Obstetrix(11)

All the women spoke in high, slightly breathy voices. I’d heard women speak like that before; Jackie, one of the younger clinic nurses, had once called it “Fundie baby voice.” Not in front of a patient, thank goodness. I didn’t much like the term; it was openly insulting, it was my job to take care of religiously devout women as much as any other women, and some women just have high voices. It’s not inherently an affectation. Listening to patient after patient who spoke in that same artificially girlish voice, though, I grimly decided that Jackie had been right.

There were two sorts of mothers here, I noticed right away that first morning: the ones who had joined the cult themselves, and the ones whose parents had joined the cult and brought them along.

The ones who’d had a relatively normal upbringing were fully grown, mature women. Some had tattoos, although many were religious, like the woman who had “saved by grace” in cursive on her left hip, and the woman who had a decorative cross and “John 3:16” on her upper arm. They all seemed comfortable with Sarah—chatty, even.

The ones whose parents had joined and brought them along were strikingly young and much quieter.

Joy was the last patient of the morning, and definitely the second kind: a slight woman barely out of her teen years. She had fine blond hair and crooked teeth. For Joy, Sarah unlocked a closet and rolled out an ultrasound device and a laptop computer. She pulled up a bunch of earlier scans, and tilted the screen toward me so I could see them. Then Joy lay back, and Sarah pulled up an image of her baby.

Joy had a bicornate uterus, a fairly severe presentation of it, and the fetus—which was a little under twenty-eight weeks along according to Sarah’s notes—was in a transverse lie.

There are a couple of ways babies can position themselves in the uterus. Vertex is what you want, if you’re the laboring mother: head down, chin tucked, face toward the back. Sunny-side up babies are head down, but facing the wrong way—that position causes back labor, which is more painful, and can cause labor to stall. Then there are the various kinds of breech, where the baby’s head is up and feet or butt are down. Usually we do C-sections for those, but I’ve delivered the occasional baby butt-first, most recently when a woman who hadn’t gotten much prenatal care showed up fully dilated and pushing, and there simply wasn’t time to do anything else.

“Transverse” is when the baby is fully sideways. You can’t deliver a transverse baby vaginally, any more than you can stick a sideways cork into a bottle of wine. Sometimes you can do an external cephalic version to get the baby to turn, but not when the mother has a bicornate uterus. It’s not safe. The only option is a cesarean delivery. This, clearly, was why they’d wanted me.

“You need hospital care,” I said to Joy.

Joy looked at me, her eyes filled with a deep wariness I’d seen more than a few times over the years. It was the look of a woman who didn’t believe any real choices were open to her. “You’re all I’m going to have,” she said.

“May I examine you?” I asked, and Sarah slid over to make space for me as Joy nodded.

I drew out the exam for a good long while, making small talk, trying to learn what I could from Joy. Her husband’s name was David. They’d married two years ago and this was her first pregnancy.

“How long has the ranch been here?”

“Three years,” she said. “Before that we lived—” She broke off and I was pretty sure she’d gotten a warning look or gesture from Sarah.

“Do your parents live here as well?”

“Pastor John is my daddy,” she said.

“How old are you?”

“I’m twenty,” she said. “David and I married on my eighteenth birthday.”

“How did you find out you had a bicornate uterus?” I asked.

“When I didn’t get pregnant right away we went to see a doctor in—we went to see a doctor, a ways away from here, and he did a whole workup. Said this shouldn’t keep me from getting pregnant but might mean all sorts of things could go wrong.”

“Did he determine the cause of the infertility?”

“Turns out it was David’s swimmers. Not so good at swimming.”

“Oh, really? And I bet they checked that last, didn’t they, after they’d stuck you with a million needles and had you pee on every sort of stick ever invented.”

That got me a hesitant smile even as I could feel Sarah stiffen behind me.

“Anyway,” Joy said. “They had me lie with David’s brother, Brother Calum; apparently there’s something about that in the Bible.”

There was, but only if David were dead, and I did not get a “widowed” vibe here, although I sure didn’t get a “happily married” vibe, either. If she’d been my patient in Minot I’d have brusquely sent her husband off on some errand and asked a bunch of questions that finished with “Are you safe at home?” (If you just spring that question on women who aren’t, some will tell you what they think you want to hear just to get away from you.) And regardless of her answer I’d have given her the number for the battered women’s shelter along with my ten-second “some abuse doesn’t leave bruises; they’ll help you with that, too” talk.

David wasn’t here. Sarah was, though. I came up with an errand for her, saying that Joy was too thin (she was, in fact, much too thin) and I wanted Sarah to go to the dining hall for some vanilla ice cream or some vanilla pudding right that minute, but she just rang a bell that brought a kid to the door, and the kid went running up to the dining hall for the vanilla ice cream, as instructed, while Sarah stayed put.