“Vous me permettez?” I asked absurdly, kneeling beside her. Perhaps if I shifted her hips, I could expand the pelvic basin, but when I lifted her thigh to push it up toward her chest, a horrid gasp leapt through her. The paroxysm seemed more a convulsion than a contraction. While it lasted the crumpled crown of the baby’s head emerged slightly from the birth canal, feathered with blood-matted hair, scalp waxen, blue black, and hypoxic. Leaning forward, my chin pressed into the back of her knee, I managed to pin her thigh against her chest, hoping to push the baby far enough back up the birth canal to turn it. It was during this blind and futile effort that I felt, at my fingertips, the hard, vein-ridged umbilical cord coiled in a double loop around the child’s neck, while the child’s shoulder remained wedged behind the cervical rim.
Shoulder dystocia. Delivery arrested by shoulder dystocia. That would account for the bad angle of the head. Yes, there could be no doubt. But why was I so sure? Because shoulder dystocia was one of the few labor complications I could remember from my obstetrics rotation? During one of those deliveries, the attending physician, with a jerk of a forceps, had snapped a baby’s collarbone to deliver it, and for days I could not expel that sickening crunch from my head.
If there was a name for that maneuver—the breaking of the clavicle to extract a distressed fetus—I didn’t remember it, and in any event I had no forceps but my ungloved hands. I struggled for a better purchase on the baby while cries surged through the girl with convulsive force. It was only after my hands had grown slick with vernix and blood, only after I had contrived a way to brace my elbows against my stomach while leaning over the girl, that I managed to force the baby back up enough to get a proper grip on its shoulders. At first the body felt like a greased piglet, but as I grasped harder, the tiny thorax seemed less slippery and more brittle, as though the pressure of my hands had melted away all insulating layers of fat and muscle, leaving only the frail cage of rib and collarbone. For an instant I hung paralyzed between the fear of losing my grip and the fear of killing the baby outright. I compressed the shoulder yoke with a desperate force: either the clavicle would refuse to break and the child would strangle in the canal or I would crush its thorax entirely. I was certain now I should give up, wait for someone to arrive, but the lantern hissed, I leaned harder, and it broke, the clavicle alone, with a wet snap.
With the shoulder collapsed against its neck, the baby shot out, propelled on a wet gush, not of amniotic fluid but of blood, frank and opaque. I tilted the head back and with my mouth tried to suck the mucus plugs from its nose, the slurry of phlegm and meconium from its throat. I lifted the little body up by its ankles—as though whatever blackness had filled it, had darkened its face to bruise-bronze, would rush out of it. Only a brownish froth, however, no more than a teaspoon, drained down the cheek toward the sealed eye. Nothing happened. The child did not breathe.
At last I replaced the small form alongside its mother, its rumpled feet bowed inward, the buttocks narrow. No afterbirth had followed the delivery, so the umbilical cord still disappeared in the mother’s vagina. Blundering through the shadows, I found an empty wine bottle and a plastic bag. I bit off the two handles of the bag, then knotted them to ligate the umbilicus. The bottle broken, a large shard served to cut or rather crush through the gristled tissues, releasing a single spurt of blood when it breached the artery.
It was then, for the first time, that I noticed: the child was a girl. The baby was a girl. But she had neither breathed nor cried, and she lay motionless where I had set her down, beside the mother now motionless too. An immense longing overcame me to leave them alone, to leave them in whatever impenetrable silence had claimed them for itself.
I decided to place the child on the plateau of her mother’s sternum, near to the heart, but when I turned the baby so that she would not slide off, the clavicle ground and gave. It must have been the pain then that did it, stiffening the little body with a galvanic jolt. In a single spasm, it kicked and arched and spewed a plume of filth, followed by a squad of cries enraged but orderly, separated by short whooping gasps. The cries drove outward in every direction and echoed off the concrete walls, and the mother’s body heaved with an answering half rasp, half wail. Her eye, rolling to the side, caught mine and held it in blind, desperate appeal.
If infection had taken hold, she could be disoriented, even delirious. Perhaps she had never been aware that I was there. The face, still waxen, tensed anew, but only briefly, as a final contraction ejected the afterbirth into the slick of effluent, and along with the afterbirth another surge of blood. I had put her hand up on the baby’s back, and for a moment she struggled to raise her head and look. The effort seemed to crush her and her head fell back, an enormous tear quivering in the hollow beside her nose.
“Voilà votre enfant,” I said. “Une belle petite fille.”
Had she heard me?
“A girl,” I said again. “A beautiful baby girl.”
But she
