The next thing I check for is the presenting part. I run my hands over Delfina’s abdomen, searching for the baby’s head. Finally I think I find it, a hard bulge the size of a small acorn squash on the right side, almost out of the pelvis. Too high.

A couple of explanations come to me: This mother has had more than five children, and her abdominal muscles and womb are so flaccid that even a full-term baby could float around in there any way it likes. Or, and this is potentially more serious, something is blocking the opening, a large fibroid tumor or, even worse, the afterbirth, stuck low in the womb.

The safest thing to do would be to leave at once for Liberty and get help, but that option isn’t open. We have no transport except Thomas Proudfoot’s burros. And even if the camp boss would drive us, on these steep, winding country roads it would take over an hour to get to the big hospital in Torrington. Finally there’s the issue of money. It’s clear that Mr. Cabrini doesn’t have any. Dr. Blum, in Liberty, has told me before that he can only afford to take paying patients, and God knows what the hospital in Torrington costs.

I open my case and pull out the new rubber gloves I didn’t have time to use at Katherine’s birth. They’re still clean, sterilized with bleach, and wrapped in roasted newspaper. The only way to find out what’s going on is to do an internal examination, but that’s risky, and also against the law.

The West Virginia Midwifery Statute of 1925 bans midwives from doing internal exams. We are also “expressly forbidden to assist labor by any artificial, forcible or mechanical means, or administer, advise, prescribe, or employ any dangerous or poisonous drugs.” The local medical societies jealously guard their right to prescribe and treat. In addition, the law requires that we must be “of good moral character.” I smile to myself. That leaves me out.

Knowing I’m violating the rules, I adjust my glasses and pull on the gloves. I’m already wanted for far worse crimes. What can they do to me for a vaginal exam? The mother stares with big eyes.

“Delfina, I need you to open your legs so I can feel what’s keeping the baby from coming.” The husband turns away and steps out on the porch, aware that this is female business. He leaves the white-haired girl as an interpreter, and she creeps up on the bed.

“What’s your name?” I ask the dirty-faced urchin.

“Antonia.”

“Antonia, can you tell your mama that I need her to lift her bottom so I can put down a clean pad and to open her legs again so I can wash her and feel where the baby’s head is? Tell her I will be very gentle. It won’t hurt.”

As the girl explains this in Italian, the woman does what I say and lets her knees fall apart. With the new brown soap I got at Stenger’s when I purchased the gloves, I carefully wipe her bottom, then pour some over my fingers. If the afterbirth is attached too low and I poke a hole in it, Delfina will bleed to death. Then I will lose both mother and baby.

The first thing I come to is . . . nothing. No foot, head, or butt poking through the opening of the cervix. No cervix, either. The patient is fully dilated. Gently I palpate the lower wall of the womb for a hard gristly growth or soft squishy afterbirth but find none. This is good news, but then what’s keeping the baby from coming?

A cord. It could be a short cord wrapped tightly around the infant’s neck, another potential disaster. If the woman pushes vigorously, the cord will make a noose and choke the baby or, even worse, pull the afterbirth away from the womb. I take my fingers out and stare at the wall, where a carved wooden crucifix hangs over the bed.

I gave up on the church a long time ago, and I’m not even privately religious. In fact, I’ll admit it: since Lawrence, my first love, perished in the train wreck and then years later Ruben, my true love and husband, was killed during the battle of Blair Mountain, my faith in God, like a tallow candle, has sputtered and gone out.

Still, looking at the carving, I silently ask Jesus and myself what to do.

“As far as I can see, we have to give it a try,” I mentally converse with him. “If I do nothing, the baby will eventually die, then the mother will become infected, and she will die too. If I do something, there’s a chance; the baby and mother might live . . .”

The man on the cross seems to nod in agreement.

“Antonia, get your father.”

Clouds have come over and the room is getting dark, but when Izzie returns with the water and reaches up to turn a knob above the hanging bulb, the newspaper-covered walls burst into harsh light.

“Mr. Cabrini, the safest thing to do is get your wife to the doctor in Liberty or the bigger hospital in Torrington, but I don’t think that’s possible without putting Delfina and the baby in more danger. I’ve checked inside her, and there’s nothing in the way. The infant is alive, but the head is too high. I think we can get the baby out in a few minutes if you’ll help us and maybe a few other women from the camp.”

Izzie shakes his head no. “The women won’t come. I’ve already asked them. They don’t like dagoes. They think we take their men’s jobs.”

I frown. When I was working with the Wobblies in Pittsburgh, I’d thought that all workers would stick together, but I am naive; people have told me this. With the gradual failure of the economy, there has been less need for steel and even less for coal, and the unions have all but disbanded. To cut costs, the mine owners bring in cheap labor, immigrants from the North and blacks from the South. Local men live in fear for their jobs, and their women try to protect them.

“Okay . . .” I think for a minute. “Then I’ll need you and the oldest boy to help. Tell him he won’t have to look.” The man throws his hands into the air and spits out a few words in Italian. It’s clear he doesn’t like this. The girl argues back in their native tongue, and he slams out the homemade oak door.

At last, reluctantly, Mr. Cabrini and his son of about nine return and we’re ready. While he was gone, I straightened the bed, propped up the limp patient, and laid out my oil, sterilized scissors, sterilized string to tie off the cord, clean rags, and a pan of warm sterilized water.

“Mother.” I address the woman through her daughter, reminding the patient, by the appellation “Mother,” what her suffering is about. “The baby’s head is too high and the cord may be wrapped around his or her neck, so we won’t have much time.” I wait for the translation.