hooting noisily, its driver gesticulating obscenely.
‘Here, we had better pull into the kerb, or we’ll have an accident. Now what’s up? Tell me. I’ve never seen you like this before.’
Cynthia was the peace-maker amongst us, a wise and mature influence. To see her crying in the street was a real shock. I gave her my handkerchief because hers was wet.
‘The baby’s dead,’ she whispered.
‘What? It can’t be,’ I gasped incredulously.
I knew she had been out all night. She had come into breakfast tired but happy, telling us of the delivery of a baby boy – a normal delivery, a healthy baby, and a contented mother. She had left them at 6 a.m., everything satisfactory. We were required to make a return visit within four hours. I had left to make my morning visits at 8.30, and Cynthia had remained behind to clean and sterilise her equipment and write up her notes before returning to the newly delivered mother and baby at 10 a.m.
‘What happened?’ I asked when I had recovered from the shock.
‘I went back to the house as usual,’ Cynthia explained. ‘I never thought anything would have happened. The door was open, and I went in. Everyone was crying. They said the baby was dead. I couldn’t believe them. I went and saw the baby. It was quite dead and cold.’
‘But how? Why?’
‘I don’t know.’
She blew her nose and wiped her eyes. ‘I don’t know. I just don’t know,’ she whispered and started crying again.
‘Look here, we’d better get back, but don’t try riding that bike. You’ll only fall off. I’ll push it for you.’
We started walking along the pavement, with me pushing both bikes – a noble but futile gesture. Have you ever tried pushing two bikes along a pavement crowded with people and prams and children running around? Soon Cynthia’s tears were mixed with tears of laughter.
‘I’ll take mine, or you’ll do someone a nasty injury.’
We walked along without speaking for a while. I didn’t know whether to ask more questions or to keep silent, but she said: ‘They’ve taken him away.’
‘Who? The doctors?’
‘No. The police.’
‘Police? Why? What for?’
‘Post-mortem examination. The parents didn’t want them to, but the police insisted, saying it was the law with a sudden, unexplained death.’ Her voice faltered and she started crying again.
‘I don’t know if I did anything wrong. I’ve been going over and over it in my mind. I did everything we were taught to do. The baby cried soon after birth. I cleared the airways. I cut the cord aseptically. All his limbs moved independently. His spine was straight, his breathing was normal, and the sucking reflex was there. He was a perfect baby, I thought. I don’t know why he died, or if I did something that might have caused his death.’
She shuddered and could hardly walk straight. The front wheel of her bike hit a bus stop, and the handlebars twisted and poked into her chest, making her groan with pain. We straightened out her bike.
‘Of course you’ve done nothing wrong. You are the best of midwives. I just know it wasn’t your fault in any way.’
‘You can’t be sure,’ she whispered. ‘That’s why the police took him away.’
We continued for a while in silence. I did not like to intrude on Cynthia’s thoughts but felt compelled to ask, ‘What did you do?’