Leah Hazard: Hard Pushed review - a midwife's tales

This layered medical memoir by practicing midwife Leah Hazard unpacks riveting tales of all kinds of deliveries and is underpinned by distress at the parlous nature of the understaffed and overworked NHS.

Medical tales (including Adam Kay’s This is Going to Hurt, Christie Watson’s The Language of Kindness, David Nott’s War Doctor, and How to Treat People by Molly Case) hit a nerve. We are fascinated because we have all been there and the NHS is absolutely central to our culture.

What sets Hard Pushed apart is that while not all of us are mothers, but we have all been born.

We meet all kinds of people, cutting across class, culture and other boundaries. One of the most telling is her encounter with the heavily pregnant Hawa, whose inability to urinate for over a day stems from female genital mutilation (FGM). The WHO estimates FGM has been carried out on 200 million women worldwide, with 3 million girls at risk of it every year. Hazard handles the discovery with tact, solving the encounter by telling Hawa that – with the aid of a catheter – she has delivered her ‘pee baby’ and can now deliver her real baby.

She recounts an emotional discussion with young midwife Trisha who cannot face the uncertainties, emergencies and sorrows that the day might bring. In her short time as a qualified midwife she has already delivered 82 babies but is deciding whether to give up the profession. Hazard’s diagnosis is that you have to be thick skinned yet remain human: her 'Notes on Getting it Wrong' chapter is a superb meditation on mistakes and recovery for both perpetuators and patients. She wryly suggests that during her training she might have slept through her alarm clock and not got to the talk on 'How Not to be Human'.

Hazard’s own practice alternates between triage nurse and actually delivering babies so we are given glimpses of the whole process. There is a lot of cleaning up to do: it is not only babies that emerge from the mother.

Society’s dark side intrudes: a malnourished teenager, hungry, unwashed and terrified, is a trafficked ‘sex worker’ who was thrown onto the streets when her pregnancy was discovered. An interpreter reveals her horrifying story: Pei Husan and her sister (since disappeared) were sold by their father. A voluntary group offer to take her in, but even when a male mini cab driver arrives to collect her, she shies away in fear of being dragged off again.

There are fascinating psychological problems: another young mother comes in because she feels the scar from her Caesarean may be infected. The cause is psychosomatic: by remaining at home alone with her young baby she’s become stir crazy, obsessively cleaning the house four times a day suffering real exhaustion and imaginary discomfort. .

There are litanies of wonderfully daft questions from the pregnant: if I go blonde, will it hurt my baby? Can I put olive oil in my ear? Does licking Mr Whippy cause foetal distress? At times there is inexplicable hostility towards the midwife and in once absorbing instance, practically everything goes wrong.

The relieved husband describes how the midwife met the couple, looked after them, delivered the baby, scrubbed, stitched and cleaned up. He kept thinking “Where’s the cavalry?” but there was just the midwife: the midwife was the cavalry.

All human life is here and although there is a subtle display of societal highs and lows the prose is occasionally clunky. Overall though, this is a fascinating and entertaining book packed with stories from the front line. Gird your loins and man – or woman – up.

• Hard Pushed by Leah Hazard (Hutchinson hardback £16.99 pb £13.99 e-book £16.99)
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