The Reluctant Midwife

by Patricia Harman

  She takes another sharp turn and follows a narrow gravel road along a bubbling creek where the water is a shocking golden color and the rocks are covered with orange slime that comes from acid runoff out of the mines.

  “I worked at Scotts Run as a public health nurse when I first came to West Virginia,” I tell her. “Up there, even some of the nonunionized camps had nice schools and churches and a clinic with a doctor, but that was over ten years ago.”

  “That’s the way it should be. Unions, just by their presence, stand for improved living and working conditions, but now that the economy has fallen apart, the coal barons can do anything they want. They know the men won’t strike. It’s not like there are a lot of jobs to choose from and they’re lucky they have one.”

  As we continue into the hollow, I see shacks perched on the hillside and a company store, but nowhere a clinic or school. Miners, wearing metal hats with lights on them, their faces so black you can only see their eyes, are just coming out of a massive dark hole. Some of them lift their heads as we pass, but only one fellow waves.

  Thelma

  “You remember Thelma?”

  “I saw her at my Women and Infants’ Clinic, years ago. Had to explain everything to her twice; she’s a little slow.”

  Patience takes another sharp turn and we pull up in front of a plain wooden miner’s house, all one story. I’m surprised, in such dismal circumstances, to see that the trim around the windows is painted a sea green, with a matching sea-green door. Purple pansies bloom in green window boxes in an attempt to bring cheer to an otherwise gray world.

  “Miss Patience!” cry three freckle-faced kids sitting on the porch. “Miss Patience! The midwife! Ma, the midwife is here.” You’d think she was Santa Claus.

  “Okay, baby dolls, you calm down!” A very pregnant redhead, with an angelic freckled face comes to the door.

  “Come in. Come in. Why, Nurse Becky, I didn’t know you were in town. I’ll make us some tea.”

  “Thelma! What are you doing out of bed?” Patience squeals. She rushes forward, pushing the children aside. Fresh blood is visible on the insides of the woman’s calves and stains her worn pink house slippers.

  “For god’s sake, you’re bleeding, Thelma! Becky, can you bring in the birth satchel? I’ll get her back to the bedroom. You children stay here. Where’s your father?”

  “He’s working in the mine, down under,” the oldest boy, around eight, answers. “Might do a double if he can. We need the money.” Patience sighs and propels Thelma down a narrow hall.

  “Will Ma be okay?” the boy says, turning to me. “That’s a lot of blood.”

  “The midwife and I will take good care of her,” I hedge.

  “Will she be okay?” he asks again.

  A cloud, like a hand, has moved over the sun.

  Blood

  When I step into the small bedroom with Patience’s birth satchel, Thelma is lying on her side, crossways on the sagging iron bed, folding clean laundry, and singing to herself. “Happy days are here again. The skies above are clear again. So let’s sing a song of cheer. Happy days are here again.”

  “Thelma, I want to check the baby’s heartbeat. Can you roll on your back?” Patience asks sweetly, though by her expression anyone—but Thelma—could tell she’s angry. “Do you know when you last felt the baby kick?”

  “Probably last night. No, maybe yesterday. It’s been quiet today.”

  The midwife holds out her hand and I know what she wants: the metal stethoscope. Her lips are drawn thin and tight. For all we know this baby could already be dead. Mrs. Booth is so clueless, it’s possible.

  “It’s okay, Thelma. It’s okay,” I whisper in her ear as Patience moves the stethoscope up and down and then across the bulging mountain of abdomen. The air in the room gets thicker as the minutes go by, and I remember that the last time I went to a delivery with Patience she only had a Pinard stethoscope, a wooden hornlike tube. She must have inherited this new metal one from the late Mrs. Potts, the colored midwife who in years past delivered half of Union County.

  Finally, Patience pushes her drooping wire-rim glasses up and begins to tap her finger in the air while staring at the gold timepiece she wears on a ribbon around her neck, and I know by watching her that the fetal heart rate is normal. We both take a deep breath and Patience breaks into a smile.

  “Your baby is fine, Thelma. Nice and strong. But why are you bleeding?” She turns to me. “It might just be bloody show.”

  “That’s a lot of blood,” I note. The mother rolls on her side and goes back to folding the laundry, as if our conversation doesn’t concern her.

  I study our patient. “Happy days are here again . . .” She has a pensive, faraway look in her eyes, and Patience and I each place our hands on Thelma’s abdomen at the same time. Her uterus is rock hard. We wait for her singing to stop and the uterus relaxes.

  “She’s singing through the contractions,” Patience whispers, then she nods her head toward the door.

  “What do you think?” she asks me as we stand in the narrow dark hallway.

  I hesitate, not sure if Patience knows the medical terms, but then remember she’s studied the whole of Delee’s Principles and Practice of Obstetrics, a medical text that her mentor, the midwife Mrs. Kelly left her. Bitsy, her young assistant, had also studied it when they used to attend births together.

  “It could be an abruption,” I offer. “Have you ever seen one?”

  “Yes.” Patience’s face grows gray. “But she’s not in severe pain. Usually, in abruptions there’s terrible pain, so most likely it’s a placenta previa with the placenta at the edge of the cervix or, God forbid, completely over it.”

  “Do you think we could get her in the car and make it to the hospital in Torrington?” I ask.

  “Maybe. If she’s only a few centimeters, we might try, but it’s three hours to the hospital so I guess I have to check her. It’s her fourth and we might not make it.”

  We both know that doing a vaginal exam in a situation like this is dangerous and not just because the West Virginia Midwifery Statute of 1925 forbids it. Patience could accidently poke a hole in the placenta and that would cause a life-threatening hemorrhage.

  “Thelma.” Patience tries to get the mother’s attention. “I need to check you. I will be very careful, but you mustn’t move or squirm around.” She pulls on her sterilized red rubber gloves and holds out two fingers. “Oil,” she says and I pour a little from the brown bottle she carries in her bag. Happy days are here again.

  Tamponade

  I hold my breath and watch Patience’s face as she slowly moves her fingers into the vagina.

  “Seven centimeters,” she finally says. “Completely thinned out and the head well engaged.” Then her eyes widen. She mumbles a curse and removes her fingers, as a handful of blood leaks out on the bed. “A partial previa. I can feel the placenta where it’s come loose on the left side, about an inch of it. I think we need to get her out of bed.”

  “Out of bed?” (This seems unusual and if I didn’t have so much respect for Patience, I’d think she was crazy.)

  “There’s no way we can get a mother of three, who’s already seven centimeters to the hospital in time. So it’s better to get the baby out quickly. Also the pressure of the head on the edge of the placenta might slow down the blood loss.”

  “You mean like a tamponade? Dr. Blum told me about this.”

  “I don’t know the word tamponade,” she whispers back, “but it’s like when you put pressure on a wound.”

  Once on her feet, Thelma begins to sway and to sing again, but she’s almost yelling the words with each contraction. “Happy days are here again! Happy days are here again!”

  I run down the hall to the kitchen, throw the midwife’s scissors for cutting the cord in a pot of water on the cookstove, then run back again and straighten the bed. “Happy days are here again!” I didn’t know such a pretty woman could yell so loud, but at least she’s not
screaming like so many women do. The contractions are only two minutes apart and the bleeding has slowed.

  I get rid of the unfolded laundry, run down the hall a second time, grab the pot of hot water, and set it on a towel on the bedroom dresser where it can cool. “Happy days are here . . . Ugggggggh!” It’s more of a growl than a groan and I nervously point to the bed, asking Patience with my eyes if it’s time for the patient to lie down.

  The midwife shakes her head no. “Here, Thelma, do like me.” Both women squat on the wooden floor. In between contractions, there’s the drip, drip, drip of red and I wipe it up.

  “Be ready for anything,” Patience whispers. “The baby may come out floppy if there’s been too much blood loss. . . .” I begin to shake inside, and to quiet my nerves try to take deep breaths.

  “What?” the mother cries. “What about my baby? Is it okay?” Patience reaches for her stethoscope and listens for a brief moment.

  “The baby’s fine,” she reassures and that may be so, or possibly not. She didn’t spend a lot of time listening. “Now bear down like you mean it!”

  “Oil,” she orders again and I pour a little of the oily golden liquid on her fingers. She wipes it around the woman’s vagina and two pushes later the head is out. “Wait! Blow!” There’s a rubbery cord around the baby’s neck. She eases it off and the baby drops into Patience’s clever hands. She holds the blood-covered, dark-haired, wailing infant out to me and when she reaches out her chubby little arms, I almost choke up. It’s as if light has burst my tired heart open. I don’t know how else to say it. Light.

  May 5, 1934

  Today I accompanied the midwife, Patience Hester, to the bedside of Thelma Booth, mother of four who was in advanced labor. Thelma was bleeding heavily and we were concerned about an abruption or previa. Since there was no time to get her to Torrington, Patience, had her stand for the last bit of labor to create a tamponade. The bleeding slowed and a healthy 5-pound, 6-ounce baby girl was born a few minutes later. The father, Wally Booth, a coal miner, at the Horse Shoe Mine, could not come home for the next twelve hours because he was working two shifts in the hole, so Patience and I had to stay the night.

  The midwife slept with the three children in their bed and gave the broken-down sofa to me. All night we could see the lights from the coal trucks going up and down the road and we had only bread and milk for supper.

  7

  Prayer

  Outside, another day fades. Inside, flames crackle in the heater stove and there’s the cozy smell of woodsmoke. Yesterday, I discovered a small pile of split oak under the porch, enough to build an evening fire, but it won’t last long, and hopefully it will soon be warm enough that, except for cooking, we won’t want a fire. Lamp oil will always be needed, but for now we have the three candles I brought from Perrysville. I am loathe to spend our last dollar on kerosene, because we might need it for food.

  I let out a breath and stand up. “Bedtime,” I tell the doctor and begin our ritual.

  First, we march to the outhouse. I wait outside while Blum relieves himself. Then he waits for me. This is progress, I have to admit; I used to have to stand right beside him and hold his male organ. Next, we return to the kitchen to wash in the white enamel washbowl and then brush our teeth with baking soda.

  This is one of the things Dr. Blum and I have in common . . . or had in common, I should say. . . . We once shared a keen desire for scrupulous oral hygiene, and I still spend at least two minutes on each of us brushing with our Reputation toothbrushes. Isaac sits on a wooden kitchen chair in a trance with his mouth as wide as a baby bird’s. I actually think he likes it.

  Finally, I remove his clothes and pull on his long white cotton nightshirt. Then I lead him to the sofa and cover him with Patience’s green quilt. (He still refuses to go up the stairs to the other bedroom.)

  My day is almost over. I blow out the candle and for a minute sit in the rocking chair next to him. “Now I lay me down to sleep. I pray the Lord my soul to keep . . .” I whisper. “If I should die before I wake, I pray the Lord my soul to take. . . .” Before I’m through with the children’s prayer, Isaac is already snoring.

  That’s when my real prayer begins, a prayer with few words. “Thank you for all that we have and help us get through tomorrow. Help us. Help us get through tomorrow.”

  Tomorrow, I think. Tomorrow or the next day, though I dread it, I will look for work again.

  Intruders

  At dawn as yellow light slides over the mountains, I wake to the sound of someone clunking around downstairs.

  Yanked out of a net of strange dreams, I sit up in bed, the hair on the back of my neck standing on end. Definitely movement . . . and I fear the worst . . . that one of the traveling men has come into our house, one or several!

  A woman alone with a companion who’s no help; we are sitting ducks. And where’s our guard dog, Three Legs, when I need him? I yank on my pants, pull a sweater over my head, and rush down the stairs, yelling more aggressively than I feel, “Who’s there! Who the hell is down there?”

  I discover Dr. Blum standing in the middle of the front room looking lost and holding his penis. Three Legs stands at his feet looking up with a big, wet grin.

  “For god’s sake, Isaac!” I admonish. “What the hell are you doing?” It’s clear what he’s doing, he’s trying to go to the bathroom, but we have no indoor toilet and no porcelain potty either. Still upset, I roughly push him out to the porch and point to the rail, waiting to see if he will get the idea. He doesn’t.

  “Oh, Isaac! Come on!” I howl as he pees on the porch floorboards. Then I let out the breath I was holding. “Sorry . . . You just are so much work to take care of!”

  “The truth is, I was scared, you know?” I continue my monologue. “I was scared! I pictured a couple of vagrants stumbling around downstairs, rough men who could hurt us.” I am still shaking, almost crying, and I have to wipe my eyes before I can see. Finally, I calm myself.

  It’s then that I realize the importance of Dr. Blum’s action. He was actually trying to take care of himself. Somewhere between unbuttoning his long underwear and opening the door and walking to the outhouse, he apparently forgot what he was doing, but he was actually trying. He was trying.

  Summons

  “Come on, Blum,” I command. “Just get in the car.” The doctor and I are dressed for another day of job hunting, and though I put on a little makeup, my mood is not great. After talking to Mr. Stenger and Mr. Bittman last time, I feel sure that looking for work will be futile, but I have to keep trying.

  I stop with one foot on the running board. A pickup, throwing dust, is moving our way. It pulls up in front of the gate, and a muscular man with thick, dark hair and a small beard jumps out. He’s wearing the regulation farmer’s coveralls in striped denim and the cloth stretches across his biceps. “You the nurse?” There’s the bulge of chewing tobacco in his right cheek.

  I fold my arms across my chest. “I am.”

  “My name’s Simon Markey from over Snake Hollow. My wife’s paining bad and Patience Murphy, the midwife, said I should get you. She said to tell you come fast.”

  “What’s the trouble? Is Patience already there?”

  “No, ma’am. She’s in Delmont delivering another baby. I called her at home and the vet told me where she was and then when I tracked her down, she told me to fetch you, that you’d sit with my woman until she could get there.”

  Oh, Patience! How could you do this? Even looking for work sounds more fun than sitting with a woman in labor.

  “She’ll likely be back in Union County within an hour or two. We need you bad, ma’am.”

  “Is this your wife’s first baby?”

  “Yes and she’s not doing well. Please come. She’s crying something awful.”

  “Did you leave her alone?”

  “Neighbor girl’s sitting with her now, but she don’t know nothin’. Just a kid. Never saw nothin’ born before but a calf and a set of kittens.”


  I let out air in a long sigh. My favorite things! Blood, goo, fear of something being wrong with the baby, and a screaming woman . . .

  “Well, I’ll have to bring my charge. He’s disabled and I have no one to watch him.”

  “You mean Dr. Blum? I guess I can mind him if you tend to my honey. He’s not dangerous, is he?”

  “You’ve heard about him?”

  “Most of Union County has by now. They say he’s not himself. Brain injury in an auto accident or something.” I don’t stop to contradict another variation of Isaac’s story. It’s as good an explanation as any, and though Blum wasn’t actually in the accident he became a victim.

  “Okay, Isaac, change of plans.” I run back inside for my black leather nurse’s bag. “We’re going to a delivery. Hopefully, Patience will be there soon.”

  Maybe we’ll earn a dollar, I think. Maybe Mr. Markey is one of the few farmers in the area who are still doing well. Who knows? I consider with optimism, maybe we’ll earn a whole fiver.

  The anxious father-to-be takes off in his truck, spitting gravel, and I follow in the Pontiac, trying to keep up.

  Dahlila

  The Markey home is a surprise. It rests on a flat overlooking the Hope Valley and though his road, “Snake Hollow,” sounds forbidding, the setting is beautiful. The two-story brick dwelling, once painted white, looks out across the hills to the spruce, pine, and hemlock mountains on the other side of the river, and his fields are green and cut short by the black-and-white cattle that graze there. I’m just getting out of the car, taking in the idyllic setting, when a scream cuts the fresh air.

  “Eeeeeeee! I can’t do this anymore! Simon Markey, you better get in here! I can’t take it, I tell you!”