The delivery had been precipitous. I had missed it, rushing in to find the baby already on the mother’s chest. Now the bleeding would not stop. I pressed on the woman’s belly and the pads beneath her filled up with blood and clots … again. The uterus hardened briefly and then slowly rose and softened under my hand. I had gone through the protocol. The nurse, resident, obstetrician, and I worked efficiently together, using drugs and fluids. I was hesitating to do what I needed to do because the patient had no epidural. Calling for narcotics, I turned to my resident. ‘‘Let’s look at that placenta again.’’ Looking at the placenta, my suspicions were confirmed. There was a denuded edge. It was subtle but there. As the pads slowly filled with blood again I had a sudden memory of a story told to me by my mother’s friend, Daniella,* about her mother, Fela, and how they survived the Second World War. I pushed the narcotic slowly into the intravenous line, explaining to the patient and her anxious husband what was happening and why I was about to do what I was going to do.
Daniella is one of my mother’s friends. They met as teenagers, and they have been the closest of friends for over 60 years. She was always one of my favorites. She was vivacious and pretty, with a long black braid and peasant skirts. She had a beautiful soft voice. As a child she seemed to me to be the very epitome of kindness. She is also an accomplished teacher, writer, and storyteller. She told me this story about her mother, a midwife, an ‘‘accoucherke’’ (akoo-sher-keh) in Nazi- occupied Poland.
They escaped from the ghetto when all the other Jews in their village were transported to concentration camps. Fela and Daniella wandered into the countryside, hiding by day and walking at night, looking for the partisans that Fela believed would hide them and keep them safe because her nursing skills would be useful to them. She had been trained in Warsaw at a famous nursing and midwifery school. She had insisted on pursuing this profession against her father’s wishes. She was very proud of being a ‘‘modern and scientific’’ midwife. Now they traveled from farm to farm where she had delivered many babies. Some people turned them away. It was, after all, dangerous to harbor Jews. Some gave them food. Some let them hide in their barn for a day or two.
By December or January they came to the farm of a poor peasant family. This simple, uneducated couple decided to let them stay and hid them in the hayloft during the day. At night they snuck them into the house and let them sleep behind the oven where it was warm. They put their own lives in danger. It was winter and she was their midwife.
A few months later, in the middle of the night, there was a pounding at the door. The frightened farmer opened the door and there was one of his neighbors.
‘‘I know you have the accoucherke hidden here, give her to me,’’ the man bellowed.
The farmer tried to persuade him that he was mistaken, there was no stranger in the house, the accoucherke had been there but she was gone. He was trying to convince the increasingly irate man to leave. At that point, the neighbor took out his revolver, threatening to kill him if he didn’t give him the accoucherke. Fela came out from her hiding place. ‘‘Why do you want me,’’ she asked the furious man. ‘‘My wife had a baby. She is dying. You have to come home with me,’’ he said. The accoucherke put on her father’s old fur coat. Its inner pockets held her few instruments and drugs. She gestured to her daughter to get ready and come with her. ‘‘I need you, not the child. Leave her here,’’ the man said. Daniella’s mother refused. ‘‘Someone is going to shoot me,’’ she said, ‘‘It is impossible to survive this war. I want to help your wife, but I will not leave my child behind.’’ He reluctantly put away his revolver and they left.
They went out into the night. The man was a wealthy farmer, a gentleman, and a former Polish Army officer. His home was a world away from the simple peasant hut where they had been hiding. It had rooms, warmth, furniture, and carpets. They came into the house and went up to the room. It was lit by candles and smelled of blood. There was the woman, lying on a mattress. Under the bed was a large wooden laundry tub, slowly filling with blood. Above the bed was a gold framed Madonna and child. The woman was as white as a piece of paper and shaking. Her whole family was gathered, kneeling around her bed. The man’s eyes turned from his wife’s face as she lay on the bed, already almost a corpse, to Fela’s. ‘‘If you save her life I will save you,’’ he vowed.
Daniella waited in the kitchen. The man sat in front of the fire, staring obsessively at the tiny baby on his lap, his face bleak and hopeless. A while later Daniella’s mother came down and washed her hands. ‘‘She is safe now,’’ she told the husband.
The man kept them safe for the remainder of the war. He rotated their hiding places so no one would suspect him. He took pride in hoodwinking the authorities. After the war Daniella and her mother made their way to Canada.
I looked at my patient. The narcotic was working. Thankful for my small hand, I reached into the uterus and felt along the half-contracted wall. I found what I was looking for. In an act, probably as ancient as the history of people who help women in childbirth, I was able to grasp that small piece of placenta and membrane and pull it off the wall and out of the uterus. The patient gasped. I gratefully felt the uterus contract around my hand. One last squeeze and the bleeding stopped. The uterus was hard and stayed con- tracted. I looked at the sweating, anxious husband. ‘‘She is safe now,’’ I said.
I straightened up and looked around the room. What a cast of characters, I thought. I looked at the new immigrant Romanian parents, my Ukrainian-born resident, the nurse, whose parents had come from India, the Chinese-Canadian obstetrician, lurking in the hall, ready to help, the new little Canadian, a baby girl. It is a United Nations in this room, I thought, bonded by this act. Here in Toronto, it is a safe haven in a world of war and fear. Here we have created a place where women can give birth with compassion and safety.
1. Are there aspects of healthcare that cross generations? Why or why not? If there are, what would they be and why?
2. How do you imagine what the circumstances are for giving birth today in areas of conflict?