I swiped the dark hair out of Mary O’Rahilly’s eyes and told her with more conviction than I felt, That should help.
She nodded weakly.
Time went by, and it didn’t help. Nothing helped.
I considered an enema but decided that she’d been eating so little, there was probably nothing in her bowels. The pangs kept coming every three minutes, a clockwork torture. For all Mary O’Rahilly’s efforts, nothing in her great taut bump seemed to be descending. Could the head be stuck at the pelvic brim? Nothing was changing except that the young woman was getting limper and paler.
I tried to clear my muddy mind and remember exactly what I’d been taught about obstructed labour. The cause could be passage, passenger, or powers—maybe Mary O’Rahilly’s pelvis was too small or misshapen, or the foetus’s head was too big or had a bad angle of presentation, or the mother was too worn out to expel the foetus on her own.
Please let this not be a case for forceps. They saved lives, but the mothers and babies I’d seen mangled…
I felt Mary O’Rahilly’s forehead—no fever. But when I took her pulse, it was over a hundred, and thready.
Panic rose in me. Between the flu and the strain of labour, she was going into shock.
Intravenous saline.
I told Bridie, Stay with her.
From the sterile trays on the high shelf I snatched a long needle, a tube, and rubber bulb syringe. I filled a bowl to the two-pint mark with hot water from the pan, measured the salt in, then brought it down to blood temperature by adding some cold.
When I tied a catgut ligature above Mary O’Rahilly’s right elbow and tightened it until a sky-blue vein stood out, she barely seemed to notice. Obedient to the next contraction, she gripped the roller towel and pushed her stockinged feet against the bare rails. (The pillow had fallen to the floor, but I couldn’t reach it.)
I injected the warm saline and pumped it into her as fast as I could.
Holding her wrist, I counted for fifteen seconds and multiplied by four. Pulse dropping towards ninety already; good. Was the force any stronger, though?
What are you doing, Nurse Power?
It was Dr. MacAuliffe in his smart black suit.
Blast it. I needed Dr. Lynn, with all her experience in lying-in wards. Unless she’d been arrested already—could she have walked right into the men in blue?
I said, I’ve given Mrs. O’Rahilly saline for shock.
I yanked the cannula out of her arm and put a clean bandage over the site. Press just there, would you, Bridie?
Why is she the wrong way around? MacAuliffe wanted to know.
So she can push against the rails with her feet.
He was soaping and scrubbing at the sink already. I gave him a pair of sterile gloves.
With his right hand inside Mary O’Rahilly, MacAuliffe waited for her next pang and pressed hard with his left on the top of the uterus.
She let out a long groan.
I gnawed my lip. One couldn’t simply pop a baby out of its mother, and it might damage them both if one tried. I’d seen wombs perforated or turned inside out by rough handling. But to say so would be insubordination.
You say she’s been trying for a full hour and three-quarters, Nurse? The head should be much lower than this.
I resisted the urge to say, That’s why I called for a doctor.
Hm, said MacAuliffe. Clearly some disproportion.
The word I always dreaded to hear—a mismatch between a narrow woman and a big-skulled foetus.
He went on: I estimate the occipitofrontal diameter to be four to five inches and the pelvic outlet rather less than four, but I can’t be sure without taking thorough measurements with a Skutsch’s pelvimeter, and that would probably require general anesthesia.
This girl might pass out at any minute, and he wanted to put her to sleep so he could fiddle with instruments and formulas to determine the exact ratio of the problem?
MacAuliffe went on, But all in all, I believe it’s time to intervene surgically.
I stared, thinking, What, here, in a makeshift fever ward with barely inches to spare between the cots?
He murmured, The mortality rate for caesareans is so high, I’d rather try a symphysiotomy. Or actually, better still, a pubiotomy.
My heart sank. These operations to widen the pelvis were common in Irish hospitals because they didn’t scar the uterus and limit future childbearing. Pubiotomy did have one advantage over a caesarean: it was less likely to kill Mary O’Rahilly even if it was performed under local anesthetic only on a