Tag: midwifery

Hard Pushed: A Midwife’s Story by Leah Hazard

“For fans of Adam Kay’s This Is Going to Hurt and Christie Watson’s The Language of Kindness,” the blurb on my press release for Leah Hazard’s memoir opens. The publisher’s comparisons couldn’t be more perfect: Hard Pushed has the gynecological detail and edgy sense of humor of Kay’s book (“Another night, another vagina” is its first line, and the author has been known to introduce herself with “Midwife Hazard, at your cervix!”), and matches Watson’s with its empathetic picture of patients’ plights and medical professionals’ burnout.

Hazard alternates between anonymized case studies of patients she has treated and general thoughts on her chosen career (e.g. “Notes on Triage” and “Notes on Being from Somewhere Else”). Although all of the patients in her book are fictional composites, their circumstances are rendered so vividly that you quickly forget these particular characters never existed. Visceral details of sights, smells and feelings put you right there in the delivery room with Eleanor, one-half of a lesbian couple welcoming a child thanks to the now-everyday wonder of IVF; Hawa, a Somali woman whose pregnancy is complicated by the genital mutilation she underwent as a child; and Pei Hsuan, a Chinese teenager who was trafficked into sex work in Britain.

Sometimes we don’t learn the endings to these stories. Will 15-year-old Crystal have a healthy baby after she starts leaking fluid at 23 weeks? What will happen next for Pei Hsuan after her case is passed on to refugee services? Hazard deliberately leaves things uncertain to reflect the partial knowledge a hospital midwife often has of her patients: they’re taken off to surgery or discharged, and when they eventually come back to deliver someone else may be on duty. All she can do is to help each woman the best she can in the moment.

A number of these cases allow the author to comment on the range of modern opinions about pregnancy and childrearing, including some controversies. A pushy new grandmother tries to pressure her daughter into breastfeeding; a woman struggles with her mental health while on maternity leave; a rape victim is too far along to have a termination. At the other end of the spectrum, we meet a hippie couple in a birthing pool who prefer to speak of “surges” rather than contractions. Hazard rightly contends that it’s not her place to cast judgment on any of her patients’ decisions; her job is simply to deal with the situation at hand.

I especially liked reading about the habits that keep the author going through long overnight shifts, such as breaking the time up into 15-minute increments, each with its own assigned task. The excerpts from her official notes – in italics and full of shorthand and jargon – are a neat window into the science and reality of a midwife’s work, with a glossary at the end of the book ensuring that nothing is too technical for laypeople.

Hazard, an American, lives in Scotland and has a Glaswegian husband and two daughters. Her experience of being an NHS midwife has not always been ideal; there were even moments when she was ready to quit. Like Kay and Watson, she has found that the medical field can be unforgiving what with low pay, little recognition and hardly any time to wolf down your dinner during a break, let alone reflect on the life-and-death situations you’ve been a part of. Yet its rewards outweigh the downsides.

Hard Pushed has none of the sentimentality of Call the Midwife – a relief since I’m not one to gush over babies. Still, it’s a heartfelt read as well as a vivid and pacey one, and it’s alternately funny and sobering. If you like books that follow doctors and nurses down hospital hallways, you’ll love it. This was one of my most anticipated books of the first half of the year, and it lived up to my expectations. It’s also one of my top contenders for the 2020 Wellcome Book Prize so far.

 

A few favorite passages:

“So many things in midwifery are ‘wee’ [in Scotland, at least!] – a wee cut, a wee tear, a wee bleed, the latter used to describe anything from a trickle to a torrent. Euphemisms are one of our many small mercies: we learn early on to downplay and dissemble. The brutality of birth is often self-evident; there is little need to elaborate.”

“Whenever I dress a wound in this way, I remember that this is an act of loving validation; every wound tells a story, and every dressing is an acknowledgement of that story – the midwife’s way of saying, I hear you, and I believe you.”

“midwives do so much more than catch babies. We devise and implement plans of care; we connect, console, empathise and cheerlead; we prescribe; we do minor surgery. … We may never have met you until the day we ride into battle for you and your baby; … you may not even recognise the cavalry that’s been at your back until the drapes are down and the blood has dried beneath your feet.”

My rating:

 


Hard Pushed was published in the UK on May 2nd (just a few days before International Midwives’ Day) by Hutchinson. My thanks to the publisher for the free proof copy for review.

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The Way of All Flesh by Ambrose Parry

This historical novel set in Edinburgh in 1847 has one of the best opening paragraphs I’ve come across in a while:

That immediately sets the tone: realistic, sly, and somewhat seedy. If the title sounds familiar, it’s because it’s borrowed from Samuel Butler’s gloomy 1903 meditation on sin and salvation in several generations of a Victorian family. I remember trudging through it on a weekend break to Strasbourg during my year abroad.

Parry (a pseudonym for husband–wife duo Chris Brookmyre and Marisa Haetzman) uses the allusion to highlight the hidden sins of the Victorian period and hint at the fleshy concerns of their book, which contains somewhat gruesome scenes of childbirth and surgery. Ether and chloroform were recent introductions and many were still apprehensive about them or even opposed to their use on religious grounds, as Haetzman, a consultant anesthetist, learned while researching for her Master’s degree in the History of Medicine.

Into this milieu enters Will Raven, the new apprentice to Dr. Simpson, a professor of midwifery. Will is troubled by the recent loss of his friend Evie Lawson, the dead prostitute of the first paragraph, and wonders if she could have been poisoned by some bad moonshine. Only as he hears rumors about a local abortionist – no better than a serial killer – who’s been giving women quack pills and potions, followed by rudimentary operations that leave them to die of peritonitis, does he begin to wonder if Evie could have been pregnant when she died.

The novel peppers in lots of period slang and details about homeopathy, phrenology and early photography. Best of all, it has a surprise heroine: the Simpsons’ maid, Sarah Fisher, who keeps shaming Will with her practical medical know-how and ends up being something of a sidekick in his investigations. She wants to work as a druggist’s assistant, but the druggist insists that only a man can do the job. Dr. Simpson recognizes that the housemaid’s role is rather a waste of Sarah’s talents and expresses his hope that she’ll seek to be part of a widespread change for women.

The Way of All Flesh is sure to appeal to readers of Michel Faber’s The Crimson Petal and the White and Steven Price’s By Gaslight. It’s not quite as rewarding as the former, but the length and style make it significantly more engaging than the latter. It also serves as a good fictional companion to Lindsey Fitzharris’s The Butchering Art; for that reason, I wouldn’t be surprised to see it appear on next year’s Wellcome Book Prize longlist.

Victorian Edinburgh on the endpapers.

Favorite lines:

“That was Edinburgh for you: public decorum and private sin, city of a thousand secret selves.”

“‘Simpson likes to think of medicine as more than pure science,’ [Raven] countered. ‘There must also be empathy, concern, a human connection.’ ‘I suggest that both elements are required,’ offered Henry. ‘Scientific principles married to creativity. Science and art.’ If it is an art, it is at times a dark one, Raven thought, though he chose to keep this observation to himself.”

My rating:

 


The Way of All Flesh comes out today, August 30th, in the UK. It was published in the States by HarperCollins on the 28th. My thanks to Canongate for sending a free copy for review.