From MIDWIFERY MATTERS, Issue No.122
by Ishbel Kargar
In September 1951, as a newly qualified nurse (SRN), I moved from Manchester to London, to start midwifery training.
Advancement within the nursing profession required an extra qualification, and for many nurses this was easily obtained by completing the Part 1 Central Midwives Board (CMB) course, (a 6 month hospital-based course), with tutors on site, then back to the general hospital, looking forward to promotion to Staff Nurse or even Sister.
In order to become a midwife however, wherever she wished to work, SCM qualification (State Certified Midwife) was required. This was awarded after the successful completion of the Part 2 CMB community-based course lasting six months, sharing accommodation with the domiciliary midwives, going out with them on their rounds, attending home births, running clinics and so on.
Although direct entry midwifery training was possible, very few hospitals offered the course. So the majority of practising midwives would have taken the above route to qualification. This partly explains the still commonly held belief that midwives are ' nurses with a bit of extra training' .
I didn' t intend to become a midwife, back then in 1952. I' d recently become engaged to an Iranian student, who had returned to his own country, and our plan was for me join him there and work as a nurse. The six months of midwifery training would give me more earning power than just a nursing qualification. Such are the ' best laid plans..'
The East End Maternity Hospital in London was an extraordinary establishment. Starting as a lying-in room in a doctor' s surgery early in 1900s, extra buildings were added over the years, to accommodate delivery room, antenatal clinic, antenatal & postnatal wards, nursery, operating theatre, lecture room, nurse' s home, etc. One of the additions was an old chapel across the garden behind the house, which had been converted into a two storey ward, postnatal upstairs, antenatal on the ground floor. The upper floor was accessed by a narrow circular staircase; naturally we didn' t let the new mothers carry their own babies up to the ward! At the side of the house, an old warehouse was joined on via a short corridor, to form the operating theatre, and by the early 1940s the hotch-potch of buildings had become a very busy maternity hospital on Commercial Road, serving the overcrowded streets in the East End of London.
We had formal lectures from the midwifery tutor and obstetrician, but the clinical teaching took place in the wards, much to the amusement of the Cockney women who were our models, for palpation, swabbing, wound dressing etc.
Large families were the norm, so antenatal clinics were noisy and crowded, as most of the women brought their younger children along with them, plus any other children not at school for one reason or another. One such child was obviously developing chicken pox, and gave it to me. A few days later I woke feeling very ill, and noticed the beginnings of a rash. My friend Greta called the Home Sister, who immediately had me transferred to an isolation hospital on the other side of London, where I eventually recovered, after two weeks, from a very severe attack of chicken pox.
Antenatal care was very spasmodic, most of the women attended for ' booking in' , after which they took away their vouchers to be exchanged for concentrated orange juice and cod-liver oil. Subsequent visits were often few and far between, and it was not uncommon for a woman to turn up in labour, not having been since her booking visit. Our skills in palpating were honed to a high standard, trying to decide the lie and position of the baby. Unexpected outcomes were not uncommon, including a most horrendous birth which fell to my lot to attend. The baby' s head descended quite rapidly, a face presentation. I looked up with alarm at the midwife assisting me, and she nodded assurance. The books had told me that this was going to be a difficult if not obstructed birth, but suddenly the head popped out, quickly followed by the rest of the baby. The face looked squashed and strange, and we both realised it was anencephalic. My expression must have been one of horror, because the midwife gave me a sharp dig in the ribs. I realised then that the mother could see my face, so I gave her a reassuring smile, and with the midwife guiding me, I wrapped the baby and handed it to the mother. The midwife had the difficult task of explaining to her that her baby would not survive, and she held the child until the placenta had been delivered, then handed it to me, asking me to put it in the cot. That was a very sad day for us all.
Work on the postnatal ward was quite busy, most of the women stayed in bed for the first few days. Three times a day, we set up the ' swabbing' trolley, and began the ward round. Most of the women had nothing more than a slight perineal graze, and each of these had her perineum swabbed down with clean cotton wool and warm water, over a bed-pan. Colour and quantity of the lochia was noted on her chart, and she was left with a clean sanitary towel.
Some of the women arrived on the postnatal ward with case-notes bearing a large red label, ' Perineal Wound' . This indicated that they had sustained a tear which had required suturing, or an episiotomy had been performed. In these cases, we prepared fresh sterile trays, scrubbing up between each woman, no chances being taken with wound infection!
The babies were cared for in the adjoining nursery, being brought to their mothers for feeding at regular intervals, depending on their birth weight. “Small’ babies were fed every three hours, while the larger ones were deemed able to go four hours between feeds. Naturally, not all the babies took to this regime, and there was quite some ' supplementary' feeding going in the privacy of the nursery, a system which would nowadays be frowned upon.
I thoroughly enjoyed my time at the East End Maternity Hospital, visiting various parts of London with colleagues during our off-duty, including attending the Midnight Carol Service in St Paul' s Cathedral, a memorable event. But it was with relief that I completed the course, and prepared to rejoin my fiancé in Iran, and that's another story!
Ishbel Kargar
This article was originally published in Midwifery Matters issue 122, Autumn 2009
AH updated 22 October 2009