“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!”