The Reluctant Midwife by Patricia Harman

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.”
    â€œThelma, 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?”
    â€œProbably 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.
    â€œIt’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 Patienceshe 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.
    â€œYour baby is fine, Thelma. Nice and strong. But why are you bleeding?” She turns to me. “It might just be bloody show.”
    â€œThat’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.
    â€œShe’s singing through the contractions,” Patience whispers, then she nods her head toward the door.
    â€œWhat 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.
    â€œIt could be an abruption,” I offer. “Have you ever seen one?”
    â€œYes.” 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.”
    â€œDo you think we could get her in the car and make it to the hospital in Torrington?” I ask.
    â€œMaybe. 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.
    â€œThelma.” 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.
    â€œSeven