“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.

***

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