Midwives (1997) Read online

  And for a time Charlotte had indeed shown signs that had led my mother to fear a placental abruption: The placenta detaches itself from the uterine wall, so that the mother may slowly bleed to death. There was a moment when Charlotte bled profusely from her vagina, and the pain inside the woman seemed more serious than the more natural agony that is labor. But the bleeding slowed to a trickle, then stopped, and if there had been an abruption, apparently it had clotted and started to heal itself.

  And at another point Charlotte's blood pressure had dropped, falling briefly to seventy-five over fifty, while the baby's heartbeat had slowed to between sixty and seventy beats per minute. My mother and her assistant had only been together three months that March, and Anne Austin still had a lot to learn: When she--a young woman barely twenty-two--placed the metal Fetalscope upon Charlotte's stomach and heard how slowly the baby's heart was beating, she cried out for my mother to listen, which of course led Charlotte to cry out in fear.

  Clearly there was chaos in that bedroom well before the worst would occur.

  Consequently, when Vietnam veteran turned Vermont litigator Stephen Hastings first agreed to represent my mother, he concluded that it must have taken a combination of inclement weather, downed phone lines, and bad luck for Charlotte Bedford to die. In his mind, had there not been black ice on the roads, my mother would have driven her patient to the hospital in Newport. Had the phones been working, she would have called the rescue squad, and they might have rushed Charlotte there. And, of course, my mother would have done everything possible had Charlotte gone into shock due to a placental abruption. My mother had been prepared to administer oxygen. She'd already instructed Anne to pull from their calico birthing bag the plastic tubing and needle and clear bag of fluid she would inject into Charlotte intravenously to keep her hydrated ... but Charlotte suddenly stabilized.

  No, the cause of death had not been placental abruption, as the autopsy would later confirm. And my mother understood this well before the real crisis began: what looked for all the world to her like a ruptured cerebral aneurysm somewhere deep inside Charlotte's brain.

  Sometimes I would overhear my mother try and explain to Stephen that while there had been moments of turmoil and confusion that night, the chain of events that cost Charlotte Fugett Bedford her life was nothing so complex as the sort of thing that pulled planes from the sky and people to their deaths. She would try and tell him it was more cut-and-dried than all that, and he would gently remind her that it wasn't.

  Or at least, he would say, it would not be in the eyes of a jury. And then once more they would discuss what had occurred in that bedroom that was indisputable.

  Charlotte Fugett Bedford went into labor with her second child on Thursday, March 13, 1981. It was late morning when her contractions began coming in earnest, and Charlotte decided that her back pains had nothing to do with the way she had lifted the vacuum when she had finished cleaning the living room. At one thirty-five she phoned her husband at the office at his church and spoke to him for three minutes. At one-forty she phoned my mother, reaching her as she was leaving the house to have the oil changed in her station wagon. Charlotte and my mother spoke for six minutes.

  My mother knew that Charlotte's labor had been relatively easy with Foogie, although the first stage--that period when the cervix dilates to ten centimeters, and the contractions become longer, more frequent, and more pronounced--had taken a day and a half in Alabama heat. The second stage, however, had been brief: Once Charlotte was ready to push, she had Foogie through the birth canal in twenty minutes.

  Although there is no recorded transcript of my mother's and Charlotte's conversation on the telephone, the prosecution never doubted her version. She said that Charlotte told her the contractions early that Thursday afternoon were still easily twenty minutes apart and lasting perhaps thirty or thirty-five seconds. My mother therefore decided to have the oil changed in her car as she had planned and then head north to the Bedfords'. She figured she would be there by three or three-thirty, and she was.

  Nevertheless, she did phone her new apprentice and ask Anne to drop by the Bedfords' right away. She wasn't sure when Asa would return, and she wanted to be sure that Charlotte had company.

  I remember getting off the school bus in Reddington that afternoon just as the skies were starting to spit a cold March rain. There was still a thick quilt of snow on the mountains, freshened perhaps every other night, but the only snow in Reddington that particular day were the drifts along the shady sides of the buildings. The temperature still hovered most afternoons in the twenties or thirties, but we knew winter was winding down and mud season would soon be upon us.

  I was not surprised that my mother was gone when I walked inside our house. I didn't have to read the note she had scribbled in blue with one of the felt-tip pens that she loved, to know she was up at the Bedfords'. I had been expecting that note for days.

  At about the same moment that I was returning home from school, one of Asa's parishioners stopped by the Bedford house and picked up Foogie. The Bedfords' home was small, and Foogie's parents had agreed it would be best for the boy to be someplace else when his brother or sister arrived.

  The first stage of Charlotte's labor was much longer for the second child than most midwives or doctors would have expected. My mother arrived at the Bedfords' in the middle of the afternoon, and testified in court that she anticipated that Charlotte would deliver her baby soon after dinner. She said she never went into a delivery with any sort of expectations, or hourly objectives in her mind: a first stage that should last ten hours, for example, followed by ninety minutes of pushing. She said no midwife or doctor did. But when pressed by the state's attorney, she said if she had any expectations at all, she might have thought Charlotte's cervix would be fully dilated by six or seven in the evening, and the child pushed into the world by nine or ten that night--at the latest.

  Fifteen minutes before midnight, when Charlotte was eight centimeters dilated and the baby's head had descended below the ischial spines to the first positive position--when there was, in my mother's mind, no longer a chance that the umbilical cord could slip past the baby's skull through the cervix, endangering the child--my mother carefully ruptured the membranes damming Charlotte's amniotic waters.

  "I don't understand why you did that," Anne whispered to my mother, concerned that the intervention had been unnecessary.

  "It was time," my mother answered with a shrug.

  At midnight it started to rain, and the droplets turned to ice when they hit the cold ground. At that moment it was thirty-three degrees Fahrenheit at the weather station at Lyndon State College. At twelve twenty-five, the phones between Newport and Richford, between Reddington and Derby Line, went dead, brought down by the weight of the ice forming on the phone lines, and some ill-timed gusts of wind. My mother and her apprentice had no idea the phone lines were down then, but they would discover it soon.

  Charlotte was fully dilated by one in the morning. Her first stage had lasted a solid thirteen hours. Charlotte's transition, that nightmarish period for many mothers just before they must begin the desperately hard business of pushing, those moments when many mothers fear with a horror that's visceral that they will not survive this ordeal, was rocky. Both my mother and Asa Bedford testified that Charlotte began sobbing through her pain, insisting that the being within her was going to rip her apart. She begged them to help her, telling them this felt different than it had with Foogie, this was killing pain, this was a torture she could not endure and she would not survive.

  "I can't do this, I can't do this! God, I can't do this!" she wailed.

  And, in at least one regard, Charlotte was right when she said it felt different than it had with her first child. Unlike during her first delivery, that day and night in Vermont she was experiencing the rigors of labor with a baby in the right occipitoposterior position: The child's head was pressing against the sacrum, the bone in the rear of her pelvis. Instead of the child facing
down as it crowns, it was possible it would emerge sunnyside up.

  But this wasn't alarming my mother. Often the baby rotates at the end of the first stage of labor or at the beginning of the second. And to increase the chances that the child would spin--and to decrease some of Charlotte's back pain--my mother had Charlotte on her feet and walking around between some of the contractions, and she had her laboring often on her hands and knees. Sometimes she asked Anne to apply hot compresses or towels to Charlotte's back; occasionally she had Charlotte squat.

  Between one and one-thirty in the morning, when Charlotte was most miserable and her sobs were loud and long and filled with despair, Asa prayed. My mother said under oath that she still viewed the delivery as normal, and nothing had occurred that would have alarmed any obstetrician or midwife anywhere in the world. Charlotte's labor to this point had been hard, but it hadn't been life-threatening or dangerous for the child inside her.

  Asa prayed softly at first, his voice even and calm, but as Charlotte's wails grew more plaintive and horrid, his praying grew more animated and intense.

  Both my mother and Anne testified that he prayed to the Holy Father to help His child Charlotte through this ordeal, to give her the strength and the courage to endure it, and to protect her throughout it. He was most eloquent when Charlotte was most quiet: When Charlotte would open her mouth wide and yell, he was often reduced to repeating the Lord's Prayer over and over.

  Sometimes Charlotte tried saying the Lord's Prayer with him, but she was never able to get through it before she would have to stop to breathe through her pain.

  And my mother kept trying to reassure them both--and, as the night grew long, her own assistant as well--that back labor was hard and painful, but it wasn't fatal.

  Shortly after one-thirty, not long after my mother had asked Asa to climb on the bed and sit behind his wife while she pushed, my mother noticed the blood. She told herself it was mere bloody show, but the timing of the flow and the quantity of the stream made her own heart beat in a way that made her nervous. She and Anne had just put the clean, oven-sterilized sheet on the bed on which she expected they would catch the child, and the stain spread on the white sheet like a glass of red wine toppled upon fresh table linens.

  Charlotte surprised my mother by heaving her body with such force that she almost rolled off the bed, and by the time my mother had caught her and told her that she was doing fine, the blood had smeared across Charlotte's thighs and her buttocks, and the palm of her hand where she had slapped the bed in her pain.

  Her suffering seemed extreme, and when my mother took her blood pressure, she saw it had fallen during the hour: The systolic reading had dropped to eighty, and the diastolic to sixty. Charlotte's pulse was up into the one-twenties, then the one-thirties, but the baby's heartbeat was as infrequent as ninety small beats per minute.

  My mother decided she would not have Charlotte begin to push for another few minutes, while she monitored her. If Charlotte's blood pressure continued to fall, if she thought the woman was slipping into shock or she saw any further signs of fetal distress, she planned to call the town rescue squad and have her taken to the hospital. If for some reason they were unavailable, she would drive her there herself.

  Three minutes later Charlotte's blood pressure had slipped to seventy-five over fifty, and the baby's heartbeat had slowed to sixty or seventy beats per minute. The vaginal bleeding had become a small, almost imperceptible trickle, and then stopped completely ... but the wet sheets were a reminder of the size of the earlier wave. And so my mother said to the two parents in the room with her that it would be in both Charlotte's interest and the child's interest to have the baby in a hospital. She said--and apparently her words were at once appropriately dispassionate and concerned--there was a chance the placenta was detaching itself from the wall of the uterus. This meant, she explained, both that their little baby wasn't getting the sustenance it needed, and Charlotte might be bleeding inside.

  My mother never came quickly or lightly to the decision that one of her patients should go to a hospital, but she also never hesitated to have a woman in the midst of dangerous complications deliver her baby with modern medicine's extensive safety net unfurled below her. For one reason or another, Sibyl Danforth took roughly one out of every twenty-five mothers to the hospital before March 14, 1981.

  Both she and Asa later testified that had the phones been working that night, things might have ended differently. Unlike some parents who would plead with my mother to let them keep trying, parents who either loved the idea of a home birth so much or hated hospitals with such extreme loathing that they would labor for hours despite the danger, the Bedfords readily agreed they would venture to the mechanized, metal-railed birthing beds and sterile operating rooms of the North Country Hospital in Newport.

  My mother picked up the phone in the bedroom to dial the rescue squad (and back then most phones in the Northeast Kingdom indeed demanded that one literally dial them) and discovered there was no purring tone. Reflexively she pressed the twin buttons in the receiver's cradle and she checked the connections: the connection of the cord to the telephone itself and the jack near the base of the wall. When she saw that both were attached, she suggested that Anne test the phone in the kitchen downstairs. A moment later Anne called up the stairs to inform my mother that the phone on the first floor wasn't working either.

  "It's gone, too!" she cried up to them, and both my mother and Asa detected panic in the young woman's voice, panic they hoped Charlotte hadn't heard. Clearly, however, she had.

  Rain and hard crystals of ice had been rapping against the bedroom windows for well over an hour now, although my mother said she had only become aware of the sound immediately after Anne yelled the bad news from the small entryway at the foot of the stairs. After the apprentice had discovered conclusively that the phones were down, Charlotte grew quiet with fear, and the insistent rain and ice against the glass sounded, my mother would say on the witness stand, "like someone was heaving handfuls of gravel as hard as they could, as if they were trying to shatter the glass."

  My mother called Anne back to the bedroom to keep Charlotte and Asa company while she went outside to warm up her car: Her station wagon was bigger than the Bedfords' little Sunbird or Anne's tiny Maverick, and Charlotte would be most comfortable in it.

  How slippery had the ground become? My mother's struggle across the bluestone walk Asa had built and across fifteen yards of driveway to the spot where she had parked her car would have been comical if it hadn't been so painful. Three days later, on Monday, her attorney had the bruises--still black and blue and ugly--along both of my mother's legs photographed. They also took pictures of the long cuts along the insides of her hands, and the sprained and swollen ankle around which she would wear an Ace bandage for weeks and weeks.

  She fell four times, she said, before she crawled on her hands and knees to her automobile, and then pulled herself to her feet by holding on to the front door's metal handle. Yet she still planned on driving Charlotte to the hospital, and began by attempting to bring the car right up to the front steps of the house--yard and bluestone be damned--so Charlotte wouldn't have to walk along the ice rink that had overtaken the Bedford property. As she pressed her foot down slowly upon the accelerator, the car's tires spun in place like immobile carnival wheels, before abruptly pushing the automobile forward and then twisting it almost three hundred and sixty degrees. It slid into the remains of an ice-covered snowbank one of Asa's parishioners had built while plowing the driveway throughout the winter. And although my mother's car wasn't damaged, she knew it would be impossible to drive to the hospital.

  If my mother cried--and it seemed to me that she had every right to as she pushed open the car door and rolled onto the ground to begin her return to the Bedfords' house--she had stopped by the time she rejoined Charlotte and Asa and Anne. But she said later she'd cried. She had birthed dead babies before, little stillborn things whose souls, in her mind, had gone to
heaven before their flesh had known a world bigger than a womb, but experience didn't make the ordeal any less sad. She said she always cried for those babies and for their parents, and she feared now that the baby inside Charlotte would die, and the Bedfords would lose their second child. (Later, the State's investigation would reveal that babies had died three times in my mother's care prior to March 14, 1981, or almost exactly as often as it happened to women in the care of obstetricians.)

  My mother testified that although the ground was slick with ice, there was a dusting of snow sticking to the grass, and when she saw it she imagined the vernix covering the body of the Bedfords' spiritless, unbreathing little baby. She imagined that baby was a boy.

  But although my mother feared they would lose the baby, she said it never crossed her mind that Charlotte Fugett Bedford would die. She knew she could stop the bleeding once she had delivered the baby (dead or alive), and surely the phone lines would be quickly fixed. She reminded herself that the woman would have to lose six or seven or even eight pints of blood before cardiac arrest would occur, and that, in my mother's view, was a lot of blood.

  And she knew in her birthing bag she had syringes, and glass vials of Pitocin and Ergotrate--drugs that caused the uterus to contract hard, and could sometimes control internal bleeding. Of course, it was illegal for her to have these regulated substances in her possession, but every midwife carried them. My mother wasn't unique.