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.

I felt sick. In my entire career, I’d had to give this kind of news only a couple of times. Once when I’d delivered a child with a hemangioma birthmark covering the entire left side of its face. The other time was when I’d delivered a little girl with only two full fingers on her left hand. “I guess we’re going to the hospital, then,” I said after more than a minute of silence. “If the baby has a cleft palate, there could be a host of other problems. We’ll need a pediatrician present.” I braced myself and took a step toward the door.

“Wait,” Neva said. She took a deep breath, as if weighing up her thoughts. “I know a pediatrician. I might be able to convince him to come here.”

I paused, afraid to hope. “Really?”

“Maybe. At least that way Gillian wouldn’t have to have a hospital birth on top of hearing this news.”

“But … do you think your pediatrician would come to a home birth?” I asked.

“Not sure,” Neva said. “Give me two minutes.”

She tugged her phone out of her pocket and jogged down the stairs. I waited where I was. I wouldn’t go in until I knew for sure; I didn’t want to get Gillian’s hopes up for a home birth if this pediatrician didn’t come through. But I was also delaying the inevitable. Was it the right thing, giving Gillian the option to proceed with a home birth? Even with a pediatrician present, we didn’t have the resources of a hospital. If the baby required a blood transfusion or operation, we would lose precious time transferring it to the hospital. On the other hand, keeping Gillian in an environment that she was comfortable with benefited everyone. I was still going back and forth when Neva appeared in front of me.

“The pediatrician is on his way. Let’s go chat with Gillian.”

Neva pushed past me into the room. If she had any doubts, I couldn’t see them. And if Neva, Miss By-the-Book, was comfortable, I didn’t have any reason to worry.

Gillian and David sat up straight as we entered, and I took a seat at the end of the bed. I placed a hand on Gill’s thigh. “Neva and I have discussed what we felt, and we are not convinced that your baby is breech after all. We need to confirm, but we think what we were feeling is—” I took a breath. “—a cleft palate.”

Gillian looked blank, then turned to her husband.

“A cleft palate is when the baby’s top lip is missing or deformed,” David said, not to Gillian but to himself. His own lip thinned as he spoke, perhaps in solidarity with his child.

“No!” Gillian’s face became alarmed. I wanted to assure her that a cleft palate was no big deal. That her baby would still be beautiful, and most likely, the deformity would be minor. But I owed her more than that.

“David’s right,” I said. “The baby may have a minor or significant deformity to the lip and palate, usually a hole between the top lip and nasal area. Now that we know what we’re looking for, we’ll check for the rest of the face to confirm, but we both think that is what we are dealing with.” I paused as another contraction took hold. Gillian worked through it and her husband helped her. When it was over, I continued. “A pediatrician is on his way. He will examine the baby once it is born. And that might be the end of it—”

“But it might not?”

“There’s no evidence of any other problems at this stage,” I said. “But we don’t know anything for sure until the baby is born. Once we confirm that the baby is not, in fact, breech, we can still try to deliver here, if you’d like.”

“Yes,” Gillian said. “I want to have the baby here. More than anything.”

I smiled at Neva, sending her a silent thank-you.

“Okay,” I said to Gillian. “Now, why don’t you lie down again?”

*   *   *

An astonishingly good-looking young man arrived an hour later. Even mid-contraction, Gillian was silenced at the sight of him. Thanks to the unforgiving rain outside, his hair was stuck to his head and his clothes were sodden. When he pushed his hair back off his face, I actually gasped. Out loud. With his strong jaw and pronounced forehead, he had a look of Elvis Presley but more chiseled, more defined. I silently cursed my daughter. It would have been nice to have some warning.

“Sorry I took so long,” he said, peeling off his soaked jacket and hanging it over the back of the chair. “I could hardly see with all the rain. The thin part of Beavertail Road was terrifying, the waves were actually crashing onto the road—I’m surprised it wasn’t closed.”

“Thank God it wasn’t,” Neva said. “That road is the only way in and out of this part of the island. If it closes…” Neva trailed away, obviously not wanting to frighten Gillian, but we all heard the subtext. If it closes, we’re stuck here. No one comes in, no one leaves. “But the rain seems to have eased off now, so we should be fine.”