A high-pitched, broken wail pulled me from my thoughts and sent me running to the sitting room. Neva was on her hands and knees on the floor, stripped from the waist down. Her face was mangled in pain. Mom knelt beside her.

“They’re sending a helicopter ambulance as soon as they can,” I said.

“They’re not going to make it, Grace,” Mom said. “The baby is coming now.”

26

Floss

The announcement that the baby was on its way came as a shock, even though I was the one who announced it. Several seconds of silence followed, and it probably would have continued if Neva hadn’t whimpered, snapping us all into gear.

“Now?” Grace asked. Her face was even more ashen than usual. “No. Surely not.”

“The baby is coming,” I said. “And it’s a footling.”

Grace dropped the phone and raced over to where I knelt. She gasped when she saw the baby emerging. It wasn’t a breech we were seeing; it was a foot. Things had just got a little more complicated. “Shit!”

“You’re going to have to deliver the baby, dear,” I said.

“I can’t. You’ve delivered a breech before—”

“Never a footling. And I haven’t delivered a child in twenty years, Grace.”

“I need to push,” Neva said between deep breaths. She looked over her shoulder at Grace desperately. “Grace, can I push?”

Grace and I exchanged a look. Neva had decided who was delivering her baby.

“Um.” Already, sweat poured from Grace. She closed her eyes, exhaled, and nodded. When she opened her eyes again, her expression was purposeful. “Soon, darling. Just pant, exactly as you’re doing.” She turned toward the stairs and hollered, “Lil!”

Lil appeared at the top of the stairs. “Did you call?”

“Yes, love,” I said. “Can you come down here, please?”

“We need your help,” Grace said as Lil descended the stairs. “Neva is going to have her baby right here, any time now. There’s no time to get to a hospital, and the road is closed anyway. I need you to go to my place. You’ll find my delivery bag on the bench in my birthing room. It’s sterile and ready to go. I also want you to grab the forceps from the counter. My keys are on the coffee table. Hurry. We have minutes, not hours.”

Grace’s voice was calm, but the urgency registered on Lil’s face. She nodded. Despite her age, despite the weather outside, despite what was going on between us, she didn’t so much as hesitate. I had never loved her more ferociously. “I’ll be as fast as I can.”

Grace knelt down. “Mom, I’m going to need you to walk me through this, step-by-step. Speak to me like I’m a student; assume I know nothing. I’m not taking any chances with this delivery.”

“All right,” I said. “We’ll need towels, a knife, and something for clamping in case Lil doesn’t get here in time. Neva, try not to push, dear. I’ll be right back.”

I hurried toward the bathroom for towels as another contraction gripped Neva. My heart thundered. A footling delivered at home? Even back in England, I’d have called the flying squad for this. And this wasn’t just any client. This was my granddaughter.

On my way back, I turned up the heat. It was important the room was nice and warm. If the baby’s startle reflex was activated by the cold, it could start to breathe in utero and inhale amniotic fluid, something we wanted to avoid at all costs. I’d learned that particular fact over fifty years ago, during midwifery training. What other midwifery training would I need to draw on today? Would it all come back to me when I needed it?

By the time I returned, the baby’s left leg had emerged as far as the knee. Grace looked like she was using every last ounce of energy to stay calm. “Mom, I need instructions. What do I do?”

I touched Grace’s shoulders. “The most important thing is that as long as delivery continues spontaneously, you need to keep your hands off. If you pull, even a little, you can interfere with flexion of the head or stop it rotating effectively. Worse, it can cause nuchal arms, where the baby wraps its arms around its neck, making it impossible to deliver vaginally. So do not touch the baby at all. Understand?”

Grace nodded, but her jaw was tight. I understood. It felt unnatural to see the baby coming and not be able to touch it. It must have felt even more unnatural when the baby was your grandchild. Silently we watched as the tiny leg emerged from Neva. Grace’s hands hovered a few centimeters back from the baby. “Now what?” she said. “I really do nothing?”

“Nothing,” I confirmed. “Just wait.”

The leg continued to come. I felt a little sick. I’d delivered a breech before, but never a footling. It was what we referred to while studying as a complicated delivery. Far from ideal under these circumstances. If things didn’t go to plan … well … I couldn’t think about that. The baby rotated as it descended, and Grace and I watched silently as the left buttock appeared, then the right. Then—pop—both legs were out. So far, so good.

“When you see the umbilical cord, pull down a small loop to prevent traction on the cord later in the delivery,” I told Grace.

Grace did as I asked. The baby was out as far as the torso. But the most difficult part was still to come.

“With the next contraction, I want you to push, Neva,” I said. “Hard as you can.”

Neva nodded, gripping the couch. And when the next contraction came, she pushed. I held my breath and, I’m sure, so did Grace. The contraction finished. Two more contractions came and went. Neva pushed and pushed. Still the shoulders did not appear. I cursed under my breath.

“The shoulders aren’t delivering spontaneously, so you’ll need to assist,” I said to Grace. Any hope for a smooth, straightforward birth was gone. Now I just prayed for a safe birth. “The anterior arm can be delivered by sliding two fingers over the baby’s back,” I said, “along the humerus to the elbow. Then you can sweep the arm around in front of the baby’s face and chest. Do the same for the other arm.”

If Grace was feeling anxious, it didn’t show. I marveled as she delivered the arms. It was a tricky technique, but it was as though she’d done it a hundred times before.

“Good,” I said. “Very good.” Now the entire baby was out, apart from the head. “Okay, Grace. Is the head engaged?”

Sweat drenched her face. “I … I don’t know.”

“Can you see the baby’s hairline?”

Grace looked. “No. I can’t.”

I looked at the baby, its little torso supported by her right hand. “Let go of the baby.”

Grace looked at me like I was crazy.

“Let it go,” I repeated. “If you let the body hang, the weight will pull the baby down and, with any luck, engage the head.”

Tentatively Grace let go of the baby, leaving it to dangle from Neva. Grace’s body became still. I doubted she was breathing.

“Good,” I said. “With the next contraction, Neva, I want you to bear down with all your might, okay?”

Neva nodded, gripping the sofa. Another contraction came and went. I willed Lil to get back. Things were moving fast, and if anything went wrong, we’d desperately need those instruments.

“Okay, Grace,” I said, turning back. “Is the head engaged now?”

Grace looked, then shook her head. I squeezed my hand into a fist.

“What is it?” she asked.

I hesitated before speaking. “I’m just a little concerned about the biparietal diameter of the head.”

I didn’t need to say any more. If the baby’s head was too large to pass through Neva’s pelvis, she would need a C-section. Without one, Neva and the baby would die. Grace knew that. Unfortunately, Neva did too.

“No!” Neva cried. “My baby—”

“—will be fine, darling,” Grace said simply. “And so will you. I’ll make sure of it.”

Neva calmed immediately. Strangely, so did I. There was something about Grace. She seemed in control. Grace, who lived for adrenaline, was, as it turned out, wonderfully cool under pressure.