Caroline de Costa - The Womens Doc: True stories from my five decades delivering babies and making history

Caroline de Costa has lived an exciting and unusual life, is a brilliant doctor, a fierce and trailblazing feminist and now reveals herself as a gripping and evocative writer!

Jane Caro AM, social commentator and writer

An illuminating, infuriating and inspiring tour around the life and career of a woman who helped changed the face of reproductive healthcare in Australia.

Gina Rushton, journalist and writer

Carolines personal journey is also the story of women in this country, their struggles, resilience and achievements in the face of a patriarchal system that cannot hold them back.

Dr Vijay Roach, President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists

First published in 2021

Copyright 2021 Caroline de Costa

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the publisher. The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10 per cent of this book, whichever is the greater, to be photocopied by any educational institution for its educational purposes provided that the educational institution (or body that administers it) has given a remuneration notice to the Copyright Agency (Australia) under the Act.

Allen & Unwin

83 Alexander Street

Crows Nest NSW 2065

Australia

Phone: (61 2) 8425 0100

Email:

Web: www.allenandunwin.com

ISBN 978 1 76052 914 7

eISBN 978 1 76106 148 6

Internal design by Bookhouse, Sydney

Set by Bookhouse, Sydney

Cover design: Christabella Designs

Cover photograph: Getty Images

For Ravi, Viveka, Alex, Naomi, Javed and Josephine

And in loving memory of Jerome Kwame Richard de Costa 19681986

Contents

In many of the stories in this book dealing with women I have had the privilege of caring for, I have changed their names, mostly to protect the womans privacy, but sometimes because I have simply forgotten the name, although not the circumstances. To make the stories flow, I have not marked this. In a few places where an asterisk * appears beside a persons name in the text, the name has been completely changed, and I want to emphasise that change because the subject being discussed is a sensitive one.

ACOGAmerican College of Obstetricians and Gynecologists

APAuthorised Prescriber

FNQFar North Queensland

FRCOGFellow of the Royal College of Obstetricians and Gynaecologists (UK)

FROGSFar North Queensland Regional Obstetric and Gynaecological Service

GPgeneral practitioner

HPVhuman papillomavirus

IUDintra-uterine device

LNPLiberal National Party of Queensland

MRCOGMember of the Royal College of Obstetricians and Gynaecologists (UK)

O&Gobstetrics and gynaecology

OBGYNobstetrician and gynaecologist (USA)

PMGHPort Moresby General Hospital

PMVpublic motor vehicle, Papua New Guinea

PPHpostpartum haemorrhage

RACOGRoyal Australian College of Obstetricians and Gynaecologists (197898; later RANZCOG)

RANZCOGRoyal Australian and New Zealand College of Obstetricians and Gynaecologists (1998present; formerly RACOG)

RCOGRoyal College of Obstetricians and Gynaecologists (UK)

RegShortened form of registrar, a middle-grade junior doctor

RFDSRoyal Flying Doctor Service

TGATherapeutic Goods Administration

VBACvaginal birth after caesarean

WNBWest New Britain province, Papua New Guinea

The first thing I saw was the tiny anus, winking at me from between two miniature buttocks that were rapidly turning blue. Winking because a moment later it plopped a bead of dark-green gunk into the steel bucket resting on the floor between the knees of Dr Jim. The doctor was unmoved by this.

Meconiums normal during breech delivery, he informed us. Its earlier in labour that you start worrying if you see it. Especially if its fresh.

We digested this wisdom in an awed silencemyself, and my fellow student Paul. It was our first day on the labour ward. (Labour wards have now been renamed birth suites, although I wouldnt say that means that labour is any sweeter. Women still work hard.)

Paul and I were the two final-year medical students allotted to watch births that day in October 1972, in the Coombe hospital in Dublin. The Coombe was one of the three venerable lying-in hospitals of Dublin, the others being the Rotunda and the National Maternity, also known as Holles Street.

We were in the new Coombe, located in Cork Street. The crumbling faade of the old premises could still be seen in a nearby street, also known as The Coombe, in the heart of The Libertiesa dense maze of nineteenth-century linen-weavers cottages that have since been gentrified. The old Coombe had spiked iron railings in front of it, like most Dublin townhouses of the Georgian period; it was rumoured that a former matron of the hospital had leaped from a second-storey window and impaled herself on these when her affair with a married obstetrician in the hospital was discovered.

Paul and I had seen two normal headfirst births since that morning. There were two labour wards, with matching architecture, on the second and third floors of the new Coombe, managing between them about 6000 births each year. This duplication could cause confusion, especially at night when sleep-deprived junior doctors would be summoned from the residents quarters across the lawn.

The call would come: Twins in Room 3 deliveringthe first ones out but the seconds a transverse lie! The doc would pull on his white coat and rush across the grass and up to Room 3 on the second floor, causing great alarm to a woman whod given birth an hour before but was being told that her second twin had to be delivered immediately, while upstairs in the other Room 3, a midwife would be cursing, Wheres the damn reg?

That morning, Paul and I had each sat with a labouring woman and taken a historywhen was your last period, how has the pregnancy gone kind of stuff. Wed had lectures on how to do that. As it happened, I had already given birth to two children, and Paul, whod come to medicine after an earlier career as a pathology technician, had fathered four. So we were perhaps less fazed by the chaos around us than some of our fellow students.

For it was very noisy. There were ten labour rooms and each one contained a labouring woman. Any woman who turned up and wasnt contracting regularly was rapidly dispatched to wait in the antenatal ward. We could hear the early groans of the first stages of labour, then the more piercing shrieks as the process intensified, when contractions began coming every three minutes and lasted 90 seconds (a long time, I can tell you). Each woman had a dedicated midwife to guide her through the process but no husbands were allowed. (There were only husbands then; partners did not exist.) In the pre-epidural era of the early 1970s, the main pain relief came from pethidine and from nitrous oxide, also called laughing gas.

I had received pethidine and gas for two births and found that it didnt so much relieve the pain as allow me to fly up into a corner of the room and watch the pain at a distance. I observed the process in other women now. They would fall into a euphoric sleep when a contraction ended, only to be woken minutes later with another sharp reminder of Eves curse.