“Your children will help you sit up, and I want you to pull back on your knees and push as hard as you can. Push with all your might. Your husband will use his hand on your abdomen to guide the head down.” I take Izzie’s hand and show him how to palm the baby’s head through his wife’s flesh.

“I’ll have my fingers inside to feel if it’s coming. If there’s a cord, I’ll try to push it aside.” This all sounds so complicated, but Antonia, using her hands to illustrate, translates quickly. “Once the head is in the pelvis, I’ll want you to squat, but don’t stop pushing for anything, don’t let the head slip back.” Delfina nods that she understands, and I see by the light in her deep brown eyes that despite her exhaustion, she has plenty of grit.

When we’re ready, I look up at Jesus and make the sign of the cross the way I’ve seen Mrs. Kelly and the Catholic women do, and the whole family follows. The minute I feel Delfina’s womb get hard, I nod and we get into position. Izzie cups the fetal head, and the round orb begins to slide down. The mother pulls back her legs and strains forward. The children, Antonio with her eyes wide and the older boy with his eyes scrunched shut, support their mother from the back.

At first I feel nothing—no cord, no limb protruding, then just the tip of something hard. “Yes!” I shout. “It’s the head. It’s coming!” What I lack in expertise I make up for in enthusiasm. This is where my two years on the stage at the Majestic come in.

Delfina takes a deep breath and strains down again. We don’t wait for another pain; I’m afraid that if she stops, the head will slip back. The children push their mother up a little higher each time, and Izzie, with the wisdom of a gentle man, keeps the head steady. He knows he can’t shove this baby out, though no doubt he would like to. With each maternal effort, I feel the skull lower until it fills the floppy cervix and then comes through. I could check the baby’s heartbeat, but that would take time, and besides, what would I do if the heart rate dropped? No! We keep on.

“It’s coming!” I shout.

Izzie hollers something in Italian that I think must mean “Push!”

“Okay, this is it! Children, help your mother to squat.” I get down to show them. “Izzie, you keep the baby’s head low, don’t let it work back.”

The woman is straining for real now. The urge is spontaneous, and the whole head is crowning. I reach behind me with one hand, dip my gloved fingers in the oil I use to counteract tears, and swipe it around the woman’s opening. Usually I would slow things down at this point, but a birth canal tear is the least of my worries.

“Yi, yi, yi!” Delfina is yipping. I don’t know Italian, but her meaning is clear. Her opening burns like a ring of fire.

Then the head is out . . . silence. Everyone stares, even the boy. There’s nothing stranger than the sight of a woman with a baby’s head sticking out of her, one life emerging from another.

I lean lower, feel for the cord around the neck, and am surprised when I find none. The newborn is already scrunching up its face, a good sign. I wipe its mouth with a clean piece of rag. “Last push!” The baby spins three times as a cord at least three feet long unwraps around his chest and a little boy falls into my lap.

Now we are all laughing. Laughing and crying. Language doesn’t mean anything in the presence of true joy. My eyes meet Izzie’s, and I see how much he loves his wife and new baby and these dirty kids. Delfina’s head falls back into his arms.

Praise Jesus, the words come to me as I look up at the crucifix.

October 30, 1929. New moon setting over the mountain.

Live-born male, 6 pounds, 4 ounces. Name, Enzo Cabrini. Seventh or eighth child of Izzie and Delfina Cabrini. Presentation, cross lying, cord around the body three times. Active labor, two days. Pushed five minutes with father holding the head down. No tears. Blood loss one cup. Mrs. Cabrini knew to put the baby right to the breast. Also present two young children, who helped the mother squat. No payment again. The women in the camp wouldn’t help us.

4

Midwife

It’s been one week since Mrs. Cabrini and Mrs. MacIntosh delivered.

I remove the blue ribbon from the last used page of my journal. The day I went to check on them, both mothers were doing well and seemed to have plenty of milk. Bitsy and Mary will wait on Katherine for her two-week lying-in period. Delfina is already up cooking and cleaning.

A few years after Ruben’s death and the disaster at Blair Mountain, when the fog around my heart finally lifted, I began to assist Mrs. Kelly with births along the south shore of the river in Pittsburgh. I couldn’t go back to Westinghouse, not after what happened. Sophie took me with her at night, more to shake me from my grief and self-absorption than because she needed me. I attended another fifteen births here in West Virginia before she died, that made thirty-five, but I’m still a novice, and after the last two births, I’m beginning to wonder if I should be attending mothers at all.

I didn’t refer to myself as a midwife at first. That changed when Dr. Blum gave my name to the state health department and I was required to register. I’d met Blum only that one time, when Sally Feder had her twins. Mrs. Kelly had never needed him again. At first I was flattered that he remembered me. Later I realized that it wasn’t because he thought I was so great; he just wanted someone to take care of the poor so he wouldn’t have to. That came after Sophie’s heart attack. Now I’m the only midwife between Delmont and Oneida, except for an elderly black woman, Mrs. Potts, but I’ve never met her.

It’s easy to be a licensed midwife in West Virginia, no exam or anything. All I had to do when the home health nurse, Becky Myers, sputtered up Wild Rose Road in her Model T was demonstrate that my house was clean and I could read and write. Then I signed some papers saying that I understood the regulations, and that was it.

Mrs. Rebecca Myers sat on my worn sofa in her pale blue nurse’s uniform with the crisp white collar and dark blue sailor tie and showed me how to fill out the birth certificate. I watched her, wondering where this very precise woman with the midwestern accent, obviously university-trained, came from. She wasn’t a local, that was for sure.

The public health nurse asked to see my birth kit. I offered her tea and had a few books on my shelves and paintings on the walls, so she must have thought I was a decent person. That’s the other requirement I mentioned before: you must be of good moral character . . .