Farewell To The East End

TRUST A SAILOR

Novice Ruth had the face of a Botticelli angel. None of the men of Poplar had the courage to speak to her as she passed by; they seemed to be in awe of her beauty, her clear white skin, her wide grey eyes, her perfect teeth and gentle smile. It wasn’t that they were afraid of talking to a nun – they talked to the others. Perhaps it was her distinction, her quiet lady-like ways and above all her loveliness that left them tongue-tied. If any of them thought, ‘a nun! What a pity, what a waste!’ they would never have dared to say so.

She was about twenty-five, closer to the age of us young girls than to the other Sisters, but she was not one of us. No, she was firmly of the monastic order and, as she was still in her Noviciate, the rule was probably stricter for her than it was for her fully professed Sisters. Her profession filled her with a joy that was well-nigh tangible, and this happiness lent radiance to her beauty. She was also a fully trained nurse and midwife. After her training she had tested her calling to the religious life as an Aspirant and then a Postulant, before going on to the two years of her Noviciate. Yet still the monastic rule would require three more years of training, with solemn vows to be taken at the end of the first and second years, and final vows at the end of the third year. It was not a path to embark upon lightly, yet it seemed no burden to Novice Ruth. Holiness appeared to be her natural milieu.

But there was another side to Novice Ruth that I am not sure anyone, apart from we girls, knew about. Certainly the people of Poplar never saw it, and I doubt if her older Sisters did. She had a tendency to a giggly girlishness that was most unexpected and therefore all the more endearing. She would laugh at almost anything. This side of her came out mostly around the big kitchen table when we were sorting out our supper, especially if two or three of us were there before the Sisters came in. This was the time when we swapped yarns about the doings of the day. Anything would set Novice Ruth off: the simplest thing like a chain or a pedal coming off a bike, or losing your cap in the wind. She would literally curl up giggling and have to hold her sides as tears streamed from her eyes. Her laughter was most infectious, and we all enjoyed supper when Novice Ruth was around.

She was also a serious mimic and could take off anyone to perfection. Sister Monica Joan was one of her favourites: ‘I see the shifting shades of the etheric ether descending into the slime of Planet Earth and illuminating ... oooh, jam and butter on these scones, how delicious.’ And she’d have us all in stitches.

One evening we were in the kitchen enjoying cheese and chutney sandwiches with crumpets and honey to follow when the heavy tread of Sister Evangelina was heard. I was always nervous of Sister Evangelina as she had made it quite clear that she did not approve of me and, for her, I could do nothing right. The characteristic ‘humph’ assailed my ears, then the humourless voice: ‘Nurse Lee, Nurse Scatterbrain, I want a word with you.’ Every muscle in my body tensed, and I leaped to my feet, knocking over a pot of runny honey. ‘Yes, Sister,’ I said smartly and turned round, to find Novice Ruth. I got nasty indigestion from that one.

No one could mimic the Cockney dialect and accent better than Novice Ruth. Whether it was the whining of a child or the scolding of a mother or the raucous shout of a coster, she had them all down to perfection. After a hard day she was particularly fond of ‘Nah ven, nah ven, le’s ’ave a cup o’ tea an’ a bi’ o’ cake, ducky. Nice bi’ o’ sailor’s cake, eh ducks?’ And we would split our sides with laughter, though I am not at all sure that, if Novice Ruth knew what the last phrase meant, she would have repeated it so often. We had heard that remark many times in the homes around the docks, and I doubt that any of us knew what it meant. I suspect we all thought sailor’s cake was a rich fruit cake with rum in it.[3]

The telephone rang at 1.30 a.m. Novice Ruth answered it.

‘Nonnatus House. Can I help you?’

A soft Irish voice replied.

‘I was given your number, and told to call you when I was in labour.’

‘What is your name and address, please?’

‘Kathleen O’Brian, 144 Mellish Street, the Isle of Dogs.’

Ruth did not recognise either the name or the address from antenatal visits. Neither could she recall any expectant mother with an Irish accent.

‘Are you booked with us?’

‘I don’t know.’

‘Well, you must be booked with someone.’

‘What does that mean?’

‘It means that you have registered for antenatal care and delivery of the baby, and for postnatal care.’

‘Oh.’

There was a long pause.

‘Well, I’m not sure what that means, but I think I’m in labour, and I was told to call you. Can you come? The pains are getting quite strong, an’ all.’

‘How often are they?’

‘Well. I don’t rightly know, I don’t have a clock, but quite often, and quite strong, and ... oh, there’s the click. The pennies are running out and I don’t have any more ... 144 Mellish Street, Isle of Dogs ...’

The phone went dead.

Ruth put on her habit and went to the office to search through the antenatal notes. She could find no Kathleen O’Brian. The woman must have booked elsewhere, but she would have to go to Mellish Street to see the woman and get the address of the correct midwifery service before she could refer her on. Ruth went to the shed and got out her bicycle. She was just about to cycle off, when she paused. Perhaps she ought to take her delivery bag. You never knew! She went back to the clinical room and fetched it.

The cold night air woke her up as she cycled through the quiet streets. She found Mellish Street without any trouble; it ran at right angles to the river. The houses were drab and tall, the street unlit, and she could see no house numbers. So she got off her bike and detached the lamp, shining it on the buildings in the hope that it would illuminate a number. It shone on number 20. She pedalled on, the cobbles making it a slow and painful ride.

Suddenly a female voice called out in the still night: ‘Is that the nurse?’

‘Yes, and I’m trying to find number 144.’

‘It’s me you are wantin’, me darlin’, and right glad I am to see you.’

The soft Irish accent was unmistakable, but the voice trailed away into a groan of pain, and the girl leaned against the wall, her head thrown back and her face contorted with agony. She suppressed the scream rising in her throat, giving a high strangulated sound, even though she pressed both hands to her mouth. The midwife took her body in both hands to support her – she was just a slip of a girl, barely more than eighteen, small and thin and heavily pregnant. The contraction was powerful and long, but eventually it subsided. The girl relaxed and laughed.

‘Oh, that was a nasty one. Me mammy didn’t ever tell me it could be as bad as that.’

‘You shouldn’t be standing out here in the street.’

‘I didn’t want you to miss the house.’

‘Well, someone else could have looked out for me.’

‘There is no one else.’

‘What! You mean you are alone here, in labour?’

‘What else could I be doing!’

‘Oh, never mind. We’ve got to get you to your bedroom before the next contraction comes on.’

‘I’ve got a room on the third floor, and I’m feelin’ fine now.’

Ruth removed her delivery bag from the bike, took the girl’s thin arm, and together they entered the house. It was completely dark inside, so she ran back to her bike to detach the cycle lamp. The torchlight illuminated the narrow stairway. They passed several closed doors, but there was not a sign of another human being. On the second-floor landing the girl started groaning and breathing heavily, doubled up with pain. Ruth was alarmed; it was possible that the girl was entering the second stage of labour. She took hold of the girl again to support her, and then suddenly felt a rush of warm fluid at her feet. The waters had broken.

‘Quickly,’ she said, ‘upstairs. Only one more flight. You have to get to your room. We can’t have the baby born on the landing.’

The contraction passed, and the girl smiled.

‘I can get there. Don’t trouble yourself, nursey. I feel fine now the pain’s gone.’

With surprising agility the girl mounted the stairs, followed by Ruth, and they entered a pitch-dark room, cold as a coffin. She looked around her and said cheerfully, ‘I’m so glad you brought a light with you, because the meter ran out, and I only had enough pennies either for the telephone or for the meter. I think it was the angels told me to use them for the telephone.’

The torch light revealed a bleak, barren room, devoid of any comfort. A rough wooden bedstead stood against one wall. A dirty, stained mattress and pillow lay on the worn-out springs. There were no sheets or pillow-cases; two grey army blankets were the only coverings. A small table and chair and a chest of drawers were the only other furniture in the room. There were no curtains, no rug or mat. An enamel bowl and a jug half full of cold water stood on the table. The electric meter was high on the wall near to the door. In those days the majority of houses and flats received gas and electricity through payment into a coin meter. When the coin ran out, the power supply cut off. Every midwife carried a shilling in her pocket, because meters running out were a constant hazard in our work. Ruth climbed onto the chair, inserted a shilling and turned the key. A dim electric light bulb hanging from the middle of the ceiling cast a gloomy light over the room, and now Ruth could see the girl more clearly. Her small face was delicately boned, and her mouth was beautifully shaped. Her eyes were cornflower blue, and her hair a glorious autumn brown. She sat on the edge of the bed, holding her stomach. Her eyes were laughing.

‘Trust a sailor! This is what happens to a girl when she trusts a sailor! What’s your name, nurse?’

‘Novice Ruth.’

‘Ruth. That’s me mam’s name. She always says ...’

‘Look here, Kathy, we haven’t got time to chatter. You can tell me what your mother says after your baby is born. It won’t be long now because I can see you are in advanced labour, and your waters have broken. Undress and get onto the bed. I must examine you. Where is your maternity pack?

‘What’s that? I don’t know.’

‘Every expectant mother is given a box for her home birth containing sheets to protect the mattress, cotton wool for the baby, sanitary towels, that sort of thing. Where are they? Have you got them?’

‘No.’

‘You should have been given a maternity pack. Who did you book with?’

‘I was just told to call you when I went into labour.’

‘You’ve told me that. But which clinic did you go to for antenatal care?’

‘None.’

‘None! You mean you have had no antenatal care?’

‘I didn’t tell anyone I was pregnant. Me mam and me grandma, they would have killed me, they would. Never trust a sailor, they always say. And I did, silly me, and now look at me.’

The girl cheerfully patted her stomach. But then her face changed. ‘It’s coming again ...’

She threw her head back as pain seared her body. Beads of sweat stood out on her forehead, and her whole expression seemed to be turning inwards as her mind and body focused on the tremendous force of the contraction.

There was no time to lose. Ruth took her stethoscope, gown, gloves and mask from the outer compartment of her delivery pack. She opened the box, and the sterile lid formed a tray on which she placed in readiness her kidney dishes, gallipots, sterile water, antiseptics, scissors, hypodermic syringe, needles, sterile cotton wool and gauze swabs, catheters and blunt forceps. She also carried chloral hydrate, potassium bromide, tincture of opium and pethidine for relief of pain. Cord clamps and cord dressings, powder for the baby and gentian violet or silver nitrate for sterilisation of the cord stump completed her equipment.

All her training and experience told her that a primigravida[4] who had had no antenatal care should be transferred immediately to hospital. But to arrange this, she would have had to go down the road to a phone box, and birth was imminent. While she was gone the baby would probably be born. She looked at the thin, horsehair mattress on sagging springs. There were no sheets, no waterproofing, no brown paper, no absorbent pads. There was no cot, no baby clothes, nor any apparent provision for a baby. There was no fire, nor heating of any kind, and the room was cold. There was a jug of cold water, but she had no means of heating it. The light was quite inadequate for delivery, and the only means of supplementing it was the bicycle lamp. But her midwife’s training had been strict and uncompromising; whatever the circumstances, she must improvise, and cope.

The contraction passed, and the girl sighed with relief.

‘Oh, that’s better. I feel all right when the pain has gone.’

‘I want to listen to your baby’s heartbeat, and then to examine you. I need to know how near you are to delivery. Would you lie down, please?’

She palpated the girl’s abdomen to determine which way the baby was lying. She listened for the heartbeat and heard it quite clearly. Satisfied that the baby was safe, she prepared to do a vaginal examination, saying as she gowned and gloved: ‘You don’t seem to be prepared for having a baby. There isn’t even a cot or baby clothes here.’

‘Well, I haven’t really been here long enough to get anything. I only came over from Ireland yesterday.’

‘What! You came on the ferry yesterday!’

‘Yes.’

‘But you might have gone into labour on the boat.’

‘I might have, but I didn’t. The angels must have been looking after me.’

‘When you got to Liverpool, how did you get to London?’

‘I got a lift with an overnight lorry driver.’

‘I can’t believe it! You might have had the baby on the lorry!’

‘The angels again.’ The girl shrugged cheerfully.

‘When did you arrive?’

‘This morning. I had been given this address and the landlord’s name. That was the only good thing my charming sailor-boy did for me.’

She looked around the room and smiled contentedly.

‘Just draw up your knees for me, please, and let your legs fall apart. I want to examine you internally. The waters have broken, and I want to feel how far you are dilated, and in what position the baby is lying.’

But there was no time for a vaginal examination. Another contraction was coming, and the girl winced in pain, throwing herself around the bed in an effort to escape it. The pain intensified as the uterine contraction became more fierce. Ruth admired the way the girl was coping with labour – she had already had a lot of physical exertion getting to London during the past twenty-four hours. She must have been tired and hungry, and there were no signs of food in the room. She had had no sedation or analgesic, yet she made no fuss nor complaint. The contraction became even more powerful, and suddenly Kathy spontaneously pulled her legs up, gave a prolonged grunt and pushed with all her strength. Ruth only got there just in time, pressing the palm of her hand firmly over the emerging head of the baby and holding it back to prevent an uncontrolled delivery.

‘Kathy, don’t push, not now, do not push. The baby mustn’t be born too quickly. Pant, my dear, quick breaths: in, out, in, out. Don’t push, just pant quickly, in, out, in, out.’

The girl did exactly as she was told, and Ruth breathed a sigh of relief as the contraction passed.

‘With the next contraction your baby will be born. I know you feel as though you want to push, but don’t, not until I tell you. I want the baby’s head to be born slowly. If you push too soon, it will come too fast. Do you understand me Kathy?’

The girl smiled weakly and nodded.

‘Is it possible for you to turn onto your left side to face the wall? It will make it easier for both of us.’

The girl nodded and turned over, and as she moved another contraction started.

Ruth was on her knees beside the low bed with its sagging mattress. The light was terrible, but she had no time to get her torch. The girl gave a low scream and buried her pretty face into the filthy pillow in order to stifle the sound. The baby’s head was emerging fast, too fast. Again Ruth held it back.

‘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.

Ruth placed her hand on the fundus of the uterus to assess progress of the third stage and stiffened with shock. The uterus still felt full, hard and bulky. ‘There’s something wrong here,’ she thought, ‘this doesn’t feel like a placenta.’

She carefully palpated the abdomen. ‘It’s definitely not a placenta. It can’t be ... It’s not possible ...’

She picked up her foetal stethoscope, applied it to the abdomen in several places and heard a rapid, regular heartbeat. Her mouth went dry, and she had to sit down again. Another baby! Undiagnosed triplets, no antenatal care, no assistance available, and apparently no one else in the building to summon help. She shivered as much from shock and fear as from the cold. Thoughts were racing through her mind. Would the delivery be normal? She had been lucky twice, but the third baby might be lying in any position. He might be a transverse lie, or a shoulder or a brow presentation ... or anything. She palpated the abdomen but could not feel a head or a breech. The foetal heartbeat was a steady 150 beats per minute, which was undoubtedly high, but might be normal for a third baby. She had never delivered triplets, nor even seen a triple birth. She felt numb with fear. Would he be healthy, like the others? There might be breathing problems, or other life-threatening difficulties derived from immature internal organs. Perhaps the placenta might come away first, leaving the baby with no maternal blood supply, or the cord might prolapse. She didn’t know if there would be one, two or three placentae. She couldn’t see inside, and she could not tell from external palpation.

Nearly half an hour had passed since the second birth, and there was no contraction. Kathy still slept quietly, but Ruth was trembling with anxiety. ‘If this is uterine inertia, it is a serious condition, and the baby will die. Dare I risk leaving Kathy alone for ten or fifteen minutes while I go to a telephone to call the hospital?’ she asked herself. She dithered. Should I? Shouldn’t I? Which course of action would be the least dangerous?

The situation resolved itself. In her sleep Kathy groaned in pain, and in the same instant there was a click from the electric meter and the light went out. The room was in total darkness. Ruth knew the bicycle torch was on the chest of drawers, but in trying to locate it she knocked it onto the floor, and then had to crawl around trying to find it. She could hear Kathy groaning and straining and pushing, but there was nothing she could do until she had light. She found the torch and switched it on. Kathy now lay calm and apparently asleep. Ruth went over to the bed and pulled back the blankets. A baby lay in a pool of blood, between his mother’s legs. She propped the torch on the end of the bed and picked up the baby. He was small, like the other two, but seemed perfectly formed, and even gave a little cry. She held him upside down, and he cried more loudly. ‘This is a miracle,’ Ruth thought. She cut another gauze swab into two pieces and ligated the cord, then cut the baby free from his mother. She lay him on his mother’s abdomen and covered them both to keep them warm. There was no other clothing available in the room, so she took one of the grey army blankets off the mother, cut it into pieces, wrapped a piece round the baby, and tucked him into the bottom drawer. The other pieces of blanket she tucked under and around all three babies to ensure that they were warm. Then she closed, or rather nearly closed, the drawers to keep out any draughts.

Meanwhile, Kathy was sound asleep, her body exhausted. Ruth sat beside her and tentatively palpated the uterus – would there be another one inside? But no; the abdominal muscles and the uterus felt soft. Ruth breathed a sigh of relief, but at the same time reminded herself that labour was far from over. The third stage had to be completed, and she knew that this was frequently the most difficult and the most dangerous part of delivery. She leaned back in the chair and closed her eyes. Was this a dream? Could it really be happening? She had been out the night before, followed by a busy day, and had enjoyed very little sleep in the past twenty-four hours. She very nearly dozed off, but a warning bell sounded in her brain, and she jumped up and splashed her face with cold water from the enamel jug. The shock soon focused her mind again.

About twenty minutes had been spent wrapping and settling the babies, during which time there had been no contractions. Something had to be done. Ruth picked up the torch and shone the beam of light into the bed. The mess was quite indescribable; a great pool of blood and amniotic fluid was seeping into the uncovered mattress – and she could do nothing about it. Normally a midwife would have covered the mattress with brown paper, absorbent sheets, a rubber sheet, and on top of that more absorbents, which could be changed frequently – but she had none of these. The mess would have to stay where it was. She shone the beam of light onto Kathy’s vulva. Three cords were showing. But how many placentae would she have to deal with? It could be as many as three, if the babies had developed from three separate ova. She did not know, and there was no way she could find out.

Ruth knew the risk of post-partum infection and in other circumstances she would have removed all soiled padding from beneath Kathy, washed her, cleaned the vulva with antiseptic, replaced the bedding with clean absorbent sheets and covered her legs with more clean sheeting. She would also have scrubbed her hands thoroughly, and put on sterile gloves. But none of this was possible. She also knew that warmth was essential, because a woman sweats during labour, losing a lot of body heat, and can become cold and shivery. Yet there was only one thin army blanket available.

She shone the torch despairingly around the empty room and saw her coat hanging on the back of the door. That would do. She took it off the hook and covered the girl with it for extra warmth. Kathy’s breathing was deep and regular, her pulse and blood pressure were on the low side, which was a good sign, and her colour was fine. There had been no contractions, and the uterus felt as it should feel.

In those days the management of the third stage of labour was left entirely to nature, and midwives were taught not to meddle or interfere with the process which separates the placenta from the uterine wall and controls bleeding. Today an oxytocic drug may be injected immediately after the baby is born, and a powerful contraction develops, separating the placenta, so that the third stage is over in a few minutes. We did not have that advantage. Patience, experience, observation and masterly inactivity were our guides. We were taught that meddling with the uterus or attempting to hurry the third stage would usually give rise to partial separation of the placenta, causing haemorrhage. We were taught never, never to pull on the cord, and only to knead or massage the fundus after uterine contractions had already developed, and only then if it became absolutely necessary.

Ruth sat quietly beside the bed, her left hand guarding the uterus, which she could clearly feel. The torchlight was growing fainter, so to save the battery she switched it off and sat in total darkness. Twenty-five minutes had passed with no sign of a contraction, and she was beginning to grow anxious. She might have to leave the girl alone while she summoned medical aid. But then she felt a distinct hardening of the uterus, and the fundus rose under her hand. Kathy moaned with pain and moved awkwardly.

‘This is it.’ Ruth stood up, switched on her torch and shook Kathy. ‘Wake up. I want you to push as hard as you can. Wake up and push down. Draw your knees up to your chest so that you can push as hard as possible, as though you were going to open your bowels – go on, push – harder.’

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.