11
Grace
“Okay, Gill, just relax. I’m going to give you an internal exam, see how you’re progressing. Lie back for me. Perfect.”
I snapped on my gloves and knelt at the end of the bed. Gillian’s husband stood to my right. “David, I need you to help me slide her down the bed. You grab her shoulders, and Gill, you lift your bottom and shimmy down. Ready? Go.”
When Gillian was in position, I started my examination. “Eight centimeters. My, my. Well done, you.”
I smiled, then felt for the head, pausing as my fingers found a hard bone in the center of the skull. I concentrated on keeping my face neutral. What was that? I splayed my fingers, feeling the soft surrounding tissue. It felt like a buttock but … it couldn’t have been. The baby had been head-down last time I examined Gillian. With my right hand I felt the outside of her stomach. Yes, it felt like a head.
Gillian started another contraction, and I removed my gloves and drifted to the sink. I couldn’t make sense of it. If the baby was head-down, what was I feeling? Even though it was unlikely, I couldn’t rule out a breech. If it was—it was high-risk. Too high-risk for a home birth. She’d have to be transferred to the hospital.
“I’m here.”
I turned. Neva stood by my side in sweatpants and a hoodie that strained over her belly. Her hair was wet and windswept. I exhaled, suddenly grateful that none of my other birth assistants were available. “Neva! Thank goodness.”
Neva turned to Gillian and David. “My name’s Neva,” she said. “I’m a Certified Nurse-Midwife, and I’ll be assisting with your birth. Looks like you’re doing a great job so far. I’ll go wash up, and then we should get you up and about. Let gravity do some work for you.” She hesitated then, and looked at me. “I mean … if that’s okay with Grace.”
“Uh … yes,” I said. “It’s fine with me.”
As Neva chatted to Gillian, an image of my little strawberry-haired baby daughter popped into my mind, so at odds with the woman I saw before me. She touched Gillian’s stomach gently but not too familiarly. Her facial expressions were professional but warm. All her best qualities were in play.
When Neva finished her chat with Gillian, she joined me at the sink. “How is it going? Have you done the internal yet?”
“Yes, though…” I lowered my voice. “The baby was head-down at thirty-five weeks, but when I examined her just now, it felt a bit like a breech. Hard in the middle, soft at the sides. I’m not sure.”
“Thirty-five weeks? That’d be late for it to turn,” she said, echoing my thoughts. “Could it have been the nose you were feeling? A face presentation?”
“I suppose.” But I doubted it. I’d felt faces before. This was different.
“Would you like me to have a look?”
I sagged. “I’d love it.”
Neva smiled and my concerns vanished, just like that. With Neva by my side, we’d work this thing out. The idea brought on a small bubble of joy.
I went to Gillian’s side. “Would it be okay if Neva did another examination before we get you up? The baby’s not in the position I expected, and I want a second opinion.”
Gillian’s face clouded.
“This happens sometimes,” I continued, trying to be upbeat. “We’re monitoring the baby’s heart rate, and there is no sign of distress. We just need to know what’s going on.”
Gillian still looked tense. “But … are you worried?”
“Do we look worried?” Neva grinned as she snapped on rubber gloves. “Now, I want you to relax for me. Wonderful. Deep breath. This won’t take a minute.”
Neva chatted throughout the examination, keeping the couple calm and reassured. But I could tell from the length of time she spent feeling around that she had concerns too. After a minute she withdrew her hand and removed her gloves. “Well, I’m baffled. From the outside, it feels like its head-down but to feel it, I’d swear it was breech.” She clicked her tongue as she thought. “My advice is that you go to the hospital. That’s what I would recommend for a client of mine.”
The atmosphere in the room took a dive. Hail pelted against the window, Mother Nature’s way of agreeing.
“But … can’t you deliver a breech baby here?” Gillian asked.
“It’s really not safe,” Neva started, then Gillian rose to her feet.
“But I … I can’t go to the hospital!” she cried. “Not after last time. Please, Grace.”
Neva put her hand on Gillian’s shoulder. “It will be all right, Gillian, I promise. But a breech birth is high-risk, and—”
Gillian started to flap. I reached for her hand. “Just stay calm, it’s not good for the baby if you get upset. Perhaps there is something we can do. Let me speak to Neva, see if we can come up with a plan.”
I gestured for Neva to join me outside and she nodded. But as I shut the door behind us, her face became a mask of disbelief. “Perhaps there’s something we can do? You’re not suggesting that we deliver a breech baby at home? Six miles from the hospital accessible by only one road. Tell me you aren’t suggesting that.”
“You’ve delivered a breech baby before—” I started.
“—I’ve assisted with a breech delivery during my midwifery training. That was in a hospital with an ob-gyn and a pediatrician, not to mention all the drugs and lifesaving machinery I had by my side! Delivering a breech baby vaginally is majorly high-risk. Doing it in a home setting is unethical. If something went wrong, they could both die.”
“Neva”—I fought to keep my voice even—“Gillian had a traumatic first birth and she’s terrified of hospitals. That isn’t good for the baby. Besides, we don’t even know for sure that it is a breech we are feeling. You said yourself it wasn’t clear. It could be something else. A face presentation, a nasal bone—”
“—That’s the problem, we don’t know what it is! It didn’t even feel exactly like a breech. Below the bone I felt … a hole.”
“The mouth?” I asked hopefully. If she felt the mouth, that meant it was head-down.
“I don’t think so. There was no space between the bone and the hole. If it is face presentation—” She sucked in a breath.
“What?” I asked.
“It could be a cleft palate.”
A short silence followed, then Neva slumped against the wall. I thought about it. If the baby was face presentation, it could have been the nose we were feeling. And the cleft could be the hole Neva was describing.
“That’s it, isn’t it?” she asked. But her tone said she desperately wanted to be wrong.