Midwives (1997)

by Bohjalian, Chris

  "No, they don't."

  "About the same?"

  "The numbers are small, so it's hard to make a statistical comparison."

  "Bearing in mind the numbers are small: About the same?"

  "Yes."

  "How about maternal mortality? Do you see a greater incidence of maternal mortality among midwives delivering babies at home?"

  "No."

  "In fact, did any nurse-midwife in your organization see any woman die in home childbirth last year?"

  "I don't think so. But that doesn't diminish--"

  "In fact, none died, Miss Martin," Stephen said, cutting the woman off before she could elaborate on her answer. "Did you know Bell Weber?" he then asked.

  "I did."

  "Would you tell us who she was?"

  "She was a nurse-midwife. She died this summer in a car accident."

  "Did she deliver babies at home?"

  Martin nodded. "In Maryland."

  "Was she a member of your group?"

  "Until she died."

  "Was she on the Division of Accreditation with you?"

  "Yes."

  "Was she on any other committees for the American College of Nurse-Midwives?"

  "She was chairing the home birth committee."

  "Your organization has a home birth committee? Really?"

  The midwife looked annoyed with Stephen, disgusted at the flippant way he'd asked the question. "Obviously we have such a committee."

  "Is that because some midwives in your group still choose to practice there?"

  "Yes."

  Stephen nodded. "Does the American College of Nurse-Midwives formally oppose home birth?"

  "No."

  "Thank you."

  Kimberly Martin was followed by another woman who had once caught babies in people's bedrooms, and then, apparently, decided this wasn't a particularly good idea. A few minutes after she began answering Bill Tanner's questions, I must have looked worried or nervous, because Patty Dunlevy turned to me and whispered that we had experts, too, and ours would be every bit as impressive as these people.

  But that afternoon it was hard for me to believe we'd have anyone as accomplished as Dr. Jean Gerson. Thirty years earlier Jean had been a young midwife delivering babies at home; now she was an ob-gyn affiliated with a teaching hospital in Boston, a faculty member at Boston University's School of Medicine, and the author of two books on prenatal care.

  She had also written extensively about the history of birth in America. It was she who reminded us early in her testimony that while labor is natural, it's dangerous: "Let's face it," she had added, "there was a time when women and babies died all the time in labor."

  Dr. Gerson had reviewed the medical history Charlotte Bedford had supplied my mother the summer Veil was conceived, and she had examined the records my mother had kept, charting the woman's progress. And she told the jury that no responsible person, doctor or midwife, would have allowed Charlotte Bedford to labor at home. It was clear based on her first labor that she was a poor candidate for home birth, and it was evident during the pregnancy that she was too frail for the ordeal. She wasn't gaining enough weight, and she was anemic.

  Moreover, Dr. Gerson was positively telegenic. She was a handsome, dignified woman who smiled when she spoke, the sort of person who was instantly likable at even the sort of distance--figurative as well as literal--that separated defense and prosecution tables in a courtroom. Years later when I was in medical school, I would recall her face and her voice, and I would find myself wishing I had gone to B.U.

  Ironically, a part of my mother's defense was the fact that Charlotte was indeed an imperfect candidate for a home birth, but not because she was anemic: Stephen planned on making an issue of the fact that Charlotte had been treated for hypertension in Alabama but had never shared this information with my mother. And so when he stood to begin his cross-examination of Dr. Gerson at the end of the day, the sun so far to the west that the courtroom was lit almost solely by the big chandelier and the sconces along the walls, we all expected the two would have a brief and perfunctory conversation.

  "Are many pregnant women anemic?" Stephen asked her, and I was surprised by the energy that still filled his voice. It may have been because I had been up so late the night before, and it may have been due to the stress, but I was exhausted. I couldn't imagine where Stephen got his strength.

  "I wouldn't say many are 'anemic,' but I would say that many experience some small degree of anemia," she answered.

  "Why is that?"

  "When a woman is pregnant, her blood volume increases. Sometimes it increases by as much as half. And so there's a natural dilution, and a natural anemia."

  "Is it treatable?"

  "Yes."

  "How?"

  A newborn baby in the back of the courtroom started to whine and fuss, and I heard the sound of the long zipper on the front of his mother's dress. I saw many of the jurors glance reflexively in the woman's direction, and then Judge Dorset looked that way, too. Almost instantly all of the men turned away when they saw the woman place the nipple on her full breast into the infant's mouth, deciding to stare intently at Stephen or the doctor instead.

  "Iron tablets. Ferrous sulfate, usually."

  "Any side effects?"

  "Indigestion sometimes. Often constipation."

  "You said you've reviewed how Sibyl treated Charlotte Bedford's anemia, correct?" Stephen asked.

  "That's right."

  "What did Sibyl do?"

  "She had her take iron tablets."

  "Did her condition improve?"

  "Not enough to merit--"

  "Did Charlotte Bedford's condition improve?"

  Dr. Gerson offered a broad smile that suggested to me--and I have to imagine to the jury as well--that she wouldn't stoop to Stephen's level of discourtesy and debate. If he wanted to interrupt her and cut her off, her smile said, fine. It made no difference to her.

  "Yes," she said.

  Stephen asked the court officer who was standing beside the rolling cart upon which Bill Tanner was piling his evidence for the medical records the State had just entered. He then handed the physician two sheets of paper lined with boxes and graphs.

  "Do you recognize these?"

  "They're the records your midwife kept of the deceased."

  "These are the records you examined?"

  "A part of them, yes."

  "What are their dates?"

  She adjusted her eyeglasses slightly and then answered, "One is from September fifteenth, 1980, and one is from February twelfth, 1981."

  "I want to focus on the hematocrit values," Stephen said, referring to the term the medical community uses to describe the percentage of blood occupied by red corpuscles. All of us in the courtroom had learned the term during the first part of Dr. Gerson's testimony. "What was Charlotte Bedford's hematocrit value in September?"

  "Thirty-one percent."

  "What is it normally?"

  "Oh, around forty-two in most women. Slightly lower in a pregnant woman."

  "How about February? What was the woman's hematocrit in February?"

  "Thirty-five."

  "Is that an improvement?"

  "A slight one."

  "When one of your patients--a pregnant woman--has a hematocrit value of thirty-five, do you anticipate a bad outcome?"

  "That's an odd question, and I'm not sure it's relevant. After all, I deliver babies in hospitals. If you mean, would it affect my handling of the woman's preg--"

  "I'll repeat the question: Would you anticipate a bad outcome?"

  Dr. Gerson was silent for a moment. Finally she said simply, "No."

  "Thank you."

  "You're welcome."

  Stephen paced toward the windows with his hands behind his back. When he had put some distance between himself and the witness, he turned back toward her and asked, "You told us earlier that Charlotte Bedford's blood pressure was slightly higher than normal. Am I correct?"


  "Yes."

  "How would you have treated it?"

  "I would have watched it very carefully. Perhaps placed her on bed rest. I don't know if I would have prescribed an antihypertensive. I might have."

  "Would you have looked for protein in the urine?"

  "Yes indeed."

  "Based on those records, did Sibyl?"

  "Apparently."

  "Thank you. Is there any indication in Charlotte Bedford's medical records that she had ever been treated for hypertension in the past?"

  "I didn't see any."

  Slowly Stephen began to walk back toward her. I'd seen him do this enough during the day that I knew it was all part of a strategy of irritation and intimidation: He was about to invade the good doctor's personal space, practically leaning into the witness box with her.

  "Am I correct that there's a box on the form that says 'Patient's History'?" he asked as he approached.

  "Yes, there is."

  "And it lists a variety of ... conditions?"

  "It does."

  "What has been circled in the box?"

  The doctor looked at the form and then read from it, "Bladder infections. German measles." When she looked up, Stephen was directly beside her, standing catty-corner so the jury could see both of their faces.

  "That's it?"

  "That's right."

  "Have the words 'high blood pressure' been circled?"

  "No."

  He nodded and prepared for the kill. Sometimes, of course, even the best hunter misses his mark; sometimes the lion charges abruptly and flusters even the coolest rifleman. This would be one of those moments. And while Stephen would ask to have Dr. Gerson's remarks stricken from the record, and while the judge would agree, the jury had not missed what occurred and I could not imagine they would forget it when they were deciding my mother's fate.

  "There is no indication that Charlotte Bedford shared her history of high blood pressure with Sibyl, is there, Doctor?"

  "Bottom line, Counsel," the doctor said, speaking quickly but calmly, her voice gently condescending, "is that the records show the poor woman had symptoms of both anemia and high blood pressure. Both. No doctor or midwife in her right mind would ever have allowed that woman to labor at home."

  We drove home Thursday night with the car's heater on, and I sat in the backseat with my knees curled up to my chest and my coat draped over me like a blanket. The heater in my mother's car could still warm the car like a woodstove, but during the previous winter it had developed a tendency to rattle, as if a piece of thick paper were caught somewhere in a vent.

  My parents said little to each other, as they had most of the week. I imagine they were too spent to talk, and even if they had the energy, I doubt they would have known what to say. Occasionally my father would try and cheer up my mother by observing how Stephen had done a fine job taking apart one witness, or how the damaging testimony of another would be negated when Stephen began our defense.

  Usually my mother would just mumble her agreement and stare at the trees we could see in the twilight.

  When we got home, however, there were glass vases of roses awaiting my mother on the kitchen counters: a bunch of red ones, a bunch of yellow, a bunch of pink. My father had had them delivered during the day, and each vase had a large card beside it he'd made himself with old photos of the two of them, architectural blueprint paper, and the binder clips I knew he used for capabilities presentations for prospective clients. The cards were beautiful, and my mother was touched.

  Later that night when they were passing my bedroom on the way to theirs, my mother was still talking about the cards and the flowers, and I found myself bragging about my father in phone calls to Rollie and Sadie and Tom.

  Friday morning began with the testimony of a woman whose little baby my mother had hoped to deliver, but who had wound up giving birth via cesarean in a hospital instead. It had been a hard, unpleasant labor, and she said my mother had demanded she push for almost half a day: ten and a half hours of pushing and resting, pushing and resting, before my mother had finally--to use this woman's word--"allowed" them to leave for the hospital.

  We were then treated to a man who insisted my mother had never warned him or his wife that there were greater risks involved with a home birth than with a hospital one. According to this fellow, he and his wife would never have tried to have their child at home had my mother been appropriately candid. Although the State was not allowed to ask the fellow how his baby's birth had turned out, my parents and I had to sit in agony throughout his testimony, aware of the fact that his infant was one of the tiny few whom my mother caught dead.

  And, as lunch approached, the State squeezed in one more witness, a doctor who explained to us all what a prolonged second-stage labor meant, and the dangers it posed for the mother. The doctor was a researcher with the American College of Obstetricians and Gynecologists in Washington, D.C., an organization of which I am now, ironically, a dues-paying member. Like Dr. Gerson, he viewed labor as a dangerous circus stunt: He was the witness who in one especially rare moment of rhetorical flourish compared a hospital to a car seat, and then jumbled a car accident and a kitchen appliance.

  But it was clear the jury got the point, and thought Dr. Geoffrey Lang was a wise and compelling man.

  In another particularly brutal exchange from my mother's perspective, he managed to simultaneously explain why pushing too long endangered a woman, while casting yet one more aspersion upon my mother's competence: "It's perfectly reasonable that someone with the limited training of a midwife would suspect a ruptured cerebral aneurysm. Obviously, that's not what occurred in this case, but someone with only rudimentary obstetric education might think such a thing."

  "What did occur?" Bill Tanner asked, and for the first time I heard spoken the word I'd seen written the month before on a wall in Stephen's office. Vagal. It was one of the words and expressions Tom Corts and I had seen scribbled in sprawling Magic Marker letters on the large sheets of white poster paper.

  "She--and this is a shorthand term some doctors I know use in conversation--vagaled. She vagaled out." With clinical formality, he then began laying the groundwork for the testimony we would hear that afternoon from the medical examiner.

  "You went easy on Farrell," my father told Stephen as we picked at our food during the recess for lunch. Farrell was the father who said my mother hadn't been clear about the risks that come with a home birth.

  "He really wasn't all that damaging," Stephen said, and he asked Peter Grinnell to pass him a paper napkin from the metal box against the diner's wall.

  "He made it sound like Sibyl hides things," my father continued.

  Stephen touched a tip of the napkin to his tongue and then rubbed the moist paper over an ink smudge on the back of his hand. "Think so?"

  "Yeah, I do. Don't you?"

  Stephen looked at the skin on his hand and folded the napkin again and again until it was roughly the size of a quarter. "It seemed a lot worse to you than it was. The jury doesn't know that he and his wife had one of those bad outcomes."

  The food on my father's plate, a grilled cheese and coleslaw, looked exactly as it had when the waitress brought us our lunches. The sandwich remained a pair of flat, butter-burned triangles, and the mound of coleslaw still held its ice-cream-scoop shape.

  "What about that doctor?"

  "Lang? I thought we went at it pretty good."

  Peter signaled for the waitress to bring the check to our booth.

  "I wish we'd done more."

  "I made sure the jury understood that every word he said was conjecture. And I made sure they realized the guy never even saw the woman's body. Tell me, what more would you have wanted?" There was no edge to Stephen's question, no trace of irritation.

  "He was a horse's ass. I wish we'd made that clear."

  Stephen nodded, letting my father's frustration roll over him like a wave. When he saw the waitress drop the bill on the table by Peter, he reached inside his sui
t jacket for his wallet.

  "Well, we'll get 'em this afternoon then," he said, and he sounded to me like my high-school track coach.

  "Look," my mother said, her voice strangely groggy as she gazed out the window at Lake Memphremagog. "There must be something flat floating out there. Look at the seagulls."

  Perhaps a hundred yards into the lake, dozens of seagulls were standing on the surface of the water--not floating or bobbing as one might expect, but standing with their small legs extended below them on pieces of driftwood. We all turned, and as I did I looked at my mother's eyes, and something about them suggested she hadn't heard a word my father and Stephen had said.