The Amish Midwife

by Mindy Starns Clark

  I pushed up the sleeves of my lab coat and headed down the hall, my blue clogs clicking against the shiny linoleum. The labor nurse stepped out of the doorway as I reached the suite.

  “How are things going?” I asked.

  “Good. She’s a trooper. Already dilated to seven.”

  “Any support?”

  The nurse nodded. “Her mom is with her. They make a good team.”

  My heart softened a little.

  “I’ll be back in a little bit.” The nurse hurried across the hall.

  I pushed through the door and introduced myself. The girl’s name was Tonya, and she stood by the edge of the bed. Even at full term she looked small, except for her belly, which jutted straight out like a shelf. She wore her dark hair in a high ponytail with a pink ribbon, and her fingernails were painted fuchsia. Her mother, Tammy, shook my hand and met my eyes, assuring me that things were going well. They had taken a birthing class together and were prepared. Tonya rolled her eyes, but then a contraction gripped her. “This stinks,” she muttered, grasping the headboard with one hand.

  “You’re doing great, honey,” Tammy cooed. Taking note of the circles under her eyes and the rumpled state of her flowered blouse and brown slacks, I knew she had been at this for a while, helping her daughter through the pain.

  Tonya moaned deeply as her contraction intensified.

  The first delivery I ever saw had been atypically peaceful and serene, a mainstream mother who had chosen to use a midwife because of her non-mainstream ideas about birthing. When the woman’s husband rubbed her back or stroked her hair, she told him thank you. Every time a contraction came, she leaned against him on their antique bed in their old farmhouse, endured it in silence, and smiled when it was over. When it was time to push, she closed her eyes, and after only two contractions out popped a baby girl, eyes wide, taking it all in. After the father cut the cord, Sophie wiped the baby off, wrapped her in a flannel blanket, and handed her over to the eager parents. They cuddled her together, and then mother and child melted back into the bed as one. Soon, the father brought their two-year-old son upstairs, where the boy snuggled with his mom and sister, patting both of their heads with his chubby hands. I recalled that I spent most of the afternoon standing in the bedroom doorway trying not to cry. Sophie remembers me helping the mother walk to the shower, stripping the bed, starting the laundry, and making toast with jam for the two-year-old.

  That was the first. After that came many more, though of course their reasons for using a midwife varied. There were modest Mennonite mothers, Hispanic migrant moms, poor mamas without insurance, and a few like that first mother who simply wanted to give birth in their own home, on their own terms.

  In my senior year of high school, I took anatomy and a medical career prep class, planning to be a labor and delivery nurse. But when I read in our textbook about the world of the nurse-midwife, I knew that was what I wanted.

  Once Tonya’s contraction came to an end, I told mother and daughter both that I would be back in a while to check on how things were progressing. Stepping into the hall, I moved toward the room of my second mother in labor, a patient of mine, Jane Hirsch. I had delivered Jane’s first baby, a boy named Jackson, almost three years before. Baby number 9. Jackson now went to a co-op preschool, and Jane worked part time in a law practice that specialized in nonprofits. This time around I had really enjoyed doing her prenatal visits, watching the interactions between mother and son. Though dad often seemed a bit preoccupied with his work, Jane was a hip and fun and devoted mom, the kind I wanted to be someday.

  “How are you?” she asked as I entered the room. Jane’s long hair was twisted up on her head, her face was much fuller than when I saw her last, more than a month ago, and her belly stuck straight up in the middle of the bed.

  “Good,” I answered. “How are you?”

  She shook her head. “You have to tell me about you first. You were off work for three weeks. I was terrified I might have to go through this without you.”

  “My father passed.” Unwanted tears sprang into my eyes.

  “Oh, Lexie.” She reached out her hand. “I’m sorry.”

  I was glad that her husband, an up-and-coming executive, wasn’t there to witness my being so unprofessional. “It’s okay,” I said, giving her hand a quick squeeze and then withdrawing it. “It was expected.”

  “But still…”

  I nodded and then forced myself to smile. “Have you had your epidural?”

  “Just.”

  “And where’s the hubby?”

  “In the cafeteria.” She laughed. “Lucky him.”

  Food was another one of the differences between a home birth and a hospital birth. At home the mom could eat yogurt and fruit and soup to keep up her strength. In the hospital, with one in three births ending in a C-section, food was withheld because a full stomach could be a sick stomach in surgery.

  The monitor beeped, and Jane and I both looked at it. She was having a contraction—a good strong one. She held up her arms and waved her hands. “I hardly feel a thing,” she said. “Just some pressure.”

  Some people have a memory for faces. I have one for births. Even though Jane’s first baby was 235 births ago, I remembered his arrival perfectly. She had arrived at the hospital too late to have an epidural. That was her top priority this time.

  “Who’s with Jackson tonight?” I asked.

  “Grandma. My mom. She’ll bring him up in the morning.”

  Jane and I chatted a little longer, and then I headed back across the hall to check on Tonya.

  She was on the bed now, sitting cross-legged.

  “Do you want a drink of water?” Tammy asked.

  The girl frowned and shook her head.

  “How’s it going?” My voice was subdued.

  “Fine,” Tonya growled, stretching out one leg and then the other. The monitor showed a contraction coming on. I waited to see what she would do. It didn’t take her long to climb off the bed with her mom’s help. Her face contorted, and she took a deep breath. Tammy stepped behind her and began rubbing her shoulders. I expected the girl to push her mother away, but she didn’t. She groaned a little as the contraction ended.

  “Let’s check you.” I helped her back onto the bed.

  She was at ten centimeters, ready to push. She was a trooper, not what I’d expected at all.

  “I’m almost there?” she asked.

  “We’ll soon see. It’s different for every—” I almost said mom, but because she might be relinquishing the baby, I said, “—one. Sometimes a woman pushes for quite some time.” Up to three hours. “But other times the baby delivers after just a few pushes.” I didn’t add that was usually the case for second and third babies. I took off my gloves, dropped them into the garbage, and then decided to stay with Tonya for the next few contractions to see how quickly things went. It would be hours before Jane delivered.

  Every once in a while I offered a word of encouragement while Tammy bustled around, dimming the lights, offering Tonya water, and timing each contraction. Even though she had the urge to push, it wasn’t strong yet, not the way it would be soon. She leaned back against the pillows on the bed, her painted nails resting atop her belly, between contractions.

  “Here comes another one,” Tammy said, switching her gaze from the monitor to the clock. Tonya pressed her hands down on her knees and pulled forward. I stepped to the side of the bed and held one of her legs. She scrunched up her face and then started to grimace.

  “Eighty-five seconds,” her mother announced.

  “You’re doing great,” I said.

  “It hurts.” She collapsed back against the pillows.

  “It’s supposed to,” her mother said, matter-of-factly. I wondered if perhaps it was the mom who had decided Tonya shouldn’t have an epidural. Maybe she wanted her to feel all the pain.

  The OB nurse came in, and I slipped across the hall to Jane’s room. She and her husband were watching the news. “How�
�s it going in here?” I parked myself in front of the computer and read the nurse’s notes. Thanks to the epidural, her contractions had slowed.

  “Doing great,” Jane answered.

  Her husband and I chatted for a minute, and then just as I was getting ready to leave, a scream jolted the night.

  “Be back soon.” I walked quickly to the door and scurried across the hall. Tonya was pushing with all her might.

  The OB nurse held one of her legs and her mom the other. I snapped on clean gloves as the nurse grinned and said, “I thought that holler would bring you running.”

  The baby’s head crowned with the next contraction. “Tonya, you’re amazing. Another push or two and—” I stopped myself from saying your baby. “And the baby will be here.”

  It took only one more push for an absolutely perfect little girl to slip into my hands. She looked up at me with wise old eyes and then hiccupped before I grabbed the suction. She hiccupped again and then began to whimper. She was tiny—probably just more than six pounds—but good sized for being three weeks early.

  “Time of birth is 11:57 p.m.,” the nurse said.

  I grabbed a warm receiving blanket and swaddled her. Baby number 245.

  Tonya collapsed back against the pillows as tears raced down her face, pulling streams of black mascara after them. “I want to hold her,” she said. Her arms reached out toward me.

  FIVE

  I searched Tammy’s face and she nodded. I leaned forward with the baby, slipping her into the teenager’s hands. Tonya pulled the little girl to her chest. “You’re so beautiful,” she said. How many new mothers had I seen say exactly that? Even at fifteen, even still a girl, she instinctually knew what to do. Tonya’s mom hovered above the two, her hands clasped under her chin. “So beautiful,” the girl said again and then she began to sob. The nurse and I moved toward the door to give them space.

  I still needed to deliver the placenta. The nurse needed to weigh the baby. And there was the matter of what to do with the newborn. Probably put her in a warm isolette in the nursery after the nurse cleaned her up. That would leave Tonya and her mom alone to grieve.

  “Are the adoptive parents here?” I whispered to the nurse.

  She shook her head.

  Thank goodness. I waited a few more minutes and then said, “Tonya, how about if you pass the baby to your mom? We have a little bit more work to do.”

  Their hands became entangled, and a second later the baby was in the new grandmother’s arms. As I concentrated on caring for Tonya, I kept track of Tammy out of the corner of my eye. She was entranced with her new granddaughter, swaying gently, making eye contact, smiling, saying sweet nothings. She was in her own world, just the baby and her. It wasn’t going to be easy for either one of them to let her go. I felt a pang for the hopeful adoptive parents. I thought of Mama and Dad, and for the first time wondered what the night I was born was like for them, if they were already in Pennsylvania or if they had waited to come. Why hadn’t I ever asked Dad about those details? If I had, would he have told me?

  The nurse directed Tammy over to the in-room isolette to weigh the baby. “Six pounds four ounces,” she said. Tonya’s mom held her hand on the baby’s chest as the nurse cleaned her.

  As I finished up, I thought of my own birth grandmother, wondering if she had been as enamored with me.

  I covered Tonya with a warm blanket and lowered the bed to a reclining position. In a second her mother stood beside her, holding the baby again. The resemblance between the three was incredible. All had the same delicate nose and heart-shaped face. Each had a little hill of a chin that jutted out.

  Tonya began to sob again.

  Her mother leaned over and kissed her forehead. “What’s the matter?”

  Tonya’s body convulsed, and her face quivered.

  Tammy perched on the bed, the baby still tucked in her arm like a football. Tonya reached out and stroked the infant’s curled fist.

  “It’s hard,” Tammy said. “I know.”

  “You don’t know.” Another sob racked her. “You got to keep me.”

  “I was older.” Tammy wiggled closer to her daughter. “Done with school. I had a job. And insurance.” Tammy’s voice was low.

  Tonya reached out for the baby.

  “Sweetie,” Tammy said.

  “Please?”

  Tammy’s face contorted as she stood. The baby began to whimper.

  “Mom,” Tonya pled.

  Now the baby was crying that traumatized newborn wail. “Shhh.” Tammy bounced the baby, but the cry grew louder.

  Tonya was sitting up now, reaching for her child, and then Tammy was sliding her into her mother’s arms. “I can’t go through with it,” Tonya whispered, sinking back down onto the bed and pulling the baby to her chest.

  Tammy nodded. “I’ll call the lawyer in the morning.” She didn’t seem surprised as she collapsed on the bed beside her daughter and now silent granddaughter. They stayed that way for a while, and then Tammy said, “You should nurse though, if you’re going to keep her.”

  Tonya nodded. I slipped out the door, dabbing at my eyes. I knew of other midwives and doctors who would have intervened. They would have at least asked Tammy if they had the resources and support they needed. I would flag Tonya’s chart for a social worker to stop in and see her, but I wasn’t going to get in the middle of it. Tammy seemed to know what she was doing. She knew what it took to raise a child. And she couldn’t be more than forty herself. She was perfectly capable of raising another baby. No, I wouldn’t get involved in this one. It hit too close to home.

  I stepped into Jane’s room, forcing myself not to think about the couple who was waiting, somewhere, hoping for that beautiful baby girl, having no idea of the heartbreaking phone call coming their way.

  At 5:23 a.m. Jane delivered her eight-pound boy. By 7:15 she was tucked into bed, ready to sleep with baby Jefferson beside her and her husband hunched on the little window seat, already snoring. The gray morning sun streamed through the leaves of the trees outside the window. I turned the blinds shut. “Give Jackson a kiss for me when he comes to meet his brother,” I said as I patted Jane’s foot.

  She nodded and smiled. “Thank you,” she whispered.

  “My pleasure,” I said. And it was. Baby number 246. It had been a perfect night.

  As I slipped into the hall, I decided to peek in on Tonya one last time. A woman, obviously a maternal aunt by how much she looked like Tammy, held the baby. Tonya slept, her mouth slightly open, on the bed.

  “Have you had any rest?” I asked Tammy.

  She shook her head. “I will later.” She turned toward me. “Does this happen very often? That a girl changes her mind about giving up her baby?”

  “It happens.”

  “Do you think I should have discouraged her?”

  I shrugged. “I don’t think there’s any right answer. I think it’s entirely up to you.” I touched the baby’s cheek. I suddenly had the urge to tell Tammy that I was adopted, that I had a grandmother who had once loved me that I never knew. But I didn’t. Instead, I handed her my card and asked that she email me a photo of the baby when she got the chance.

  “You bet I will,” she said.

  Kin was the word that came to mind when I stepped out of the room. It was such an old-fashioned word. I remember Mama talking about her relatives who lived in Kansas and saying, “My kin…” I’d looked the word up in the dictionary a few months after she died and found “persons of common ancestry.”

  I was kinless.

  The next day I applied for a Pennsylvania nursing license and emailed requests for information from three traveling nurse agencies. In the following weeks, on my days off, I sorted through Dad’s things, trying not to drown in my grief. Memories of my parents and obsessions of my nowkinless state hovered like a thick fog on the Willamette River. Then came the mid-March morning, almost five weeks after my father had passed, when the fog began to clear.

  I was riding my
bike across the Broadway Bridge on my way home to Northwest Portland after a long labor and a difficult delivery of baby number 255. The weather was cold and the river was the color of steel. A tugboat pushed a barge toward the Saint Johns Bridge, and somewhere in the distance a whistle blew. Halfway across the bridge my cell phone began vibrating in the pocket of my bicycle jacket. I slowed and pulled it out. Sophie.

  I stopped the bike, leaning against the railing as I said hello. A pigeon flew up from the underside of the bridge. Another bicycle went by me, the rider a flash of orange-and-yellow Lycra topped with a superhero helmet. Slapped across the back of the helmet was a bumper sticker, “Keep Portland Weird.”

  “Hi, Sophie,” I said loudly, trying to be heard above the roar of the traffic on the metal plates of the bridge.

  She told me she had more information about the midwife in Pennsylvania that she’d told me about the day of Dad’s funeral. “It turns out she does need help,” Sophie said. I could barely hear her and began to wheel my bike with one hand. She said the woman was in legal trouble. I guessed it was one of those messy lay-midwife licensing issues and was thankful I hadn’t agreed to help the woman. I already had a lead on a traveling nurse job in Pennsylvania, and my nursing license had arrived yesterday.

  “I don’t know what the issue is, exactly,” Sophie said. “I’ll let you know when I find out more. But, and this is really why I’m calling, I’m pretty sure you and Marta—the woman’s name is Marta Bayer—are related somehow. At least the mutual friend we have thinks so. I wish my mother were still alive to tell us how, exactly.”

  “My parents didn’t have any relatives in Pennsylvania,” I said, but even as the words came out of my mouth, I realized what she meant. She was talking about a blood relation.