The Midwife Trilogy by Jennifer Worth

was not present.
    This took about five minutes to complete, during which time the child had stopped crying. He was sitting up and Novice Ruth was playing with him with a couple of balls, pushing them back and forth. Her refined, delicate features were offset by her white muslin veil which fell down as she leaned over. The child grabbed it and pulled. The other children laughed. They seemed happy again. No thanks to their rough and brutal mother, I thought as I went over to Lil, who was now lying on the couch.
    She was fat, and her flabby skin was dirty and moist with perspiration. A dank, unwashed smell rose from her body. Have I got to touch her? I thought as I approached. I tried to remind myself that she and her husband and all the children probably lived in two or three rooms with no bath, or even hot water, but it did not dispel my feeling of revulsion. Had she not hit her child in that heartless manner, my feelings might have softened towards her.
    I put on my surgical gloves, and covered her lower half with a sheet, because I wanted to examine her breasts. I asked her to pull up her jumper. She giggled, and wobbled around, pulling it up. The smell intensified as her armpits were exposed. Two large pendulous breasts flopped down either side of her, prominent veins coursing towards huge, near-black nipples. These veins were a reliable sign of pregnancy. A little fluid could be squeezed from the nipples. Just about diagnostic, I thought. I told her this.
    She shrieked with laughter. “Told you so, didn’t I?”
    I took her blood pressure at that point, and it was fairly high. She will need more rest, I thought, but I doubt if she will get it. The children had recovered their spirits, and were racing about once again.
    I pulled her jumper down and uncovered her abdomen, which was large, the skin simply covered with stretch marks. The slightest pressure from my hand showed a fundus above the umbilicus.
    “When was your last period?”
    “Search me. Las’ year, I reckons.” She giggled, and her tummy flopped up and down.
    “Have you felt any movements yet?”
    “Nope.”
    “I am going to listen for the baby’s heart beat.”
    I reached for the pinard foetal stethoscope. This was a small metal, trumpet-shaped instrument, used by placing the larger end over the abdomen, and then pressing the ear against the flattened smaller end. Normally the steady thud of the heartbeat could be heard quite clearly. I listened at several points, but could hear nothing. I called Novice Ruth, as I felt I needed confirmation, and also an assessment of the duration of pregnancy. She couldn’t hear a heartbeat either, but thought that other signs indicated pregnancy. She asked me to do an internal examination to confirm it.
    I had been expecting this, and dreading it. I asked Lil to draw her knees upwards and part her legs. As she did so, the odour of stale urine, vaginal discharge, and sweat wafted up to greet me. I struggled to control the nausea. I mustn’t be sick, was all I could think of at that moment. Tufts of pubic hair stuck up in clumps, matted together by sticky moisture and dirt. She might have crabs, I thought. Novice Ruth was watching me. Maybe she understood how I was feeling - the nuns were very sensitive, but they spoke little. I dampened a swab with which to clean the moist bluish vulva, and it was whilst I was cleaning her that I noticed that one side was very oedematous, swollen with fluid, whilst the other was not. I started to part the vulva with two fingers, and it was then that my finger encountered a hard, small lump on the oedematous side. I rubbed my finger over it several times. It was easily palpable; hard lumps in soft places make one think of cancer.
    I could feel Novice Ruth watching me very closely all the time. I raised my eyes, and looked at her questioningly. She said, “I’ll get a pair of gloves. Do not proceed just yet, nurse.”
    She returned a couple of seconds later, and took my place. She