Poor Thomas, he’s hardly said a word. Everyone must call on him for everything. Tonight he has to work the night-owl shift at the mine, and I wonder how we’ll get home.

We enter quietly through the back door of the Hudsons’ white colonial. A wraparound porch with swings and ferns in pots and wicker furniture graces the front. Before we get into the kitchen, I hear a scream, and for some reason, it crosses my mind that the way the girl got pregnant might not have been consensual. The judge’s son would be eighteen or twenty, a fully grown man; she’s only fourteen, little more than a child.

Mrs. Hudson, with gray-streaked brown hair done up in a bun, sits at the long maple table with a cold compress on her head. She doesn’t get up. The cook, Nancy Savage, a thin coffee-colored woman in a white uniform, welcomes us in. Upstairs the wailing starts up again.

Thomas takes his hat off and bows with his head to the judge’s wife. “Mrs. Hudson.” He nods to the colored woman of about his mom’s age. “Miss Nancy, this is Patience Murphy, the midwife from over Hope Ridge, and her assistant, my sister, Bitsy.”

“Bless you!” The cook stands and directs her comment to both of us. “I hope you can get that girl to settle down. She’s going to tear herself up or lose that baby if she don’t behave.”

“Yes, thank you so much for coming,” Mrs. Hudson murmurs, glancing from under the comfort rag on her brow. “Nancy, take their things and show them up the back stairs. I just hope you can do something. The child has already run my husband off, and if this keeps up, I’ll have to leave too.”

The wailing starts once more. By the sound of it, the pains are about every four minutes. Mrs. Kelly always told me to let laboring women find their own way. “It’s their journey,” she said. “You can’t lay the road for them.” I take a deep breath. Maybe she’s right, but screaming has never seemed helpful to me, and despite my chosen name, I’m not as patient as she was.

Upstairs, Nancy nervously pushes the guest bedroom door open.

“Twyla,” she whispers, “the other midwives have come.” A pillow flies across the room and hits me in the face. It doesn’t hurt, just offends me a little. “Now, Twyla, don’t be that way! These nice ladies are going to help you get your baby.” The girl’s mother retreats and slips down the stairs, understandably at her wit’s end.

“I don’t want no baby!” Twyla shouts after her. So that’s the trouble. It’s hard to suffer the pains of childbirth if you don’t welcome the infant.

“Hi, Twyla,” I try. The girl turns her back and starts wailing again. She’s a slip of a thing, probably not five feet tall, with wild curly hair and very light, almost golden, eyes, strange in a brown face. Mrs. Potts sits in the corner in a rocking chair, her hands empty in her lap. She’s clearly had enough of this, but a midwife can’t give up, can’t leave her patient until the baby’s out and the mother and infant are stable.

“Whooooooooooooooooooo!” Twyla shrieks. Bitsy surprises me by dropping the satchel, going right up to the patient, and putting her hand over the young woman’s mouth. She pats Twyla’s lower face so her wail sounds like a barn owl. “Whoooo. Whoooo. Whooooo. Whooooooo.” The girl slaps Bitsy’s palm away. “Who are you?”

“I’m the midwife’s assistant, and I’m here to get you under control,” Bitsy states firmly. Mrs. Potts and I stare at each other, shocked at such boldness.

“Yeah? Have you ever had a baby? I feel like my whole damn body is being ripped apart!” The profanity doesn’t bother me, I’ve heard far worse on the union picket lines, but Mrs. Potts cringes.

Bitsy doesn’t miss a beat. “Well, I’ve never had no damn baby, but I know enough not to struggle with the contractions. They always win. You’re just making a mess of this. Your baby would have come a long time ago if you weren’t fighting it. And you are scaring him, don’t you know. When you scream, you scare the baby. They can hear everything.” I smile, thinking how well Bitsy puts this. You scare the baby. I’ll use that line myself with my next out-of-control patient.

Another pain hits before the older midwife and I can consult about the baby’s position. Twyla starts her yell, but Bitsy, undeterred, lays her hand over the girl’s mouth again and this time pats so fast that the Whooooooooooo comes like an Indian war whoop. Twyla laughs. She’s met her match. Bitsy wipes the girl’s face with a cool cloth, and that’s the end of the screaming.

“Thank you for coming, dear. I’m getting too old for this,” Mrs. Potts confides in a whisper. “I don’t mind when a woman is serious about her job, but this girl struggles and there’s no father. You heard?”

“Thomas told us.”

The old lady shakes her head. “We’ve been doing this all night. I checked her one time, four hours ago. She was only halfway dilated, but the head was real low. Maybe you can check her now. See what you think. If she’s not progressing, we’re going to have to get her to the hospital, no matter how she kicks and screams. We can’t let anything happen.”

I approach the patient for the first time. “Twyla,” I say softly, not wanting to upset her again or be hit with another pillow. “I’m Patience. Mrs. Potts and I think you might be getting close to delivering. I’d like to check you after your next contraction to see if the baby’s getting lower.”

I don’t offer the alternative: And if it’s not coming, we are going to have to struggle you into an auto against your will and drag you to the hospital in Torrington, fifty miles away, where you’ll be strapped down, given gas, and have the baby cut out. (Dr. Blum could probably do it, but he doesn’t take coloreds.) The Hudsons are a respected family in the mountains and would pay for a cesarean section, even in hard times.

I remember the story Mrs. Kelly told me, that the first successful cesarean section in the United States was, in fact, performed in Mason County, West Virginia, back in the late 1700s. According to her, a physician performed the operation on his wife, who was in obstructed labor. The doctor, a Mr. Bennett, accomplished the surgery with only laudanum for anesthesia. Amazingly, both mother and infant survived.

Bitsy persuades Twyla to lie still and open her legs while I wait with my sterilized rubber gloves on. When the next contraction ends, I kneel at the bedside. Mrs. Potts is right. The head is very low, and I’m pleased to discover that there’s only a ring of cervix left. “You’re almost there!”