The Midwife of Hope River

by Patricia Harman

  Knowing I’m violating the rules, I adjust my glasses and pull on the gloves. I’m already wanted for far worse crimes. What can they do to me for a vaginal exam? The mother stares with big eyes.

  “Delfina, I need you to open your legs so I can feel what’s keeping the baby from coming.” The husband turns away and steps out on the porch, aware that this is female business. He leaves the white-haired girl as an interpreter, and she creeps up on the bed.

  “What’s your name?” I ask the dirty-faced urchin.

  “Antonia.”

  “Antonia, can you tell your mama that I need her to lift her bottom so I can put down a clean pad and to open her legs again so I can wash her and feel where the baby’s head is? Tell her I will be very gentle. It won’t hurt.”

  As the girl explains this in Italian, the woman does what I say and lets her knees fall apart. With the new brown soap I got at Stenger’s when I purchased the gloves, I carefully wipe her bottom, then pour some over my fingers. If the afterbirth is attached too low and I poke a hole in it, Delfina will bleed to death. Then I will lose both mother and baby.

  The first thing I come to is . . . nothing. No foot, head, or butt poking through the opening of the cervix. No cervix, either. The patient is fully dilated. Gently I palpate the lower wall of the womb for a hard gristly growth or soft squishy afterbirth but find none. This is good news, but then what’s keeping the baby from coming?

  A cord. It could be a short cord wrapped tightly around the infant’s neck, another potential disaster. If the woman pushes vigorously, the cord will make a noose and choke the baby or, even worse, pull the afterbirth away from the womb. I take my fingers out and stare at the wall, where a carved wooden crucifix hangs over the bed.

  I gave up on the church a long time ago, and I’m not even privately religious. In fact, I’ll admit it: since Lawrence, my first love, perished in the train wreck and then years later Ruben, my true love and husband, was killed during the battle of Blair Mountain, my faith in God, like a tallow candle, has sputtered and gone out.

  Still, looking at the carving, I silently ask Jesus and myself what to do.

  “As far as I can see, we have to give it a try,” I mentally converse with him. “If I do nothing, the baby will eventually die, then the mother will become infected, and she will die too. If I do something, there’s a chance; the baby and mother might live . . .”

  The man on the cross seems to nod in agreement.

  “Antonia, get your father.”

  Clouds have come over and the room is getting dark, but when Izzie returns with the water and reaches up to turn a knob above the hanging bulb, the newspaper-covered walls burst into harsh light.

  “Mr. Cabrini, the safest thing to do is get your wife to the doctor in Liberty or the bigger hospital in Torrington, but I don’t think that’s possible without putting Delfina and the baby in more danger. I’ve checked inside her, and there’s nothing in the way. The infant is alive, but the head is too high. I think we can get the baby out in a few minutes if you’ll help us and maybe a few other women from the camp.”

  Izzie shakes his head no. “The women won’t come. I’ve already asked them. They don’t like dagoes. They think we take their men’s jobs.”

  I frown. When I was working with the Wobblies in Pittsburgh, I’d thought that all workers would stick together, but I am naive; people have told me this. With the gradual failure of the economy, there has been less need for steel and even less for coal, and the unions have all but disbanded. To cut costs, the mine owners bring in cheap labor, immigrants from the North and blacks from the South. Local men live in fear for their jobs, and their women try to protect them.

  “Okay . . .” I think for a minute. “Then I’ll need you and the oldest boy to help. Tell him he won’t have to look.” The man throws his hands into the air and spits out a few words in Italian. It’s clear he doesn’t like this. The girl argues back in their native tongue, and he slams out the homemade oak door.

  At last, reluctantly, Mr. Cabrini and his son of about nine return and we’re ready. While he was gone, I straightened the bed, propped up the limp patient, and laid out my oil, sterilized scissors, sterilized string to tie off the cord, clean rags, and a pan of warm sterilized water.

  “Mother.” I address the woman through her daughter, reminding the patient, by the appellation “Mother,” what her suffering is about. “The baby’s head is too high and the cord may be wrapped around his or her neck, so we won’t have much time.” I wait for the translation.

  “Your children will help you sit up, and I want you to pull back on your knees and push as hard as you can. Push with all your might. Your husband will use his hand on your abdomen to guide the head down.” I take Izzie’s hand and show him how to palm the baby’s head through his wife’s flesh.

  “I’ll have my fingers inside to feel if it’s coming. If there’s a cord, I’ll try to push it aside.” This all sounds so complicated, but Antonia, using her hands to illustrate, translates quickly. “Once the head is in the pelvis, I’ll want you to squat, but don’t stop pushing for anything, don’t let the head slip back.” Delfina nods that she understands, and I see by the light in her deep brown eyes that despite her exhaustion, she has plenty of grit.

  When we’re ready, I look up at Jesus and make the sign of the cross the way I’ve seen Mrs. Kelly and the Catholic women do, and the whole family follows. The minute I feel Delfina’s womb get hard, I nod and we get into position. Izzie cups the fetal head, and the round orb begins to slide down. The mother pulls back her legs and strains forward. The children, Antonio with her eyes wide and the older boy with his eyes scrunched shut, support their mother from the back.

  At first I feel nothing—no cord, no limb protruding, then just the tip of something hard. “Yes!” I shout. “It’s the head. It’s coming!” What I lack in expertise I make up for in enthusiasm. This is where my two years on the stage at the Majestic come in.

  Delfina takes a deep breath and strains down again. We don’t wait for another pain; I’m afraid that if she stops, the head will slip back. The children push their mother up a little higher each time, and Izzie, with the wisdom of a gentle man, keeps the head steady. He knows he can’t shove this baby out, though no doubt he would like to. With each maternal effort, I feel the skull lower until it fills the floppy cervix and then comes through. I could check the baby’s heartbeat, but that would take time, and besides, what would I do if the heart rate dropped? No! We keep on.

  “It’s coming!” I shout.

  Izzie hollers something in Italian that I think must mean “Push!”

  “Okay, this is it! Children, help your mother to squat.” I get down to show them. “Izzie, you keep the baby’s head low, don’t let it work back.”

  The woman is straining for real now. The urge is spontaneous, and the whole head is crowning. I reach behind me with one hand, dip my gloved fingers in the oil I use to counteract tears, and swipe it around the woman’s opening. Usually I would slow things down at this point, but a birth canal tear is the least of my worries.

  “Yi, yi, yi!” Delfina is yipping. I don’t know Italian, but her meaning is clear. Her opening burns like a ring of fire.

  Then the head is out . . . silence. Everyone stares, even the boy. There’s nothing stranger than the sight of a woman with a baby’s head sticking out of her, one life emerging from another.

  I lean lower, feel for the cord around the neck, and am surprised when I find none. The newborn is already scrunching up its face, a good sign. I wipe its mouth with a clean piece of rag. “Last push!” The baby spins three times as a cord at least three feet long unwraps around his chest and a little boy falls into my lap.

  Now we are all laughing. Laughing and crying. Language doesn’t mean anything in the presence of true joy. My eyes meet Izzie’s, and I see how much he loves his wife and new baby and these dirty kids. Delfina’s head falls back into his arms.

  Praise Jesus, the words come to me as
I look up at the crucifix.

  October 30, 1929. New moon setting over the mountain.

  Live-born male, 6 pounds, 4 ounces. Name, Enzo Cabrini. Seventh or eighth child of Izzie and Delfina Cabrini. Presentation, cross lying, cord around the body three times. Active labor, two days. Pushed five minutes with father holding the head down. No tears. Blood loss one cup. Mrs. Cabrini knew to put the baby right to the breast. Also present two young children, who helped the mother squat. No payment again. The women in the camp wouldn’t help us.

  4

  Midwife

  It’s been one week since Mrs. Cabrini and Mrs. MacIntosh delivered.

  I remove the blue ribbon from the last used page of my journal. The day I went to check on them, both mothers were doing well and seemed to have plenty of milk. Bitsy and Mary will wait on Katherine for her two-week lying-in period. Delfina is already up cooking and cleaning.

  A few years after Ruben’s death and the disaster at Blair Mountain, when the fog around my heart finally lifted, I began to assist Mrs. Kelly with births along the south shore of the river in Pittsburgh. I couldn’t go back to Westinghouse, not after what happened. Sophie took me with her at night, more to shake me from my grief and self-absorption than because she needed me. I attended another fifteen births here in West Virginia before she died, that made thirty-five, but I’m still a novice, and after the last two births, I’m beginning to wonder if I should be attending mothers at all.

  I didn’t refer to myself as a midwife at first. That changed when Dr. Blum gave my name to the state health department and I was required to register. I’d met Blum only that one time, when Sally Feder had her twins. Mrs. Kelly had never needed him again. At first I was flattered that he remembered me. Later I realized that it wasn’t because he thought I was so great; he just wanted someone to take care of the poor so he wouldn’t have to. That came after Sophie’s heart attack. Now I’m the only midwife between Delmont and Oneida, except for an elderly black woman, Mrs. Potts, but I’ve never met her.

  It’s easy to be a licensed midwife in West Virginia, no exam or anything. All I had to do when the home health nurse, Becky Myers, sputtered up Wild Rose Road in her Model T was demonstrate that my house was clean and I could read and write. Then I signed some papers saying that I understood the regulations, and that was it.

  Mrs. Rebecca Myers sat on my worn sofa in her pale blue nurse’s uniform with the crisp white collar and dark blue sailor tie and showed me how to fill out the birth certificate. I watched her, wondering where this very precise woman with the midwestern accent, obviously university-trained, came from. She wasn’t a local, that was for sure.

  The public health nurse asked to see my birth kit. I offered her tea and had a few books on my shelves and paintings on the walls, so she must have thought I was a decent person. That’s the other requirement I mentioned before: you must be of good moral character . . .

  Becky is my friend now, and I know a little bit more about her. She’s a widow like me, and she’s not from the Midwest. I had the accent wrong. It’s Vermont, but she worked at Walter Reed during the war, then came to West Virginia to work in the mining camps during the typhoid epidemic of 1918. The Presbyterian Women’s Mission asked her to stay, and now she’s employed by the state Department of Health in Charleston.

  It hadn’t been easy, she told me. This was on her second visit, and we were sitting out on the porch. Local doctors had objected to her presence at first, thinking she was practicing medicine. If you ask me, she probably knew more than they did, but she’d never say it. “You have to understand how to work within the system,” she warned. “Don’t overstep your bounds.”

  Becky’s the one who told me about the Frontier Nursing Service in Hyden, Kentucky, and encouraged me to keep records of my births in this diary. Before that, I just wrote the date and baby’s name in the family’s Bible like Mrs. Kelly did.

  Mrs. Myers asked why I didn’t go to the nursing service in Kentucky for more formal training. She’s a registered nurse with a degree from some fancy college up north, Yale, I think, and that’s where she heard about the school for midwives. She forgets that I’m not a nurse and have no money for travel or tuition. Anyway, who would take care of mothers like Delfina while I was gone? Not Dr. Blum. He charges twenty-five dollars if he comes to your home, thirty dollars if you go to his hospital. Twenty-five dollars would buy shoes for the whole Cabrini family for two years.

  I pull my rocking chair over to the front window to admire my journal in better light. It’s a beautiful book and quite too expensive. When I saw the bouquet of tulips embossed on the brown leather cover, I had to have it.

  Inside, in the top corner of each lined page is a small colored print of a poppy or rose, a toad or snail, some living thing. There’s a lock and a key that I keep on the cord with Mrs. Kelly’s gold watch. My life has been difficult, and the delicacy of the empty pages is what charmed me, like a friend I could talk to, some gentle, sensible woman . . .

  Mr. Stenger, the balding pharmacist with one lazy eye, gave the journal to me in trade, as well as twenty dollars, for taking care of his seventy-three-year-old mother, Cora, when her foot went bad from sugar several months ago.

  I stayed in her home in Delmont, bathing her, cleansing the open sores, using my comfrey and goldenseal poultices and some of the medicated powders from the pharmacy. More than anything, I cooked, did her household chores, and kept her foot elevated so it could heal.

  That was before I inherited my cow from the Johnsons and had to be home every evening. When the bank foreclosed on their farm at the bottom of Wild Rose Road, they couldn’t take the cow with them to Wheeling. Besides, I’d delivered their son and they wanted to repay me.

  I inherited this house and land too, from Mrs. Kelly, after she passed. Turned out she’d made an appointment to prepare her will with Mr. Linkous, the lawyer in Delmont, just three weeks before her demise. I found that out later from Mr. Johnson, who’d driven her into town in his truck. It made me wonder if she’d known she was dying . . . but she never let on. Dr. Blum explained that some vessels in Sophie’s heart had burst from hard farming work, that women weren’t meant for it, but I knew better. Her heart broke when her lover, Nora, left us. After that it was just a slow bleed.

  I throw another log into the woodstove. Outside, a few snowflakes float down, gentle reminders that winter is coming. Somehow I must find money to buy wood. Coal would be nice, but it’s far too expensive. The bare trees shiver in the gray light and only a few groves of pines splash green higher up on the mountains. You can see the Hope River clearly now, but not the rocks and the rapids.

  Treasured Child

  Sometimes I get confused. Most of my life I’ve felt I was dreaming. Now and then I wake up, sometimes for months, sometimes for minutes. I’m a character in a play, and I can’t tell if I’m making it up or if a great puppeteer is making me dance.

  I’ve played too many roles in too short a time; had too many names, lived in too many places. It helps me to go back to the beginning.

  I was born Elizabeth Snyder on October 19, 1893, in Deerfield, a small town north of Chicago and a few miles inland from Lake Michigan. My mother was a teacher, the daughter of a prominent farmer who died before I was born, and we lived with my grandmother in a two-story white Victorian on Third Street.

  My father was a seafaring man, a first mate on a lake freighter hauling wood and iron from Wisconsin to Ohio. His parents died in the yellow fever epidemic of 1878 in New Orleans, so I never knew them.

  As a little girl, I attended the Congregational Church, where Mama played organ and Papa sang in the choir when his ship was in port. I was an avid reader and devoured every book I could find, as well as the Chicago Tribune that Papa brought from the city. I played the piano, loved to sing and dance, and fished with my pa in a canoe on the Des Plaines River, a treasured only child, but that didn’t last.

  In the winter of 1902, my beloved grandma passed away from a lung condition and
we buried her in the hard, cold ground. Not three years later, more tragedy followed. My father’s ship, the Appomattox, on its last run from Milwaukee, foundered in a November fog. The freighter, the longest wooden ship on the Great Lakes, carrying a load of iron ore from Lake Superior, grounded on a sandbar in the mist. Papa was the only crew member who died, swept overboard by a ten-foot wave.

  When the representative from the shipping company brought the news, Mama looked at me and said, “At any minute your life can change. Remember this. Between one breath and another, the song can stop and everything can be different.”

  Later I wondered, in my childish mind, if in actuality Papa had just jumped into a lifeboat and rowed away, faking his death to escape his debts. His body was never recovered.

  In our first months of grief, things went from bad to worse. Mama was shocked to learn, from her solicitor, that we were destitute. The money my grandmother had left us was gone, gambled away by my father in high-stakes card games out on his freighter. Because of his debts, the Trust Company of Illinois foreclosed on our home and we moved to a rooming house in Deerfield. Those were hard times. It was Christmas, and I was twelve.

  Fortunately, Mother was able to retain her teaching position, but our quarters were cramped and her pay was minimal. We sold our furniture, the piano, everything but our clothes, the family Bible, her hymnal, and a few favorite books. In the evenings, Mama did washing for the traveling men. I was taken out of school and sent to work with Mrs. Gross, the seamstress, on Westgate.