The Midwife Read online

  FOR PHILIP,

  because he gave me his most precious gift: time.

  Each child has something to teach us, a message that will help to explain why we are here.

  — from the Talmud

  Acknowledgments

  For sharing expertise and giving encouragement, generous assistance, or loving support I thank: A La Veille Russie, Sherrie Allen, Laurie Bloomfield, Sandra Branch, Jem Cohen, Don Cutler, Peggy Drake, Glen Duncan, Margot Edwards, Ann Falbo, Karen Goldstein, Anna Herz, Carl and Loretta Hirsch, Julie Houston, Barbara Katz, Ralph and Muriel Keyes, Stephen and Shari Leviss, Mary Lindsay, Annie Macketon, Esther and Ruth Mandel, Allen Men-kin, Lynn Moen, Mount Vernon Public Library, New York Academy of Medicine, New York Historical Society, New York Public Library, New York University Archives, Suzanne Nichols, Rosalind B. Paulson, Mary Pisaniello, Gerald Slaper, Neil Spector, Val Stout, Rita and St. Clair Sullivan, Judy Sutherin, Robert and Donna Wade, Vicki Walton, Warren County Library, Elsie, Leonard, and Robin Weisman, Leah Weisman, Ruth Wilf, Jack Yager, YIVO Institute for Jewish Research, and especially my persevering editor, Daphne Abeel.

  BOOKONE

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  Russia

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  Victor Qolonovin

  Delivered April 7, 1904

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  1

  HANNAH WAS SEATED ALONE at one of the round tables readied for eight students. "Clang, Clang!" The bells reverberated through the vast dining hall, then ceased. In the brief interlude Hannah caught her breath. "Clang!" There it was: two bells, a break, and one final bell — the call for the "Midwife On Duty." For the first time in Hannah's life that call was for her.

  A brief, unfocused glimpse of her reflection in the polished wooden table revealed trembling lips and the excited gleam in her eyes. She took one final sip from her tea glass and willed herself to remain calm.

  Hannah Blau had been admitted to the Imperial College of Medicine and Midwifery ten months before, after winning a place among the 2 percent of each class allotted to the Jews by law. In 1903 Hannah was the sole Jewish person admitted to the Midwifery Division in five years. One Jewish woman and four Jewish men were attending the Medical Section. Those five at least had each other on whom to rely, but Hannah was by herself in her class of fifty purebred Russian midwives.

  She was a stranger, a foreigner in her own country. Although technically she was as Russian as they, her first language had been Yiddish, and she still spoke theirs with an accent. While she could usually follow academic discussions, the casual social conversations, the jokes, and their idiom further excluded her from the company of these educated women from Moscow and St. Petersburg.

  Hannah left her tea glass to the serving girl. No midwife, not even a Jewish one, was expected to handle food or crockery. As Hannah rose from her chair she methodically centered her student's striped apron and snapped the bow at her waist to improve the crispness of her appearance. Her straight black hair was pulled back into the traditional severe bun worn high on their heads by all student midwives. Most of the women in her class did not consider this attractive, but the ebony crown only enhanced Hannah's fine bones and lively green eyes.

  With back erect and shoulders squarely set, she was determined to leave the hall looking confident. The experienced midwives took their time. Just as she neared the halfway point to the double doors, someone coughed slightly. Hannah glanced involuntarily toward the sound, and there, in the far-right corner of the room, sat a woman who wore metal-rimmed glasses that were slipping down the bridge of her large nose. Her rounded face, framed in burnished curls, was certainly not handsome, but as she caught Hannah's eye she gave a broad smile and a tilt of her head that unmistakably meant "Good luck to you."

  There was no time to dwell on the identity of her mysterious advocate, for as the tower clock chimed quarter past eight in the morning Hannah realized it was her bad luck to be summoned just as a fresh shift was coming on duty. Now members of the teaching staff could hover about criticizing her delivery technique.

  Hannah's performance on this first practical test of her career was not entirely within her control. There would be two other factors: the laboring mother and the little stranger she carried. Hannah hoped this would not be the mother's first baby, which, statistically, would indicate a longer, more tedious labor. As her steps quickened down the hall and through the two large West Wing wards on her way to labor and delivery, Hannah allowed herself to

  imagine her ideal patient: stoical, cooperative, and appreciative, with a quiet demeanor that would demonstrate to any passer-by what excellent care Sister Blau was giving. And the perfect baby, a slim-boned female, would be born pink and have a lusty cry, owing, most certainly, to the fine technique and thoughtful ministrations of the new midwife!

  The Imperial College and Lying-in Hospital were housed in a grand palace that had been built for Catherine the Great's son Paul before he became czar in 1796. He was eccentric, tyrannical, unusually ugly, and was strangled by his own oEcers after only five years on the throne. Thus his name was never associated with the building, which consisted of two wings that formed a horseshoe curve to the east and west. Its massive colonnaded front faced directly on the Voznesenski Prospect, opposite the River Moskva. The large oval courtyard contained gardens, which were still maintained though not kept in the profusion of flowers that would have satisfied an imperial prince of Russia.

  A three-storied rotunda formed the heart of the structure. Its first floor, designed as an elegant ballroom, was now the dining hall. The two upper stories contained offices for the administrators and doctors. Balconies of filigreed iron encircled the second and third tiers, and one could step from an office to look down on the dining tables or up at the opaque glass dome divided into eight sections. The rose-veined marble floors and walls absorbed no sound, for they had been designed to be acoustically sympathetic to chamber music recitals. At the points where the eight enormous arches supported the structure, corners were formed. If one person stood directly facing a crevice and spoke to someone standing diagonally opposite, the listener could clearly understand the words spoken fifty feet away. Thus, if a student sat in the wrong nook her most hushed whisper might be heard by a party across the vast room or up several tiers. Indeed this was one place where the walls did have ears, and so the first rule a new entrant learned was "Never discuss private matters in this public place."

  The West Wing, which housed the charity wards, was known as the Luisa after the Grand Duchess Luisa Maria Augusta of Baden,

  who had married Paul's eldest son, Alexander. Here the peasant women of Moscow were cared for by student and professional mid wives.

  Every Luisa mother filled out two cards, one with the name she wished to use during her stay at the hospital, and another containing her correct identity, which was sealed inside an envelope to be opened only in case of emergency. If a mother had nothing to hide, she would use her real name during convalescence, but if she wished to conceal an indiscretion she knew her secret was safe within the walls of the Luisa. The Imperial Foundling Home was located only a short distance away, and all a mother had to do if she wished to give up her baby was ring a bell outside its gates and a basket would be lowered to receive the infant. Only one question would be asked — "Has the baby been baptized?" — before it would be drawn up five stories and thereafter cared for by the Crown.

  The East Wing, called the Catherine for Paul's empress mother, was still furnished with many of the original royal tapestries, canopy beds, ornately carved chairs, and faded, yet elegant, carpeting even in the delivery suites. While the surroundings were appreciated by the noblewomen who gave birth there, the dust catchers cont
ributed to a rate of puerperal infection that was almost twice as great in the Catherine as in the Luisa, where the cold floors and unadorned wooden tables and chairs were much easier to keep clean.

  Student midwives, while not expected to straighten their own rooms, were responsible for the thorough scrubbings that preceded every delivery in the Luisa. But the elite clients of the Catherine were delivered by doctors assisted by ignorant peasants with no knowledge of aseptic procedures. Thus the wealthiest, most privileged Russian lady was likely to deliver in a far more germ-filled room than the humblest pauper. Many wives and daughters of the medical staff chose the Luisa because they had heard they would fare better there, although no one had yet correctly surmised the reason.

  Luisa babies remained with their mothers, sleeping in little boxed-in shelves attached to the wall near the bed of the mother, who tended and fed her own baby as much as possible, while the

  VICTOR GOLONOYIN J

  Catherine babies were kept in a central nursery where staff wet nurses suckled more than one infant at a time. Rashes, sores, and contagion of all sorts thus passed quickly from one baby to another. Catherine mothers would remain in this environment for more than a month, while Luisa mothers were released as soon as possible to make room for new cases. Thus their children had less time to contract disease. The official excuse for the difference in mortality and morbidity rates in the two wings was 'The noblewomen are more delicate, the peasant women of hardier stock."

  At the entrance to the birthing corridor Hannah saw her name chalked in on the callboard: "H. Blau, Midwife On Duty." That morning only one expectant mother lay on the thin hair-stuffed mattress upon which she would labor and deliver. She was in her last few hours of hard labor, attended by Sister Kochubey, who looked as though she had been up all night with her recalcitrant patient. Two other women in very early labor were pacing up and down the corridor, silently shuffling close to the walls. Neither looked up when Hannah arrived, and so she surmised they were not her concern.

  Hannah turned her attention from them to a frail woman in a black cape and feather hat sitting on a bench and talking quietly with Dr. Speransky. She held her breath as she realized that this fine lady, hardly the peasant she had been expecting, was to be her patient.

  "Aha! Madame Golonovin, you see I told you we wouldn't have long to wait. Here comes Sister Blau to attend you. I am certain you will find her very sympathetic." Dr. Speransky's words, cordial to the patient's ears, were condescending enough to remind Hannah that this superior disliked her only Jewish student.

  "My pleasure to meet you, Madame." Hannah bowed her head in respect, but curtsy she would not. "May I ask how frequently you are feeling your pains 7 "

  Madame Golonovin paused. Hannah wondered if her accent had confused her or if she had already guessed that Hannah was Jewish.

  "I have no pains," she said simply. "It's just that they told me this was the best time to come, you see ..."

  The doctor interrupted her. "Madame's water broke last night and we thought she might come in now to save herself an uncomfortable journey, since labor should begin quite soon."

  "Yes, that was a good idea," Hannah acquiesced politely.

  "Sister, we thought Madame could have this first room, if that is agreeable to you." They stepped into the Luisa's only remaining private room, with windows that overlooked the rose gardens. A large, low canopy bed and the one tapestry that had not been removed made the room infinitely more grand than the other charity accommodations.

  Dr. Speransky was of the same diminutive height as Hannah, but double her breadth and weight. One direct stare from her steely grey eyes sent shivers down the spines of all the students, most particularly Hannah. The doctor lowered her voice to a rasping whisper. "Madame Golonovin is the wife of one of our ministers of state, Sergei Ivanovich Golonovin. He refuses to let a male Catherine doctor touch his wife, let alone examine or deliver her, and so we assured him that Madame would receive excellent care in the Luisa from our wise midwives. Do you understand?"

  "Might she accept a blind birth?" Hannah suggested tentatively. This was commonly performed by male doctors, who, for the sake of their patients' modesty, worked completely by the sense of touch. The doctor reached under the covers and skirts with only his hands and did all his examinations and deliveries with his eyes averted to a point in the distance, a skill much practiced by the male students, who prided themselves on the sensitivity in their fingers.

  "Impossible!" Dr. Speransky bellowed. "Golonovin cannot believe that any man, even a doctor, wouldn't have unnatural thoughts for his beloved wife. She will do as well here, we all know that."

  "Yes, of course. I will do my best to make her comfortable," Hannah stammered.

  "We expect more than your best!" Dr. Speransky hissed. As she marched from the room her layers of taffeta petticoats sounded like rushing water.

  VICTOR GOLONOVIN

  After the doctor paused to give Madame Golonovin a few comforting words, she disappeared down the center of the corridor. The two laboring women and a passing scrubwoman pressed to the walls to allow her to pass quickly.

  Hannah was alone with her patient.

  After the briefest APPRAISAL, the young midwife suspected problems might arise during labor and deliver) . Madame Golono-vin's height was average, but her skeleton could barely support a full-term pregnancy. The skin stretched tightly over the delicate bones of her pale face where a miniature nose was but a precise chiseled stub in which the large, tensely pinched nostrils seemed curiously out of place. Madame's wide-set brown eyes contemplated Hannah cautiously and her apparent distrust seemed to mask a far deeper fear.

  Though anxious to begin the physical exam to see if Madame's pelvic bones would be as narrow and weak as Hannah suspected, she hesitated to touch her patient until Madame was more relaxed. Since it could be a full day before her pains came with any regularity, Hannah thought she should insist her patient rest before her ordeal began in earnest. This noblewoman did not look as though she would have the stamina to withstand a lengthy labor, but if she had borne any previous children there might be hope for more rapid progress; Hannah surmised, though, that anyone as nervous as she seemed to be was probably a first-time mother, or primi-para.

  Hannah regretted she had no medications with which to ease Madame's suffering. Though the doctors were experimenting with gases and potions, they tested their use in childbirth only when the patient was in such distress that death was probably imminent. In contrast, the midwife's tools were her training in the natural pro-

  cesses of the body, her understanding of the forces that a woman's personality displayed during labor, and a few techniques in applying this knowledge. Hannah's concern was to spare her patient undue agony at all costs.

  "Oh, Madame Golonovin!" Hannah pleaded silently. "Please make this labor easy, for your sake as well as mine!"

  Instinctively Hannah knew that if she could demonstrate she was not afraid of her charge it would put her in the position of being her momentary equal as well as hint at the intimate level of contact that would be forthcoming. Tentatively she touched Madame Golonovin on the shoulder and found her cloak still wet with the cold Moscow spring rain. Madame turned cautiously.

  "Come, let me show you to your room," Hannah said, making an effort to speak in her clearest, softest voice.

  But her patient stared over her large mounded belly without moving. "I don't think that is possible. I have, I believe ..." She stumbled over her words and blushed a mottled crimson from her collar to the soft honey curls that framed her forehead.

  Hannah bit her lip. "How stupid of me. Already I have failed her!" she thought to herself, remembering that Madame's bag of waters had broken several hours before.

  "Of course, your waters, how distressing for you," Hannah said with sympathy. Then she bent closer to Madame's ear and took one of her velvet-gloved hands into her own small chapped one. "But you must know that while this may never have happened to you before, here
it is the most common of occurrences."

  Madame smiled slightly and looked directly at Hannah for the first time. "At least my outer skirt is still dry," she whispered.

  "I will fix some cloths for you. Just wait one moment."

  Hannah returned from the storeroom with a large linen pad and asked Madame to lean against the wall and tilt her hips while the midwife deftly lifted her skirts and fastened the pad in the waistband at the back of her underdrawers, pulled it through her legs, and finished tucking it in front. Then she undid Madame's wet petticoats and gave them to an assistant who was hovering nearby.

  "Madame will need these washed immediately," Hannah ordered.

  "Yes, Sister, I'll see to it," the young woman replied with defer-

  ence. Hannah made a mental note to learn the name of the serving girl, who might become useful to her if she wasn't prejudiced against her by the other midwives.

  "Now are you more comfortable?" Hannah asked. "We have some waiting to do. Your little one will have to decide whether or not she is coming today."

  "Oh, not she!" Madame protested gaily. "We are expecting another son!"

  Another. Hannah had been wrong in her assumption that this was to be Madame's first child. "You have a boy at home, then?" Hannah asked casually but realized she had made a terrible error as she watched the tears welling up behind Madame's dark eyes. The woman held her breath for a moment.

  "There are none at home," she said simply.

  Madame Golonovin looked so pale Hannah feared she might faint if she were questioned further.

  "You must get settled and I will order tea. That should help you feel much better." Hannah supported Madame's elbow and guided her down the hallway and into her room, which had just received an additional scrubbing. The floor was still damp in spots, so Hannah tightened her grip and steered Madame to the chair by the leaded glass windows.