The Midwife of Hope River Read online

  At last we see lights and in another few minutes the village of Hazel Patch, a collection of a dozen or so houses and small farms associated with a little white chapel. Thomas quickens his pace, and though I’m dreading what we’re about to walk in on, I hurry my mount to catch up with him.

  What was I thinking when I pulled on my boots? How can I help an experienced midwife like Mrs. Potts, someone who’s probably been delivering babies for fifty years, while I got my certificate only two years ago just by signing my name? And the family . . . I don’t even know them. I’d rather be home in my cozy warm bed.

  We pass the little church, a small clapboard affair with a wooden steeple, and then follow Thomas down a private road bordered on either side by a neat split-rail fence. At the end is a two-story log house with light pouring out of every window. A woman howls into the night, a wild sound. Bitsy and I shiver. The woman stops for a few minutes and then starts up again.

  Mrs. Potts

  Sensing my apprehension, Bitsy gives me a squeeze and slides off our mount. Though she hadn’t wanted me to come, she grabs my birth satchel without hesitation and accompanies Thomas up to the door. I follow carefully, determined not to make my grand entrance by falling on my butt again.

  Thomas knocks twice while we stomp the ice off, but he doesn’t wait for an answer. He opens the door and lets us into a large living room with oak bookshelves against the log walls, an organ, and a fawn velvet sofa. It’s the kind of room I imagine a judge or a physician would have had in the pioneer days, only there wouldn’t have been electric lights. Hazel Patch is located right on the main road, close to the power lines. The way Bitsy referred to the Hazel Patch folk as “those people,” I thought we were coming to a hardscrabble place more like the mining camp.

  Across from the door is a bright yellow kitchen with a pale green enameled high-backed gas stove. Two dark-skinned women and a shorter coffee-colored lady are laying out food. The three, all wearing flowered housedresses and aprons of various shades, turn to greet us.

  “Mrs. Potts?” Thomas calls, removing his hat.

  The stooped brown midwife, dressed all in black, with a neat white apron, a white lace collar, and a white bandanna, comes down the hall. She walks as though her joints need oil, but her face is nearly unlined. From another room, the patient in labor wails like a trapped animal.

  I’m surprised when the elderly lady passes Thomas and Bitsy and wraps her arms around me. “Honey,” she says, “I’m Grace Potts. I’m so sorry to bring you out on a night like this, but I didn’t know who else to call and we have a sitiation here.” She says situation in a funny way, like a lot of older Appalachians do. “Dr. Blum won’t come to Hazel Patch or allow coloreds to come to his clinic, or we would have already gone. You’ll see what I mean in a minute.”

  “Thomas says the arm is coming out first. Can you feel the head at all?”

  Grace Potts holds out both her worn hands, gnarled with arthritis, each knuckle of each finger distorted, the tops ebony and lined with veins twisted and crossed like a road map but the palms as pink and smooth as mine. “It’s way up there. I was hoping you could—”

  We are interrupted by cries from the bedroom, and I hurry that way with Bitsy right behind me. “Will she let me check her?” I’m all business now, and whatever trepidations I had are gone. There’s a job to be done, a puzzle to be solved. I can at least try. Thomas turns toward the kitchen, where the trio of cooks fusses around him, proffering coffee and coffee cake.

  “She’d let the vet check her if it would rid her of this pain,” Mrs. Potts observes. I wonder if she means Hester or she’s just making a general observation. Maybe someone should call him. He did pretty well with the horse.

  In the bedroom we discover the patient, a dead ringer for the cabaret singer Josephine Baker. She’s on her hands and knees wearing a white nightshirt, and she looks at us with big tear-filled brown eyes.

  Bitsy, who already sorted through my satchel a few days ago, opens the bag and hands me my sterilized rubber gloves while I sit on the side of the bed and place my hand on the woman’s calf. I’m impressed with my new assistant, who doesn’t hesitate but gets out her own new gloves too, the ones Mrs. MacIntosh bought her at Stenger’s Pharmacy before she left Liberty.

  Mrs. Potts makes the introductions. “Cassie,” she says, “this is another midwife, Patience Murphy, and her assistant, Bitsy. She’s going to check you inside, real gentle, and see how we can get this child out.”

  I wonder if the older midwife realizes that according to the midwifery statute of West Virginia we are now breaking the law, but I have to admit she’s clever, the way she says “how we can get this child out,” not “if we can get this child out.” She also legitimizes Bitsy by calling her my assistant, not my helper or maid. I’m surprised to hear that she even knows my last name.

  “Here, honey, roll over so Miss Patience can feel.”

  Cassie moans but does what we ask of her. I indicate that Bitsy should pour oil on my gloved fingers, and when I lift up the patient’s gown, I am stunned.

  Arm Presentation

  Though I wouldn’t have come all this way through an ice storm if I hadn’t been prepared for the complication, the sight of an infant’s arm sticking out of a woman’s vagina is something you don’t want to see. I meet Bitsy’s brown eyes and note that she shows no shock, a good trait for a midwife. (You never want to alarm a patient.) You’d think she sees this all the time.

  “Can you open your legs a little wider, Cassie?” I ask. “Squeeze Bitsy’s fingers, and if you feel like yelling, try panting like a dog . . . pant, pant, pant . . . don’t push. I’m going to grease my fingers and go all the way in and find the baby’s head. Heart rate?” I turn to the older midwife for confirmation that this baby still lives.

  Mrs. Potts pulls a metal stethoscope, a fancy one like Dr. Blum’s, out of her deep apron pocket. “There was a heartbeat a few minutes ago.” She listens intently and then nods. “Right lively,” she tells me.

  “Good. Ready, Cassie?”

  Cassie screws up her face and nods, but her eyes are on Mrs. Potts. Bitsy pours some more olive oil on my glove and, following the limb up to the shoulder, I use my other hand, on the mother’s abdomen, to find the head. It’s a tight fit, but if I could get the arm back inside, I might be able to get the head down into the pelvis. I remove my fingers and think how to do this.

  “Don’t push, Cassie. Don’t let her push, Bitsy. I’m going to go all the way in and try to reinsert the arm, then bring down the head.” I don’t mention that the one time I tried something similar was with a horse and I was bringing a hoof out, not putting it in.

  “Mrs. Potts, can we get her bottom up in the air? I need her buttocks to be higher than her chest, upside down almost. Some pillows?”

  Despite her apparent fragility, the old lady has quite a voice, and she whips into action. “Samantha, Mildred, Emma!” she calls as if with a bullhorn. “We need every pillow from the bedrooms upstairs, and I mean now.”

  I have no idea which of the three ladies lives in this well-appointed log home, but within two minutes the room fills with feather pillows. I wince, seeing the lace-trimmed pillow slips. They won’t look so nice with blood on them. “Bitsy, get rid of those nice covers. Can we get some towels too?”

  My helpers assist me to build a pile of pillows about two feet high, which we cover with towels. I then have Emma and Mildred lift Cassie’s bottom up on the cushioned platform. It sinks down, of course, but I’ve still achieved my objective. As the patient’s buttocks go up, the baby recedes and only the wrist and hand stick out. When we see the fingers move, everyone cheers and the mother smiles for the first time.

  “Mrs. Potts,” I address the elderly midwife, “I’m going to flex the arm at the elbow and push the hand in. Then I’m going to push up on the shoulder. When I tell you, can you guide the head down? Maybe one of these ladies can help if you get tired.”

  The old lady rolls up her sleeves. �
�Here, Mildred.” She takes one of the tall woman’s hands and places it under her own arthritic fingers exactly where I want it. This birth is becoming a real community event.

  “Everyone ready? Cassie, don’t push! Don’t push until we get the head in the birth canal and get rid of the pillows. Mrs. Potts will tell you when it’s time. Once you begin to push, don’t stop for anything.”

  I think of the cord, the possibility that it’s wrapped around the baby’s neck. Except for the arm hanging out, this is so much like Delfina Cabrini’s birth at the King Coal camp. The woman called Samantha begins to sing in a low voice, “Joshua fit the battle of Jericho, Jericho, Jericho.” A fighting song!

  “Joshua fit the battle of Jericho and the walls came tumbling down.” The other ladies join in, even Bitsy, everyone but Mrs. Potts and me. I’m way too busy worming my way up the birth canal.

  This time, because of the tilt, the shoulder is much higher and I’m almost up to my elbow when I begin to nudge it to the left with two fingers. Mrs. Potts senses what I’m doing and begins, at the same time, to slowly guide the head down on the right. It helps that the patient has had several babies; I have room to work in.

  Cassie is getting more and more uncomfortable, and Bitsy tells her to pant. The laboring woman’s eyes are so big I think they might pop, but she doesn’t cry out. She just pants like Bitsy instructs her and I wonder how my new assistant knows how to do this; she’s only seen one birth, Katherine MacIntosh’s.

  By the placement of Mrs. Potts’s and Mildred’s hands, I can tell that the head’s coming down nearer and nearer to the brim of the pelvis. To make room, I slowly slip my hand out, and the head follows easily into the space.

  “Okay, push now, honey,” Grace Potts commands. “Push with all your heart!”

  The aunties whip the pillows away and help the mother sit up in bed just as the head with long black curls crowns at the opening.

  “Sweet Jesus! I’m gonna faint,” the shorter of the trio exclaims and feels for a chair as the baby shoots out, dragging an afterbirth that looks like a two-pound calf liver. The cord is only eight inches long! Quick as a wink Mrs. Potts ties it off and hands the baby to Mildred, who wraps the tiny crying girl in a clean towel.

  “Praise Jesus!” “Thank the Lord!” everyone exclaims.

  Another healthy baby. If I believed in God, I would bow down . . .

  Hemorrhage

  The blood that follows within minutes is the real emergency—as if an arm presenting weren’t bad enough. I start massaging the womb, talking to it as if it could hear. “No, you don’t. You stop bleeding! Stop it right now!”

  “Get your fist back in there,” Mrs. Potts orders. I know what she means, but I’ve never done it before. It’s called, by DeLee, bimanual compression. There’s a picture of the procedure in my obstetrics textbook. “Use your other hand on the outside. Fold the floppy uterus over your fist and hold on tight.” The older midwife spits out her instructions as she fumbles behind her for a small brown bottle on the dresser. “Drink this,” Mrs. Potts commands. Bitsy holds the flask to Cassie’s lips.

  Potts is in total control now and the blood is slowing, so I try to remove my hand.

  “Not yet,” she directs.

  I go back in and hold on when I see the hemorrhage start up again.

  “Vinegar,” Potts demands, and the shortest of the three ladies trots to the kitchen, returning with a small ceramic jug. The midwife pours the pungent liquid over one of my sterilized rags and hands it to me.

  “Clean her uterus out. There must be clots. The vinegar will help stop the hemorrhage while the blue cohosh and shepherd’s purse tincture that we gave her takes effect. Any time a woman has pain with no progress, be ready for this. If the bleeding doesn’t stop pretty quick, we’ll try ice.”

  At the sight of so much blood, the three musketeers, Mildred, Samantha, and Emma, have backed out the door with the baby. Bitsy takes Cassie’s hand, softly singing “Joshua fit the battle of Jericho . . . Jericho . . .” into her ear to keep her calm.

  “Ice?”

  “Ice in the uterus will cause the blood to contract.” I think she means blood vessels, but I don’t ask. I’ve read about surgeons using ice to stop a hemorrhage during a cesarean section, but it always seemed to me it would cause such shock that a woman would die of chill instead of blood loss.

  Mrs. Potts takes Cassie’s wrist while she stares at her gold wristwatch, the kind nurses have, and her lips move as she counts the patient’s pulse. “You are such a good girl, Cassie. We’ll have you fixed up in a minute.

  “Go, ahead, bring the rag out and all the thickened blood you can find,” the elderly lady instructs me. When I do what she says, I find myself holding a handful of clots the size of chicken gizzards. Mrs. Potts then takes over and from the outside squeezes the uterus like she’s wringing out a dishrag. More clots plop out, and I wipe them up.

  “All right, then!” the old midwife calls. She takes a big breath and kisses her patient on the top of her head. “You can stop rubbing now. Bitsy, check every few minutes and make sure the womb stays firm.” My assistant—I think of her that way already—knows what to do from Katherine’s birth. Tears are streaming down both sides of Cassie’s face. “Let’s give the mama her baby and get it on the teat. That will help them both feel better.”

  Still shaking as I wash up at the kitchen sink, I take a big breath. Bitsy cleans up the bedroom, and Mrs. Potts dresses the infant’s cord. Outside, the sky lifts the pink hem of its nightdress along the eastern edge.

  “Here, honey.” Mildred, who turns out to be the baby’s granny and the mistress of the house, hands me one of her clean housedresses to wear over my top. She points down the hall. “You can change in my bedroom.”

  “Mr. Miller! Reverend Miller! All clear!” She calls out the back door to her husband and the menfolk hiding in the barn. “Come on in. Food’s on the table!”

  By the time I’ve tidied up, the three cooks are harmonizing in the kitchen. “There’s a rainbow ’round my shoulder and a sky of blue above.” A catchy Al Jolson song. The older midwife pads down the hall, smiling, and shocks me when she does a little boogie at the kitchen door. In the parlor she sits down to reorganize her birth kit, so Bitsy and I sit down beside her.

  “I try to keep everything fresh,” she tells us, giving instructions as if she’s talking to herself. “You never know when you might be called again . . . not that I go out as often as I used to.” Her little brown eyes sparkle at Bitsy, then at me, and I wonder which of us she’s training. “Do you need some of my bleeding medicine? I have an extra bottle.” She holds a glass vessel out and I take it, grateful for the gift.

  “What’s in it, again? Is it something I could make myself, or is it private?” In the Appalachian Mountains cooks jealously guard their recipes for black velvet cake, potato salad, fried chicken, and sticky buns. It might be the same with medicinal tonics.

  “Don’t be foolish. If it could help save a mother’s life, of course I’d want you to have it.” She proceeds to write down, on a torn piece of wrapping paper, the herbs she uses and how to prepare them as Mildred pokes her head into the hall.

  “Come on, Auntie Potts! You’re first to eat and then Patience.” I smile at their thoughtfulness and am a little surprised when I enter the kitchen. In this household, at least after the hard work of birthing, the women eat first. Three black men stand back, leaning against the wall or the counter, eyeing the food. There’s Thomas, our escort; Darwin Washington, the father of the new baby; and an older gentleman I take to be the reverend. Then there’s the women bustling around, a sea of black and brown faces, with mine as white as the full moon in October. I note that no children are present and decide that in this tight-knit community, there would be plenty of willing attendants down the road.

  As if she lives here, Bitsy steps up to the table and begins to serve collards and mashed potatoes, along with meat sandwiches on homemade white bread. Mildred takes a breakfast tra
y into the bedroom for Cassie and Darwin.

  “They give her a name yet?” Thomas asks when Mrs. Miller returns.

  “Couldn’t be more fitting.” The grandma laughs, glancing out the window toward the crystalline trees. “An old-timey West Virginia name.” Everyone stops chewing and waits. “Icey.”

  “Good-bye.” “God bless.” “Thank you so much, girls!” We are standing on the porch staring out at the glitter that covers every twig and branch. The holly bush by the Millers’ front door is sheathed in ice. Even the power lines that come up the drive droop low and are hung with icicles. Reverend Miller, the grandfather of the infant, stands and stares across the yard. “We don’t have much,” he says, shaking hands with me, “but what we have is yours. Please call on us for anything.”

  I cannot help comparing this joyful scene with the Cabrinis’ isolation in the coal camp or the MacIntoshes’ seclusion in their brick mansion. The feeling in this happy home gives rise to thoughts of my time in Pittsburgh with the suffragettes, radicals, and union organizers of both colors, and a shadow passes over me. Gone are those days, and they can never come back. I must stay here, on the edge of the world . . .

  When the sun rises over the mountain, we are blinded by light. “Morning has broken,” I sing the old song. “Like the first morning . . . Blackbirds have spoken . . . like the first bird.”

  November 28, 1929. Quarter moon waning.

  Arm presentation delivered with Mrs. Potts, colored midwife of Hazel Patch. Female infant. Icey Washington. Second baby of Cassie and Darwin Washington. I had to go inside and push the arm back and out of the way while Mrs. Potts held the head down. No vaginal tears. After the birth, the arm was very swollen and blue but seemed to bend without making the baby cry. I was proud of myself for figuring out what to do, but then there was heavy bleeding. Mrs. Potts showed me how to do womb compression, which I had read about, and she gave me her recipe for an herbal tincture. Weight 6 pounds, 15 ounces. Present, Mrs. Potts, Bitsy, who was a great help, and all the Miller women and the other ladies, whose full names missed me.