The Reluctant Midwife (17 page)

“Just tell me,” I insist, sounding braver than I really feel, “what I'm supposed to do when I go to a birth. I'll write it all down and memorize each step.”

We've been installed in the Hesters' house for more than a week and Patience is staying in bed, as she should. Dr. Blum is downstairs at the kitchen table silently drawing pictures for Danny in a sketchbook that Daniel gave him.

“Okay, let's get to it,” Patience says, becoming serious. “Mrs. Kelly always told me that most mothers could deliver their own babies if they had to, so try not to worry so much. The midwife is there for the two out of ten that might have trouble.”

“
Two out of ten!”

“Well, roughly. So, here's what you do. First thing, check the baby's heartbeat. After that, make sure of the baby's position. I always keep the woman up as long as she can stand it. The pain will be less and the contractions stronger. Do vaginal exams only if you have to. Maybe one at the beginning if you aren't sure about the presenting part and maybe another if the labor seems stalled. Of course, all your supplies and gloves should be sterile, but you know that.”

“Okay, okay,” I interject. “Let me catch up. I'm writing as fast as I can. . . . So after I assess that everything is normal, what happens next? Do I just sit in the corner and wait? Do I boil water? Do I go to sleep?” I say this as a joke, knowing Patience would never go to sleep.

“No. You give her support. Walk with her, be sure she is well hydrated and has nourishment to keep up her strength, nothing heavy like bread or pork and beans, but fruit, broth, tea with honey, things like that. And get your instruments laid out well in advance. Sometimes women will surprise you.”

“I learned that with Dahlila.”

“And while you're waiting, be calm, tell her she's doing great and try to get her to laugh.”

“Make her laugh?”

“Yeah. Laughter is good for everyone. I didn't used to know that. . . . Oh, yeah, every hour or so check the baby's heartbeat again.”

“Yes. Yes. Dr. Blum insisted on that.” I am scribbling fast. I'll make an outline later.

Patience goes on to tell me how to support the perineum, how to check for a cord around the neck, how to deliver the shoulders without a tear, and how to get the baby to breathe if it has trouble. Then she describes what I do in the third stage of labor, the most dangerous time for the mother. She instructs me to be vigilant, watch for a show of blood, never pull on the cord, and so on.

“And I have a suction bulb in my birth kit.” She tilts her head. “Which will be your birth kit for a while, Becky . . . if you are willing. . . . I know you're reluctant, but that's what makes you brave. Even when you are scared you do what needs to be done. . . . These are the women who are due in the next six months.” She hands me a short list.

Brave!
I think as I stare at the names and break out in a sweat.
Am I really going to be able to do this?
The first name on the list is Lilly Bittman.

“Childbirth is such an intense experience,” the midwife acknowledges, putting a hand on my arm and looking into my eyes to encourage me. “Think of it. The moment a new person enters the world, everything changes. Everyone must move over to make room, every person, every rock, every tree, every star, and the midwife is privileged to witness the miracle.”

I'm driving too fast, I know I am, but if I don't speed up, Lilly is going to deliver without me. I run the one stop sign in Liberty, make a U-turn in the middle of Main, and pull up in front of Bittman's Grocery, trying to remember all the instructions I wrote down.

It's three
A.M.
, and no one's around, so the U-turn doesn't matter, but I had forgotten that the grocery store would be closed at night and the way into the young couple's apartment is up the back stairs.

I make another U and cut down the alley, where I have to decide which stairs are the Bittmans'. I hadn't realized that all of the storefronts on Main have stairs in the back, but I finally decide the one with the lights on must be it and, grabbing Patience's birth satchel, I take the steps two at a time.

At the landing, I stop for a few moments to compose myself, pull back my hair, and straighten my top. If I had time to take my own pulse, I'm sure it would be one hundred and twenty!
Breathe
, I tell myself, like
I
was the one in labor.
Breathe
.

Then I knock twice on the back door. “ 'Bout time you got here!” B.K. laughs. (He sure is calm!) Maybe Lilly's not in hard
labor after all, though on the telephone he certainly sounded like he thought she was.

“I came as soon as I could. You only called me forty minutes ago. How's Lilly?”

“Come in. You'll see.” He leads me back to their small bedroom where I find the mother holding her newborn infant with her little boy in his pajamas sitting next to her on the bed.

“See how soft he is,” the sightless woman says, showing her five-year-old, her face calm and radiant. “Oh, Miss Becky! I'm sorry I couldn't wait. The baby was coming about the same time you did that U-turn on Main, not more than five minutes ago. How does he look? I can tell he's healthy because he cried right away. Does he have all his parts? I mean, I know he has his boy parts, but everything else. . . .”

The young blind woman amazes me. “Did B.K. see me out the window, skidding around?”

“No, I heard you.”

“You heard me while you were pushing the baby out? Weren't you screaming?” Here she laughs.

“No, I was singing right up until the end and then I gave a grunt and B.K. caught the baby . . . Well, not exactly caught, but supported it as it slid out on the bed.”

“I helped too,” announces Little B.K.

“What did you do?” I ask, just to be polite. Really, I'm horrified. The end result is apparently fine, but anything could have happened.

“I got the blanket and helped Pa wrap him up. There's still a cord on him, though. Ma said we couldn't take it off 'til you came.” Here he turns to his mother. “What we gonna call him, Ma? He has red hair, but it can't be B.K!
Not B.K
. That's already taken.”

“Well, at least there's
something
for me to do. I can trim the cord,” I tell them.

“Can I help?” asks Little B.K.

“I guess . . .” This is a request I've never confronted before.

I gently take the newborn out of Lilly's arms, but not before the mother kisses him three times, then I weigh him with Patience's hanging scale, assist Little B.K. to cut the rubbery blue cord with sterile scissors, and do my newborn exam.

The baby is perfect in every way, but one. He has webbed toes. I don't know how to tell the parents. They will surely be upset, so I put it off until later.

“You are to do nothing to the cord,” I tell them, “except to change the dressing. It will fall off on its own in about two weeks.”

“What about the afterbirth?” B.K. asks. “Shouldn't it be coming?”

“Yes, anytime now, yes.” I shiver inside. The fact is, I was so concerned about missing the birth, I'd forgotten the placenta and thought my job was done. Patience told me the third stage of labor is dangerous for the mother, and here I am gabbing away.

“Are you feeling any afterbirth pains yet, Lilly?”

The blind woman pulls down the sheet, pulls up her nightgown and rubs her lower abdomen. There's very little blood on the bed, so I don't think the placenta has separated.

“Can't you pull it out? I feel so sweaty, I'd like to get up and wash.” She pulls her damp curls away from her face.

Lordy! Fifteen minutes after giving birth and she wants to bathe? “No, we should wait. It won't be long.” B.K. sits in the rocker singing to his older son, his long, thin legs up on the bed frame:
“Sleep my child and peace attend thee. All through the night. Guardian angels God will send thee. All through the night.”
The boy is almost asleep so it's as good a time as any to give them the news about the baby's birth defect.

“Well, you were lucky,” I tell the couple moving over to a stool next to Lilly, in case she gets upset. “The birth went fine. Sometimes
there can be a cord around the neck and that can be dangerous but all's well that ends well. . . . There is one thing about the baby I need to tell you though.” Here B.K. stops singing and Lilly's sightless eyes get big.

“You probably didn't notice but your new son has webbed toes.” I pause for their reaction and am surprised when they laugh.

“Oh, we looked for that right away,” Lilly tells me. “All the Bittman men do! B.K. and Little B.K. and Grandpa. We just say it makes them good swimmers.”

How is it that you always notice the tick of a clock when you are waiting?
Tick. Tock. Tick. Tock
. Lilly puts the newborn on the breast as easily as a sighted person. B.K. settles his five-year-old in his bed in the next room, then comes back with his guitar and strums a few tunes. He yawns. It's catching, and Lilly and I yawn too.

Tick. Tock. Tick. Tock
. It's been forty minutes since the birth of their second son.

“Mmmmmm,” Lilly moans, and I look between her legs expecting to see a gush of blood but there's nothing. “Mmmmmm,” she moans again and I palpate her uterus. It's rock hard and at the level of her umbilicus.

“I think the afterbirth must be separating. Do you feel an urge to push?”

“No,” Lilly says. “But it actually hurts more than my labor pains. It hurts quite a bit.” I look between her legs again. Still no blood and the cord hasn't lengthened. B.K. yawns again. It's almost four
A.M
.

At four fifteen Lilly sits up on one elbow. “Miss Becky, I have to pee. Could I get up and use the bathroom? These pains are getting worse. I really have to do something!” Beads of sweat are on the mother's upper lip and her normally pale pink skin is chalky. She pulls her red hair away from her face and it looks like a skull.

I
really have to do something, so I check the uterus one more time. It's now three centimeters
above
the umbilicus. Not a good sign. There must be blood building up inside.

“B.K., I think we should let Lilly pee. Maybe that's part of her discomfort, but I don't really want her to go down the hall. She might faint or something. Do you have an old-fashioned potty, you know, the kind that people use when they don't have an indoor bathroom?”

“Sure, right here. She used it when she was on bed rest.” He pulls a white enamel receptacle out from behind the door.

I check again for any signs that the placenta is coming. Still no blood between the mother's legs. “Okay, Lilly, just take it slow and I will be right here if you feel woozy.”

“I am a little dizzy, but just a little.”

Oh, damn
. I'm making such a mess of this. I should have gotten her vital signs before she got up. How is it that I know just what to do for a victim of trauma, a sick child, or a surgical patient, but I'm lost at a simple, uncomplicated home delivery?

I think I know the answer. Birth is a potentially dangerous situation, but in this relaxed environment, I lose my way. All this guitar playing and kissing and kids sitting on the bed gets me off track!

Slowly, we sit Lilly up. Slowly, we lower her legs off the side of the bed. Slowly, we help her squat over the commode. B.K. and I turn away so she can tinkle. But it's not a tinkle. It's a flood! Lilly pees and pees and pees.

“Mmmmmmm! Miss Becky, I really have to get this damn thing out of me! If you won't pull it out, I will. Where's the cord?” Lilly gropes around between her legs.

“No, Lilly!”

She finds what she's feeling for. “Uggghhh.”
Plop
. The afterbirth drops into the commode and blood and pee splash over everything. “Oh, thank goodness! But I think I made an awful mess.” Lilly stands up without assistance and sits on a wooden bedside chair. Her uterus is now back to normal, firm, and three centimeters below the belly button.

I stare at the potty, nearly full of red. Would Lilly be upset if she could see this? It's impossible to estimate the blood loss since the blood is mixed with urine. Maybe two cups of blood, maybe four? I decide to go with three.

“Whew! I feel a lot better! Can I wash up and go to sleep now, Miss Becky? At least I didn't mess the bed.”

“Sure,” I say as if the whole prolonged third stage of labor was no big deal.

“I can't wait to tell Mama in the morning. She will be so flabbergasted!” Lilly says, grinning.

When I let myself out the back door, both mother and father are climbing into bed with their newborn between them. On the landing of their back stairs I stand for a minute looking down the alley at the halo of light around the gas streetlamps. Inside I can hear singing, a man and a woman. “
Hush-a-bye, don't you cry. Go to sleep, little baby
.”

Lilly's dark world is not dark at all.