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Midwives - Chris Bohjalian

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On an icy winter night in an isolated house in rural Vermont, a seasoned midwife named Sibyl Danforth takes desperate measures to save a baby's life.

She performs an emergency caesarean section on a mother she believes has died of a stroke.

But what if Sibyl's patient wasn't dead - and Sibyl inadvertently killed her?

As Sibyl faces the antagonism of the law, the hostility of traditional doctors, and the accusations of her own conscience, Midwives engages, moves, and transfixes us as only the very best novels ever do.

About the Author

Chris Bohjalian is the critically acclaimed author of 11 novels, including Skeletons at the Feast and the New York Times bestseller, The Double Bind, published by Pocket Books. His work has been translated into eighteen languages and published in twenty-one countries. He lives in Vermont with his wife and daughter.

Prologue

Throughout the long summer before my mother's trial began, and then during those crisp days in the fall when her life was paraded publicly before the county -- her character lynched, her wisdom impugned -- I overheard much more than my parents realized, and I understood more than they would have liked.

Through the register in the floor of my bedroom I could listen to the discussions my parents would have with my mother's attorney in the den late at night, after the adults had assumed I'd been sleeping for hours. If the three of them happened to be in the suite off the kitchen my mother used as her office and examining room, perhaps searching for an old document in her records or a patient's prenatal history, I would lie on the bathroom floor above them and listen as their words traveled up to me through the holes that had been cut for the water pipes to the sink. And while I never went so far as to lift the receiver of an upstairs telephone when I heard my mother speaking on the kitchen extension, often I stepped silently down the stairs until I could hear every word that she said. I must have listened to dozens of phone conversations this way -- standing completely still on the bottom step, invisible from the kitchen because the phone cord stretched barely six feet -- and by the time the trial began, I believe I could have reconstructed almost exactly what the lawyer, friend, or midwife was saying at the other end of the line.

I was always an avid parent watcher, but in those months surrounding the trial I became especially fanatic. I monitored their fights, and noted how the arguments grew nasty fast under ¬pressure; I listened to them apologize, one of them often sobbing, and then I'd wait for the more muffled (but still decipherable) sounds they would make when they would climb into bed and make love. I caught the gist of their debates with doctors and lawyers, I understood why some witnesses would be more damning than others, I learned to hate people I'd never met and whose faces I'd never seen. The state's medical examiner. The state's attorney. An apparently expert midwife from Washington, D.C.

The morning the judge gave the jury its instructions and sent them away to decide my mother's fate, I overheard her attorney explain to my parents what he said was one of the great myths in litigation: You can tell what a jury has decided the moment they reenter the courtroom after their deliberations, by the way they look at the defendant. Or refuse to look at him. But don't believe it, he told them. It's just a myth.

I was fourteen years old that fall, however, and it sounded like more than a myth to me. It had that ring of truth to it that I heard in many wives' -- and midwives' -- tales, a core of common sense hardened firm by centuries of observation. Babies come when the moon is full. If the boiled potatoes burn, it'll rain before dark. A bushy caterpillar's a sign of a cold winter. Don't ever sugar till the river runs free.

My mother's attorney may not have believed the myth that he shared with my parents, but I sure did. It made sense to me. I had heard much over the past six months. I'd learned well which myths to take to my heart and which ones to discard.

And so when the jury filed into the courtroom, an apostolic procession of twelve, I studied their eyes. I watched to see whether they would look at my mother or whether they would look away. Sitting beside my father in the first row, sitting directly behind my mother and her attorney as I had every day for two weeks, I began to pray to myself, Please don't look at your shoes, please don't look at the judge. Don't look down or up or out the window. Please, please, look at me, look at my mother. Look at us, look here, look here, look here.

I'd watched the jurors for days, I'd seen them watch me. I'd counted beards, I'd noted wrinkles, I'd stared beyond reason and courtesy at the way the fellow who would become the foreman had sat with his arms folded across his chest, hiding the hand disfigured years earlier by a chain saw. He had a thumb but no fingers.

They walked in from the room adjacent to their twelve chairs and found their seats. Some of the women crossed their legs at their knees, one of the men rubbed his eyes and rocked his chair back for a brief second on its rear legs. Some scanned the far wall of the courtroom, some looked toward the exit sign above the front door as if they realized their ordeal was almost over and emancipation was at hand.

One, the elderly woman with white hair and a closet full of absolutely beautiful red flowered dresses, the woman who I was sure was a Lipponcott from Craftsbury, looked toward the table behind which the state's attorney and his deputy were sitting.

And that's when I broke down. I tried not to, but I could feel my eyes fill with tears, I could feel my shoulders beginning to quiver. I blinked, but a fourteen-year-old girl's eyelids are no match for the lament I had welling inside me. My cries were quiet at first, the sound of a mournful whisper, but they gathered fury fast. I have been told that I howled.

And while I am not proud of whatever hysteria I succumbed to that day in the courtroom, I am not ashamed of it either. If anyone should feel shame for whatever occurred that moment in a small courthouse in northeastern Vermont, in my mind it is the jury: Amidst my sobs and wails, people have said that I pleaded aloud, "Look at us! Oh, God, please, please look at us!" and still not one of the jurors would even glance in my mother's or my direction

1

I used the word vulva as a child the way some kids said butt or penis or puke. It wasn't a swear exactly, but I knew it had an edge to it that could stop adults cold in their tracks. Vulva was one of those words that in every household but ours conveyed emotion and sentiments at the same time that it suggested a simple part of the basic human anatomy for one sex or an act -- like vomiting -- that was a pretty basic bodily function.

I remember playing one afternoon at Rollie McKenna's, while her mother had a friend of hers visiting from Montpelier. It was one of those rare summer days in Vermont when the sky is so blue it looks almost neon -- the sort of blue we get often in January on those days when the temperature won't climb above zero and the smoke from your neighbor's woodstove looks as if it will freeze when it first appears just above the tip of the chimney, but rarely in June or July. Like Mrs. McKenna, her friend worked for the state education department. As the two adults sat around a wrought-iron table on the McKennas' brick terrace (a terrace that seemed inappropriately elegant to me even then), sipping iced tea with mint leaves from my own mother's garden, I proceeded to tell them about Cynthia Charbonneau's delivery in all the detail I could muster.

"Mrs. Charbonneau's baby was nine pounds, two ounces, but my mom was able to massage the vagina and stretch the muscles so the perineum didn't tear. Most women who have babies that are around nine pounds have to have episiotomies -- that's where you cut the perineum from a lady's vagina to her anus -- but not Mrs. Charbonneau. Her vulva's fine. And the placenta came right behind Norman -- that's what they named the baby -- by, like, two minutes. My mom says the placenta was big, too, and it's buried right now by this maple tree Mr. Charbonneau planted in their front yard. My dad says he hopes their dog doesn't dig it up, but he might. The dog, that is."

I was probably nine at the time, which meant that the McKennas had lived in Vermont for a little over a year, since they had arrived in our town from a Westchester suburb of New York City on my eighth birthday -- literally, right on the day. When the moving van started chugging up the small hill in front of our house, I told my dad I expected it would turn left into our driveway and unload my presents.

My dad smiled and shook his head and said I might just as well expect the moon to drop out of the sky onto our rooftop.

I had never been to Westchester, but I had an immediate sense that the McKennas were from a town more mannered than Reddington: The terrace was a dead giveaway, but they were also a lot more stiff than those of us who had put in any time in Vermont -- especially my parents' friends from the days when they hung out with the folks from the Liberation News Service and viewed love beads as a profound political statement. I liked the McKennas, but on some level I suspected from the moment Rollie introduced me to her mother that the family wasn't going to last long in our part of Vermont. They might do okay in Burlington, the state's biggest city, but not in a little village like Reddington.

I was wrong about that. The McKennas did all right here, especially Rollie. And while there were actually parents in town who would not allow their little girls to play at my house -- some merely fearing their daughter would wind up at a birth if my mother was unable to find a baby-sitter, others believing that among the strange herbs and tinctures that were my mother's idea of medical intervention were marijuana, hashish, and hallucinogenic mushrooms -- the McKennas didn't seem to mind that my mother was a midwife.

Telling Mrs. McKenna and her friend about Norman Charbonneau's passage through his mother's vaginal canal was as natural for me at nine as telling my parents about a test at school on which I'd done well, or how much fun I might have had on any given day in December sliding down the hill behind Sadie Demerest's house.

By the time I was fourteen and my mother was on trial, I had begun to grow tired of shocking adults with my clinical knowledge of natural delivery or my astonishing stories of home births. But I also understood that words like vulva were less endearing from a fourteen-year-old than from a younger girl.

Moreover, by the time I was fourteen and my own body was far along in its transformation from a child's to a teenager's -- I had started to wear a training bra in the summer between fifth and sixth grade and begun menstruating almost a year before the county courthouse would become my second home -- the whole idea of a nine-pound, two-ounce anything pushing its way through the ludicrously small opening between my legs made me queasy.

"I just don't see how anything that big will ever get through something that small!" I'd insist, after which my father would sometimes remark, shaking his head, "Bad design, isn't it?"

If my mother was present she would invariably contradict him: "It is not!" she would say. "It's a magnificent and beautiful design. It's perfect."

Because she was a midwife, I think my mother was bound to think this way. I'm not. Moreover, I'm thirty years old now, and I still cannot begin to fathom how anything as big as a baby will someday snake or wiggle or bash its way through what still looks to me like an awfully thin tunnel.

Although my mother would never have taken one of my little friends to a birth, just before I turned eight I began to accompany her to deliveries if a baby decided to arrive on a day or night when my father was out of town and her stable of sitters was busy on such short notice. I don't know what she did before then, but she must have always found someone when necessary, because the first birth I remember -- the first time I heard my mother murmur, "She's crowning," which to this day makes me envision a baby emerging from the birth canal with a party hat on -- occurred on a night when there was a tremendous thunderstorm and I was in the second grade. It was late in the school year, perhaps as close to the commencement of summer as the first or second week in June.

My mother believed babies were more likely to arrive when the sky was filled with rain clouds than when it was clear, because the barometric pressure was lower. And so when the clouds began rolling in that evening while the two of us were eating dinner on our porch, she said that when the dishes were done she might see who was available to baby-sit tonight, if it came to that. My father was on the New York side of Lake Champlain that evening, because builders were going to break ground the next day for a new math and science building he had helped to design for a college there. It wasn't his project solely -- this was still three years before he would open his own firm -- but my father could take credit for figuring out the details involved with building the structure into the side of a hill and making sure it didn't look like offices for the North American Strategic Air Command.

The first infant I saw delivered at home was Emily Joy Pine. E.J., as she would come to be called, was an easy birth, but it ¬didn't look that way to me a month short of my eighth birthday. I slept through the phone call David Pine made to our house about ten in the evening, probably because my mother was still awake and answered promptly. And so Emily's birth began for me with my mother's lips kissing my forehead, and then the image of the curtains in the window near my bed billowing in toward the two of us in the breeze. The air was charged, but it had not yet begun to rain.

When we arrived, Lori Pine was sitting on the side of her bed with a light cotton blanket draped over her shoulders, but most of the other bedding -- blankets and bedspread and sheets -- had been removed and piled in a small mountain on the floor. There were some fat pillows at the head of the bed that looked as if they came from an old couch. The mattress was covered with a sheet with the sort of pattern that might have looked appropriate on a big, ugly shower curtain: lots of psychedelic sunflowers with teardrop-shaped petals, and suns radiating heat and light.

That sheet, I would overhear, had been baked in a brown paper grocery bag for over an hour in the couple's kitchen oven. It may have been tasteless, but it was sterile.

When my mother and I arrived, the woman who was her apprentice back then was already there. Probably twenty-four or twenty-five years old at the time, Heather Reed had already helped my mother deliver close to forty babies at home; when we walked into the bedroom, she was calmly telling Lori to imagine the view her baby had of the uterus at that moment.

My mother was nothing if not hygienic, and after she had said hello she went straight to the Pines' bathroom to wash up. She would probably spend ten full minutes scrubbing her hands and soaping her arms before she would place her palms softly upon a woman's stomach, or pull on a pair of thin rubber gloves and explore a laboring mother's cervix with her fingers.

When she emerged from the bathroom, she asked Lori to lie back so she could see how she was doing. Lori and David's two small sons had already been taken up the road to their uncle's house, while their aunt -- Lori's sister -- was here, rubbing Lori's shoulders through the blanket. David had just returned from the kitchen, where he had been preparing tea made from an herb called blue cohosh, which my mother believed helped to stimulate labor.

Lori lay back on the bed, and as she did her blanket fell away and I saw she was naked underneath it. I had assumed she wouldn't be sleeping in pajamas with pants like me, but it hadn't crossed my mind as I stood in the bedroom that she wouldn't be wearing a nightgown like my mother, or perhaps a big T-shirt of the sort my mother and I both slept in on hot summer nights.

Nope, not Lori Pine. Buck naked. And huge.

Lori Pine had always been a big woman in my eyes. She towered over me more than most moms when we would find ourselves standing together at the front register of the Reddington General Store, or in the crowded vestibule before or after church. Her boys were younger than I, one by two years and one by four, so I had no contact with her at school. But I did seem to find her standing near me often, and I had this fear at the time that if I ever needed to get past her in an emergency, she would plug up the entire doorway, an ample, spreading, broad-bottomed plug of a woman.

In a real emergency, I now imagine, Lori Pine would actually have used her size to whisk me up and out of danger, tossing me through an exit or doorway with the same ease with which I throw my cats outside the house in the morning.

But what struck me most when I saw Lori Pine naked on her bed was simply her pregnant belly. That's what I saw, that's what I remember: a massive fleshy pear that sat on her lap and protruded as high as her bent knees, with a small nub in the middle that reminded me of those buttons that pop from the breasts of fully cooked chickens or turkeys. I didn't know then that a pregnant belly was a pretty solid affair, and so I expected it to flatten and slip to her sides like a dollop of mayonnaise when she lay back; when it didn't, when it rose from the bed like a mountain, I stared with such wonder in my eyes that Lori rolled her face toward me and panted what I have since come to believe was the word "Condoms."

I've never figured out whether the word was meant for me as a piece of advice that I should take to heart, as in "Demand that your man always wear a condom so you don't end up trying to push a pickle through a straw," or as a warning against that particular form of contraception: "This is all the fault of a condom. There are better forms of birth control out there, and if I'd had any sense at all, I'd have used one."

Whether Lori Pine really did say the word condoms or something else or merely my name when she saw me standing there -- my name is Constance, but at a young age I learned to prefer Connie -- I'll never know. I like to believe she said condoms; so many other beliefs shatter when we grow up, I want to keep this one intact.

In any case, whatever she said made everyone in the room aware of the fact that I was there, leaning against the wall.

"Do you mind if she stays, Lori?" my mother asked, nodding slightly in my direction. "Tell me honestly."

Lori's husband took her hand and stroked it, adding, "She could join the boys at their uncle's, you know. I'm sure Heather wouldn't mind driving her up there."

But Lori Pine was as generous and uninhibited as she was large, and she said she didn't mind having me there at all. "What's one more pair of eyes, Sibyl?" she said to my mother, before starting to wince from a contraction, her head snapping toward me as if she'd been slapped.

And so I stayed, and got to see Lori Pine's labor and E.J. Pine's birth. My mother and I had arrived about ten-thirty in the evening, and I stayed awake through much of the night and into the next morning. I did doze in the bedding that had been tossed onto the floor, especially when the thunder that had rolled east across the Champlain Valley and the Green Mountains passed over us into New Hampshire, but they were short naps and I was awake at quarter to six in the morning when my mother had Lori begin to push, and again at seven thirty-five when E.J. ducked under the pubic bone for the last time, my mother pressing her fingers against the infant's skull to slow her down and give her mother's perineum an extra few seconds to yawn.

E.J. was born at seven thirty-seven -- like the airplane. Labor was about nine and a half hours, and it was in the opinion of everyone present a breeze. Everyone but me. When I dozed, it was probably because I could no longer bear to watch Lori Pine in such pain and had shut my eyes -- not solely because I was tired and my eyes had drooped shut on their own.

The room was dim, lit only by a pair of Christmas candles with red bulbs David had pulled from the attic for the event just after my mother and I had arrived. Had it not been such a windy night, they would have used real candles, but Lori wanted to labor with the windows open, and David had recommended sacrificing authenticity for safety.

Lori had started to express her disappointment when she saw David reappear with the plastic sconces instead of wax candles, but then another contraction ripped through her body and she grabbed my mother's arms with both hands and screamed through clenched teeth: a sound like a small engine with a bad starter trying to turn over.

"Breathe, Lori, breathe," my mother reminded her placidly, "breathe in deep and slow," but by the way Lori's eyes had rolled back in her head, my mother might just as well have told her to march outside and hang a new garage door, and that was the last any of us heard that night from Lori Pine about candles.

I hadn't really seen an adult in pain until then. I had seen children cry out, occasionally in what must have been agony -- when Jimmy Cousino broke his collarbone when we were in the first grade, for example. Jimmy howled like a colicky baby with a six-year-old size set of lungs for speakers, and he howled without stopping until he was taken by a teacher from the playground to the hospital.

It was a whole other experience, however, to see an adult sob. My mother was great with Lori, endlessly smiling and reassuring her that she and her baby were fine, but for the life of me I couldn't understand why my mother didn't just get her the adult equivalent of the orange-flavored baby aspirin she gave me when I didn't feel well. The stuff worked miracles.

Instead my mother suggested that Lori walk around the house, especially in those first hours after we got there. My mother had her stroll through her two boys' bedrooms; she recommended that Lori take a warm shower. She asked Lori's sister to give the woman gentle backrubs and massage her shoulders. At one point, my mother had Lori and David looking at snapshots together in a photo album of the home births of their two sons -- pictures that had been taken in that very bedroom.

And while I don't believe witnessing Lori Pine's pain frightened me in a way that scarred me, to this day I do remember some specific sounds and images very, very well: My mother cooing to Lori about bloody show, and the blood that I glimpsed on the old washcloth my mother had used to wipe the sheet. Lori's panting, and the way her husband and her sister would lean over and pant beside her, a trio of adults who seemed to be hyperventilating together. Lori Pine slamming the back of her hand into the headboard of her bed, the knuckles pounding against it as if her elbow were a spring triggered by pain, and the noise of the bone against cherry wood -- it sounded to me like a bird crashing into clapboards. The desperate panic in Lori's voice when she said she couldn't do it, she couldn't do it, not this time, something was wrong, it had never, ever hurt like this before, and my mother's serene reminder that indeed it had. Twice. The times late in the labor when Lori crawled from her bed and was helped by my mother and Heather to the bathroom, her arms draped over their shoulders as if she were the sort of wounded soldier I'd seen in the movies who was helped from the battlefield by medics, good buddies, or fellows who hadn't previously been friends. The image of my mother's gloved fingers disappearing periodically inside Lori Pine's vagina, and the delighted sweetness in her voice when she'd say -- words spoken in a hush barely above a whisper -- "Oh my, you're doing fine. No, not fine, terrific. Your baby will be here by breakfast!"

And it was. At quarter to six in the morning when Lori Pine started to push, the sky was light although covered with clouds, but the rain had long passed to the east. No one had bothered to unplug the plastic Christmas candles, so I did: Even in 1975, even just shy of eight, I was an environmentalist concerned with renewable resources. Either that or a cheap Yankee conditioned to turn off the lights when they weren't needed.

ISBN: 9781847393395
ISBN-10: 9780375706776
Audience: General
Format: Paperback
Language: English
Number Of Pages: 372
Published: 3rd September 2009
Dimensions (cm): 19.9 x 13.2  x 2.9
Weight (kg): 0.261