Coal camps that are unionized have a one-room schoolhouse, basic cabins for the miners and their families, a clinic, and a store, but this camp, from the looks of it, is a makeshift affair, no unions, no benefits, nothing. The houses are little more than shacks.

Passing us, a ragged line of men wearing metal hats with lights on the front turn to stare. Their faces are so covered with coal dust, their eyes are the only thing alive, and you can’t tell by looking who’s Scotch Irish, who’s Negro, who’s an Italian brought in by the coal barons to work the black gold. Five years ago, 20 percent of the miners were black, former sharecroppers who found better work and better money by leaving the South. Now, with the closing of the mines, the numbers are way down. Trailing along behind the men are two little boys not more than ten, also wearing miner’s hats.

When we lived in Pittsburgh, Mrs. Kelly, Nora, and I fought alongside the International Workers of the World, the Wobblies, for the Child Labor Amendment of 1919, but the Supreme Court shot it down. Somehow the judges believed the federal government didn’t have a right to regulate the industrialists and it would be just fine for young children to work in sweatshops or miles underground.

Trotting hurriedly through the village on the burro, I make note of the lack of outhouses. There’s not one privy anywhere, and when it rains the human waste seeps into the ground and runs downhill to the communal well. Despite the chill in the autumn air, children play barefoot in the yellow-brown creek. A rail-thin woman wearing a thin blue-and-white-flowered feed-sack dress walks out on her stoop and throws the water in her dishpan across her yard.

At last Thomas halts in front of a sloping black tar-papered shack where a girl of about eight watches the road through the dusty four-pane window. The youngster’s face brightens, and she announces my arrival to whoever’s in the room. From the looks of the place, this is another birth for which I won’t be paid, and it’s not because they lost their money in the stock market, either.

The dark man helps me off my burro, hands me my satchel, and prepares to leave. “Thanks for escorting me, Mr. Proudfoot.”

There’s just the flicker of a smile. “Ma’am,” he responds, tipping his hat. That’s all he says; then he’s gone.

Delfina

Stumbling up the rickety steps with my birth satchel, I wish Thomas Proudfoot had at least stayed to introduce me. Inside, who knows what I’ll find? But before I can knock, the door flies open.

“She’s doin’ poorly,” a nervous man says. His little mustache quivers, and his large brown eyes with long lashes illuminate his worried face.

I take in the room. Newspapers cover the interior walls to keep out the wind. There are two big beds, a worn sofa, a rocker, and a cradle. In one corner, a crude kitchen counter has been put together with shelves of weathered boards. The iron cookstove, a wooden table with six unmatched chairs, and the one lightbulb that hangs on a long cord from the ceiling—that’s all there is.

I’m surprised to see that the family has electricity, but remind myself that all coal camps do. The mines need electric power to bring mechanical shuttles up on tracks. It used to be donkeys that brought the coal out; before that, men were used as pack animals, and before that, children and females because they were small.

A woman lies moaning under a tattered brown quilt in one of the rumpled beds. Three little boys dressed in rags sit at the table, hiding their faces, but the girl, still perched on the windowsill, looks right at me. Nobody smiles. Nobody says hello. I’ve entered a Charles Dickens world.

I skip the introductions. They know who I am. “How long has she been having pains, Mr. Cabrini?” When she hears my voice, the woman on the bed looks up, and I see that she’s about my age, maybe younger. Her curly brown hair is matted on one side, and her face is flushed and sweaty.

“Since last night.” The man has a strong Italian accent, and I wonder if his wife and children speak any English at all.

“Is she leaking fluid?” Cabrini shrugs that he doesn’t know.

“Is your water trickling out?” I direct my question to the woman louder than I need to. Why do we always increase the volume when we think someone can’t understand?

“Her under-bloomers is wet,” the girl tells me. Obviously, the daughter speaks a little English.

Four children. The patient may have delivered several more that died at birth or a few months later. Infant mortality is high in the mountains. If a mother has ten children and she’s impoverished, without good sanitation, two, at least, will die. Even in the best of conditions, like those of Katherine MacIntosh, the chance of stillbirth or death within the first year of life is one in ten.

I turn to the girl. “What’s your mother’s name?”

“Mama.”

“Delfina,” the man corrects.

“Delfina.” I sit down next to my patient and place a hand on her shoulder. “Delfina, my name is Patience Murphy. I’m the midwife.” I dropped my married name, Gordesky, after Blair Mountain, and I say “midwife” with reservation following my blunder at Katherine’s delivery.

“I know you’re weary and have been in labor for a long time, but could you roll on your back, please, so I can check you?” Her pains, by the change in her breathing, are mild and about every five minutes; she hasn’t had a strong one since I entered the room. This is not a good sign. We want robust contractions to get the baby out, and if the womb is exhausted, it won’t clamp down afterward and the mother will bleed.

I turn to the mister. “We’ll need boiled water. Have the boys bring a bucket from the well. Send them outside while I figure out what’s going on. Your daughter can stay. I might need her.

“Can you roll on your back after the next pain?” I ask the mother again.

The girl says something in Italian, and her mother rolls slowly, dragging her belly along with her hands, then plopping it down. I note the dried blood on the inside of her legs when she pulls up her shift.

The first thing I do is listen to the fetal heart rate with my wooden horned fetoscope. I do so with dread, afraid of another stillbirth, but finally find the tick-tick-tick high on the abdomen, higher than I’d expected.

By Mrs. Kelly’s gold pocket watch, which I wear just as she did, on a ribbon around my neck, the infant’s heartbeat is regular, about 140 beats a minute, and I’m grateful that Delfina’s skin is still cool—no fever yet.