A home birth

Many recent posts have been excerpts from my memoirs, or memories that have surfaced since I wrote those memoirs.  Here are memories of some interactions with a lovely family.  Alan and Mary McNally came to Adelaide from the north of England, from Leeds if my memory is reliable, about the time I graduated from medical school in 1949. Alan was an aeronautical engineer, Mary had been a nurse-midwife before they married and began making babies. Mary was born in Limerick in the west of Ireland, moved to Yorkshire with her parents when she was in her early teens. Her accent baffled people with an ear for accents, as I like to think I have. She had to explain her accent to me, and I got an impression she had done this before. They lived across the lane behind our home in my last three years in general practice in Adelaide. Wendy met Mary when she called on us with a delicious fresh baked cake on the day we moved in, and the two soon became firm friends. The oldest of their children, a girl also called Mary, was 14, and like her mother she had a blended accent, in her case remnants of Yorkshire behind her emerging Australian twang. Her mother said it was traditional on her mother’s side of the family to name the firstborn daughter Mary. Young Mary was very impressive, mature beyond her years, an outstanding student who radiated competence and had more social skills than anyone her age we’d ever met. Her mother told me that young Mary had first said she was going to grow up to be a doctor before she was six years old, and had never wavered from this ambition. She asked if she could read my textbooks and I willingly consented.  She became our baby sitter, and I soon got used to seeing her absorbed in one of my medical books when we came home. Her mother, Mary senior, was pregnant again, her sixth, and all was going smoothly. She asked me to arrange for a home birth and I had to tell her we didn’t do home births in Australia, and anyway a few days in a maternity ward would give her a chance to get away from the kids for a rest. I booked her in the cottage hospital a few blocks away. She shrugged, smiled, said nothing. When she came for her routine prenatal visits she often brought young Mary, and asked me to let the girl listen to the baby’s heart beating. I showed young Mary also how to feel her mother’s belly, identify the parts of the growing baby’s body.

One afternoon young Mary knocked at our back door: could I come to see her mother? I went across the lane from our back garden to the McNally’s. She was in the bedroom, in labour but not in distress; she said young Mary had given her an enema that morning at her request.  She and young Mary had cleaned the room, perhaps the whole house, meticulously. There wasn’t a speck of dust anywhere. The bed had a rubber sheet over the mattress, extra lights from other rooms lit it up like a sports arena. Newspapers covered the floor by the bed to catch any blood or amniotic fluid that might get spilt.  A baby’s crib stood ready for the new arrival. A large bowl of water mixed with ‘Dettol’ disinfectant and clean towels were laid out on a bedside table, on which a pressure cooker also sat. Young Mary told me this held sterilized scissors and tape, to cut and tie the baby’s umbilical cord. She said now what she had not told me earlier, that her mother’s waters had broken earlier in the day, not long after the enema. She stood calmly at the bedside, wrist watch in her hand, timing her mother’s contractions. She told me these were coming every two minutes. I did a rectal examination which revealed that Mary senior was fully dilated and the baby well down in the birth canal. The birth was imminent.  Half heartedly I suggested that it was time for her to go to the hospital just a few blocks away, but I knew as I said it that I was wasting my breath. She was determined to have this baby at home. What’s more, she wanted young Mary to assist me. I accepted the inevitable, asked young Mary to nip across the lane to tell Wendy what was going on, and come over to help as soon as she could get a sitter to keep an eye on Rebecca. Fortunately we had a backup sitter when young Mary wasn’t available. Alan was at his company’s offices in Melbourne, was due home next morning on the overnight train. We’d have to manage without his help. Jane, next in line after young Mary, would have to mind the three little boys.   I remembered a few other things that might be useful so when young Mary came back, I too made a quick dash through our back garden and the house, to pick up my big medical bag, some disinfectant drops for the baby’s eyes and a few other bits and pieces that might be useful.  I hadn’t supervised a home birth before, had to recall what other equipment we used in the labour ward.

  

I was gone no more than 5 minutes but as I should have known, things can happen quickly once labour is under way. When I got back, young Mary was holding the baby’s head, gently turning its shoulders so these would deliver smoothly – her mother’s nurse-midwife experience had kicked in, and she had told young Mary what to do. I took over as the rest of the baby, a boy, slid out, bellowing lustily. We didn’t need the suction tube I had taken an extra minute to find, but I used it anyway to clear any remaining mucus from the baby’s airway. Another energetic push a few moments later squeezed out the placenta. Meanwhile, young Mary had opened the pressure cooker and brought out the sterilized scissors and tape. I nodded for her to go ahead, tie and cut the umbilical cord. I watched as she did this and sterilized the cut end of the cord with iodine, her capable hands moving confidently as if she had done this many times before rather than for the first time. She had tucked her golden hair into a head scarf to keep it out of the way but she didn’t have a face mask and I watched as her expression switched from concentration and determination to delighted pleasure. I put drops in the baby’s eyes, young Mary draped a blanket around him, and passed him to her mother whose outstretched hands steered him to her breast and named him Liam.  There wasn’t much bleeding, and young Mary – her face glowing with pleasure and pride – set about cleaning her mother and helping her fit a sanitary pad. Young Mary had followed her mother’s directions extremely well and the perineum was intact, not torn as it might have been if the head had descended too rapidly..

Everything proceeded smoothly in the postpartum period. Happily, this coincided with the spring school break in September, and Alan had scheduled holidays so the whole family was available to care for Mary and Liam, the new baby.  Mary (Senior) confided in me that everything had gone according to her plan. She had asked young Mary to give her the enema hoping it would hasten the onset of labour so she could have the baby while Alan was out of town because he would fuss and worry about risks, and would side with me about sending her to hospital. She'd had three home births in England and much preferred these over going to hospital - medicalizing childbirth, she called it. That may have been the first time I heard that term. 

Young Mary told me a week or so after Liam was born that she had decided to specialize in obstetrics.

Liam was a sturdy 2-year old toddler by the time Wendy and I set off with our kids for my new life in public health sciences. Wendy and Mary exchanged letters and cards for a few years. Alan came to see us soon after we settled in Edinburgh, during one of his periodic visits to the UK head office of his company, and gave us news of the family. They had decided six was enough so Liam was their last child. Young Mary was doing very well, due to graduate from medical school later that year, still aiming to specialize in obstetrics. 

In 1969, our last year in Edinburgh, we were delighted to get a phone call from young Mary. She had come to Edinburgh to train in obstetrics. I was flattered when she said my presence there had as much to do with her choice of Edinburgh as the high reputation of the University of Edinburgh’s department of obstetrics. When Mary called on us, she brought a handsome young Bengali doctor with her. Clearly this was a serious relationship.  We saw them both again once or twice but they were both working 70-80 hour weeks as hospital registrars (senior residents) and didn’t have much free time. Alan and Mary came to Britain for their wedding, and we were invited too but by then we had moved to Ottawa, and moreover the wedding took place in the same week as Jonathan’s open heart surgery so it was impossible for us to attend. Young Mary didn’t go back to Australia after she got her specialist qualifications in obstetrics. She and her husband settled eventually in Yorkshire where both secured consultant appointments. They had two children, both boys, so the family tradition of naming the first daughter Mary cam to an end. Occasionally I saw her name on articles or letters in the Lancet or BMJ, and she published also of course in specialized journals of obstetrics and gynecology. Then, alas, I saw her photo above an obituary in the BMJ 2 or 3 years ago.  Like so many other women, she had succumbed to breast cancer. But not before she had given fifty years service to medicine and to maternal and infant health care.