Warspite shuddered stem to stern from the recoil of her own weapons and the underwater shock waves spreading out from the exploding bombs. She heeled to port. Her captain must have ordered a defensive change of course.
He felt someone tugging at his sleeve. He turned and saw AB Henson. No, there was a killick badge sewn on his sleeve. Leading Seaman Henson must have achieved his much-desired promotion. He was having to yell over the racket. “Begging your pardon, sir,” he proffered a steel helmet, “but Mister Wallace, my officer, sent me. He said, and I’m quoting him, sir, honest, ‘Tell that silly bugger of an MO to get under cover. Make him understand that falling shrapnel from our own guns can kill. And if—’ his words, sir, not mine, honest, ‘the daft sod won’t, at least get him to wear a tin hat.’” He offered the helmet once again.
There was an explosion louder than the rest and Fingal turned and stared at the cruiser abeam and to port. He thought it might be HMS Gloucester. There was a row of near-miss bomb splashes tumbling back off her far side, but her bridge was a flaming shambles. One bomb at least had hit and he doubted very much if steel helmets would have been much protection for the poor sods on duty there. Farther away a destroyer had hauled out of line and smoke was pouring from her foredeck.
He took a deep breath. He had been thoughtless, even reckless, in satisfying his curiosity instead of reporting to his station, and if a bomb hit Warspite all the medical staff would be very busy.
“Thank you, Henson, I appreciate Mister Wallace’s concern, but I won’t need it. I’m going below now,” Fingal said. “I’ve seen enough.”
36
Dear Nurse of Arts … and Noble Births
“Thank God you’re here and thanks for coming, Doctor O’Reilly.” Dougie Duggan, the sleeves of his collarless shirt rolled up, held open the door of his terrace house in the council estate. “Doreen’s upstairs. Her sister Mabel’s with her, so she is, and wee Daphne, our daughter, is at her granny’s.”
Fingal carried his two maternity bags into a narrow hall with a staircase at one side. Kitty followed.
A quavering moan, which rose in intensity before fading, drifted from above, and the smells of fried bacon and boiled cabbage wafted through the half-open door to the kitchen at the end of the hall.
“You know Mrs. O’Reilly,” O’Reilly said. “She’s a trained midwife.”
Dougie Duggan nodded. “I’m very glad you’ve come, missus.” He rolled down his sleeves. “It’s no place for a man when his wife’s having a wean, but I reckoned I should wait til someone got here, seeing Miss Hagarty’s tied up with another delivery.”
Kitty smiled. “I’d have thought it wouldn’t be a bad idea if a husband was nearby to give a bit of support.”
Dougie Duggan tipped his head to one side. “No harm til you, Missus O’Reilly—”
The inevitable Ulster preamble, O’Reilly thought, to a flat-out contradiction.
“No harm, and mebbe things is different in Dublin where you come from, but up here—”
This time the moan was louder. More intense.
Dougie Duggan stared up at the ceiling, shook his head, and grabbed a sports jacket from a peg on the wall. “Up here, men get offside when women is in labour. Always have done. It’s only natural. Having wee ones is women’s work.” He took a pace through the open door. “Mabel’ll know where til get me when it’s all over, so she will. Away you on upstairs, Doctor and Missus O’Reilly.” And with that—he fled.
“Things are not different in Dublin where I come from.” Kitty shook her head. “Natural, he calls it.”
“Come on,” O’Reilly said, and started to climb the stairs. “Dougie’s right, of course. Whether it’s natural or not, it is the tradition. Women do the labouring—and they don’t call it that because it’s easy—and the men, well, the men disappear—”
“Down the boozer with their pals,” Kitty said. “I know. The Duck may be in for a busy afternoon.”
O’Reilly stopped on the landing. “Mary Dunleavy may be. Her dad’s going to be in bed for a week. I’ll tell you about it later. Right now,” he pushed open a bedroom door, “we’ve a job to do.”
He bent and set both bags on a carpeted floor and immediately was aware of the smell of amniotic fluid. The membranes must have burst already. Miss Hagerty had told him that Doreen Duggan’s last labour had lasted only seven hours and the contractions of this one were now coming three minutes apart.
The bedroom was big enough for a double bed, two chairs, and a dressing table. Chintz curtains were pulled back, and bright sunlight spilled into the room. “Hello there, Doreen, Mabel. Wee one’s on its way?” O’Reilly said.
“It is, Doctor.” Mabel, a beefy brunette woman in her late twenties, was sitting on the side of the bed holding Doreen’s hand. “Poor wee Doreen’s getting ferocious pains, so she is. I’m very glad youse could come. I’d’ve done my best if I had til,” she lowered her voice and whispered, “but see that there Dougie? See him? About as much use as teats on a bull.”
O’Reilly hid a grin, but he heard Kitty chuckle. “I’d better get to work and take a quick look. If you’d excuse me?” He wasted no time introducing Kitty. She’d take care of that herself.
As soon as Mabel had moved away from the bed, O’Reilly took her place. “The baby’s only two weeks early, Doreen, and the pregnancy has gone very smoothly. Miss Hagarty would be handling your delivery as usual if she wasn’t already at another confinement. So there’s no need to worry,” he said. “And it sounds like you’re moving along so I need to get a look at your tummy.” He turned back the bedclothes and hoisted her flannel nightie.
“Go right ahead,” she said, “and I’m dead glad you’re here, sir.” She managed a weak smile that crinkled the corners of her blue eyes.
Before he could do more than lay one hand on the great swollen belly with its silver striae gravidarum, stretch marks, Doreen grabbed his free hand and started to squeeze. Again she moaned through clenched teeth. Under his examining hand he felt the uterus, which in labour is simply a huge, muscular piston, contract until at the peak of the labour pain it was as hard as an anvil. His left hand felt as if she was crushing it to a pulp.
He glanced at his watch so when the next contraction came he could assess the duration of this one and the interval between the two. And this wasn’t an early labour contraction either. The birth would be soon, he was sure. As he waited for the wave of muscular spasm to pass, he heard Kitty saying, “I’m Kitty O’Reilly. I’m a nurse and a midwife. I’m here to help Doctor O’Reilly.” He smiled. Exactly. The fact that they were man and wife was irrelevant at that moment; that they were trained professionals was important.
Kitty said, “We need your help too, Mabel.”
“Aye, certainly. What’ll I do?”
“Can you bring up a good wheen of old newspapers?”
“Aye. I can. There’s a brave clatter under the stairs.”
“Then off you trot.”
“Do you not want any hot water, Mrs. O’Reilly? Everytime a woman has a baby on the telly, like in that there Doctor Kildare or in the fillums, the doctor always tells someone to boil lots of water, so he does.”
Kitty laughed. “I never know what for unless they all drank gallons of tea.”
“Oh, I see, that’s all right then,” said Mabel. “I’ll go and get the papers.”
O’Reilly glanced at Kitty. Without any bidding, she was starting to open the maternity bags and prepare the instruments.
Doreen stopped moaning and both the pressure under O’Reilly’s right hand and Doreen’s iron grip of his left eased.
“Good lass,” said O’Reilly. “When did the pains start?”
Doreen used the back of her right forearm to push back locks of auburn hair that had fallen over her sweaty forehead. “About three hours ago, Doctor, and my waters broke about fifteen minutes back.” His nose had not been wrong.
“All right.” And her last labour hadn’t been very long. He told himself to
get a move on. It took a very few minutes to complete an abdominal examination and report to Kitty with a running explanation for Doreen, “One baby, right dorso-anterior, that’s with its back to the front and to your right, Doreen, and that’s as it should be, a vertex presentation right occipito-anterior. The baby’s head is coming first with the back of its head to the front and to the right. The head is nearly engaged, and that tells me the widest part of the baby’s head is where it should be on its way into your pelvis. You’re cracking along.”
“Doctor O’Reilly?” Kitty handed him an aluminium Pinard foetal stethoscope with its circular flat earpiece and its wide trumpet of a mouth.
He took it and with his back turned to Doreen he winked at Kitty and was rewarded with a lovely smile. “Just going to check the babby’s heart rate, Doreen.” He put the wide mouth on the abdominal wall, leant with his ear to the earpiece, listened, and counted. “It’s going like a liltie at a hundred and forty-four beats a minute, regular as clockwork. Perfectly normal.” He grinned at Doreen and she smiled back in return, but it vanished as she gritted her teeth. “You went to antenatal classes,” O’Reilly said, “and they taught you how to breathe, just like your last delivery. So pant, Doreen, when a pain comes. We don’t want you pushing yet. Pant. Big breaths. Biiiiiig breaths.”
The puffing, panting mother-to-be got through another contraction.
“I think this might help, Doctor,” Kitty said, playing the part of the midwife to perfection. She handed him a face mask attached to a small cylinder by a valve and piece of polythene tubing. The initials “BOC” for British Oxygen Company and the word ENTONOX were printed on the cylinder.
“Great idea,” O’Reilly said. “Thank you.” He took the equipment and for a moment had a mental image of himself learning to give anaesthetics in 1940 at the Haslar Naval Hospital near Plymouth. “This is a fifty-fifty mixture of laughing gas and oxygen, Doreen,” he said, laying the cylinder on the bed beside her and handing her the mask. “The second you feel a contraction starting, clap the mask over your nose and mouth—” He showed her how. “—and take deep breaths. It’ll cut the pain, but it won’t knock you out and it won’t hurt your baby. Nurse O’Reilly will help you while I go and wash my hands.”
As he was leaving, Mabel returned with an armful of old newspapers. “We’re going to spread these on the mattress under you,” Kitty was saying, “and put a rubber sheet on top of them to protect your bedclothes. Can you roll onto your left, Doreen?” Supremely confident that the midwife training Kitty had received at the Rotunda Hospital in Dublin had not deserted her, O’Reilly headed along the landing looking for a bathroom where he could wash his hands.
* * *
Half an hour had passed since O’Reilly had put on rubber gloves and carried out a pelvic examination. He had determined that the neck of the uterus, the cervix, had become paper-thin and dilated to eight centimetres—only two more to go before the birth canal was free from obstruction. The leading part of the baby’s head had descended well into the pelvis, and the landmarks on the tiny creature’s head had allowed him to determine that although the head was lying with its widest part in line with the widest axis of its mother’s bony pelvis, as it descended farther toward the outside world the head would rotate until it was lying, he smiled at his nautical usage, exactly fore and aft in relationship with the middle of the mother’s pubic symphysis in front and her coccyx, her tailbone, astern.
During those thirty minutes Kitty had kept a regular watch on the mother’s blood pressure and both her and the unborn’s heart rates. All had remained normal, and judging by how little she now moaned, the Entonox had certainly helped reduce her ability to feel the contractions.
He was now jacketless with his shirt sleeves rolled up, wearing a floor-length red rubber apron, face mask, and rubber gloves. He stood on the right side of the bed. Kitty, also bare-armed, gloved, and masked, was on the left. Mabel had withdrawn with a promise that she would “put the kettle on anyroad, because even if nobody else wanted one, she was sure Doreen would like a wee cup of tea in her hand once the baby was born, like.”
“Won’t be long now,” he said to a drowsy Doreen, who at that moment was gasping into her mask as a contraction hit. As he had been taught as a student all those years ago at the Rotunda, the toughest part of midwifery was the waiting, but the waiting was nearly over. At the peak of this contraction, a black circle appeared, about the size of one of those American silver dollars he’d seen during the war. “She’s fully dilated,” he told Kitty, “and the head’s nearly crowned.” It would be fully crowned when the widest diameter of the baby’s head had entered the world.
“Time to get her pushing,” Kitty said.
“Aye,” said O’Reilly, “you’ve not forgotten your old trade.”
“No, but I had almost forgotten how exciting it is to help bring a new wee one into the world,” she said. “The last time we did this was more than a year ago now, before we were married.” She puckered at him then asked, “Dorsal or left lateral?”
“Dorsal,” O’Reilly said. “I think she’ll be able to push better and be a bit more comfortable. In fact…” And why not? “You’re on her left side. Why don’t you deliver her and I’ll help?”
“May I?”
“Don’t see why not. You’re fully trained and it’s like riding a bicycle. You don’t forget how. It all came back to me after the war.” And not giving Kitty the chance to back out, O’Reilly said, “Doreen?”
“Uhhh?”
“I want you to lie on your back and draw your knees up. The baby’s coming. You’re going to have to push now.”
Doreen nodded.
Kitty turned and leaned over Doreen’s left thigh, facing the foot of the bed, while O’Reilly supported the labouring woman’s shoulders.
Doreen started to make a growling noise in her throat. Another contraction was starting.
O’Reilly put one arm round her shoulders and helped her to bend so she was squatting more vertically. “Push, Doreen. Push.”
The veins stood out on her forehead. She clenched her teeth and O’Reilly could feel the effort as Doreen contracted her belly muscles to add downward pressure to that being exerted by the uterus.
“Push.”
“Head’s crowned,” Kitty said. “Starting to extend. No more pushing.”
“Big breath, Doreen. Pant.” O’Reilly knew that now the widest part of the baby was through the pelvic canal, the back of the head, the occiput, would pivot on the symphysis and it would be Kitty’s job to guide and control it so that there was no tearing of the mother’s tissues by the baby’s face and chin. Her task would be easier if the forces bearing on the baby were lessened.
Doreen’s breathing became more shallow. The uterine contraction had passed.
He looked to where Kitty was busying herself with a mucus-trap suction device, using her own mouth to suck on one end while at the other a narrow plastic tube cleared the baby’s mouth and nose of mucus that would drop into a plastic bottle between the two tubes.
“I have to push again, I have to.”
“All right, Kitty?”
“Go ahead. The shoulders will be here in no time.” Kitty sounded as if she was out for a gentle ramble on a beach. No fuss. No bother.
To the manner born, O’Reilly thought. She’d come a long way from the student nurse who, back on a ward at Sir Patrick Dun’s Hospital in the ’30s, had collected up all the old men’s false teeth and washed them in one basin—with predictable results when she’d tried to match each set of dentures with each set of toothless gums. Kitty really was a consummate professional now and he admired that greatly.
“All right, puuush.” O’Reilly supported Doreen’s shoulders and watched Kitty as she guided the newly emerged baby’s head, then its shoulders and its trunk from the birth canal. He could see the umbilical cord—the spirally, twisted pair of arteries and one vein surrounded by protective jelly.
“It’s a boy,” Kitty said wi
th satisfaction.
Doreen’s reply was drowned by a powerful screech.
“And he’s a boy with healthy lungs,” O’Reilly said as Kitty gently laid the baby on the rubber sheet and clamped and cut the umbilical cord.
O’Reilly lowered Doreen onto her pillows. “Just be a tick,” he said, and moved to the foot of the bed. “All right?”
“Fine,” Kitty said. “No tears and I’ve just to wait for the afterbirth. You carry on.”
“Right.” He inclined his head. “There’s ergometrine already drawn up in a syringe for when you’re sure the placenta’s out in one piece. I’ll see to the wean.” He had a towel ready and picked up the chissler, gently wiping away the greasy, whitish vernix caseosa, the waterproof material that still clung to the baby’s skin. As he worked, he calculated the Apgar score, named for the American anaesthetist Virginia Apgar, who in 1952 invented a ready reckoner for assessing the health of newborns. Her own name was the mnemonic for the criteria by which the baby was graded. Appearance. Pulse. Grimace. Activity. Respiration. On a scale of nought to ten, O’Reilly gave young Duggan a nine. First rate. Then he quickly made sure that the baby boy had a full set of fingers and toes. Finally he fished in his trousers pocket and brought out a small bottle of silver nitrate. A few drops in each eye would protect the baby from gonorrhoeal eye infection contracted during passage along the birth canal, and subsequent blindness. While it was unlikely that this infant was at any real risk, it was always better to be safe than to be sorry.
He picked up the bundle. He had wrapped the newborn in his blanket so that a hood was formed around its head—babies could lose a lot of body heat through their heads. “Here you are, Mammy,” he said as he presented her with her new son. “One healthy wee boy complete with all his bits and pieces.”
She smiled and took the bundle. “Thank you,” she whispered, peeping in under the hood and pointing with an outstretched finger. “Och,” she said, “och, Doctor O’Reilly, he’s beautiful. Thank you. And thank you, Mrs. O’Reilly.” Two tears ran down Doreen Duggan’s cheeks. As she smiled and spoke gentle nonsense words to the babe, a tiny hand reached out and clasped his mummy’s finger.