The Mountain Midwife (2 page)

She took a step back from the door. “Do you need a midwife?” The admission tasted like ashes to speak. “I deliver babies, and I can’t—”

“Why do you think I’m here, you stupid—” A string of adjectives of profane origins accentuated this assault on Ashley’s intelligence. “She’s going to drop this baby any minute.”

“Where is she?” Ashley shifted the cordless landline phone so her forefinger rested on the preprogrammed emergency button. “Let me see her.”

The man’s hand, broad and liberally sprinkled with red hairs, left its pressure on the door. He stepped aside far enough for Ashley to catch a glimpse of a woman, bent forward as far as her belly would allow. Straight blond hair masked her face and nearly touched the porch floor. A low moan escaped her along with the faintly bleachy odor of amniotic fluid. Her water had broken. Not
good for someone Ashley had never seen. Examining her after the water had broken risked infection.

She’d have to take the chance.

Ashley shut the door far enough to release the chain, then opened it again. “Bring her in.”

The man scooped up the woman more like a sack of feed than a person he cared about. “Where to?”

“This way.” Resisting the urge to suggest he carry his lady in a more loving manner, Ashley led the way down the hall, flipping on lights as she went. “What’s her name?”

“Uh, Jane.”

“Uh?” Ashley’s rubber sole squeaked against the floorboards as she halted and twisted around. “You’re not sure?”

“Yeah, yeah, sure I’m sure.” The man didn’t meet Ashley’s eyes. “Jane Davis.”

Not Jane Smith?
Ashley kept the thought to herself.

“How old are you, Jane?”

In response, the young woman made a mewling sound like a kitten and writhed in the man’s hold. Not unusual for a woman in labor to remain wordless. Pain caused some females to draw into themselves, and yet that generally changed when the second stage of labor began.

Ashley looked at the man, unshaven, clothes rumpled, and that unpleasant animal stink, and tried to meet his eyes without success. “How old is she, Mr. Davis?”

He shrugged. “Nineteen? Twenty?”

“Uh-huh.” If the girl was eighteen, Ashley would eat her nurse-midwifery license. And if the girl wasn’t at least eighteen or lawfully married to the man with her, Ashley had trouble on her hands.

She resumed her course to the exam room. “How long have you been in labor?”

A groaning whimper from the girl was the only response she gave.

“Too long, the lying . . .” The man’s voice was a mere rumble.

For the girl’s sake, Ashley hoped he wasn’t her husband or even her boyfriend. He was worse than indifferent to her situation—he was hostile to it.

She pasted a smile on her lips and crossed the kitchen’s tile floor. “How long is too long then?”

“Her water broke an hour ago.”

The girl groaned.

Ashley wanted to join her. She settled for a mild, “Oh dear.”

“Made a mess all over my truck.”

“I’m sure it did.” Ashley reached for a doorknob.

Accessible through the kitchen and an outside entrance with a small foyer, the addition to the ancient farmhouse had been built by her mother two decades earlier to accommodate the patients who found being examined or giving birth at the midwife’s home more convenient than their own. This was only the second time Ashley had delivered a baby there, though her mother had used the room often. That other time she’d had a birthing assistant with her and hours to prepare.

“Set her on the bed.” Ashley gestured to the daybed she used instead of a traditional examination table.

Fortunately, she always kept it prepared with clean sheets and special sterile and absorbent paper. Her instruments were sterile as well, but not set out, not ordered, not to hand.

Watching the man all but drop “Jane” on the bed, Ashley began to assemble equipment from her birthing kit—gloves, clamps,
scissors. The patient remained supine, her face ashen and glazed with sweat. Her hands clutched the sheet in a white-knuckled grip while that haunting keening issued from her lips.

Ashley needed to examine her, at the least palpate her abdomen to see if the baby was head down yet. If Jane was dilated and the baby’s head wasn’t down, she needed to call the hospital and take the girl to the nearest emergency room for an obstetrician. She needed one of the birthing assistants she usually worked with, preferably Sofie Trevino, but doubted she could arrive from her house on time.

“Will you get her undressed?” Ashley called over her shoulder to—Mr. Davis? “Just her slacks.”

She caught hold of the cart containing the computerized baby monitor, Pinard stethoscope, and a stack of sterile towels and dragged it close to the bed.

From the bed, Jane emitted a primal growl.

Ashley spun toward the patient. She now lay on her side, her knees drawn up, her arms clasping her belly. She wore loose dark pants and an oversize T-shirt. The latter was good, the former a problem if Ashley’s suspicions that the baby was coming at any moment proved true.

“I need your help taking off her slacks.” She kept her voice calm, though her heart kicked up a notch.

To say something was wrong with this situation was an understatement. The girl was too still for a woman heading into the second stage of labor, and the man too indifferent to have any relationship with his female charge. He hadn’t so much as flickered a pale eye-lash over his paler blue eyes, let alone made a move to help.

Ashley tried another tack, the one she used on frantic fathers. “Mr. Davis—wait, what is your first name?”

“John.”

Of course it was. John and Jane. He couldn’t have thought up more generic names had he tried.

“Help me undress her right now.”

“Oh, no.” John paled. “I won’t—I can’t—”

He backed to the doorway. “I-I’ll just wait here in the kitchen.” He vanished around the corner and yanked the door closed.

Ashley could insist he help. She knew a dozen tricks for getting the pregnant woman’s uncooperative partner to assist her if no one else was available. But this man’s attitude was all wrong, his lack of interest in the woman stretching beyond fear of making a fool of himself like fainting at the sight of blood.

Ashley turned her attention to her patient. “Jane?”

The girl didn’t respond.

“Is your name Jane?”

Another one of those primal growls was the only response, sign of another contraction nearly atop the previous one.

“I need to get your pants off, Jane.” Ashley rested one hand on the girl’s shoulder in a gesture of reassurance and reached beneath the shirt with the other.

The girl flinched away from Ashley’s touch.

“Jane, I’m not going to hurt you.” Ashley smoothed silky blond hair away from the girl’s sweating face. “I’m a certified nurse-midwife and have delivered almost five hundred babies.”

And unless instinct and experience were failing her, she was about to deliver one more momentarily.

“I need to get your slacks off of you first. Do you understand?”

The girl nodded.

Progress.

“Let’s get you onto your feet just long enough to get those slacks off.”

Easier said than done. Jane couldn’t weigh more than a hundred and twenty pounds even presumably full-term, but she seemed incapable of doing anything to help herself. Applying her own considerable strength, Ashley half pushed, half pulled the girl onto her side. Twice contractions gripped Jane’s belly, and she let loose with more of those animal moans, deep and inhuman.

Ashley held on to her. “Wrap your arms around me as hard as you can.”

Jane went as stiff as the hard mattress beneath her and flattened her hands on the bed. Mere inches from Ashley’s, her blue eyes darted back, forth, up, down. The pulse at the base of her throat slammed against her pallid skin like hammer blows. Ashley needed to take her blood pressure, monitor for fetal distress . . . a dozen prebirth preparations.

The third growling emission crescendoed into a shriek.

Scissors in hand, Ashley dropped to her knees beside the bed and slit the inside seams of the pants from hem to mid-thigh. The cheap cotton fabric tore with a hard tug, parting at the crotch. Ashley yanked on sterile gloves just in time to cradle the baby’s head—a correct back-to-front position.

“Good girl. It’s coming. Don’t push. We want this to come nice and slow.”

The girl pushed.

“Easy does it. I know you want to push, Jane, but try, really.” Ashley cradled the head in one hand. Forehead, nose, chin.

“Nice and slow.” Ashley cleared mucus from the baby’s nose and mouth, waited for the next contraction, then began to ease the shoulders out.

A small baby. Narrow shoulders. With the mother growling and keening in turns, the baby girl slid the rest of the way into
Ashley’s hands, with her eyes and mouth open as though she were surprised to enter the world. Ashley’s heart constricted, the familiar pain of emptiness of her own womb. Twenty-nine and not the slightest prospect of marriage, let alone children. Neither had seemed possible so far. Now neither would fit into her plans for the future, and yet—

Blood followed the entrance of the infant into the world, jerking Ashley’s attention back to the tasks at hand. Normal. Perhaps a little more than normal. Nothing to worry about—yet.

“Good work, Jane.”

The little girl’s first cries filled the room.

John pounded on the door. “Is it here? Hey, lady.”

Ashley wiped the baby as clean as she could without prepared water and wrapped the baby in the towels, wishing they were warmer.

“Hey, what’s going on in there?” John shouted.

“Either get in here and help or be quiet,” Ashley called back.

She lifted the baby to its mother. “Take her while I cut the cord.”

And deal with the third stage of labor.

Most of Ashley’s patients welcomed this moment. The chance to hold their baby immediately was one reason they chose a home birth. But Jane turned her face away and began to sob.

The infant wailed louder. The harder she cried, the harder Jane wept.

And John pounded on the door again. “What’s wrong?”

“Too much for me to list,” Ashley muttered. Aloud, she shouted, “Get in here.”

The door slammed back against the wall and John charged in. “What’s wrong? The baby sounds all right.”

“The baby is all right.” Holding the infant, slippery in birthing
fluid and towels, in the crook of one arm, Ashley clamped then cut the umbilical cord. “But Jane isn’t.”

She was still bleeding. Some blood was normal. This much was not. Nor were the bruises on the girl’s thighs. They were old and fading stripes about the width of a man’s belt, with the occasional wide, round patch as though the buckle end had been applied.

Ashley glanced at John poised in the doorway with one foot out as though he intended to bolt again. His buckle was of normal size, an average-size rectangle.

More questions raged in Ashley’s head, but she still had work to do with the patient and the baby, half of them tasks the birthing assistant usually performed.

“Take her.” Ashley rose and laid the mewling infant in John’s huge hands. The baby’s mouth worked. John’s mouth worked.

A grim smile twisted Ashley’s lips. “Hang on tight. She needs her neck supported, and she may squirm a little.”

“I can’t hold a baby.”

“And I can’t attend to your—Jane and hold her.” Having no choice but to trust the man to keep the baby safe, Ashley grabbed a plastic pan from her supply cabinet and returned to her patient, to kneeling beside the girl—and the blood. “Jane, we have to get the placenta out. That means a little pushing this time.”

Jane turned her face toward the wall, eyes squeezed shut. Tear tracks ravaged her face, but no fresh moisture dripped from beneath her golden lashes.

“Jane.” Ashley spoke with all the authority six years of experience had given her. “Pay attention to me. I need you to push. We need to get that placenta.”

Perhaps the bleeding would stop with that.

Jane didn’t move. Her belly contracted on its own, but too
weakly. Ashley could administer a dose of Pitocin, but she dared not with the bleeding.

“Come on, sweetheart.” She stroked Jane’s belly, feeling the mass still inside. “Work with me or I’ll have to get you to a hospital.”

“No.” The breathless, husky whisper was the first word the girl had spoken.

Ashley startled, her hands kneading the girl’s abdomen a little too hard. Jane gasped, and the afterbirth expelled with far too much blood, too much for the pan. It splattered the plastic sheeting on the bed, the floor, Ashley’s pants.

“John?” As she packed gauze to stanch the blood, Ashley kept her tone calm, but loud enough to be heard over the baby’s apparently healthy lung exercises. “What kind of car do you have?”

“I gotta pickup, why?”

“Two seats or one?”

“Front only.” He stepped to the doorway. “What—” He broke off on a curse. “What’s wrong with her?”

“I don’t know. I have no medical history to do anything but guess right now. But I do know that we need help and fast. We can use my Tahoe. It’s faster than waiting for an ambulance.” She stood. “I’ll get my keys and call the hospital to be ready for us.”

She caught up the cordless phone and began to dial even as she charged through the kitchen and up the steps to her room and her purse.

She’d been holding the phone to her ear for a full thirty seconds before she realized it was dead.

It couldn’t be dead. She had taken it from its charging cradle. She slid to a halt outside her bedroom and stared at the receiver. Not the battery. The keypad glowed with life, but no dial tone sounded when she pushed the green On button.

Her skin prickled all over. Short hairs beneath her heavy braid stood on end. She willed them down. The couple and the birth were all wrong, but they had nothing to do with no dial tone. This was the country. Phone lines went dead. No problem. Her cell phone rested on the nightstand beside her car keys and wallet and another phone. She tested that one, too, conscious of wasting time. No dial tone.