The Secrets of Midwives

by Sally Hepworth

  “Are you sure it’s over?” Robert asked.

  Neva must have nodded.

  “Then he’s an idiot. An idiot and certainly not a gentleman. Abandoning you when you’re about to have a baby. What have you done to deserve that?”

  I crept a few steps forward and pressed my ear to the wall.

  “I slept with a married man, Dad. A man who was going through something awful with his wife.”

  I clapped a hand over my mouth. But Robert, in usual Robert fashion, didn’t react.

  “She’s made a full recovery—his wife—and she knows nothing about me. The whole thing was a horrible mistake.”

  I wanted to run in there, to wrap my arms around her, but something stopped me. Robert was with her.

  “Well … you know what, sweetie? If there’s something I’ve learned from being married to your mother, it’s that mistakes, misjudgments, failures—sometimes they’re the best part of life. In fact, as far as mistakes go, I’d say this one is the best you’ve ever made. Creating a life. Giving me a grandchild.”

  Neva laughed and sniffed. “You sound like Mom.”

  “She’s rubbed off on me after all these years. As for Patrick … well, I’m guessing he’ll need some time. He might come back. You never know.”

  “I doubt it. Why would he?”

  “You can flagellate yourself if you want, justify all the reasons he won’t come back to you, the reasons he shouldn’t. But you know what? It won’t affect the outcome. You’re better to focus on what you do have, which is a baby, due very soon. A baby who, even without a father, has been blessed in the parent department.”

  I peered around the corner. Robert had his arm around Neva, and her head rested on his shoulder. I took a step back, then another, retracing my steps out the front door and onto the street.

  I powered along the unplowed roads for what felt like hours. The ground was carpeted white, apart from patches where reeds peeked through, too frozen even to sway in the wind. Suddenly it was all so clear. Why Neva didn’t come to me. Why she was so much more open with her father. I’d come into our relationship with so many strings attached. Love me. Share with me. Validate me. And when she didn’t, I pushed her even harder. Even further away. The truth was, she could never have filled me. She wasn’t the one who’d left the hole. It was my father.

  As I walked, I watched two cars skid in the snow, and passed a third lodged in a fence. I kept walking. I didn’t know where I was headed, but after an hour or so, I found myself outside Mom’s house. It was where I usually ended up when things got tough.

  I let myself in and strode toward the sitting room, then skidded to a stop. Neva sat by Mom’s side, cradling a mug of coffee. Tearstains swam on her creamy skin. “Neva!”

  I don’t know why I was surprised. I’d been walking for a long time—there had been plenty of time for her to leave her father and come to see her Gran. A part of me was hurt that she hadn’t factored me into the visiting schedule, but I immediately took that thought back. This wasn’t about me; it was about Neva. And there would be no strings attached. Not anymore.

  “Grace!” she said. “I’ve been looking for you everywhere.”

  “You were?” My cheeks heated. Although I knew it shouldn’t matter, I warmed through at this fact.

  “I’ll make more coffee,” Mom said, rising slowly from the armchair. I moved to Neva’s side, and she fell into my arms.

  “Shhhh,” I said. “It’s okay, darling. It’s okay.”

  She cried until my chest was wet. It was strange, rocking my twenty-nine-year-old daughter in my arms. Strange and sort of beautiful. She told me it was over between her and Patrick. She told me it was all her fault. She told me about the ob-gyn and his wife with cancer. Unlike Robert, I didn’t have any words of wisdom, only sympathy. Sympathy and sadness that, unlike when she was a little girl, I couldn’t magic her pain away with a kiss and an ice cream.

  Mom arrived back with coffee a short time later.

  “Okay,” Neva said. “I’m going to the bathroom and then I’m going to come back and get myself together. Okay?”

  I nodded, pressing confidence into my face. “Okay.”

  Neva heaved herself to standing. She moved slowly, carefully, her knees buckling under the weight of her belly. It had grown since the last time I saw it, and now it was hard to believe she had a month to go. As she lumbered toward the door, a shudder skittered through her.

  “You okay, darling?”

  She nodded with a slight wince. “Fine. A few Braxton Hicks, that’s all.”

  She toddled out, and when she was gone, I raised my eyebrows at Mom, a question of sorts.

  “She’s got herself into quite the situation,” Mom said. There was something playful in her expression. “Reminds me of someone else I know.”

  I laughed. “She reminds you of me? Ha.”

  “More and more lately.”

  “Don’t let her hear you say that.”

  “Too late. I heard.”

  Neva stood in the entrance to the sitting room, her legs slightly apart. A wet stain darkened the leg of her sweatpants. “My water just broke.”

  I leapt to my feet. It was a month early, not dangerously early, but early. I eyed the patch again. Was it possible that it was something else? Many women had trouble with their pelvic floor in the late stages of pregnancy, perhaps—

  “I felt the pop, and there was a good volume of liquid, so yes, I’m certain,” she said. “And it was followed immediately by a contraction I couldn’t talk through.”

  Mom, sensing the urgency, rose to her feet.

  “And you said you’d been having some Braxton Hicks?” I asked. “How often and for how long?”

  Before she could answer, Neva doubled over, breathing the slow familiar pant of a woman in progressed labor. Mom and I exchanged a horrified look.

  “They were irregular until about an hour ago,” she said once the contraction ceased. “Since then, I don’t know. About every five minutes or so? I wasn’t paying close attention. I didn’t think it was labor.”

  I concentrated on keeping my face calm, but I was already a step ahead, and my observations were grim. The snow outside was approaching knee-deep. The only road to the hospital was closed. And even though I could deliver a baby at home with my eyes closed, this baby was four weeks premature. My own clients who went into labor this early would be referred to a hospital.

  Neva moved about the room, robotically collecting her phone, her coat, her keys.

  “What are you doing, darling?”

  “I’m getting my stuff together. We need to get to the hospital.” Another contraction started. Her face contorted.

  “Beavertail Road is closed, Neva. Besides, it’s carnage out there. I wouldn’t put my worst enemy on that road.”

  “Well, what do you suggest?” she said once another contraction had ceased. “That we deliver a breech baby right here?”

  My blood iced in my veins. Somehow, with everything else going on, I’d forgotten Neva’s baby was breech. Now that fact pinned me to the spot. If anything went wrong, the baby, and Neva, would—

  “I’ll call the ambulance!” I yelled. “Mom, can you examine her? I need to know the baby’s position, dilation, everything.”

  I snatched the receiver off the cradle and stabbed the numbers into the phone. The few seconds it took to connect felt like an eternity. All I could hear was my heartbeat. I began to pace.

  “Emergency Services, how may I direct your call?”

  I stopped short. “I need an ambulance. My daughter is in labor with a breech baby—thirty-six weeks gestation. Her water has broken and her contractions are rapidly becoming more painful and frequent. She needs to go to the hospital, but the road is closed and we’re stuck here.”

  “Where are you located, ma’am?”

  “Conanicut Island. Southern tip, near Hull Cove.”

  Long nails tapped against a keyboard.

  “She’s five centimeters dilated, G
race,” Mom called from the other room.

  “And your daughter is in labor?” the woman on the phone asked. “How far progressed—is she pushing?”

  “No! She’s not pushing. She’s five centimeters dilated, and the last two contractions were about three minutes apart. Her water has broken. It’s a breech baby,” I repeated. “It needs to be delivered in a hospital.”

  “And she’s full term?”

  I bit back my urge to scream. “No. She’s thirty-six weeks gestation.”

  “Okay.” Tap. Tap. Tap. “Hold the line please, ma’am.”

  I began pacing again. In the sitting room, Neva lay on a pillow on the floor, battling through another contraction. Mom knelt beside her, a tough position for a woman in her eighties, but she looked at ease. Almost like it was no big deal, delivering a breech baby at home.…

  Of course. I’d completely forgotten. Mom had delivered breech babies during her midwifery training in England, in circumstances far more challenging than these. It was some comfort, but still I didn’t plan for us to be delivering it here tonight.

  “Are you there, ma’am?”

  “Yes.”

  “I have requested a helicopter for your daughter, but there are a number of emergencies this evening with this weather, and it might not be soon enough. I will get an ob-gyn on standby to talk you through it over the phone, just in case. In the meantime, I’m going to need your full name, address, and two contact phone numbers.”

  Neva started moaning again. I felt ill to my core. It couldn’t have been longer than two minutes since the last contraction. This baby was coming, and fast. And they were going to give me an ob-gyn over the phone?

  “I need someone here. I need medical equipment. I’ve never delivered a breech baby.”

  There was a pause. “Have you ever delivered a baby?”

  I screamed internally. “Of course! I’m a midwife. I’ve delivered hundreds of babies. But this is my daughter’s baby. Its breech and four weeks premature. We cannot deliver it here. We need an ambulance!”

  “Just calm down, ma’am.” Tap. Tap. Tap. Tap. “I need you to stay in control, for your daughter’s sake. I’ve requested a helicopter ambulance, but we need to plan for the worst-case scenario. If you are an experienced midwife, the worst-case scenario isn’t as bad as it could be.”

  I dropped my head into my hand. This wasn’t happening. This. Was. Not. Happening. Not Neva. I’d take the charge against me from the Board of Nursing. I’d settle for a boring, sexless marriage with a husband who hated my guts. I’d forfeit any notion of a close relationship with Neva forever. I’d forget about her baby’s father. But I wouldn’t lose my daughter.

  A high-pitched, broken wail pulled me from my thoughts and sent me running to the sitting room. Neva was on her hands and knees on the floor, stripped from the waist down. Her face was mangled in pain. Mom knelt beside her.

  “They’re sending a helicopter ambulance as soon as they can,” I said.

  “They’re not going to make it, Grace,” Mom said. “The baby is coming now.”

  26

  Floss

  The announcement that the baby was on its way came as a shock, even though I was the one who announced it. Several seconds of silence followed, and it probably would have continued if Neva hadn’t whimpered, snapping us all into gear.

  “Now?” Grace asked. Her face was even more ashen than usual. “No. Surely not.”

  “The baby is coming,” I said. “And it’s a footling.”

  Grace dropped the phone and raced over to where I knelt. She gasped when she saw the baby emerging. It wasn’t a breech we were seeing; it was a foot. Things had just got a little more complicated. “Shit!”

  “You’re going to have to deliver the baby, dear,” I said.

  “I can’t. You’ve delivered a breech before—”

  “Never a footling. And I haven’t delivered a child in twenty years, Grace.”

  “I need to push,” Neva said between deep breaths. She looked over her shoulder at Grace desperately. “Grace, can I push?”

  Grace and I exchanged a look. Neva had decided who was delivering her baby.

  “Um.” Already, sweat poured from Grace. She closed her eyes, exhaled, and nodded. When she opened her eyes again, her expression was purposeful. “Soon, darling. Just pant, exactly as you’re doing.” She turned toward the stairs and hollered, “Lil!”

  Lil appeared at the top of the stairs. “Did you call?”

  “Yes, love,” I said. “Can you come down here, please?”

  “We need your help,” Grace said as Lil descended the stairs. “Neva is going to have her baby right here, any time now. There’s no time to get to a hospital, and the road is closed anyway. I need you to go to my place. You’ll find my delivery bag on the bench in my birthing room. It’s sterile and ready to go. I also want you to grab the forceps from the counter. My keys are on the coffee table. Hurry. We have minutes, not hours.”

  Grace’s voice was calm, but the urgency registered on Lil’s face. She nodded. Despite her age, despite the weather outside, despite what was going on between us, she didn’t so much as hesitate. I had never loved her more ferociously. “I’ll be as fast as I can.”

  Grace knelt down. “Mom, I’m going to need you to walk me through this, step-by-step. Speak to me like I’m a student; assume I know nothing. I’m not taking any chances with this delivery.”

  “All right,” I said. “We’ll need towels, a knife, and something for clamping in case Lil doesn’t get here in time. Neva, try not to push, dear. I’ll be right back.”

  I hurried toward the bathroom for towels as another contraction gripped Neva. My heart thundered. A footling delivered at home? Even back in England, I’d have called the flying squad for this. And this wasn’t just any client. This was my granddaughter.

  On my way back, I turned up the heat. It was important the room was nice and warm. If the baby’s startle reflex was activated by the cold, it could start to breathe in utero and inhale amniotic fluid, something we wanted to avoid at all costs. I’d learned that particular fact over fifty years ago, during midwifery training. What other midwifery training would I need to draw on today? Would it all come back to me when I needed it?

  By the time I returned, the baby’s left leg had emerged as far as the knee. Grace looked like she was using every last ounce of energy to stay calm. “Mom, I need instructions. What do I do?”

  I touched Grace’s shoulders. “The most important thing is that as long as delivery continues spontaneously, you need to keep your hands off. If you pull, even a little, you can interfere with flexion of the head or stop it rotating effectively. Worse, it can cause nuchal arms, where the baby wraps its arms around its neck, making it impossible to deliver vaginally. So do not touch the baby at all. Understand?”

  Grace nodded, but her jaw was tight. I understood. It felt unnatural to see the baby coming and not be able to touch it. It must have felt even more unnatural when the baby was your grandchild. Silently we watched as the tiny leg emerged from Neva. Grace’s hands hovered a few centimeters back from the baby. “Now what?” she said. “I really do nothing?”

  “Nothing,” I confirmed. “Just wait.”

  The leg continued to come. I felt a little sick. I’d delivered a breech before, but never a footling. It was what we referred to while studying as a complicated delivery. Far from ideal under these circumstances. If things didn’t go to plan … well … I couldn’t think about that. The baby rotated as it descended, and Grace and I watched silently as the left buttock appeared, then the right. Then—pop—both legs were out. So far, so good.

  “When you see the umbilical cord, pull down a small loop to prevent traction on the cord later in the delivery,” I told Grace.

  Grace did as I asked. The baby was out as far as the torso. But the most difficult part was still to come.

  “With the next contraction, I want you to push, Neva,” I said. “Hard as you can.”

  Neva
nodded, gripping the couch. And when the next contraction came, she pushed. I held my breath and, I’m sure, so did Grace. The contraction finished. Two more contractions came and went. Neva pushed and pushed. Still the shoulders did not appear. I cursed under my breath.

  “The shoulders aren’t delivering spontaneously, so you’ll need to assist,” I said to Grace. Any hope for a smooth, straightforward birth was gone. Now I just prayed for a safe birth. “The anterior arm can be delivered by sliding two fingers over the baby’s back,” I said, “along the humerus to the elbow. Then you can sweep the arm around in front of the baby’s face and chest. Do the same for the other arm.”

  If Grace was feeling anxious, it didn’t show. I marveled as she delivered the arms. It was a tricky technique, but it was as though she’d done it a hundred times before.

  “Good,” I said. “Very good.” Now the entire baby was out, apart from the head. “Okay, Grace. Is the head engaged?”

  Sweat drenched her face. “I … I don’t know.”

  “Can you see the baby’s hairline?”

  Grace looked. “No. I can’t.”

  I looked at the baby, its little torso supported by her right hand. “Let go of the baby.”

  Grace looked at me like I was crazy.

  “Let it go,” I repeated. “If you let the body hang, the weight will pull the baby down and, with any luck, engage the head.”

  Tentatively Grace let go of the baby, leaving it to dangle from Neva. Grace’s body became still. I doubted she was breathing.

  “Good,” I said. “With the next contraction, Neva, I want you to bear down with all your might, okay?”

  Neva nodded, gripping the sofa. Another contraction came and went. I willed Lil to get back. Things were moving fast, and if anything went wrong, we’d desperately need those instruments.

  “Okay, Grace,” I said, turning back. “Is the head engaged now?”

  Grace looked, then shook her head. I squeezed my hand into a fist.

  “What is it?” she asked.

  I hesitated before speaking. “I’m just a little concerned about the biparietal diameter of the head.”

  I didn’t need to say any more. If the baby’s head was too large to pass through Neva’s pelvis, she would need a C-section. Without one, Neva and the baby would die. Grace knew that. Unfortunately, Neva did too.