The Secrets of Midwives

by Sally Hepworth

  The next time Mark tried to kiss me, I closed my eyes. But it didn’t matter. The passion was gone.

  I hadn’t expected to hear from Mark again. But a few days later, I did: Did I want to catch a movie? Did I want to try that new French restaurant? Part of me did. But every time I tried to respond to his texts, my thumbs froze. Eventually he stopped texting, and I was grateful. Until now.

  Mark turned to the woman to his right, as if remembering she was there. “Oh, uh … Neva, this is Imogen.”

  “Hello, Imogen,” I said, forcing myself into a standing position. “Nice to meet you.”

  Her lips pressed together in a tight smile. “Hello.”

  This, I knew, was the part when we would mutter something about being late, and shuffle off in separate directions. I was about to start the ball rolling when Mark’s expression darkened.

  “Could you give us a minute, Imo?” His voice was falsely bright, but his gaze, I suddenly noticed, was fixed on my stomach. “I’ll meet you at your place.”

  Imogen’s puzzled expression must have matched mine. She looked from me to Mark and back again. Then her eyes found my belly. “Oh-kay,” she said, frowning. “See you at home.”

  Mark smiled at her reassuringly. But when Imogen was gone, his smile fell away. “You’re pregnant,” he said to me. It sounded like an accusation.

  “Yes.”

  “It’s not—” He cleared his throat. “—it’s not mine?”

  “No. Oh God, no.” At least now I understood why he’d asked his girlfriend to leave.

  “When are you due?” he asked.

  “December thirty-first.”

  I waited as he did the math. Then, satisfied, he nodded. “Well. Congratulations, I guess. I wish you luck.”

  We bobbed our heads, the mood once again awkward. Drops started to fall from the sky, all at once heavy and separate, like tiny, teeming water balloons. The timing was good.

  “Well, I guess I’d better—” Mark jabbed his thumb in the direction Imogen had headed.

  “Yes,” I said. “Me too. Nice to see you, Mark.”

  “You too,” he said.

  I watched as Mark jogged away. Then, while I fumbled in my pocket for my keys, my phone began to ring.

  I pressed the phone to my ear. “Hello.”

  “Neva, I need your help.”

  “Grace?” My heart beat a little faster. “What’s wrong?”

  “I have a client in labor. Her sister was meant to be my birth assistant but she’s from out of state and the baby is coming early. I’ve tried Mary and Rhonda, they can’t come. Any chance you could assist?”

  I processed the information she’d given me. Grace did home births. The baby was early. The equation didn’t add up. “If the baby’s premature, Grace, you need to take her to the hospital.”

  “She’s thirty-seven weeks along, so there’s no need for a hospital. She’s having the baby at my place.”

  A man leaving the building held the door open for me, and I gave him a wave as I slid inside. “What stage is she at?”

  “I haven’t examined her yet, but I’d guess she’s five to six centimeters dilated, water intact, contractions six minutes apart for the last hour. Second baby.”

  “When did labor start?” I started up the stairs.

  “A couple of hours ago, but it’s progressing at a reasonable rate.” I could hear the desperation in Grace’s voice. “Darling? I really need you.”

  I heaved the door open and plodded into my apartment. “I’m on my way.”

  “You are?” Grace’s voice broke. “You’re really coming?”

  “Of course I’m coming,” I said. The idea that she thought I wouldn’t brought on a wash of shame. Sure, Grace and I had our troubles. But she was my mother. And no matter what problems existed between us, if she needed me, I’d come.

  11

  Grace

  “Okay, Gill, just relax. I’m going to give you an internal exam, see how you’re progressing. Lie back for me. Perfect.”

  I snapped on my gloves and knelt at the end of the bed. Gillian’s husband stood to my right. “David, I need you to help me slide her down the bed. You grab her shoulders, and Gill, you lift your bottom and shimmy down. Ready? Go.”

  When Gillian was in position, I started my examination. “Eight centimeters. My, my. Well done, you.”

  I smiled, then felt for the head, pausing as my fingers found a hard bone in the center of the skull. I concentrated on keeping my face neutral. What was that? I splayed my fingers, feeling the soft surrounding tissue. It felt like a buttock but … it couldn’t have been. The baby had been head-down last time I examined Gillian. With my right hand I felt the outside of her stomach. Yes, it felt like a head.

  Gillian started another contraction, and I removed my gloves and drifted to the sink. I couldn’t make sense of it. If the baby was head-down, what was I feeling? Even though it was unlikely, I couldn’t rule out a breech. If it was—it was high-risk. Too high-risk for a home birth. She’d have to be transferred to the hospital.

  “I’m here.”

  I turned. Neva stood by my side in sweatpants and a hoodie that strained over her belly. Her hair was wet and windswept. I exhaled, suddenly grateful that none of my other birth assistants were available. “Neva! Thank goodness.”

  Neva turned to Gillian and David. “My name’s Neva,” she said. “I’m a Certified Nurse-Midwife, and I’ll be assisting with your birth. Looks like you’re doing a great job so far. I’ll go wash up, and then we should get you up and about. Let gravity do some work for you.” She hesitated then, and looked at me. “I mean … if that’s okay with Grace.”

  “Uh … yes,” I said. “It’s fine with me.”

  As Neva chatted to Gillian, an image of my little strawberry-haired baby daughter popped into my mind, so at odds with the woman I saw before me. She touched Gillian’s stomach gently but not too familiarly. Her facial expressions were professional but warm. All her best qualities were in play.

  When Neva finished her chat with Gillian, she joined me at the sink. “How is it going? Have you done the internal yet?”

  “Yes, though…” I lowered my voice. “The baby was head-down at thirty-five weeks, but when I examined her just now, it felt a bit like a breech. Hard in the middle, soft at the sides. I’m not sure.”

  “Thirty-five weeks? That’d be late for it to turn,” she said, echoing my thoughts. “Could it have been the nose you were feeling? A face presentation?”

  “I suppose.” But I doubted it. I’d felt faces before. This was different.

  “Would you like me to have a look?”

  I sagged. “I’d love it.”

  Neva smiled and my concerns vanished, just like that. With Neva by my side, we’d work this thing out. The idea brought on a small bubble of joy.

  I went to Gillian’s side. “Would it be okay if Neva did another examination before we get you up? The baby’s not in the position I expected, and I want a second opinion.”

  Gillian’s face clouded.

  “This happens sometimes,” I continued, trying to be upbeat. “We’re monitoring the baby’s heart rate, and there is no sign of distress. We just need to know what’s going on.”

  Gillian still looked tense. “But … are you worried?”

  “Do we look worried?” Neva grinned as she snapped on rubber gloves. “Now, I want you to relax for me. Wonderful. Deep breath. This won’t take a minute.”

  Neva chatted throughout the examination, keeping the couple calm and reassured. But I could tell from the length of time she spent feeling around that she had concerns too. After a minute she withdrew her hand and removed her gloves. “Well, I’m baffled. From the outside, it feels like its head-down but to feel it, I’d swear it was breech.” She clicked her tongue as she thought. “My advice is that you go to the hospital. That’s what I would recommend for a client of mine.”

  The atmosphere in the room took a dive. Hail pelted against the window, Mother Nat
ure’s way of agreeing.

  “But … can’t you deliver a breech baby here?” Gillian asked.

  “It’s really not safe,” Neva started, then Gillian rose to her feet.

  “But I … I can’t go to the hospital!” she cried. “Not after last time. Please, Grace.”

  Neva put her hand on Gillian’s shoulder. “It will be all right, Gillian, I promise. But a breech birth is high-risk, and—”

  Gillian started to flap. I reached for her hand. “Just stay calm, it’s not good for the baby if you get upset. Perhaps there is something we can do. Let me speak to Neva, see if we can come up with a plan.”

  I gestured for Neva to join me outside and she nodded. But as I shut the door behind us, her face became a mask of disbelief. “Perhaps there’s something we can do? You’re not suggesting that we deliver a breech baby at home? Six miles from the hospital accessible by only one road. Tell me you aren’t suggesting that.”

  “You’ve delivered a breech baby before—” I started.

  “—I’ve assisted with a breech delivery during my midwifery training. That was in a hospital with an ob-gyn and a pediatrician, not to mention all the drugs and lifesaving machinery I had by my side! Delivering a breech baby vaginally is majorly high-risk. Doing it in a home setting is unethical. If something went wrong, they could both die.”

  “Neva”—I fought to keep my voice even—“Gillian had a traumatic first birth and she’s terrified of hospitals. That isn’t good for the baby. Besides, we don’t even know for sure that it is a breech we are feeling. You said yourself it wasn’t clear. It could be something else. A face presentation, a nasal bone—”

  “—That’s the problem, we don’t know what it is! It didn’t even feel exactly like a breech. Below the bone I felt … a hole.”

  “The mouth?” I asked hopefully. If she felt the mouth, that meant it was head-down.

  “I don’t think so. There was no space between the bone and the hole. If it is face presentation—” She sucked in a breath.

  “What?” I asked.

  “It could be a cleft palate.”

  A short silence followed, then Neva slumped against the wall. I thought about it. If the baby was face presentation, it could have been the nose we were feeling. And the cleft could be the hole Neva was describing.

  “That’s it, isn’t it?” she asked. But her tone said she desperately wanted to be wrong.

  I felt sick. In my entire career, I’d had to give this kind of news only a couple of times. Once when I’d delivered a child with a hemangioma birthmark covering the entire left side of its face. The other time was when I’d delivered a little girl with only two full fingers on her left hand. “I guess we’re going to the hospital, then,” I said after more than a minute of silence. “If the baby has a cleft palate, there could be a host of other problems. We’ll need a pediatrician present.” I braced myself and took a step toward the door.

  “Wait,” Neva said. She took a deep breath, as if weighing up her thoughts. “I know a pediatrician. I might be able to convince him to come here.”

  I paused, afraid to hope. “Really?”

  “Maybe. At least that way Gillian wouldn’t have to have a hospital birth on top of hearing this news.”

  “But … do you think your pediatrician would come to a home birth?” I asked.

  “Not sure,” Neva said. “Give me two minutes.”

  She tugged her phone out of her pocket and jogged down the stairs. I waited where I was. I wouldn’t go in until I knew for sure; I didn’t want to get Gillian’s hopes up for a home birth if this pediatrician didn’t come through. But I was also delaying the inevitable. Was it the right thing, giving Gillian the option to proceed with a home birth? Even with a pediatrician present, we didn’t have the resources of a hospital. If the baby required a blood transfusion or operation, we would lose precious time transferring it to the hospital. On the other hand, keeping Gillian in an environment that she was comfortable with benefited everyone. I was still going back and forth when Neva appeared in front of me.

  “The pediatrician is on his way. Let’s go chat with Gillian.”

  Neva pushed past me into the room. If she had any doubts, I couldn’t see them. And if Neva, Miss By-the-Book, was comfortable, I didn’t have any reason to worry.

  Gillian and David sat up straight as we entered, and I took a seat at the end of the bed. I placed a hand on Gill’s thigh. “Neva and I have discussed what we felt, and we are not convinced that your baby is breech after all. We need to confirm, but we think what we were feeling is—” I took a breath. “—a cleft palate.”

  Gillian looked blank, then turned to her husband.

  “A cleft palate is when the baby’s top lip is missing or deformed,” David said, not to Gillian but to himself. His own lip thinned as he spoke, perhaps in solidarity with his child.

  “No!” Gillian’s face became alarmed. I wanted to assure her that a cleft palate was no big deal. That her baby would still be beautiful, and most likely, the deformity would be minor. But I owed her more than that.

  “David’s right,” I said. “The baby may have a minor or significant deformity to the lip and palate, usually a hole between the top lip and nasal area. Now that we know what we’re looking for, we’ll check for the rest of the face to confirm, but we both think that is what we are dealing with.” I paused as another contraction took hold. Gillian worked through it and her husband helped her. When it was over, I continued. “A pediatrician is on his way. He will examine the baby once it is born. And that might be the end of it—”

  “But it might not?”

  “There’s no evidence of any other problems at this stage,” I said. “But we don’t know anything for sure until the baby is born. Once we confirm that the baby is not, in fact, breech, we can still try to deliver here, if you’d like.”

  “Yes,” Gillian said. “I want to have the baby here. More than anything.”

  I smiled at Neva, sending her a silent thank-you.

  “Okay,” I said to Gillian. “Now, why don’t you lie down again?”

  * * *

  An astonishingly good-looking young man arrived an hour later. Even mid-contraction, Gillian was silenced at the sight of him. Thanks to the unforgiving rain outside, his hair was stuck to his head and his clothes were sodden. When he pushed his hair back off his face, I actually gasped. Out loud. With his strong jaw and pronounced forehead, he had a look of Elvis Presley but more chiseled, more defined. I silently cursed my daughter. It would have been nice to have some warning.

  “Sorry I took so long,” he said, peeling off his soaked jacket and hanging it over the back of the chair. “I could hardly see with all the rain. The thin part of Beavertail Road was terrifying, the waves were actually crashing onto the road—I’m surprised it wasn’t closed.”

  “Thank God it wasn’t,” Neva said. “That road is the only way in and out of this part of the island. If it closes…” Neva trailed away, obviously not wanting to frighten Gillian, but we all heard the subtext. If it closes, we’re stuck here. No one comes in, no one leaves. “But the rain seems to have eased off now, so we should be fine.”

  He looked at me. “You must be Grace. It’s nice to finally meet you.”

  He grinned, revealing almost-perfect-but-not-so-perfect-that-they-looked-fake white teeth. I raised my eyebrows at Neva. Finally? How long had he been around?

  “I’m Patrick,” he said. I waited for the rest. Patrick Whoseummywhatsit, doctor of this and that, and God of all things medical. That was how all doctors introduced themselves in my experience, particularly when they were addressing midwives, who—according to them—were a bunch of uneducated cowboys. But not Patrick. He didn’t even give me his last name. And before I could ask him for it, he was already wandering over toward my clients.

  “Hi, there, Gillian, David,” he said, pulling up a chair and sitting. “I’m Patrick. I’m a pediatrician. Neva’s filled me in on what’s going on. I’m sure you are worrie
d, but try to leave all the worrying to me and concentrate on delivering this baby. Cleft lips and palates can be corrected with surgery. And you’ve had proper prenatal care, so I say we remain optimistic. In fact, let’s get excited. We’re about to meet one of the most important people in your life.”

  I glanced at Neva and she shrugged. Yes he’s special, her expression said. Indeed, he was rather special. In a couple of sentences, he had managed to turn the somber mood in the room around. It was very un-doctorlike. I liked him immediately.

  “Okay, I’m going to sit back now and let the pros do their thing,” he said. “Neva is one of the best midwives in town, and if Grace is her mother, then you’re in fantastic hands.”

  Patrick rose even further in my opinion. A doctor who wasn’t taking over? Who called us—the midwives—pros? Where did Neva find him? And more important, how could I make sure she kept him?

  “Right, let’s get you moving,” Neva said. “I’d like to see this baby come before sunup!” She brushed past Patrick, giving him a nudge with her elbow. He smiled at her, and I saw something in his eyes. He liked her. Hope fizzed inside me, but I tried to push it down. Dared I even hope that this gorgeous man was the father of my grandchild?

  Neva moved Gillian onto a birthing stool, where she spent the next three hours. Labor progressed steadily, and as the sun peeked through the blinds, she began to bear down.

  “Try not to push,” I told her as she began to crown. I squatted by her feet. “Just pant. Slowly, slowly. Good girl. I want the head to come out slowly.”

  “Here it comes,” Neva said, moving in close with a towel.

  As the baby’s face came out, Neva cooed. Patrick had moved in closer and was studying the baby’s face. The baby had a cleft lip and palate, no doubt about it. But Patrick smiled encouragingly at the parents. I had an overwhelming urge to hug him. What a wonderful doctor. What a wonderful man.

  “The head’s out,” Neva said.

  I hooked my fingers under the baby’s shoulder to bring it under and around the pubic bone. Then we waited for the next contraction. The atmosphere was exuberant, exactly as it should be for a first-time home birth.