Chapter 20
Ruth’s hands, as sure and nimble as any Nora had ever seen, fumbled over the cloth doll Nora had ordered from a perplexed seamstress.
“Supine?” Ruth asked uncertainly.
“No,” Nora said, trying not to sound discouraged.
“Supine is face up. Most babies, as you know, are born in the prone position.” Nora twisted the doll to a supine position on the table.
It stared up at them with its stitched eyes.
The seamstress had jointed the shoulders, elbows, hips, and knees, just as Nora had requested.
She wished there was a way to make the neck as malleable as a real baby’s.
Ruth sighed. “What’s wrong with saying ‘face up’? Everyone knows what that means.”
“What’s wrong is that you won’t understand lectures or articles when a doctor describes a position as supine or prone.
” Nora pitched her voice into something more patient.
“When we know the Latin terms, it helps us communicate with doctors and scientists around the world. I’d never have managed in Italy if I didn’t know Latin. ”
“Yes, well, I’m never going to Italy, and Mrs. Kelly won’t be yelling Latin while she’s giving birth. She’ll bawl me out in plain English.” Ruth cocked an eyebrow at Nora. She’d agreed to weekly lessons, eager to learn about the forceps, but hadn’t expected to begin with Latin.
“We can’t be at odds,” Nora pleaded. “There’s enough opposition to both of us to waste disagreement on each other.
” Flecks of iridescent gray in the marble table glinted in the sallow midday light.
“You know about the petition. If Adams has his way, I worry any midwife who takes pay for her work could be prosecuted. You could go to prison just for practicing.”
Establishing a training program, and licensing if necessary, was the best defense Nora could think of—and the way to communicate standards was in the language doctors had made their own.
Ruth’s glare deepened. Nora never knew if the woman was seeing a fellow woman or an enemy doctor. “We never had this problem before.”
Before I came along. Nora rolled her shoulder backward.
“They feel threatened. But we can prove to them that midwives, educated in the latest practices, achieve better outcomes, and that will sway opinions. We’ve enough women’s clubs to take up our cause if we can make a stirring argument.
” Nora looked over Mara, the model. She’d carefully removed the glass dome that enclosed the yawning cavity of the abdomen.
“Once you get used to the sound of it, the Latin terms are no harder than English,” Nora promised, handing the doll back to Ruth. “Button on the umbilical cord and placenta, and we’ll practice delivering different presentations. You’ll see.”
Ruth did as she was told, pausing to glimpse around the cavernous surgical theater that doubled as a lecture hall. Outside, the rain drenched everything into a soggy mess. London hadn’t seen the sky in over a week.
She placed the baby into the ceramic body, the top of the head protruding through the vaginal opening. “Vartrix.”
“Vertex,” Nora corrected with a smile.
Another sigh.
“We call it the crown,” Ruth grumbled.
“Now, keep the vertex presentation and let’s change the body position. Show me an anterior presentation.”
Ruth’s hands shook as she fumbled the doll into position.
“That’s right!” Nora cheered. “When the occipital bone is in front of the mother.” Nora picked up the small skull she’d placed on the table and stroked the shapely bone that rested just above the neck on the back of the head.
“We name the position by the child first, orienting using his occipital bone. Then we name where it is facing. Anterior means forward. So occiput anterior means his occipital bone is pointing the same direction as the mother’s navel. ”
Excitement heated her cheeks, but Ruth’s expression… No excitement there.
“You’re understanding it just fine,” Nora half laughed. “You’re only annoyed with me.”
“It seems a waste of breath,” Ruth confirmed. “But go on, try another one.”
They went through posterior, transverse, breech, until Ruth couldn’t be tricked.
“Just think,” Nora said, stretching out a kink in her lower back, “when you attend my lectures and some doctor boasts over his occiput posterior birth, you can ask if it was a right or left presentation and leave them all gawping.”
A light glinted in Ruth’s eye. “I do like the sound of that.”
Nora laughed. She’d make a medical marvel out of this midwife. At least, she would if she had enough time. Now that the entire household knew about her pregnancy, she found herself scrutinized at every turn, three doctors and two women piling on so many opinions that it nearly buried her.
But Ruth knew about women and childbirth, more than Julia or Mrs. Phipps. In her own way, more even than Nora or Horace or Daniel. She might be the best source of advice. But suppose she agreed with them? Nora couldn’t afford to leave her work yet.
“Have you seen cholera in any of the places you’ve visited?” Nora asked, composing her words carefully.
Ruth’s eyes widened. “Not seen any of that in years,” she answered. “Has it come?”
“No,” Nora reassured her. “There was one family that went down with an illness resembling it, but there’s no other cases.”
The way Horace described it, rapidly transmitting infection was a hallmark of the disease. So it was still possible that these cases were something else. Nora licked her lips. “I just don’t know how cholera would affect a pregnant woman.”
“I hope you don’t have to find out.” Ruth began tidying away their lesson materials, packing the cloth baby into a wooden box. Her calm expression and large, expressive eyes rested on Nora, inviting confidences.
Easy to see why other women came to her time after time.
Nora sighed, preparing to nudge some especially weighty words across the table. “Have you ever seen a woman four weeks late who wasn’t pregnant?”
“I see pregnant women who haven’t had a season in years. And some who spotted so much they didn’t know they were with child—rather like our Mrs. Roland, if you recall. Haven’t you seen the same?” Her eyes crinkled at the corners. “Or are we talking about yourself?”
“My courses have been fairly regular,” Nora admitted. “But I’m four weeks late now.”
Ruth was too acclimated to true surprises to fluster or hop about with such news. Her eyes sharpened as they surveyed Nora from top to toe. “How’s your appetite?”
“Less?” Nora still didn’t know if she was imagining it.
“Vomiting?” Ruth marched on.
“No.”
“At least you’re spared that so far.” Ruth shifted her weight and pressed her fingers onto the stone tabletop.
“There was an older woman—over thirty—pregnant for the first time. I cared for her until a doctor took over her case. He didn’t worry over her extreme sickness because he thought women were designed to be sick when expecting.
She passed away at month six. Her husband never went right after that. ”
Nora slid her hands along the limp linen of her skirt, hiding them in her deep pockets. Magdalena had never mentioned morning sickness killing her patients, but that didn’t mean she hadn’t seen it. Nora must write and ask. “Dr. Croft said my nose looked swollen.”
Ruth tilted her head and pinched her lips in assessment. “I don’t see any difference.”
“And he said my urine smells different.”
Ruth’s forehead folded into perplexed wrinkles. “You had him smell your urine?”
“Not intentionally,” Nora hastened. “He used the water closet after me. He’s particularly”—there were many words to choose from, but the one she wanted didn’t exist—“olfactious.”
A scrunched nose revealed Nora’s explanation hadn’t helped at all.
“He’s sensitive to smells.”
“Then how does he stand sticking his nose into all the…” Ruth waved a hand, struggling for a word to name the cadavers.
“Bodies,” Nora supplied. It was kinder than corpses, and Ruth was particularly resistant to learning from the deceased. “He’s adjusted somehow.”
“What about you? Most of my…my patients”—she was resistant to adopting other doctor words too—“are troubled by smells. It’s often one of the first symptoms.”
“I’ve had a harder time working with the bodies. Lately, I seem more susceptible to strong smells.”
Ruth nodded, her hair the color of a field after gleaning, when streaks of silver glistened on brown stalks. “You probably are, then. Some women seem to know instinctively within days. I’m surprised you don’t have a sense, with all your training.”
Nora smoothed the top of the box, watching the gray light from the windows play over the glossy wood grain. She still had smudges of watercolor paint on her hands from an earlier project. “Everyone says I’ll have to abandon my work after I have a child.”
“You’ll need a good lie-in, for certain,” Ruth confirmed. “You can’t be standing for hours and running all over town.”
Nora dipped her head.
“Not for a good two months,” Ruth continued. “Some midwives say less. And I won’t fib and say I haven’t seen mothers back at work in less than five days, but that’s only the ones who would starve without it.”
“Yes, but,” Nora fumbled, “some say I mustn’t practice at all after I’m a mother.”
A deep frown pressed itself onto Ruth’s face. “I have five children. I work every day.”
Nora’s eyebrows flexed, something coming into focus. Somehow, she had never considered Ruth’s work as…work.
“You can’t be a midwife unless you’ve had your own.” Ruth crossed her arms against her lean chest. “The more, the better.”
“What do you mean? Surely there are women—” Her thoughts moved faster than her tongue, listing the midwives she knew: Mrs. Howell, Mrs. Bailey, Ruth…
“Nah.” Ruth shook her head emphatically. “No one will come to you until you’ve endured it yourself. I had a skilled aunt who never married, and no one would go to her. She had to assist my grandmother.”
“Do you mean there are prerequisites?” Nora pinched the cloth foot of the infant doll tightly, rolling the lumpy batting between her fingers.
She’d assumed they came to their careers by necessity or happenstance, but if there was some sort of regimen, wouldn’t that evidence help in the coming confrontation with London’s doctors?
“Aye. You can’t be a midwife until you’re married, and you must be taught by someone with a reputation. My mother could coax a child out of anyone. She lost far less than other midwives she knew.”
Nora checked the windows to see if the storm had lifted, but rivers of water still twisted down the panes. The dawning light was in her mind and nowhere else.
Motherhood is a prerequisite for them—a qualification no male doctor could claim. Obstetrics was a fully recognized branch of medicine, and shouldn’t it function hand in hand with midwives, experienced women who knew all the facets of pregnancy, birth, and motherhood?
“You’ll only be better once you’re a mother yourself,” Ruth pointed out, still perplexed.
Nora shook her head. None of this should have been news to her. She’d seen midwives hustling about their work for years, but in Italy, most of the women she’d worked with were nuns. She hadn’t stopped to think that here…here they were all married women with children.
She squeezed her hands into fists, the dig of her nails inside her palms reassuring and welcome.
She could confine her work to obstetrics and still practice surgeries.
Complex ones. Hysterectomies. Cesareans.
Hemorrhages. A thrill careened up her back, raising the hairs on her neck.
Horace and Daniel never objected to Mrs. Franklin doing her work, so how could they object to Nora practicing women’s medicine?
The other physicians might not recognize it, but she was about to become even more qualified.
No longer would “contractions of the muscles” or “compression of other organs” be illustrations in an anatomy book, but her own experience.
What the men said in theory, she would know viscerally, with the scars and stretch marks to prove it.
She could advocate for the midwives more effectively once she had benefited personally from their expertise, and advancing the cause of mother-midwives also allowed her to take on Magdalena’s charge to improve opportunities for women to work and study.
Protecting and training midwives wasn’t just a cause for her. It was her future, and Ruth’s, and—
Don’t get ahead of yourself, Nora cautioned silently.
Her mind might be reeling with possibilities and precedents, but she must be wise. If Adams was determined to oppose her, she’d face him, one move at a time.
If only his petition didn’t bear Daniel’s name.