Home > Rabbits in Switzerland > Rabbits in Switzerland: A Midwife’s Cautionary Tale – a novel

Rabbits in Switzerland: A Midwife’s Cautionary Tale – a novel

In the early 2000s Talia Ripley left behind her carefree twenties to train as an NHS midwife. Which left her somewhat unprepared for the effect of life-and-death responsibility, roving shift patterns and battle-hardened midwifery colleagues on her life with her boyfriend their two small children.

Ten years later together with Ethan Crane (the same boyfriend, fortunately) they wrote a (semi-)fictional satire of her early midwifery years. Mostly because it was cheaper than therapy. Rabbits in Switzerland is the result.

Available as ebook and paperback on Amazon. Read an excerpt below, download an epub excerpt directly, or via Amazon.

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When Luisa qualifies as an NHS midwife, she senses the beginning of life as a proper adult. ‘Oh, you’re a midwife,’ compliments absolutely everyone. But the kudos of the job forces her to hide the reality: a terror of life-and-death responsibility for childbirth, sanity-troubling fatigue, and the slow destruction of relationships with her boyfriend and young twins.

The undeniable reward of helping bring new life into the world leaves her unable to admit the downsides. The terror of responsibility means it is not just labouring women who evacuate their bowels before a birth. New mothers’ perfectionist demands and their ring-bound birth plans make night shifts all the harder. And over the course of one sleep-deprived week, the eccentricities of her demented colleagues and the creaking bureaucracy of the NHS drive Luisa to hysterical despair.

There is no one to whom Luisa can admit her nagging doubts about her medical career: not her over-dedicated colleagues, whose own sanity requires the elevation of midwifery to the status of religion. Not to her boyfriend Justin, brought low by the stress and lack of excitement in their life, and with whom an attempt at after-work seduction in a car park results instead in the vandalising of their own car. And if she meant her career to be a feminist role model for her twin girls, they are now more under the influence of Justin’s mother Bea, whose idea of childcare is induction into the pagan rituals of her mini-cult life-coaching circle.

Rabbits in Switzerland asks: if this is your dream job, what exactly is the dream? What is the value of a working life, when it tramples over your family, your social life and your sanity?



‘Limbering time,’ says Gina, as Luisa enters the delivery suite changing room. Gina squats on her haunches, arms raised above her head, a hand holding each opposite elbow. ‘Make sure you limber, Luisa. If you don’t keep the body fit, you’ll never fight off your illness.’ She rolls her body forward into a push-up position, her head almost inside the nearest locker.
‘I’m not ill,’ says Luisa.
‘And that’s what I like, a positive attitude. Illness is very much in the mind.’ Gina taps her temple, balancing her weight on one hand. ‘But you are ill. We’re all ill. It comes with the territory.’
Gina was right – illness in the midwifery unit was rife. Sick bugs shot through the delivery suite, aided by the midwives who dragged themselves to work regardless of their fevers and violent coughs, spreading infection so as not to let down their colleagues and to be there for the birthing women. The one consistently healthy person was Debbie, and she took more sick leave than anyone.
‘I don’t think I’m ill right now.’ Luisa takes the scrubs from her bag. ‘In fact I’m feeling good tonight.’
‘That’s good. Work your way through it.’ Gina lowers her body to the floor. ‘Carla Jones. Nineteenth of the seventh ninety-nine. APGARS 2 at one minute.’ She pushes herself back upright. ‘You want to say your own with me? Sandra Emmentine. Fourth of the third two thousand and six. Shoulder dystocia, eleven minutes.’
‘I – did some before I left.’
‘The mantras?’
‘Exercises. Stretching.’
‘I thought as your mentor I recommended mantras. Keep the near misses screaming at the front of your mind.’
‘I did try,’ says Luisa. ‘But I didn’t find it that helpful.’
Gina jumps forward into a squat and crouches in front of Luisa. ‘Don’t hold back,’ says Gina. ‘Tell me what’s terrifying you.’
‘I’m not sure there’s much that terrifies me,’ says Luisa. Apart from the very tall consultant who demands random birth observations I can’t recall. Or Dora, the midwife who no longer works on delivery suite, who only speaks in grunts. Or that when I ask Diane why Dora can no longer work, Diane laughs and says she shouldn’t say, and then doesn’t say. Or the equipment supplies cupboard where, when I am almost confident I can locate a cord clamp in under thirty seconds, discover someone has reorganised the cupboard, and the search has to begin again. Or the rota – more specifically the rota changing with just a few days notice, and the effect this has on Justin’s ability to speak to me. Or the thudding noise the lift makes when it reaches the ground floor. ‘I mean I’m learning where things are all the time. And everyone is really helpful and nice.’
‘Bollocks,’ said Gina. ‘Back after extended leave in a new unit? You must be terrified. And how can you think Jenny is nice? Come on, what keeps you awake at night? What are your danger points? It’s my job to know.’
What kept her awake were lovingly detailed scenes of emergency caesareans and shoulder dystocias, that returned to her in vivid clarity at three o’clock in the morning. Images of babies born white and limp imprinted on her retina as she woke, frozen in terror, unable to pull the emergency buzzer. Luisa had not always dreamt of being a midwife, but now she dreams of being a midwife all the time.
‘Well – I’m a bit worried about being out of practice, I suppose,’ said Luisa.
‘So, terrified of making a mistake during a birth? Good. And?’
‘Not terrified. Just – a bit anxious.’
‘Let’s move from anxious back to terrified,’ said Gina. ‘I want you terrified. No midwife should be anything other than terrified. If you’re not terrified, you’re not paying attention.’
‘But I’m getting better,’ said Luisa. ‘I can sense it getting better.’
‘Nor do I want you getting better,’ said Gina. ‘I haven’t had a solid pre-shift bowel movement in the ten years I’ve been here. I wouldn’t have it any other way.’
‘But I am getting better,’ insisted Luisa. ‘I’m keeping focussed on having some really good births.’
‘Forget births.’ Gina stretches her leg up in an arc behind her. ‘It’s not like women spend much time actually pushing the baby out, is it? Your priority is the welfare of women. And what a great privilege. A sacred reward at the first stirrings of life. You’re with woman.’
‘I am?’ Luisa pulls on the cotton trousers at speed, her foot catching in the green material.
‘With Woman. Midwife, With Woman. The Old German. Didn’t they teach you that in training?’
‘No – ‘
‘We had to chant it to a drum beat on the university playing fields. Caring for women, that’s always our primary role. Whatever the circumstances. And as your mentor I don’t want you pushed around and told what to do by Jenny or any other co-ordinator.’
‘But isn’t it the co-ordinator’s job to tell you what to do?’
‘You can’t be a good midwife if you don’t trust your own instincts. Who says you should even listen to me? I don’t want you taking any notice of me, either. Not if it’s your decision. Don’t listen to me. What do I know?’

Luisa first wanted to be a midwife before the birth of the twins. Midwifery fitted her idea of a life’s work. At least it was the life’s work she wanted before actually doing the job. Now she was actually doing the job, this was only one activity amongst many she wanted to do: sleep, spend time with Justin and the girls, read a book without falling asleep, talk about something other than midwifery.
Even when she not working as a midwife she was forced to talk about working as a midwife. No one asked insurance people, or bankers, or greengrocers how their work was going. Not, at least, at the beginning of every conversation. And what How is midwifery going? meant, was Are you enjoying yourself? Are you enjoying yourself more than I do in my job? A need to confirm that their hierarchy of job satisfaction was intact, that catching babies as they are born, helping women bring new life into the world was as beatific as it sounded. ‘Oh, it must be so rewarding,’ said everyone.
The triangular maternity office is empty when Luisa walks in. She hurries to the white board, scans the two columns of boxes.
‘Checking out the competition?’ Nikki comes up behind her, puts her hands on Luisa’s hips and wiggles them, in a way that if a man did the same would be a solid case for sexual harassment.
‘Um. No?’
‘I think of it like a casino,’ says Nikki. ‘Who will I get tonight? The red or the black?’
‘You mean blood or meconium?’ says Luisa.
Nikki does not reply, and instead dances back and forth on the spot, shaking one foot after the other. She doesn’t mean anything.
‘I’d just like to get a good birth in tonight,’ says Luisa. ‘I haven’t had a nice easy birth for a couple of weeks.’
‘I went for three whole months once,’ laughs Nikki. ‘Nothing but caesareans and forceps. It was terrifying. I tried to get my therapist to agree that I was cursed. I didn’t see what else it could be.’
‘And did she? Agree?’
‘My therapist never says anything. Waste of money if you ask me, I always have to do the talking. She’s worse than Martyn. I think I’m going to dump her,’ says Nikki.
‘Are you always terrified?’ Luisa whispers, though there is no one else in the office. ‘Gina says I need to stay terrified.’
‘Oh no. I’m past that.’
‘And where are you now?’
‘To be honest I kind of miss those loose bowels before every shift. Kept me slim. I used to vomit up my lunch most days.’
‘You were actually sick?’
‘Only for the first couple of years. But don’t let on to Jenny. If she thinks I’ve stopped being sick, she might start asking me to act up as co-ordinator.’ Nikki sees Luisa’s expression. ‘But I love it now, of course. And hey. You’ve only been here a month or so, haven’t you? Of course you’re still being sick.’
‘Eight weeks. I’ve been here eight weeks.’
‘And no one’s died,’ laughed Nikki.
‘I worked in another unit. A while ago.’
‘Well, there you go.’
‘But birth is amazing, isn’t it?’ Luisa nods her head at Nikki. ‘Such a privilege to be with woman when they’re giving birth.’
‘So beautiful,’ says Nikki. ‘There’s nothing quite like a nice birth.’
‘Exactly.’ Luisa grabs Nikki’s wrist. ‘A really beautiful birth.’
Nikki slides her hand down to Luisa’s, links fingers and slow dances her around in a circle.
Other midwives file into the office, and Luisa releases herself from Nikki. She turns back to the board and scans down the names in the boxes. Eloise. Eloise, P2 both SVDs. Eloise is mine.
‘So if we’re all here,’ says Jenny, when midwives have filled the office, lined along the desk and wedged amongst the two computers. ‘We’ve got Philippa in Mary Cronk, who is epileptic. She’s been quiet so far. Two prostins and was ARM’d at 17.15. Should have started synto already.’ Jenny taps the white board with a green marker pen.
Luisa stands motionless to avoid a bid, the penniless auction gawper, angling her eyes past Jenny at the poster on the wall. SAFETY TIP OF THE WEEK: Do Your Counts. A swab left in a vagina is a never event. The text runs in a circle, its colours moving through a rainbow gradient.
A doctor appears in the doorway that opens onto the corridor. Gina spins to the doorway, blocking his way. She wears a hi-vis tabard – across its back are the words: HANDOVER IN PROGRESS. DO NOT ENTER.
‘I wondered – ‘ says the doctor.
‘It’s handover,’ says Gina, a hand on either side of the doorframe. ‘Can’t you read?’
‘Read what?’
Gina spins around to show him the tabard. ‘Come back in ten minutes.’
The doctor leaves without a word.
‘If we aren’t allowed doors, someone has to stand guard,’ says Gina to Jenny.
‘Why aren’t there doors any more?’ says Nikki.
‘Infection control,’ says Jenny.
‘How does that help infection control? says Nikki.
‘How the hell should I know?’ says Jenny.
‘I’ll take the epileptic.’ Diane sits in the one office swivel chair, a half-stitched blanket over her knees and a large embroidery needle in one hand. ‘I haven’t seen a good grand mal in a while.’
‘Not you,’ says Jenny. ‘We keep you back in reserve, don’t we Diane?’
‘Right-ho, captain.’ Diane salutes, almost stabbing her eye with the needle.
‘I don’t want her flapping all over my ward. Nikki, I’m giving Philippa to you.’
Jenny moves down the board, assigning women, until she gets to Eloise.
‘I’ll take Eloise,’ says Luisa. ‘We have a bit of a connection. I mean I know her slightly.’
‘Really?’ Jenny peers round at Luisa, a hawk sizing up her territory. ‘I wouldn’t normally dump her on one of the newly qualifieds.’
‘I’m not newly qualified.’ says Luisa.
‘Well, whatever. If you want her,’ says Jenny, and scratches LISA next to the box for Eloise. ‘I was going to give someone like her to Gina. Given her history.’
‘Hit me,’ says Gina.
‘I don’t know her that well,’ says Luisa.
‘That was her boyfriend who assaulted one of the MCAs last week,’ says Jenny. ‘When they were kept waiting in triage. Apparently he’s on the sex offenders register, and there’s a pile of child protection issues. The baby’s being removed at birth.’
‘I don’t want to mess up your system,’ says Luisa. ‘Maybe it’s a different Eloise that I know.’
‘Shall I take her, then?’ says Gina. ‘So we can stop playing musical chairs with labouring women? I mean she sounds like the sort of woman who needs the best midwifery care, don’t you think?’
‘If you want her, Gina.’ Luisa looks down, hands clasped, the penitent nun.
‘Not a question of wanting. Never a question of wanting,’ says Gina.
To Luisa’s relief Jenny scrubs out her name and replaces it with Gina’s.
Jenny assigns the other women and the midwives file off out of the office.
‘So, Lisa, I’m going to give you – ‘ says Jenny when only the two of them remain in the office.
‘Luisa,’ says Luisa.
‘What?’ says Jenny.
‘Sorry. I’m Luisa, my name’s Luisa. Not Lisa.’
‘So Luisa, I’m going to give you Cheryl in Shelia Kitzinger,’ says Jenny. ‘Do you think you can handle her? Primip, bit needy. Should pop quite soon.’
‘Of course. And I’m not newly qualified,’ says Luisa. ‘I’m just new at this hospital.’
‘That’s newly qualified in my book.’ says Jenny. ‘I’ll keep an eye on you, don’t you worry.’
She could mean anything, thinks Luisa. Perhaps that’s being kind. Or maybe an outright threat – with Jenny it is impossible to tell.
‘And Luisa,’ says Jenny. ‘Tonight’s watchword is?’
Luisa opens her mouth but says nothing.
‘No need to look so carved up about it!’ laughs Jenny. ‘I don’t do tests. I’m telling everyone. Bladder care. Tonight’s focus.’
‘Bladder care. Right. Thanks, Jenny.’
Jenny does not hear.
Luisa knocks on the door of Sheila Kitzinger and goes straight in.
‘And who are you?’ A bearded man whips inside the privacy curtain that encloses the doorway, pulls the two halves together behind him.
‘I’m Luisa,’ says Luisa. ‘Your midwife?’
‘Oh, er. Hi.’ The man releases a hand from the curtain and holds it out to Luisa. ‘I’m Eric. I’m the groundsman.’ Eric runs one hand and then the other through his waxed hair. ‘Come in, come in. We’ll need to, need to go over a few things.’
The strip lights in the room are unlit. Instead three standard lamps circle the bed.
‘Oh look,’ says Annie, the day-shift midwife. She sounds surprised, excited even, at Luisa’s entrance. ‘This is Luisa. She is going to be your nighttime babycatcher.’
The woman on the bed exhales a noisy breath. The bed inclines her at forty-five degrees – a sheet covers the ball of her abdomen and up to her chest, where a lilac paisley shirt takes over. Her hands grasp tight to her belly.
‘Hello, Cheryl,’ sing-songs Luisa.
Eric steps between Luisa and the bed, blocking her view of Cheryl.
‘So you’re going?’ Cheryl says to Annie. Don’t leave me, I think I’m going to die, who is this woman?, the tenor of her voice implies. She blows out another long stream of air.
‘I’m off to bye-byes now. You’ll be fine with Luisa.’ Annie says to Eric. ‘Luisa’s a brilliant midwife. You’re going to have a lovely birth with her instead.’
‘We are.’ Luisa cranes her head to the side in order to see Cheryl, but Eric moves with her. ‘We’re going to have a lovely birth,’ she says to Eric’s denim shirt.
Annie pushes Cheryl’s notes booklet into Luisa’s hand. Her eyebrows dart up and to the side in a chaotic pattern, an attempt to communicate with a woefully small vocabulary.
‘So, when Cheryl came in, there was a little bit of the red stuff, just a couple of thimbles,’ says Annie. ‘We had a bit of a tizzy over that, so we thought we’d have a little extra check on baby with the, the.’ Annie lays a hand on the foetal heart monitor.
‘Have you seen Cheryl’s birth plan?’ Eric’s flitting eyebrows are bushier than Annie’s, darker and thus more informative, and manage to both criticise Annie and direct Luisa towards the ring-binder he thrusts into her hands at the same time. He flips over the title page – Luisa cannot be certain, but thinks she saw a calligraphic quote.
Luisa skips the birth plan’s introductory paragraph and looks at the first item on the bulleted list.
Keep discussion to an absolute minimum to allow Cheryl to focus.
Eric jabs a finger to a line lower down the list, in bold:
No direct conversation with Cheryl, all conversation to go through Eric to aid maximum concentration.
‘Our antenatal midwife, Josie, said we should do everything we can to relax and be comfortable,’ says Eric. ‘To make Cheryl relaxed and comfortable.’
‘Of course. That’s what we all want,’ says Luisa.
Cheryl would like no overhead lighting (we will provide our own lamps). (Does the hospital have a service lift?, reads the footnote.)
Cheryl wishes to be free to have an active labour, with a variety of mats, beanbags and slings at her disposal.
No medical interventions, drugs or pain relief unless absolutely necessary.
We would like hospital staff to acknowledge that although for yourselves this is one birth amongst many, for us this a unique and sacred event.
Cheryl will have a vaginal birth.
Annie is doing her own finger-jabbing, trying to turn the page. On the next sheet it says:
‘Well, that seems fine,’ Luisa says to Cheryl, then swings her gaze over to Eric. Cheryl is oblivious – she emits a moan from deep in her diaphragm and drags the gas and air mouthpiece towards her to take another nitrous oxide hit.
‘Baby had a bit of a funny turn, and the beeps went slow for a minute or two,’ says Annie, nodding furiously. ‘That’s why we’re keeping Cheryl in bed, still on the machine-y thing. And the – baby door was four centimetres at 19:45 – a quarter to eight. So next look at a quarter to midnight.’
Eric frowns, processing each word, in fear of missing the ones that mean this woman and baby are both going to die.
‘The next – ?’ says Luisa.
‘Her whoopsie,’ says Annie. ‘You need to check Cheryl’s whoopsie at a quarter to midnight.’
VE 23:45, Luisa scribbles on the notes.
‘Well that’s me done.’ Annie makes a point of speaking directly to Cheryl. ‘You two have a lovely baby with Luisa,’ she says, and disappears behind through the curtain and out the door.
‘I’m so uncomfortable.’ Cheryl accuses Luisa. ‘It just hurts.’
‘Well how about changing position?’ says Luisa. ‘Perhaps some moving around? For active labour?’ Luisa remembers the birth plan phrase.
‘Annie said Cheryl needed to stay on the bed.’ Eric’s frown is still in place. Have they have given us the stupid midwife? it says. ‘For the machine.’
‘Well let’s just check the machine.’ Luisa extends the concertinaed paper from the foetal heart monitor. The monitor has drawn a regular mountain range except for two deeper V’s an hour earlier, a sign of momentary foetal distress. Safe to ignore if not repeated, thinks Luisa. That’s Annie fussing, saying she needs to stay on the machine. Or is that Annie being sensibly cautious?
‘Well, my advice is that we get Cheryl off the bed and moving around,’ Luisa says to Eric.
‘You want me to move around?’ says Cheryl.
‘Only if you, if Cheryl wants to,’ she smiles towards a standard lamp. ‘It’ll get things moving. Towards a lovely natural birth.’
‘I want to move around!’ cries Cheryl, and bursts into tears. ‘Can I just get off this bed!’
‘But what about the monitor?’ says Eric. ‘Annie said we need to keep monitoring.’
‘We can still monitor the baby and let you move around,’ says Luisa. In theory, anyway.
‘Annie didn’t want to let me move around,’ sobs Cheryl. ‘I want to do what feels natural. I mean our ancestors never gave birth in hospitals, did they? And tribal women get by okay without caesareans, don’t they?’ She laughs, the teacher mocking the pupil’s stupidity.
‘They do,’ says Luisa. Apart from the ones that died in childbirth, of course.
‘We did want to birth at home, really,’ says Eric.
Cheryl gets her feet off the bed and onto the floor, and Eric unrolls a yoga mat before her, a very short red carpet. Cheryl sinks to her knees and forward onto her hands, and with the monitor cable tight against her skin her shirt rides up so she is almost naked.
‘Well when there’s been a little bleed it’s good that we can look after you here,’ says Luisa.
‘Oh god. That’s so much better!’ Cheryl bursts into tears again.
Eric bursts into tears as well. ‘Oh, thank you!’ he says to Luisa.
‘Annie was so unbending,’ sobs Cheryl. ‘I can’t work with unbending people.’ She screws up her eyes and grabs Eric’s hand.
‘Well, all of us midwives have different ways of working,’ Luisa says to Eric. Luisa rests an arm over Cheryl’s shoulder as she breathes through the next contraction. ‘Tell Cheryl she’s doing well,’ says Luisa to Eric.
‘You can talk to me,’ says Cheryl, snorting out through her nose. She leans her head on Luisa’s shoulder. ‘You understand. I want you to talk to me.’
‘I’m here for you,’ says Luisa. ‘We’re all here for your lovely birth.’
‘Don’t leave me,’ says Cheryl.

‘And how’s it going in here?’ An hour later Jenny bursts through the delivery room door, sweeps back the privacy curtain. Eric squat jumps to his feet, but Luisa intercepts first.
‘We’re fine,’ says Luisa. She looks around the room for anything she might be doing wrong. ‘We’re in a quiet phase.’
Jenny grabs the notes booklet, still in motion. Jenny is always in motion – during her orientation tour Jenny told Luisa to think of the co-ordinator’s role like the space probe Voyager, orbiting through the rooms and using their energy as a gravity slingshot to the next.
‘So when did we last have a wee? Have we been regularly voiding?’ Jenny circles the room and peers down at Cheryl. Eric tries to insert himself in front of Cheryl.
‘We’ve had a big wee, haven’t we Cheryl?’ says Luisa. She cannot be sure of the size of the wee, as Cheryl refused to use a bowl.
‘And you’ve done a recent pulse? Up-to-date with obs?’ says Jenny.
‘Perhaps I could have a quick word outside?’ Now Luisa docks with Jenny’s pace and steers her in the direction of the door.
‘It’s just that Cheryl has a bit of a phobia. A fear of medical language,’ says Luisa outside the room.
‘Really? That’s brilliant.’ Jenny sounds genuinely delighted. ‘Never had one of those myself. What are you using, sign language?’
‘I’m trying to keep her as quiet as possible. She’s very keen on a natural birth. Her birth plan says she doesn’t want a caesarean unless absolutely necessary.’
‘What was that?’ The Registrar appears next to Jenny.
‘Apparently Luisa’s woman doesn’t want a caesarean unless absolutely necessary,’ laughs Jenny. ‘I heard you were really into unnecessary caesareans. It’s one of your specialities, isn’t it?’
‘Love them,’ The Registrar turns to Luisa. ‘I’m not in the habit of performing caesareans unless absolutely necessary.’
‘It’s – what Cheryl says in her birth plan,’ says Luisa. ‘It’s what Cheryl wants.’ She tries to find another reason to use Cheryl in a sentence, but nothing comes to mind.
‘Cheryl’s the one with the bleed, isn’t she?’ the Registrar says, more kindly. ‘What’s the trace look like now?’
‘It’s definitely normal,’ says Luisa. ‘Just one decel. Or two. That’s why I thought it was fine to take her off constant monitoring,’ she says to Jenny.
‘One or two decels is fine,’ says the Registrar. ‘So long as there’s no more bleeding. Shall I come have a check?’ says the Registrar.
‘I’d like you to check,’ says Jenny.
‘The decels are for less than half of contractions.’ Luisa says to Jenny’s back. ‘So still normal by the new NICE guidelines.’
Luisa knocks and re-enters Shelia Kitzinger. Eric sees the Registrar and jumps to his feet.
‘Er, hello,’ says Eric. ‘And who are you?’
‘I’m the doctor,’ says the Registrar.
‘Cheryl, honey?’ Eric calls over to the bed. ‘Are you okay with the doctor coming in?’
‘I’d like the doctor in please,’ says Luisa. ‘If that’s okay.’
‘Is that okay, Cheryl?’ calls back Eric.
‘If Luisa thinks it’s okay, it’s okay.’ Cheryl takes a gasping hit from the gas mouthpiece.
‘I’m the groundsman,’ Eric says to the Registrar. ‘Cheryl wants me to keep an eye on who comes in and out of the room,’ he says, as though explaining why he’s brought his football sticker album to show her.
‘Gatekeeper!’ Cheryl shouts through the gas and air mouthpiece. ‘You’re the gatekeeper!’
‘The doctor has come to have a check on – to check on baby,’ says Luisa. ‘To check the machine for the baby’s heart.’
‘What’s wrong with the baby’s heart?’ says Eric.
The Registrar examines the concertinaed readout of the foetal heart monitor.
‘There’s nothing wrong with the baby’s heart. We just want to be sure there’re no dips like before,’ says the Registrar. ‘There’s some big gaps here,’ she says to Luisa. ‘What’s with the gaps?’
‘We were mobilising – to promote normal birth,’ says Luisa. ‘But the traces in between are fine, yes?’ Luisa points at the print out.
‘Well, I don’t know what’s been happening in the gaps,’ says the Registrar.
‘We’ve been trying to have an active labour,’ Luisa looks to Cheryl for some acknowledgement. Cheryl eyes the doctor suspiciously.
‘It says it here in the birth plan.’ Eric proffers the booklet to the Registrar.
‘Well the trace looks pretty normal up to here. I’d recommend leaving it on until we have a solid stretch of normal,’ says the Registrar, smiling at Eric. ‘Also, I can’t see anything in the notes about bladder care. Bladder care is a concern. May I?’ the Registrar asks Cheryl, her splayed hands almost touching Cheryl’s belly.
Cheryl looks as though she wants to kill her, and nods.
The Registrar finger-squeezes Cheryl’s lower belly. ‘When did we last go to the toilet?’ she says.
‘It was just over an hour ago,’ Luisa inserts herself between the Registrar and Cheryl.
‘And you voided properly?’
‘I did. Cheryl did,’ says Luisa. ‘Didn’t you Cheryl? You said it was a big wee?’
‘I don’t know it was that big,’ says Cheryl. ‘Is that why it hurts so much? I haven’t been able to wee properly the last couple of times.’
You traitor, thinks Luisa. You never said anything before.
‘You need to make sure to keep the bladder emptied. I can feel that it’s a bit full,’ the Registrar says, and it stings Luisa all the more coming from the nice teacher.
‘Maybe catheterise to empty the bladder,’ says the Registrar as she leaves. ‘I’ll come check in again a bit later.’
‘I can’t have one of those tubes in me,’ says Cheryl when the Registrar has gone. ‘I can’t deal with tubes. I’ll just go for another wee.’ Cheryl pushes herself up to her elbows.
‘We did say in the birth plan,’ Eric reminds Luisa. ‘About keeping medical intervention to a minimum.’
‘The thing is, you might not be able to wee now.’ Luisa says this to the trolley as she finds the in-out catheter. ‘Because of the baby pushing down. But we don’t have to use a tube that stays in.’ Luisa matches her deep inhalation to Cheryl’s own. ‘We can empty your – all your wee with an in-out one. One that doesn’t stay in.’
Cheryl and Eric are silent as Luisa holds the thin plastic catheter tube over Cheryl’s parted labia, a bowl in her other hand. Vagina, urethra, clitoris, Luisa reminds herself. Not too high. Don’t try and catheterise a clitoris again. She slides the tube into the urethra and urine jets from the end of the tube.
‘Is that much normal?’ says Eric, peering over.
‘It’s a little more than normal.’ Luisa levels the almost-filled bowl and tries to press her thumb over the mini-funnel at the end of the catheter.
‘It looks like too much,’ says Eric.
‘What’s too much?’ calls Cheryl.
‘Would you mind helping me a moment, please Eric?’ says Luisa.
The bowl overflows, Cheryl’s urine seeping over the side and down Luisa’s arm.
‘What can I do?’ Eric watches as Luisa’s sleeves darken.
‘If you could fetch another bowl from the trolley.’ Luisa feels the warm liquid exit the end of her sleeve, dribbling down her stomach and into her knickers.
‘This one?’ Eric skips over with the bowl, and Luisa swaps full for empty, tipping in some excess and spilling only a little more over her hands. She has never seen so much urine.
‘Now I’m going to need to pop out for just a minute,’ Luisa says as she removes the catheter.
‘You’re leaving?’ says Cheryl, and screws her face in preparation for another contraction.
‘If you remember from the birth plan,’ says Eric, ‘we did say that we didn’t want to be left unattended at any point.’
‘I need to pop out for a second. To change.’
Cheryl looks at Eric, pleading. Eric looks down at his bowl of piss.
‘I just got a little of – that on me.’ Luisa points at the bowl.
Cheryl starts to cry, though Luisa is not sure whether in apology or pain.
‘And how are we getting on in here?’ Jenny enters the room without knocking, moves directly to the foetal heart monitor.
‘We’re fine, we’re good,’ says Luisa. ‘I was just about to write up the notes. We were just having a wee. Bladder care,’ she nods at Jenny.
‘Message of the week!’ sings Jenny. ‘And what time do we have scheduled for our next vaginal examination?’
Jenny looks only at Luisa, a landowner excluding the peasants from the conversation. Only Jenny could take No direct conversation with Cheryl and convert it into a sick rudeness for her own amusement, thinks Luisa.
’23:45,’ says Luisa. ‘I’m about to write it all in the notes. I just need to get changed.’
‘I’ve put a foetal heart CTG review and sticker in the notes. Left a space for your notes,’ says Jenny. ‘If I were you I’d be keeping a monitor on at all times. And I’ve used your last sticker. You’ll need to get more CTG stickers.’ Jenny waves a hand behind her as she leaves the room.
‘I thought we didn’t need the monitor on all the time,’ says Eric.
‘Let’s put it back on for now.’ Luisa waddles back over to Cheryl, clips the monitor back on. She can feel Eric and Cheryl watching her.
‘I have to leave for just a moment,’ says Luisa.
‘Is the baby’s heart okay?’
‘It’s fine at the moment. And I’ll have another check when I’m back.’
‘If you do have to go out,’ says Eric, ‘would you mind getting Cheryl some more water?’
Luisa feels Cheryl’s urine cool in her sleeves, on her belly, down in her underwear. She walks to the door with a wider stance, to separate her legs from the sodden trouser material. ‘I’ll fetch some more water when I get the stickers.’
‘Just getting CTG stickers,’ says Luisa to Jenny in the crowded office. She puts down the empty water jug and rifles through the stationery drawer. The drawer is crammed with paper and blood test envelopes and patient information leaflets on DVTs, but no stickers. ‘Aren’t the CTG stickers kept in this drawer?’
‘In that box,’ says Erin, the maternity care assistant. She points to a nondescript cardboard box under the desk. ‘But there aren’t any more,’ she says, in a way that suggests this is symbolic of not only the organisational principles of the hospital, but the entire fabric of human society.
‘Need to get you more familiar with where everything is, Luisa,’ says Jenny. ‘I should give you one of my little tours. Seeing as you’re new.’
‘The stickers are normally in the drawer, I think,’ says Luisa. ‘And I know where the stickers are kept now.’ Luisa checks her watch fob: she has been away from Cheryl for almost ten minutes, and though she is in clean clothes has neither water nor stickers.
‘I can’t do you one of my tours now,’ says Jenny.
‘I don’t think I need another tour,’ says Luisa. ‘Where do I find more stickers?’
‘Shall I fetch some?,’ says Erin. ‘Is that what you’re asking me to do? You can say.’
‘Oh please. Thank you, thank you so much, Erin.’ She wants to ask Erin where she is fetching them from, but Erin has marched out.
‘I’ll give you one of my tours when you’re back on tomorrow night,’ says Jenny.
‘Thank you. Thanks, Jenny. I think I’ve already had a tour though,’ says Luisa. ‘And I don’t think I’m on tomorrow night. I’m Thursday night and Friday night.’
‘You don’t think you’re on? Or you’re not on?’
‘I’m not on. Not tomorrow night.’
‘Vertex visible in Joy Gardner,’ calls Rebecca through the open doorway.
‘I think someone hasn’t been checking the off-duty,’ says Jenny. ‘Wednesday and Thursday nights, Luisa, that’s what the off-duty says. I was only just now checking tonight’s numbers. I’ll be right there,’ she calls through the doorway to Rebecca.
‘No. No. I checked last week. The off-duty said Thursday and Friday.’ Luisa’s voice shifts up an octave. ‘I can’t be on tomorrow night. I’ve got something on tomorrow night.’
Luisa grabs the black off-duty folder from the shelf, pulls it open onto the desk and threads sheets around the rings.
‘Well, that’s Fran for you,’ laughs Jenny. ‘Why they allow someone who’s a numerical imbecile to look after the rota I’ll never know.’
In the column for Wednesday night Luisa sees LUISA KEANE written on a sticker that covers the name underneath, and a line scrubbed through her name for Friday.
‘But I can’t work. I’ve got something arranged. With Justin. My – boyfriend.’
‘Not any more you haven’t,’ says Jenny. ‘They did the same to me last week. I actively thought about killing Fran.’ Jenny laughs, in a way that offers no reassurance that she would not actually go through with Fran’s murder.
The office telephone rings. ‘Hello, maternity?’ Jenny grabs the receiver.
Luisa stands facing her, wanting to be part of the telephone conversation.
‘Don’t we need rings for that, darling?’ says Jenny softly. ‘No, I don’t think they’ll let you do it without rings.’ Jenny frowns at Luisa, and Luisa steps away. ‘Well, I don’t know if Ratners even exists any more. No, of course, of course. Thursday is fine. Of course I want to. I want everything the way you do. I’m just thinking that for a special day like this everything should be good and ready.’
Luisa picks up Cheryl’s water jug, which is still empty. She needs to get back to Cheryl.
‘Love you, darling,’ says Jenny, and puts down the phone. She stands with her hand on the receiver.
‘What’s that about a special day?’ Diane looks up from the swivel chair and her embroidery, her head torch casting a lighthouse beam around the room.
‘So guess who’s getting married!’ Jenny turns around, shields her eyes, and to Luisa’s surprise, and horror, cries big tears that drop from her cheeks to the ground.
Diane squeezes Jenny’s arm in a way that looks painful. Luisa wonders if she ought to hug Jenny.
‘Is that to Karl?’ says Gina from the computer.
‘Oh yes. Always Karl. Karl’s my rock,’ says Jenny.
‘I’m so glad you two worked things out,’ says Diane. ‘I thought you said Karl was always quite against marriage.’
‘He become a lot more keen when I pointed out that without us married it might be difficult for him to get half my pension,’ says Jenny. ‘He hasn’t got anything of his own, poor lamb, what with him taking care of the children all these years.’
‘So romantic. So when’s the big day?’ asks Diane.
‘To-morrow,’ sings Jenny.
‘Well that’s lovely. I’m so happy for the two of you.’ says Gina, exhibiting none of the familiar traits of happiness.
‘And Karl’s booked it for the afternoon,’ says Jenny, ‘so I’ll even be able to get some sleep in beforehand. I want you all there, of course. If you’re not on shift.’
‘Was it – a surprise, then?’ Luisa says, desperate for an entry back into conversation with Jenny.
‘You could say,’ laughs Jenny. ‘Bit of an impulsive romantic is my Karl.’
‘He threw that on you, for tomorrow?’ says Diane. ‘He’s lovely, your Karl.’
‘He’s thrown a lot worse at me before. Though only lightweight stuff. Soft toys, mostly. It’s understandable. It’s been hard for him with the Richard thing.’
‘Mm,’ says Diane. ‘I liked Richard, he was nice. Still is nice, I imagine.’
‘You’ve never met Richard,’ says Jenny. ‘Or Karl.’
‘Even so,’ says Diane.
‘About tomorrow night, Jenny,’ says Luisa.
‘But it had to end,’ says Jenny. ‘It did have to end. Even though I loved Richard. Love him.’ She starts to cry again.
‘So Karl never found out that Richard was actually Phoebe’s dad?’ says Diane.
‘He wasn’t though, was he?’ says Jenny. ‘The DNA test was conclusive.’ Jenny pulls herself off the desk and stands up. ‘Well. It’s worked out for the best, hasn’t it?’
‘Here you go,’ says Erin, and dumps a plastic-wrapped block of sheets into the cardboard box under the desk.
‘About tomorrow tonight, Jenny,’ says Luisa.
The phone rings again. Jenny picks up. ‘Hello, maternity?’
‘So you and Justin having a night together?’ Diane looks up, her head torch blinding Luisa.
‘Oh. Yes.’ Luisa cannot remember ever telling Diane Justin’s name. ‘Trying to. It’s difficult when shifts change at the last minute.’ Can Diane help? Diane can’t help. She turns to the computer, but Gina has gone. Only Jenny can help. ‘Diane, the light. You’ve still. On your head.’
Diane reaches up and clicks off the head torch, but leaves it on her head.
‘Not a problem for me any more,’ giggles Diane. ‘Robbie left me more than twenty years ago now. Well I suppose I left him.’
‘Because of midwifery?’
‘Oh no. Because we never saw each other.’
‘That’s why I need a night with Justin. Tomorrow night.’ Why tell Diane? Diane is crazy. Because Diane is there, is listening. ‘And Fran has put me down for tomorrow without telling me.’
‘Poor Luisa.’ Diane goes back to her patchwork squares.
‘If’s difficult. When our shifts change at the last minute.’ She speaks loudly, in the direction of Jenny. Jenny turns to to shield the phone receiver from the noise.
‘Does he demand sex in the garden in the mornings yet?’ says Diane.
‘Robbie did that?’
‘Not as such.’
‘We haven’t had sex in two weeks,’ says Luisa.
‘I haven’t had sex for two weeks either,’ says Diane. Luisa is not sure what type of who Diane hasn’t had sex with. ‘To be honest with all these vaginas around I’m not bothered about my own,’ says Diane.
Luisa wishes this conversation was happening with someone other than Diane. Anyone other than Diane.
‘Jenny.’ Luisa sees Jenny replace the phone receiver. ‘About my shift tonight. It’s just I’ve had something arranged with Justin for ages.’
‘Are we still talking about that?’ says Jenny, heading for the doorway.
‘I have some hours owing.’ Luisa moves to block her exit. ‘I could use those. Take some of them for tomorrow night?’
‘Highly irregular. I have to go check on Rebecca’s woman, Luisa.’
‘I didn’t know I was working until now,’ says Luisa.
‘Well.’ Jenny narrows her eyes. ‘If you want, I’ll have a look at the numbers again. No promises.’
‘Please. Thank you. Thank you, Jenny.’
Erin sighs, crouches to retrieve the block of stickers, rips them open and hands a sheet to Luisa.
‘And thank you, Erin,’ says Luisa. ‘Thank you so much.’
‘It’s a good while you’ve been away from that iffy trace in Sheila Kitzinger now, isn’t it Luisa?’ Jenny disappears out the doorway.

I can tell Justin he got the dates wrong again, thinks Luisa. I was always working Wednesday night. You didn’t check the calendar again. Your mother didn’t believe in calendars, and you don’t understand them. She pictures her indignation, but her imaginary self turns away from Justin, embarrassed.
Luisa opens the door to Sheila Kitzinger. She looks at the time on her watch fob: 22:37. Too late to call Justin. Actually not too late. But don’t want to talk to Justin, anyway, don’t want to ask Justin. Don’t want to have to ask.
She stands, motionless, inside the chamber enclosed by the curtain around the inside of the door, and realises she did not knock. She turns and raps on the inside of the door.
‘It’s just me, Luisa,’ she calls.
‘But you’re already inside.’ Eric stares at her through the gap in the curtain.
‘Yes I am.’
‘Oh. Weren’t you going to fill that up?’ Eric nods at the empty water jug in Luisa’s hands.
‘I was. I am.’
A buzzer sounds, this one whooping up and down, treble to bass: the emergency buzzer.
‘I’m sorry, I have to go again,’ says Luisa.
‘To fetch the water?’
‘For the buzzer. An emergency. The emergency buzzer?’
‘But what about the monitor?’
Luisa runs into the room, glances at the monitor trace. The print out looks normal and healthy, the regular bouncing mountain skyline. The emergency buzzer whoops. Luisa runs back towards the door.
‘Is it okay?’ says Cheryl.
‘It looks absolutely fine. I’m sorry, I’ll be back very soon. There’s an emergency,’ she says again. ‘With another woman. And,’ she adds as she grabs the door handle, ‘when I come back I’ll bring some water. Lots of water.’

The red emergency light flashes above Joy Horner room, the first entrance to Luisa’s left. She pushes open the door and runs in.
‘We’ve got shoulders!’ calls Sue, as if this is the next meal up in this busy cafe.
Luisa stops in the middle of the room. The blonde woman on the bed looks at her anxiously, a baby’s grey head protruding from her vagina.
‘Someone put out a four twos,’ Gina swerves into the room, moves past on the right of Luisa and over to the bed.
Four twos. Are eight. Fast bleep call out. Should I do that? thinks Luisa.
‘I’m on it.’ Nikki appears on Luisa’s left, then swings around and heads back out the door. ‘Obstetric and neonatal, yes?’
‘We need legs back,’ Gina swings the bed out from the wall and squeezes herself into the gap, at the same time sliding her hands under the blonde woman’s left thigh. Sue is already lifting the right leg.
‘So who is it we have here? Excuse-y me.’ Diane lays a hand on Luisa’s shoulder, easing her aside.
‘This is Julia,’ says Sue, imitating Diane’s sing-song tone. ‘Can someone flatten the bed?’
Luisa has missed Erin entering the room, but there is Erin, flattening the bed. Luisa waves jazz hands at either side of her head.
‘Someone take from me,’ says Gina.
‘So, Julia,’ Diane takes Julia’s right leg from Gina, and pushes down against the knee, forcing Julia’s thigh into her chest. ‘Your baby’s just got a little bit stuck. Sorry luvvie, I know it can seem really scary. And sorry about all the moving and poking you around, but it’s important that we do everything really fast. Gina here will get your lovely baby out before you know it.’
‘Somebody get the resuscitaire,’ calls Gina.
The resuscitaire. I can do that. That’s me. Luisa turns and runs out of the room, has to stop running almost as soon as she’s started. The resuscitaire stands against the wall to her left. She grabs the long handle on the front, pulls at the white unit in the direction of Joy Horner. The resuscitaire remains fixed against the wall.
‘It’s too heavy,’ says Luisa.
Jenny grips the resuscitaire handle, forces Luisa to relinquish to her, and hooks her foot under the lever at the unit’s base, flicking it upwards with her toes.
‘Brakes, Luisa.’ Jenny pulls the resuscitaire away from the wall, pushes it against the door of Joy Horner, opening it ahead of her. Luisa follows her in.
‘Can we have some super-pubic pressure?’ says Gina. ‘Oh – don’t worry. We’re good. Here we go.’
From the back of the room Luisa sees the baby’s purple shoulder emerge underneath Julia’s raised leg. The entire body slithers out into Gina’s waiting hands. Gina lifts the baby up and onto Julia’s stomach.
‘My god. She’s so chubby, isn’t she?’ cries Julia.
‘Towels, towels, towels,’ says Gina. ‘Who’s got towels?’
Where are the towels? Luisa crouches and looks on the bottom of the trolley. No towels.
‘Here’s towels.’ Erin unfurls and hands a towel to Gina over the baby girl lying on Julia.
Gina rubs vigorously at the towel-covered baby.
‘Excuse me.’ The paediatrician comes in and stands next to Luisa. ‘So where are we at?’
‘Um. The shoulder was a bit stuck,’ says Luisa.
The baby’s cry fills the room.
‘Shoulder dystocia, called at 22:38, baby delivered 22:40,’ says Gina. ‘Good APGARS. You may stand down,’ she tells the paediatrician.
Midwives file past Luisa, out of the room, and she follows on from Gina at the end of the line, the last duckling.
‘That was good,’ Luisa says to Gina. ‘How you did that. That was – good.’ Unlike me who did nothing.
‘What was?’ Gina continues down the corridor.
‘The emergency. I didn’t know – ‘
‘Didn’t know what?’
‘Everything was done. There was nothing else to do.’
Gina halts, swings round, almost into Luisa. ‘How is your woman, Luisa? Are you supporting her?’
‘Fran swapped my shifts. I have to work tomorrow night.’
‘Diane told me you said they can’t do that so soon before. That they won’t do that to you.’
‘Don’t listen to Diane.’
‘So they can do that?’
‘I mean don’t listen to Diane about anything. What’s the problem with working tomorrow night?’
‘I have a thing. A thing I have to do. With Justin.’
‘Well, tell him you can’t do it.’
‘But we had it – arranged. Diane said they never change your shifts.’
Gina stops and faces Luisa. ‘Is it him? Justin? Jealousy again?’
‘I mean is he another one of those who can’t handle that you’re a woman with an empowering job?’
‘Yes. No – ‘
‘Always complaining that you’re out of the house?’
‘Not all the time.’ Why is she defending Justin? Because he is not the kind of man Gina thinks he is. No man is the kind of man Gina thinks he is.
‘If he doesn’t understand what you do, that’s his look out,’ says Gina. ‘If I had it my way we would have mandatory public workshops for midwifery orientation. But if he won’t understand, that’s up to him.’ Gina puts a hand on each of Luisa’s shoulders. ‘You do realise that men kick up and feel threatened when a woman has an empowering job? After centuries women are slowly gaining a foothold in career parity and men cannot stand it. You want to nip it in the bud. We’ve all had to do it.’
Luisa nods weakly. ‘Does your partner complain?’
‘Not any more. I saw it coming a mile off, and gave him the red flag treatment.’
‘And that worked? The red flag treatment?’
‘Never heard from him again.’
Luisa wipes her eyes with the back of her hand.
‘You’re a protector, Luisa.’ Luisa worries for a moment that Gina will take hold of her hand. Gina takes hold of her hand. ‘You look after women through one of life’s great experiences. Don’t you know that? Go back and support your woman. How is your woman?’
‘She wants everything,’ says Luisa.
‘Support your woman and everything else follows.’ Gina releases Luisa’s hand and casts her off, a figure skater pushing their partner away across the ice.
But I’m not like you, thinks Luisa.

Luisa knocks and enters Sheila Kitzinger, pushing through the curtain with two jugs of water.
‘We – ‘ starts Eric.
‘It’s me,’ Luisa says. ‘I’m back now.’ The words leap out of her, belligerent. Not belligerent. Firm.
‘Where were you?’ moans Cheryl from the floor.
‘There was an emergency but now I’m back.’ She stares at Eric, holds her whole body still, defiant. I was helping save a baby’s life. Not really helping, but I was there. ‘When that siren goes we all have to drop everything and go help.’
Eric’s mouth opens, closes again, and he looks away. ‘Is – everything okay now?’ he says.
‘Oh yes. All okay now. Emergencies actually happen quite often.’ Luisa kneels and lays a hand on Cheryl’s shoulder. ‘They’re only small emergencies. It’s not like anybody’s going to die. Well, it’s an emergency so of course there’s a small possibility. That’s why we have to run. But it never happens. Hardly ever, anyway.’
‘Sometimes babies die?’ says Cheryl.
‘What we need is to focus on the energy of this room,’ says Luisa.
Luisa checks the foetal heart monitor: the trace now has regular downward U’s at each contraction, the line recovering slowly back to the baseline with each one. Luisa’s own heart dips in solidarity with the baby.
She unfolds the monitor print out, holds it so Cheryl can see. ‘Here,’ she says. ‘See these dips?’
‘Oh god,’ says Eric.
‘These are irregularities,’ says Luisa. ‘But we’re going to see if we can deal with them right away. And we’re going to hopefully make them better. Let’s put you on your left side.’
‘Is my baby in danger?’ says Cheryl.
‘If you’re on your side, it means the heavy weight of your womb isn’t pressing down on your vena cava.’
‘The what?’ says Eric.
‘Vena cava. Not a medical term,’ she adds. ‘It’s Latin.’
‘But aren’t a lot of medical terms in Latin?’
‘More Greek these days,’ says Luisa. ‘Interestingly that’s why no one knows how to spell diarrhoea.’ That makes no sense, she thinks, but Eric appears to accept the explanation.
Cheryl lies on her side for the next contraction – as it ends the monitor beat slows from techno to waltz. Luisa shows her and Eric the new trace: the V is shallower, the heartbeat recovered more quickly.
‘Is that better?’ says Eric.
‘Oh yes,’ says Luisa. But will they revert to normal? ‘Those dips are definitely shallower than before.’
‘But it’s not good?’ cries Cheryl.
‘It’s better,’ says Luisa. ‘But we’ll see if we can do even better still.’ Once I’ve called the Reg. Though if I call the Reg they’ll really get worried. Should I call the Reg?
‘The good old vena cava,’ says Eric, with tears in his eyes. ‘Thank god you’re here.’
‘So. Any progress?’ The Registrar is back in the room. ‘What dilation are we at now?’
‘We were about to do an examination.’ Luisa looks over the Registrar’s shoulder at the trace. The U’s are the same size, no deeper, but no shallower either. ‘We were just changing position. To help with the decels.’
‘Mmm.’ The Registrar continues to stare at the trace. ‘Well, you carry on. I’ll wait.’
‘So, Cheryl,’ says Luisa, ‘as you probably know, we offer checks, you know, downstairs checks, every four hours.’ She stares straight at Cheryl to avoid seeing the Registrar’s expression. ‘And we think it’s probably a good idea, to check just about now.’
‘Okay,’ says Cheryl. ‘Can you tell me the leg thing again?’
‘Feet together, flop open your knees,’ smiles Luisa over her shoulder as she washes her hands in the basin.
Luisa kneels on the floor next to Cheryl. Her gloved fingers round the curve of Cheryl’s vagina and she feels along the upper wall of the vagina to find the cervix. ‘Well, baby seems to have lots of hair!’ she says, as always. She parts her fingers into a V, pushing against the edge of the cervix. Is that five centimetres? Please let it be five. Six? It feels like five. How can I be sure when I can’t see my fingers?
‘Well there’s definitely some progress there,’ she says. ‘You were four centimetres, and now we’re five. Maybe up to six.’
‘Which is it?’ says the Registrar. ‘Five or six?’
‘Five.’ Luisa nods at Cheryl.
The Registrar looks again at the trace, then lets the graph paper fall against the stand. ‘I think I’d like a check myself. Sorry to do it twice. But when it’s an important decision, I think we need a second opinion.’
‘When what’s an important decision?’ says Eric.
Luisa can see Eric bursting with supplementary questions but he waits whilst the Registrar performs a second vaginal exam: teacher marking her homework in front of the whole class.
‘That’s closer to four,’ says the Registrar. Luisa looks to see if Cheryl has heard, but her face is screwed in pain as the next contraction begins. ‘Not that far on, to be honest.’
Midwife and doctor stare into the distance as Cheryl’s contraction finishes, Eric alternating between squeezing her hand and glancing up at Luisa’s painful mannequin smile.
‘We would normally recommend a hormone drip called syntocinon,’ says the Registrar. ‘When your contractions aren’t moving things on to achieve a vaginal birth. But I’m a bit worried that your baby might not cope.’
‘My baby can’t cope with what?’ wails Cheryl.
‘We’re keen on is a vaginal delivery,’ says Luisa to the Registrar. ‘Aren’t we?’
‘But didn’t you get the examination wrong?’ says Eric to Luisa. ‘What does that mean?’
The Registrar looks down at the notes. Luisa has to answer. ‘Well – ‘
‘And now you’re saying we should use this synthetic drug?’ says Eric. ‘We didn’t want any drugs. Don’t you remember in the birth plan we said we didn’t want any drugs?’
‘We don’t have to use synto,’ says Luisa. ‘It’s just that things haven’t progressed as well as we might want. I mean you’ve made great progress. But not quite as much as we – but of course everyone is different. Each labour progresses at its own pace. But your pace is just a little bit slow. But I’m asking so we can get your perspective and your feelings on the idea of using synto.’ You can’t use that many buts in a sentence.
‘Is it safe?’ says Cheryl. ‘Will my baby not be safe?’
‘Of course there are risks. There’s always some risk.’ The Registrar’s voice is low and even – no amount of bad behaviour is going to get to her.
It’s alright for you, thinks Luisa, you’re going to waltz off in a minute. They’re my children – I have to live with them.
‘That makes it not safe!’ cries Eric.
‘In any procedure there are always risks,’ says the Registrar.
‘My baby is not having any risks!’ sobs Cheryl.
‘Well if you feel strongly,’ The Registrar looks to Luisa. ‘If you decline synto, then we’d need to go ahead with a caesarean, anyway. There are of course also risks with a caesarean.’
‘I want a caesarean!’ cries Cheryl. ‘I want this baby out now!’
Now you want a caesarean? What about your fucking ancestors and the tribal women? cries Luisa in her head.
‘Then I’ll set it in motion.’ The Registrar heads for the door.
‘Okay. Thank you. Okay.’ Cheryl looks sad, but holds her composure as the Registrar leaves.
‘I’m not sure I understand,’ says Eric. ‘I don’t get it.’ He is animated, moving around the room on Cheryl’s behalf.
‘Well we have known about baby’s little dips, haven’t we?’ says Luisa. ‘We’ve known for some time.’
‘But why?’ Cheryl snorts in, then floods out tears. ‘I thought if we did everything you said I wouldn’t need a caesarean?’
‘Well I didn’t say for sure. This was always a possibility. Because of the little dips.’ And also because you wouldn’t let me say the word caesarean.
Jenny knocks and comes straight in. ‘Luisa,’ she says. ‘If we’re going for caesarean, you need to get started with the theatre pathway.’ She pushes a booklet into Luisa’s hands and leaves without looking at Cheryl or Eric. A proscribed schedule for the next few minutes shunts into Luisa’s brain: gown, theatre pathway questions, check when theatre ready.
‘The doctor is always looking to the whole, holistic picture.’ Luisa looks down at the theatre pathway booklet, at all the little boxes to be filled out. She crouches next to Cheryl. ‘Now Cheryl, I just need you to answer a few questions.’
‘Can’t we do this later?’ cries Eric. ‘We need a bit of a minute to regroup. I mean, who tears open the chrysalis and allows the butterflies to escape?’
‘It has to be done now, I’m afraid. When did you last eat and drink?’ Luisa focuses in on Cheryl, on her crumpled face.
‘It’s not like I’m hungry,’ wails Cheryl, and looks to Eric, as if at least he might say something sensible.
‘There’s a few checks we must do. We just need to know if your stomach is full.’ Luisa wants to hug her, a human hug, but there is no time. Instead she flicks through the notes booklet to find labels printed with Cheryl’s name, peels off and attaches one to the theatre pathway booklet. In the booklet’s boxes she writes Cheryl’s name, her own name, the Registrar’s name. The name of the consultant-in-charge. Who is that?
‘It would have been useful if we had understood what those things on the trace meant.’ Eric flaps his outstretched palms up and down, his camera almost swinging into Luisa’s face. ‘As we were going along.’
Luisa cannot remember the name of the consultant-in-charge. But she does know that it makes no difference. She writes Mr Stone, in a scrawl, in a way that could easily be confused for someone else.
‘Well we did know about the little dips,’ says Luisa softly, back to air hostess. She hears her tone of authoritative finality, suggesting further questions and alternative choices are now pointless. ‘I’m sorry.’ She waits for three, four, five seconds. ‘What about eating and drinking, then?’ Luisa scribbles in more boxes to avoid looking at Cheryl.
She works through the questions: caps and crowns? any loose jewellery? any prosthetics? Cheryl answers in a monotone, and Luisa cannot look up as she answers, since she needs to flick through the notes to find Cheryl’s stats: due date; gestation; risk factors. To her relief Cheryl becomes occupied by her next contraction, and Luisa leaves her with Eric whilst she frantically scribbles.
‘But weren’t we doing really well before?’ Eric stands with Luisa as the contraction finishes. ‘I thought we were doing really well?’
‘You were doing really well. Emotionally you were, you were both doing great.’
‘And now we’re not even doing that,’ says Eric, and looks so sad that Luisa wants to hug him as well.
‘Luisa.’ Jenny appears behind her again. ‘About tonight. I’ve checked, and it does seem that you have a few hours owing.’
Luisa turns to face her. ‘I don’t have to work tonight?’ She looks back at Eric, then back to Jenny.
‘Steady there,’ says Jenny. ‘You have four hours owing and our numbers aren’t completely decimated for once. Which means if you want you can start at midnight.’
‘Midnight? That’s, umm.’
‘It’s up to you. You can do the whole shift if you like.’
‘Midnight sounds great. Thank you. Thank you, Jenny.’
‘So – if you don’t mind,’ says Eric behind her. ‘Can you tell us what happens now?’
Erin knocks and comes straight into the room, and hands Eric a square of blue cotton scrubs. ‘If you can just put those on,’ says Luisa. ‘For theatre.’ She almost makes the traditional reference to looking like George Clooney, but Eric’s face warns against it.
The Operation Department Practitioner, already in scrubs, knocks and comes straight in. ‘Hello, Cheryl,’ he sings, and takes the checklist from Luisa. ‘When did you last eat and drink? Do you have any caps or crowns?’
‘Didn’t I answer all this?’ wails Cheryl.
‘They have to check,’ says Luisa. ‘It’s important to check, to check what I did. If you can just answer the ODP’s questions, Cheryl.’
‘No, then,’ sobs Cheryl. ‘I’ve failed. Failed. What did we do wrong?’
‘Nothing. You did nothing wrong,’ says Luisa. ‘Sometimes this is just how it happens.’ God might know, thinks Luisa, but there is no god. Even the tall consultant, even he doesn’t know.
Eric emerges from the bathroom, kneels to hug Cheryl. The scrub trousers end halfway down his calves, the cotton so thin that the words Calvin Klein are visible at his waist.
‘Are you okay?’ Cheryl grabs Eric’s hand.
‘I’ll be fine so long as I don’t have to sit down,’ says Eric.
‘Are you good to walk to theatre, Cheryl?’ says the ODP, as to his deaf grandmother. He hooks a hand inside her elbow and helps her to her feet. Cheryl steps obediently to the door, Eric falling in behind.
‘Caesareans are very common nowadays,’ says Luisa. But Cheryl and Eric are gone.
It is past three o’clock by the time Luisa has assisted at Cheryl’s caesarean and processed her upstairs to the postnatal ward. That’s what I did, she thinks, processed her, shunted her through and spat her out the other end.
For the next few hours Jenny has Luisa cover breaks, and she drags her body around the ward, until the faint morning light in the large corridor window breathes new energy into her: a new dawn. It’s a new day. It’s the same life and I’m not feeling good.
At 07:15 she pulls out her phone and switches it on. It beeps immediately with a text from Justin.
Checking in for switch over time.
Luisa powers down the corridor as the long blast of a call buzzer sounds, and slips into the changing room. Didn’t hear the buzzer, she thinks, as she taps Justin’s picture on her phone. From the changing room toilet comes the sound of someone straining.
‘It’s me,’ she says. ‘What are you checking?’
‘Only when you’ll be back. Me, the girls, we’re up.’
‘I’ll be back when I’m always back.’
‘Though you remembered about the car? I can’t drive, so I’m walking to the station?’
‘Sure, the car.’ She has forgotten about the car. She knows he’s not trying to make her feel guilty, but mentioning the car has done so anyway, and resentment balloons in her again.
From the toilet comes the sound of more straining. ‘Sorry! Sorry, whoever that is out there,’ calls Diane. ‘I’m always like this on nights. It’s all those bloody cakes lying around.’
‘Poor you,’ calls Luisa, to demonstrate her lack of embarrassment.
‘Thanks,’ says Justin. ‘Thanks, sweetie.’
‘Not you. There’s a woman here, in the toilet.’
‘You’re with a woman in the toilet?’
‘Not in the toilet. There’s a woman, in the cubicle.’
‘So as I’m needing to walk to the station.’ Justin chirps, like a relative cracking jokes at a funeral. ‘I just wanted to check you’re going to be home a bit earlier. On time.’
‘I’m going to try. I have to go. So that I can leave on time.’
‘I need to leave dead on eight twenty-five.’
Luisa listens to the new noises from the toilet cubicle, like Diane is tapping out morse with her feet.
‘You finish at eight, yes?’ says Justin.
‘I can’t guarantee it, Justin.’
‘You know, my train. I can’t be any later because I’m leaving early to be back for tonight. For date night?’
‘Is that what we’re calling it? Date night?’
‘Isn’t date night that Fifty Shades of Grey thing?’ calls Diane.
‘You remembered?’ says Justin.
‘I remember,’ says Luisa. ‘I’m looking forward to it. I have to go.’ Home, sleep, food, sex, make sure Justin is asleep, back to the hospital: she pictures the timeline of the day ahead. It looks almost manageable, on paper. ‘I’ll text you if I’m going to be late.’
Luisa steps out of the changing room, eyes on the dark screen of her phone.
‘Can you get to triage, Luisa.’ Jenny is moving so fast she only just pulls up without a collision. Luisa smells a mintiness on her breath. ‘Right now please. There’s a multip in there. Seven centimetres and she’s getting a bit grunty. You can put her in Joy Gardner.’
Luisa looks at her watch: 07.35. I can’t do a handover baby, she pleads, but only silently, to herself.
‘Sorry for the handover baby,’ says Jenny, and Luisa has never heard anyone make the word sound so empty of apology.
‘I do have to leave on time today,’ says Luisa.
‘Don’t we all? Your baby, your paperwork, Luisa. You know that.’ Jenny walks away, a hand in the air. ‘Everyone loves a handover baby!’
‘Hulloo, Kayleigh,’ says Luisa as she enters triage. ‘I’m Luisa. I’ll be looking after you now.’
On the bed a young woman on all fours gives no sign she has heard, and instead focuses an intense gaze at the wall.
‘So I’m going to feel your stomach.’ Luisa puts a hand on Kayleigh’s belly: the uterus muscle is rock solid.
‘It’s her third,’ says a middle-aged woman in the chair who looks so similar to Kayleigh, even down to the same highlights in her hair, that she cannot be anyone except her mother. ‘Her second was very fast. Can you get her to a room, please? The other nurse said she was seven centimetres, and it’s going to be quite soon.’
‘Well, sometimes a third baby can surprise you.’ Air-hostess tone, but firm, in a way that invites no comeback. Luisa glances at Kayleigh’s mother, trying to assess how pliable she might be. ‘And babies born slower do of course stretch your perineum more slowly.’
‘Well, I think this one has been quite fast,’ says Kayleigh’s mother.
‘Well, you never know with babies.’ You never know anything. Babies, boyfriends, careers – everything’s unknown. ‘We’ve got a room ready for you. Shall I find a wheelchair to get you there?’ she asks Kayleigh. ‘Then you can have a sit down.’ And it’ll take me a few minutes to find one.
‘Don’t need one.’ Kayleigh climbs off the bed with remarkable agility and grabs Luisa’s arm. ‘Walk me.’
Luisa guides Kayleigh along the corridor, pausing for each of her contractions, which Kayleigh conducts in a businesslike manner, so calm that her mother offers no words of encouragement or sympathy. Luisa can see the day-shift midwives arriving and pulls up her watch fob: 7.42. Less than twenty minutes to go. This birth does not have to happen in the next twenty minutes. You never really know with births.
Outside Joy Gardner room Kayleigh stops again, and emits a cry, the last gasp of a dying soldier in a pointless war.
‘I think I need to push,’ says Kayleigh, and pulls herself into the room.
‘Well, you were only seven centimetres before.’ Luisa steers her inside the curtain to the bed, her voice light and carefree. ‘I would hold off pushing until we know for sure that you’re fully dilated.’ A wash of shame brings her out in goose-pimples.
‘She could be fully dilated,’ says the mother, dropping two bags by the bed. ‘Can’t you check?’
‘Well we generally only do vaginal examinations every four hours,’ says Luisa. The mother’s expression demonstrates that she has already lost any respect she might have had for Luisa. Which as she took over Kayleigh’s care less than five minutes ago must be some kind of record. And which is fair enough, because right now I am a pretty shit midwife.
Kayleigh lies on her side on the bed. ‘I’m going to push now,’ she cries.
‘You push when you need to, love,’ her mother grabs Kayleigh’s hand.
‘Okay. Maybe we should get to pushing,’ says Luisa.
There is a knock at the door. ‘Excuse me one moment,’ says Luisa and retreats out of the curtain. ‘You just do what you feel you need to, Kayleigh.’
Annie is at the door, and Luisa feels slightly faint at the idea that in the intervening hours Annie has been home and enjoyed a whole night’s sleep. Hidden behind Annie is a nervous student midwife.
‘Nadine here needs to get her birth numbers up,’ says Annie.
‘Oh. Great. Lovely. Yes, we’re almost there!’ Luisa grabs Nadine by the arm, pulls her into the room and hands her some surgical gloves. ‘Here we go. This is Kayleigh. Low risk. Para two. Two SVDs. Rhesus pos. Spontaneous onset. Seven centimetres at 7.15.’
‘It’s coming!’ cries Kayleigh from the other side of the curtain.
‘Is anyone going to actually deliver this baby?’ says the mother.
‘Yes, me!’ says Nadine. Annie and Nadine disappear behind the curtain.
That was my best handover ever, thinks Luisa. Brief, no extraneous information. Perhaps I work well under pressure.
She checks the time again: 07.55. I can go. I can leave!
Luisa runs to the changing room, pulls off her scrubs top as she goes. For once her clothes are on the hook where she left them. She dumps the scrubs in the laundry basket. Can I leave before eight o’clock? I’ve done everything, haven’t I? There’s nothing Jenny can say.
She peers out the changing room door, and with no one in sight, runs to the delivery room double doors, swipes her card and there’s the lift, the lift door is open, waiting. And she’s in, going down. Safe.
Luisa exits the lift and strides out into the multi-storey car park, moves towards daylight, and the sun rejuvenates her, her body light, nothing weighing on her. Her bag is not weighing on her. She isn’t carrying her bag. My bag is in the locker. My purse, phone. My keys.
Five minutes, it’ll take me five minutes, she thinks as she runs back to the lifts. She looks up at the illuminated numbers above the left hand lift, and then above the right, as they slowly descend. The left hand lift stops on 6. Stops and waits. The right hand stops on 9.
This isn’t fair, thinks Luisa. Not fair.

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