The Midwife of Hope River (36 page)

“Dr. Hester was on his way back from a call, coming along Salt Lick through the valley, when he saw the vehicle lights in the distance surrounding your house and your fence in flames. He drove to my place and called the sheriff, and then we headed back.” The vet is now letting the howling dogs out of the house. They bound down the steps but find no threat or danger, nothing but friends who reach out to pet them.

“We're just glad you're okay,” the pastor summarizes, patting me on the back and moving on to Bitsy. I wander over to the Maddocks' truck. “Sarah,” I say. There's a rifle resting across her lap, and I believe she was prepared to use it.

“I was so scared,” she explains. “When I first saw the fire from my bedroom window, I thought it was your house ablaze, but Mr. Maddock heard the mob and could tell it was the fence burning. About that time we saw Hester's Ford and the Hazel Patch folks coming up Wild Rose. I'm so sorry this happened.” She reaches out the truck window and hugs me with one arm, and I'm startled at the strength of it.

As I go over to thank Mrs. Miller and Twyla, it begins to snow. Too early, I think, but I laugh and raise my hands anyway. Small hard flakes drop straight down to the ground.

“Most people around here aren't like those men, you know that, don't you?” Mildred Miller asks me, putting her hands on my shoulders and looking into my eyes. Twyla stands next to her with her baby wrapped tight in a wool shawl. “Most people appreciate what you and Bitsy do.” The young mother nods, and I realize they're right. Most people do appreciate us. Most, if they'd known what was happening, would have come to our rescue too. The reverend's wife looks up into the falling flakes. “You could come home with us, honey.”

“No, that's okay. We'll be fine. They won't be back. We let our stock out at the height of the fracas so if they tried to burn the barn down, the animals would get away. Now we have to round them up and get them in.”

“Are you sure?” I nod my head yes. “Well, then.” She takes my hands. “We better get back before the roads get too slick.”

As if by command, Mr. Maddock tips his hat and climbs into his truck. The Millers and Twyla turn to their hack while Bowlin cranks her up. I tighten my mouth when I see Bitsy get in next to him in the front. She lifts one hand and waves good-bye.

From far away, around by the stone bridge over the Hope, I hear the wail of a siren. A little late, Sheriff Hardman is on his way, but the reverend will meet him and have him turn back. It's all over in minutes. Hester is the last to leave.

“I'll help you with the animals.”

“Thanks,” I say feebly, suddenly very tired, all the fury drained out of me. Bitsy is gone, and I am alone again.

 

Within a half hour, we locate Moonlight and her calf down by the creek and get the horse in. There are only the chickens left, but it's too dark to find them and I just pray they make it back in the morning.

“Nice auto.” Hester motions to the Olds parked in the back of the dark barn.

“It was William MacIntosh's,” I explain. “Katherine gave it to us, but we can't afford gas.” He shrugs as if he understands, gives the stock some hay, then secures the doors.

“Maybe I should stay.” I know he's just being neighborly.

“No, I'm fine. Really. I don't need looking after, but thanks, thanks for everything.” I mean more than thanks for coming to the rescue. The baby kicks hard, and I step away.

A few minutes later, he starts up his Ford and pulls out of the drive.

 

Around me, quiet. No wind. No animals barking, just the soft snow.

Mrs. Potts is gone. Thomas Proudfoot is gone. Becky Myers is gone. William and Katherine MacIntosh are gone and now Bitsy, but I am still here and a new life is coming. The snow sizzles when the flakes hit the still flickering remains of the picket fence, and it smells like we've been having a campfire.

From the front porch, I watch as the vet's taillights get smaller and smaller, then almost wink out. Then I watch as he stops at the intersection of Salt Lick and Wild Rose Road and turns the Model T around. He must have forgotten something. The Ford creeps reluctantly back up the mountain.

“I can't leave,” Hester says, slamming the roadster's door.

“Why? I told you I don't need looking after.”

He lifts his eyes from the ground. “You don't?” And gives me his half smile.

“Okay, maybe a little.” For me this is a big admission.

The snow falls harder, dampening the ring of fire. I take Daniel's palm and lay it over my abdomen. There's no need for words. He looks at me a long time, not surprised about the pregnancy. He's an animal doctor . . .

 

Shelter

“Sasha! Emma!” We call the dogs in. They've had a great time chasing the departing cars, and they shake their wet smell over everything. Hester throws more logs on the fire and opens the damper. Then, without talking about it, we go up to bed and strip off our damp clothes . . . all of them, even our socks. We lift our cold feet and pull up Mrs. Kelly's feather quilt. Unlike the last time we lay together, I am shy, unsure what will happen.

“Close your eyes, Patience,” Hester says. “I'll be here in the morning.”

“My name is Lizbeth . . . and I need to tell you my story.”

He turns on his back with his hands under his head and says softly once more, “Close your eyes, Lizbeth. I'll be here in the morning.” Then he takes a deep breath, and I can tell he's asleep.

 

Most of my life I've felt I was dreaming. Now and then I wake up, sometimes for months, sometimes for minutes. Tonight I'm awake, and I lie thinking about the recent events and the people whose lives have crossed mine like veins in an old woman's hands. Their faces float past . . . the twisted and the lame . . . the strong . . . the loving . . . for we are all twisted and lame, strong and loving.

There they go, moving down the Hope River. Mrs. Kelly and Mrs. Potts, who never knew each other, holding hands, their wet gray hair plastered over their heads, then Bitsy, Mary, and Thomas Proudfoot, wading tall in the shallows, and William MacIntosh too, floating facedown.

Ruben and Lawrence are there, and they race each other as they dive into the water. Katherine sits on the green grassy bank, keeping her golden bob dry and playing with baby Willie. There are rocks in the river that are unavoidable. Some of us will be bruised; some will be torn. Some will be sucked under, but some will be freed.

 

I rest my cheek over Daniel's heart and take shelter in the sound of its beating.

Acknowledgments

I'd like to thank first my husband, Tom Harman, MD, and my family for their support for my writing, as well as my staff at Partners in Women's Health Care, who put up with my changes in schedule for book-related matters.

I'd also like to thank my editor, Lucia Macro, and her great team for helping me give birth to this book, as well as my agent, Barbara Braun, and her staff for all their assistance.

In addition, I can't fail to mention my appreciation for my fellow writers, midwives, friends, and muses (you know who you are) for the early reading of the manuscript.

And finally, readers, dear readers, one more round of thanks, this time for your e-mails of encouragement. Like Patience, we must listen to the great heart that beats for us all.

P. S.

Insights, Interviews & More . . .

About the author

Meet Patricia Harman

P
ATRICIA
H
ARMAN
has spent more than thirty years caring for women as a midwife, first as a lay midwife, delivering babies in cabins and on communal farms in West Virginia, and later as a nurse-midwife in teaching hospitals and in a community hospital birthing center.

She spent more than a decade in the sixties and seventies in her wild youth living in rural communes in Washington (Tolstoy Farm), Connecticut (The Committee for Non-Violent Action), and Minnesota (Free Folk). During the Vietnam War years, she and her husband, Tom Harman, traveled the country, often hitchhiking, as they looked for a place to settle. In 1974, they purchased a farm with a group of like-minded friends on top of a ridge in Roane County, West Virginia. There on the commune, they built log houses, dug a pond, grew and preserved their own food, and started the Growing Tree Natural Foods Cooperative.

It was during that time that Patsy attended her first home birth, more or less by accident. “Some people are destined,” she has written. “I was staying at a woman friend's commune when she went into labor and I ended up delivering my first baby.” Soon after, Harman traveled to Austin, Texas, to train with a collective of home-birth midwives. When she returned, she became one of the founding members of the West Virginia Cooperative of Midwives. Her passion for caring for women and babies led her to become an RN as the first step in getting licensed as a certified nurse-midwife. In 1985, with her children, a yowling cat, and her husband she traveled north, pulling a broken-down trailer, to begin her training at the University of Minnesota, where she received her MSN in nurse-midwifery.

For the past twenty years, Ms. Harman has been a nurse-midwife on the faculty of the Ohio State University, Case Western Reserve University, and most recently West Virginia University. In 1998 she went into private practice with her husband, Tom, now an ob-gyn, in Morgantown, West Virginia. There they devoted their lives to caring for women and bringing babies into the world in a gentle way.

When, in 2003, the cost of liability insurance for obstetricians skyrocketed from $70,000 a year to $140,000, the Harmans decided to give up deliveries. Though many loyal patients grieved the loss of their favorite midwife/physician team, the change in lifestyle gave the author time to begin writing her first book,
The Blue Cotton Gown: A Midwife's Memoir
.

Patricia Harman still lives and works with her husband, ob-gyn Thomas Harman, in Morgantown, West Virginia, at their clinic, Partners in Women's Health Care. Though she no longer attends births, she provides care for women in early pregnancy and throughout the life span. She brings to this work the same dedication and compassion she brought to obstetrics.

 

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About the book

A Q&A with Patricia Harman

 

What motivated you to write this book?

After I finished my first two books,
The Blue Cotton Gown: A Midwife's Memoir
(2008) and
Arms Wide Open: A Midwife's Journey
(2011), I got so much positive feedback that I wanted to start another book right away.

I decided it would be interesting to try fiction, take some of my home-birth experiences and write a novel. Because our country and indeed the world is going through the biggest economic crisis since the Great Depression, it seemed timely to begin the tale the day after Wall Street crashed.

 

What inspired the story?

The courage of people has always moved me, so I wanted to write about someone who had been faced with many difficulties and whose life took some extraordinary twists and turns.

 

What kind of research did you have to do to make the past come alive?

The details of Patience's life were meticulously researched, mostly online. It's great what you can find out by doing a Google search: the price of bread in 1930; the name of streets in Pittsburgh then; herbal treatments for postpartum hemorrhage: the percentage of blacks and Italians in West Virginia coal mines.

It's also possible to find photographs of people and places from the past. I printed out images of faces I thought looked like my main characters and referred to them frequently. I also read a number of books about the Great Depression and several novels written in the 1920s and 1930s. One of the most helpful sources of information about the times was a copy of the 1927 Sears, Roebuck catalogue.

I didn't have to research what it would be like to live without electricity, running water, or a vehicle. I lived that way for fifteen years in log cabins on homesteads and rural communes.

I also spent many of my younger years as a peace activist and political radical. Though the issues of my time are different from those of Patience's time, I know what it feels like to live for the cause.

 

How realistic are the home births you describe? What kind of research did you do for them?

Over the years, as a midwife, I've delivered thousands of babies at home and in the hospital. I kept logs for most of those births and can remember the details even now. I found old medical books and articles to help me understand what Patience would have known about the physiology of birth.

Though some of the birth scenes depict rare situations, they are all very possible. Listening for a baby's heartbeat with a wooden fetoscope, for example, is quite difficult. If the pregnant woman didn't feel her baby move for a few days and the midwife couldn't hear that subtle tick-tick, it would be reasonable to think the baby was dead. There were no ultrasound machines or fetal monitors then.

The joyous parts of childbirth are also portrayed realistically. Birth when a woman is allowed to move or dance or even get into water is especially wonderful.

As a birth attendant, direct-entry midwife, and nurse-midwife for more than thirty years, I've seen almost everything. Thankfully I've never had a mother die, but I've delivered stillborn babies. I've seen hemorrhages. I've seen malpresentations. I have also been privileged, over and over, to witness the power, great courage, and ecstasy of women in labor.

 

How do you come up with your characters and story line?

A writer has to have a good imagination. I start with the protagonist, imagine what she looks like, what her personality is like, what her background is. Then I put her into an extreme situation. After that, it's as though I can see a film unrolling in my head.

A character walks into a room. I imagine the light, the furnishings, sometimes the smells and sounds. What happens next can be a complete surprise, something unplanned. Another person enters. Words fly back and forth. Words I didn't even think of! The story begins to have a life of its own.

 

Do you still work as a midwife?

I still work part-time in the women's health practice I share with my ob-gyn husband, doing prenatal care and gynecology. Because of the high cost of medical liability insurance for obstetrics in the United States, we no longer deliver babies. This was a great loss for us and for the community.

On the other hand, since I am not getting up at all hours of the night, I now have more energy to write! Though I haven't delivered a baby for years, it seems like yesterday and I still think of myself as a midwife, only now I empower, support, and educate women with my books.

 

Discussion Questions

  1. The opening scene in
The Midwife of Hope River
presents a dark and scary view of birth. Do you think most women (and men) see birth that way, or do they look forward to childbirth as a peak experience? How do you feel about childbirth?

  2. Have you ever lost a baby or known anyone who has?

  3. Living without electricity was an ordinary part of rural life in the 1930s. We are so used to all our conveniences now. How would you feel about living without them?

  4. Unions played a big part in Patience's life and an important part in U.S. history. What is your experience with unions? Have you ever been a union member, or has anyone in your family? What place do unions have in modern times?

  5. Most people think of inhabitants of Appalachia as Caucasian. Did it surprise you to read about African-American miners?

  6. What did you think about the developing friendship between Bitsy and Patience? Realistic? A stretch of the imagination?

  7. Have you ever had a servant in your home? What was your relationship to them?

  8. The author writes of Patience's loneliness, living out on the farm without Mrs. Kelly or her Pittsburgh community of radical friends. Do you think you could make it alone like that?

  9. What do you think the book says about the human capacity to endure hardship, loneliness, and fear?

10. Patience tells us of her grief and guilt over having killed her husband accidentally while trying to get the goon off him at the Battle of Blair Mountain. The experience defined her life for many years, yet she couldn't talk about it. How can a person let go of something like that? How important is it for a person to find someone to talk to?

Interesting Facts About Midwives and Childbirth

W
ORLDWIDE
, 80 percent of babies are born into the hands of midwives. In the United States, midwives attend only 10 percent of deliveries, but that number is growing. Ten years ago, it was only 3 percent.

Since 2002, certified nurse-midwives have delivered more than three million mothers in the United States. More families are choosing to deliver at home. In 2011, there were more than 26,000 home births in the United States.

During the period between 1900 and 1930, in this country, maternal deaths during or soon after childbirth were 7 per 1,000 women. One out of ten infants did not survive the first year of life.

Currently in the United States, there are more than 13,000 certified nurse-midwives. CNMs are trained in universities as RNs and usually have master's degrees. They can do gynecological care and some primary care and write prescriptions for medication as well as deliver babies in the home, a birthing center, or a hospital. There are also more than 400 certified professional midwives. A CPM is usually not an RN but a direct-entry midwife who specializes in natural deliveries in birthing centers and at home. The author has had two babies at home with midwives and believes it's a safe alternative for low-risk women if the provider is experienced, well trained, and has a backup plan in case of problems.

 

For more information or to find a midwife in your community, go to:

American College of Nurse-Midwives: www.midwife.org

Midwives Alliance of North America: www.mana.org