“You bloody idiot!” I shouted at him. “Come back here!”
“Ifrinn!” Jamie dived past me and ran after the mule, saving the rest of his breath for the chase.
“Who the damnation are you?”
I turned to see a young Cherokee man standing in the flickering light of the doorway, glaring at me. He was leaning on the doorframe, his long hair disheveled and blood on his shirt.
I took a deep breath, straightened my spine, and walked up to him.
“I, sir,” I said, “am the midwife. Do please go and sit down.” I didn’t wait to see if he obeyed this injunction; I had work to do.
My patient was sitting on a crudely made birthing chair near the hearth, collapsed forward, arms dangling and her dark-blond hair nearly black at the roots with sweat, the ends dripping over her immense belly. Two little boys, of perhaps five and three, clung to one of her legs, howling. Her legs and feet were grossly swollen.
“Come here, Billy.” Agnes, her face dead white save for the scarlet palm print on her cheek and her voice no more than a squeak, took the bigger of the boys by his collar and pulled him away. “Georgie, you come, too—come, I said!” The fright in her voice stirred them, and they turned and clung to her, whimpering. Agnes looked at me, her eyes huge in mute appeal.
“It will be all right,” I said to her, softly, and squeezed her arm. “Take care of the little ones. I’ll see to your mama.”
I knelt down and looked up into the woman’s face. A bloodshot blue eye stared back at me through the snarled wet hair. An eye glazed with exhaustion—but still an intelligent, conscious eye; she saw me.
“My name is Claire,” I said, and laid a hand on her belly. She was wearing a filthy shift, so transparent with sweat that her protuberant navel showed through it. “I’m a midwife. I’ll help you.”
“Jesus,” she whispered, whether in prayer or from simple astonishment, I couldn’t tell. Then her face clenched into a knot and she curled over her belly with a bestial noise.
I kept my hand on her, but bent down to one side and peered up through the hollow of the birthing stool. A narrow slice of pale crown showed for an instant as she pushed, then disappeared.
I felt the spurt of excitement that always came with imminent birth, and my hand tightened on her belly. Another spurt came, this one of sudden fear.
Something bloody was wrong. I couldn’t tell what, but something was very wrong. I straightened up, and as the pain released its grip, I rose and took the woman by her shoulders, helping her to sit up. There were no towels to hand; I lifted my skirt and wiped her face with my petticoat.
“How long have you been pushing?” I asked.
“Too long,” she said tersely, and grimaced. I bent and looked again, and without her shadow obstructing the situation, I saw that she was dead right. The perineum was nearly purple and very swollen. That was it: the child was stuck, the crown of its head battering with each spasm, but not able to come further.
“Jesus H. Roosevelt Christ,” I said, and both her eyes popped open in astonishment. “Never mind,” I said. “When it lets go”—for the next pain was coming, I could see it in her face—“lean back against the wall.”
Her husband—I assumed that must be the man who’d slapped Agnes—seemed to have gone outside and was apostrophizing the night in an incoherent mix of Cherokee and English.
“Right,” I said, as calmly as possible, and put off my cloak and shawl. “Let’s just see what we have here, shall we, Susannah?”
There were splashes of blood on the dirt floor, but it was dark, with large, visible clots—just bloody show. She wasn’t hemorrhaging, though there was a slick of blood on her thighs. Her waters had broken some time earlier; it was hot and the small room smelled like a Jurassic swamp, fecund and reeking.
The contractions were coming every minute, powerful ones. I had only moments between them in which her belly relaxed enough for me to palpate it, but on the second try I thought I felt … the muscles of her belly tightened like an iron band, and I counted under my breath, hands still on her. Relaxation … I knew where the head was, was the child facing backward? I pressed hard on the relaxed belly, trying to find the curve of the spine …
“Ngg!”
“It will be all right. Count with me, Susannah … one, two …”
“Rrrrggh!”
I counted silently. Twenty-two seconds and the contraction eased. Spine … there was the blunt point of an elbow, and there, a curve that had to be the child’s spine … only it wasn’t.
“Bloody fucking hell,” I said, and Susannah made a noise that might have been a groan or an exhausted laugh. The rest of my attention was focused on the thing under my hand. It wasn’t the curve of a spine, nor yet of buttocks. It was the curve of another head.
It vanished with a new contraction, but I kept my hand doggedly on the spot, and as soon as the spasm waned, I felt frantically, to and fro. My first panicked thought—a memory of a double-headed infant, seen in a jar of spirits of wine—disappeared, succeeded by something that was partly relief, partly new alarm.
“It’s twins,” I said to Susannah. “Did you know that?”
She shook her head to and fro, slow as an ox.
“Thought … maybe. You … sure?”
“Oh, yes,” I said, in a tone that made her laugh again, though the sound was cut off abruptly by the next contraction.
The relief caused by the thought that we probably weren’t dealing with a gross deformity was fading fast, replaced by the next thought—if the first baby wasn’t moving, it was perhaps caught in an umbilical cord, possibly dead, or entangled with its twin in some fashion.
Further palpations, pushing when I thought I had an idea what I was pushing on, groping for a mental picture of what might be going on inside … but even the best midwife can tell only so much, and the only thing I was reasonably sure about was that the placenta—one placenta, or two? If it was one, it might rip loose with the first birth and then we’ll have an abruption that will kill the mother—hadn’t yet detached, though given the position of the baby’s head, there could easily be gallons of blood backed up behind the infant …. No. I looked up at Susannah’s face. No, if she were hemorrhaging, she’d be white and losing consciousness. As it was, she was bright red and clearly still fighting.
But we didn’t have much time. Two umbilical cords, either of which could be wrapped around a neck, or slip down between the child and the pelvic bones and be crushed with a contraction, starving one child of oxygen … and that was the least of it …
My mind ran rapidly down the list of potential problems—some I could dismiss on the grounds of what I could see and feel, some (like the faint horror of its being conjoined twins) I could dismiss on grounds of high odds against, others, on grounds that I couldn’t do a thing about them, even if I knew what was going on. That still left a few to be worried about.
And the child was not moving. It was alive; I could feel a pulse when I got my fingertips briefly on the head. And it was oriented properly, facedown; I could feel the biparietal sutures in the skull. But it wasn’t moving!
My shoulders ached, and so did my hips and knees, from kneeling on the dirt floor so long, but I felt it dimly, an irrelevant observation. I had one hand in her vagina, the other on her belly, probing through the wall of skin and muscle, feeling for some pattern in the tangle of tiny limbs. Susannah’s sweat was slick and hot under my hands—that was good, the wetness helped me feel movements …. The contraction came on with a force that smashed my fingers between skull and pelvis and made Susannah scream and me bite my lip not to.