The cot is ready. A good size washing bowl is available, and gallons of hot water are being boiled downstairs. There is no running hot water in the house and I wonder how they used to manage when there was no water at all. It must have been an all night job, going out to collect it and boiling it up. On what? A range in the kitchen that had to be fuelled all the time, with coal if they could afford it, or driftwood if they couldn't.

But I haven't much time to sit and reflect. Often in a labour you can wait all night, but something tells me this one will not go that way. The increasing power and frequency of the pains, coupled with the fact that it is a fourth baby, indicate the second stage is not far away. The pains are coming every three minutes now. How much more can she bear, how much can any woman bear? Suddenly the sac bursts, and water floods the bed. I like to see it that way; I get a bit apprehensive if the waters break early. After the contraction, the mother and I change the soaking sheets as quickly as we can. Muriel can't get up at this stage, so we have to roll her. With the next contraction I see the head. Intense concentration is now necessary.

With animal instinct she begins pushing. If all is well, a multigravida can often push the head out in seconds, but you don't want it that way. Every good midwife tries to ensure a slow steady delivery of the head.

"I want you on your left side, Muriel, after this contraction. Try not to push now while you are on your back. That's it, turn over dear, and face the wall. Draw your right leg up towards your chin. Breathe deeply, carry on breathing like that. just concentrate on breathing deeply. Your sister will help you" I lean over the low sagging bed. All beds seem to sag in the middle in these parts, I think to myself. Sometimes I have had to deliver a baby on my knees. No time for that now though, another contraction is coming.

"Breathe deeply, push a little; not too hard." The contraction passes and I listen to the foetal heart again: 140 this time. Still quite normal, but the raised heartbeat shows how much a baby goes through in the ordeal of being born. Another contraction.

"Push just a little Muriel, not too hard, we'll soon have your baby born."

She is beside herself with pain, but a sort of frantic elation comes over a woman during the last few moments of labour, and the pain doesn't seem to matter. Another contraction. The head is coming fast, too fast.

"Don't push Muriel, just pant -- in, out -- quickly, keep panting 'like that."

I am holding the head back, to prevent it bursting out and splitting the perineum.

It is very important to ease the head out between contractions, and as I hold the head back, I realise I am sweating from the effort required, the concentration, the heat and the intensity of the moment.

The contraction passes, and I relax a little, listening to the foetal heart again -- still normal. Delivery is imminent. I place the heel of my right hand behind the dilated anus, and push forward firmly and steadily until the crown is clear of the vulva.

"With the next contraction, Muriel the head will be born. Now I don't want you to push at all. just let the muscles of your stomach do the job. All you have to do is to try to relax, and just pant like mad"

I steel myself for the next contraction which comes with surprising speed. Muriel is panting continuously. I ease the perineum around the emerging crown, and the head is born.

We all breathe a sigh of relief. Muriel is weak with the effort.

"Well done, Muriel, you are doing wonderfully, it won't be long now. The next pain, and we will know if it's a boy or a girl."

The baby's face is blue and puckered, covered in mucus and blood. I check the heartbeat. Still normal. I observe the restitution of the head through one eighth of a circle. The presenting shoulder can now be delivered from under the pubic arch.

Another contraction.

"This is it Muriel, you can push now -- hard."

I ease the presenting shoulder out with a forward and upward sweep. The other shoulder and arm follow, and the baby's whole body slides out effortlessly.

"It's another little boy," cried the mother. "Thanks be to God. Is he healthy, nurse?"

Muriel was in tears of joy. "Oh, bless him. Here, let me have a look. 'Ow, 'e's loverly."

I am almost as overwhelmed as Muriel, the relief of a safe delivery is so powerful. I clamp the baby's cord in two places, and cut between; I hold him by the ankles upside down to ensure no mucus is inhaled.

He breathes. The baby is now a separate being.

I wrap him in the towels given to me, and hand him to Muriel, who cradles him, coos over him, kisses him, calls him "beautiful, lovely, an angel". Quite honestly, a baby covered in blood, still slightly blue, eyes screwed up, in the first few minutes after birth, is not an object of beauty. But the mother never sees him that way. To her, he is all perfection.

My job is not done, however. The placenta must be delivered, and it must be delivered whole, with no pieces torn off and left behind in the uterus. If there are, the woman will be in serious trouble: infection, ongoing bleeding, perhaps even a massive haemorrhage, which can be fatal. It is perhaps the trickiest part of any delivery, to get the placenta out whole and intact.

The uterine muscles, having succeeded in the massive task of delivering the baby, often seem to want to take a holiday. Frequently there are no further contractions for ten to fifteen minutes. This is nice for the mother, who only wants to lie back and cuddle her baby, indifferent to what is going on down below, but it can be an anxious time for the midwife. When contractions do start, they are frequently very weak. Successful delivery of the placenta is usually a question of careful timing, judgement and, most of all, experience.

They say it takes seven years of practice to make a good midwife. I was only in my first year, alone, in the middle of the night, with this trusting woman and her family, and no telephone in the house.

Please God, don't let me make a mistake, I prayed.

After clearing the worst of the mess from the bed, I lay Muriel on her back, on warm dry maternity pads, and cover her with a blanket. Her pulse and blood pressure are normal, and the baby lies quietly in her arms. All I have to do was to wait.

The above is an excerpt from the book The Midwife: A Memoir of Birth, Joy, and Hard Times by Jennifer Worth. The above excerpt is a digitally scanned reproduction of text from print. Although this excerpt has been proofread, occasional errors may appear due to the scanning process. Please refer to the finished book for accuracy.

Reprinted by arrangement with Penguin, a member of Penguin Group (USA) Inc., from The Midwife

Copyright © Jennifer Worth, 2002

Author Bio

Jennifer Worth, author of The Midwife: A Memoir of Birth, Joy, and Hard Times, trained as a nurse and then moved to London to become a midwife. She lives with her husband in Hertfordshire. They have two daughters and two grandchildren.