I pull the tent flap aside, and my eyes fly open. “Holy cow!”

The mother, a pale-skinned slip of a thing not more than sixteen, is lying on her side with a baby’s head halfway out. The girl’s not even trying to push, just lying there crying. The trouble is that the tissue all around the infant’s head is beet red and distended, as if the head’s been crowning for a long time.

“Her name’s Docey,” the home health nurse tells me.

“Lord, Docey, how long’s this been going on?” That’s me. Becky is kneeling to one side, trying to bring some order to the dirty pallet. She picks up the wet, bloody rags with the tips of her fingers and throws them out the tent door.

“How long has the head been down here?” I ask again.

Docey opens her eyes, a startling blue-green, the color of the river in winter when the ice first opens. She shakes her head as if time has no meaning and she’s too tired to talk but not too tired to cry.

“Eeeeeee. Owwwww!” she whimpers when a contraction hits her, making no effort to bear down. “It burns so bad, I think I’m going to split open.”

“It’s her first,” Becky fills me in. “I got some of her medical history the first time I was here. It was Judge Hudson that called me. Apparently everyone who’s crossed the bridge today has heard a woman scream. After the third complaint he wanted someone to go check. For some reason he thought of me, not the sheriff.”

I am hardly listening. If I don’t do something soon, she really might split open, right to the rectum. She won’t die from it, but she might be ruined for life.

“It’s gonna be okay, Docey. You can do this . . . We’re going to need warm compresses.”

Outside, I throw orders around like Napoleon. “Where’s the hot water? Did it boil yet? Get more wood. I need a clean bowl, some sterilized twine, and a sterilized knife. Who has one?”

The black man holds out his pocketknife and wipes it with the tail of his plaid flannel shirt. “Good enough, get it in some hot water . . . Now, do you have any lard?” All activity stops, and the men jerk up from their appointed tasks.

“Lard?”

“Yeah, I said lard. Do you have any? Bacon grease? Anything?”

The crying starts up in the shelter again. The older guy, Will, rustles around in a canvas knapsack and comes up with a tin decorated with a smiling pig.

“Patience!” That’s Becky. “Patience!” When I reenter the tent, the home health nurse is so anxious you’d think maybe she’s never seen a birth before. “Don’t leave me!” she says. What do they teach these people in nursing school?

“Make a low table for the water, the lard, and the sterilized knife just outside the tent!” I yell to the men.

Docey yells louder. “OW! OW! OW!” She still lies on her side, and the head hasn’t moved. I consider listening for a heartbeat, but how do I know if the baby is even alive? Better concentrate on just getting it out. I indicate that Becky should hold the girl’s upper leg, and she does so with shaking hands.

“Docey,” I try, “you have to stop screaming. You’re scaring the baby.” I remember Bitsy’s words with Twyla, and they seem to work. The girl doesn’t shut up, but she turns down the volume.

“The baby’s stuck right at the opening, but I’m going to ease it out. You have to push when I tell you. Even if it hurts, you have to push, but just a little at a time. Once we get ready, it will all be over in a few minutes.”

It occurs to me that my optimism may be misplaced. What if the swollen tissue is not what’s holding the baby back? What if the infant’s shoulders are wedged up behind the pubic bone?

Outside the tent I hear rustling, and I look out to see the men making a platform with two rounds of wood. The oldest guy brings over a pot of hot water. The bearded fellow hands me the can of lard, and the youngest one proudly shows me his pocketknife, gleaming in a still steaming pork-and-beans tin.

Hope

Docey cries out again and again, throwing her head back and forth.

“It’s okay. It’s okay,” I soothe.

“It’s okay,” Becky copies me, patting the girl’s arm as if she were a dangerous animal about to bite.

“It’s gonna be okay. You’re gonna have a baby in your arms soon.” That’s me again.

With a twitch of my head, I tell Becky to get the warm compresses. She wrings one out, glad to have something useful to do.

“My theory is that the warmth will soften the tissue and help the mother relax,” I explain. It seems to be working. Between pushes, I can now get two fingers in, indicating that there’s a little more stretch, and with the next contraction we see some real progress.

“Look honey, the baby is coming.” The hairy head peeks out just a little more.

The men can’t help themselves. From outside, they shout their encouragement. “Atta girl!” “You’re getting her now!” “That’s our champ!”

All my attention is focused on that tight, swollen ring of fire. This is the part where I’m fully awake. I make a crown with my hands and just pray that the baby’s still living.

“I can see ears. A few more pushes, and the widest part will be out. Push a little. Blow a little. Whoo. Whoo. Whoo.”

With the next effort, progress happens fast, and my fears of the shoulders being too big prove unfounded. A wailing pink infant girl flops into my lap, followed by a gush of blood and then the placenta.

Docey’s blue-green eyes fly open as she realizes it’s really a baby and not just more searing pain. “My baby! My sweet!” It’s the first words I’ve heard from her, other than about how bad it hurts.

“Hot damn!” a man utters behind me, peeking in. “Pardon.”

The guys can’t help themselves; they have to see. I block their view of the mother but let them get a glimpse of the baby.

Will wipes beads of sweat off his face with a crumpled blue bandanna. “Watcha gonna call her?”

Docey doesn’t answer at first but inspects the jewel in her arms. “What’s the name of this river?”

“The Hope,” Becky and I answer together.

“That’s her name then, Hope.”

Twenty minutes later, I accept a hot cup of joe from the men around the fire. Becky stays in the tent to show the mother how to breastfeed, her hands no longer shaking. Birth is a messy, primitive event, and I’ve noticed before that it’s not for everyone.