Then she realized: who came to a county fair alone? Much less a pregnant woman venturing into the sweltering heat of the crowds. Beth carried nothing with her—no bag, no trinkets from the arcade games, not even a water bottle. Her dress had no pockets, therefore no phone or wallet, either. Where had she come from? Why was she alone?
“What’s your full name, Beth? Tell me who I can call for you. Family?”
Beth just shook her head, lips pressed tight. The sound of an engine came from around the corner of the tent and the ambulance appeared. About time, Leah thought, grateful that the baby had waited. The rig pulled up and the rear doors opened. Ruby, Nate, and Emily all hopped out, followed by a medic, who was joined by his partner. Ruby herded the kids to the far side of the wall of bottles, thwarting their efforts to see what was going on.
“Had to show them how to find you back here, didn’t I?” Ruby said before Leah could voice the question.
“Thanks. Please get the kids home. I need to stay with her.”
Ruby didn’t argue, thank goodness—but Leah knew she’d pay for it later. Ruby always collected on her debts.
“What’ve we got, Doc?” the first medic asked as his partner pulled the gurney close.
“Uncertain gestational age, I’m guessing approximately thirty-four to thirty-six weeks. Contractions less than two minutes apart, urge to push, some spotting, no med history but also no recent prenatal care.” As she gave them the report, Leah helped Beth onto the gurney and the other medic strapped her in as another contraction hit.
“I need to push,” Beth cried out.
“Breathe, Beth. Give us a sec to get you into the ambulance,” Leah told her, ignoring the medics’ panicked looks. They were only EMT-basics, not trained in advanced life support. Like most Pennsylvania EMS services, Craven County relied on volunteers, so it wasn’t always possible to staff every shift with full-fledged ALS paramedics.
“You are coming with us, right, Doc?”
Leah nodded, her focus on Beth as they jostled her into the back of the ambulance. The first medic joined her while the other got in front to drive. “Get her on the monitor, hand me the OB pack, let’s get some O2 going.” She grabbed a pair of gloves and slid them on, immediately feeling more in control of the situation despite the bumpy ride as they drove over the grass, heading out to the dirt road leading to the two-lane highway twisting down the mountain to Cambria City.
Under the oxygen mask, Beth heaved in breath after breath as Leah examined her. The medic prepped the neonatal resuscitation equipment and stood by, ready to hand Leah whatever she needed. When she examined Beth, the baby was already crowning, a head of dark hair pulsating with Beth’s movements.
“The baby’s right here,” Leah told Beth. “Try hard not to push for a moment while I check.” Everything looked good; the amniotic fluid was clear except for a small amount of blood—not unusual. “Do you know if it’s a boy or girl?”
“Girl,” Beth said between gasps. “They thought it was a girl.”
“Well, won’t be long now before we know for sure.” Leah glanced at the medic and he nodded his readiness. They bumped over a curb and the road got smoother. Good timing. “Beth, when the next contraction comes I want you to push for a count of ten, okay?”
Sweat pouring into her eyes, hands gripping the gurney’s rails, Beth nodded. Leah grabbed a towel and a pack of gauze, hands at the ready. She kept one hand on Beth’s belly and felt the contraction before Beth made a sound.
“Okay, push, push, push!” Leah urged as the baby’s head emerged. Then she saw the bulging, gelatinous umbilical cord that connected the baby to the mother’s placenta. The cord had wrapped itself around the baby’s neck. “Wait. Stop. Breathe but do not push.”
“What’s wrong?” Beth cried out between gasps.
“Just hang on.” Leah carefully teased the nuchal cord over the baby’s head, taking care not to pull too hard—the baby was still depending on its blood flow, not to mention the risks of hemorrhage to Beth if it tore. Once the head was free, she swiftly suctioned fluid from the baby’s airway. “Okay, now push.”
Beth blew her breath out as another contraction hit. Leah slid her hands around the baby, guiding the shoulders, turning it to make the passage easier. It was a good size for a preemie—but Beth had been so uncertain of her dates that it was possible the baby wasn’t as early as Leah had supposed. The head and shoulders were delivered by the time Beth collapsed back, gasping for air.
“One more push like that and we’re done,” Leah coached her even as she took advantage of the few seconds between contractions to suction out the baby’s mouth and nose again. Another contraction hit and the baby slid out into Leah’s waiting hands.
No meconium, color a bit dusky, she noted as she suctioned again then dried and stimulated the baby with the towel. The baby took a gasp, breathing on its own, but still not crying.
“Is she okay?” Beth gasped. “Why can’t I hear her?”
“She’s a he,” Leah told her with a smile as she continued to rub the baby’s back, hoping to coax a gusty cry to finish clearing his lungs. The medic attached an oxygen monitor and checked the baby’s pulse, but Leah knew they’d both be good—the baby’s color was pinking nicely and she could feel his heartbeat beneath her fingers. She clamped and cut the umbilical cord, grabbed a clean, dry towel and wrapped the baby, bracing herself as the ambulance sped around a curve.
“Does he have a name?” Leah took the medic’s stethoscope and listened for herself. Despite
