They did come to me to deliver their babies. They came to me so many times to deliver their babies that by the end of my first year of private practice I was in need of major recuperation. Five babies the first month, 10 the third, increasing up to 20 a month by the time my first vacation came. I drove up to the camp at Pleasant Pond that August, walked into the lake up to my neck and stood there for two weeks, weeping with exhaustion.
It was partly the count. Just the number of hours you have to be awake to deliver 20 babies – for some reason, I won’t or can’t sleep when I’m out on a delivery, even if nothing’s going to happen for a while. Then, in the beginning, I was applying the standards I used when I was working in the hospital; I used to arrive very early and stayed with the patient a long time after the birth so that I could protect them from unnecessary interference in their birth and in their early hours with their child. But those things are only part of it; I was most exhausted by teaching myself how to work well with the woman and her family on her own terrain.
When you go to the hospital to have your baby, they put you in a bed like all other hospital beds, they dress you in a gown like all other hospital gowns, they surround you by an entire hospital staff that guides you along a track that diminishes your individuality and its unique demands, they substitute sophisticated procedures and, relatively speaking, your having a baby is efficient and unemotional for the attendants.
When I started out in practice by myself, I didn’t fully appreciate that when I went single-handedly to deliver babies at home – one midwife in the midst of at least three generations of a family – that I would be, in many respects, at their mercy. The qualities of their lives and relationships crowded in on the relatively simple act of birth, making it rich with possibilities – some beneficial, some not.
For, in spite of how uniform the Amish appear to be, in spite of their rigorous discipline over their community’s behavior, not all Amish people are the same. Conventional wisdom says that no people are all the same; but when you see people who look like each other and are all quiet and say a lot of the same things when they do talk . . . it’s hard to believe otherwise.
In Intercourse, at the People’s Place, they have a slide show that helps tourists get some of the Amish facts straight. I usually take my guests there first, partly because I never tire of the show and partly because it explains things so well.
From the show my friends have quickly grasped the idea that food is not religion, although it is an important – and loved – part of Amish life. Fairly quickly, they grasp the idea that the Amish prefer their way of life to the mainstream; they do not envy life in the cities nor do they envy ‘progress’. What is hardest for my friends to grasp is that Amish people are not all the same. They are not pressed, as the slide show says, ‘out of one Amish cookie cutter.’
There are lively gentle people, pious gentle people, funny ones, boring ones, mean ones, kind ones, intelligent ones, ones not so smart.
Take intelligent ones, for example.
I was still working with Stephen when Amos and Barbara King started having trouble with their fourth baby. They’d lost their third baby in the hospital one or two weeks after birth, and now the fourth was having trouble breathing and wasn’t eating well. Stephen figured it was a virus but sent it to the hospital for some tests. Amos insisted it wasn’t a virus. The pattern, he repeated, was the same as with the child before.
Amos was right; it wasn’t a virus. The baby’s metabolic system wasn’t working right and though Country Hospital couldn’t determine exactly why it was dysfunctional, Stephen had narrowed it down enough so that the researchers he called at Infants & Children’s were ready with specific tests when the baby arrived. Thirty-six hours later, amino acid analyzer tests showed that the mother’s milk was killing the fourth child, just as it probably had killed the third.
Amos King – simple Amish farmer, chicken breeder, corn picker, manure shoveller, father today of five children, two of whom are normal and three of whom have the metabolic disorder – has become an expert on this exquisitely complex and changeable condition. So educated have we all become, due to Amos’s way that, in spite of the possibility of handicap in their last baby, I felt completely safe in delivering it at home. At the crucial 12th hour after birth, exactly, a local medical technician, a young man who knew the family and who was, therefore, willing to get up before dawn to make the test, appeared at the King’s farmhouse door, took a blood sample from the new baby, drove it to Infants & Children’s and, in a record 30 hours after birth, we found out the baby had the metabolic disorder and the special diet was begun.
Amos King found the sensitivity I had often missed in the medical system. In his gentle, self-effacing style, he succeeded at what the rest of us have often failed at: getting the specialist to adapt to an unusual circumstance. Amos King does have joy in his face and he is innocent of personal competition or self-serving motives. That’s why, I guess, the hospital set aside its normal regulations and allowed Amos King to walk right alongside that second sick baby’s blood as it made its way through the labyrinth of usually proud, protective, and intensely competitive researchers. He asked them about the physiology of the disease – although he wouldn’t have called it that in the beginning – and explained that he needed to understand because he lived on a farm a long way from Infants & Children’s and he would be needing to make as many routine tests on the baby as was possible for him to do at home, and he would be needing to figure how to adjust the baby’s diet accordingly. Researchers, who don’t customarily share their discoveries with each other until after publication, got chatty about the ins and outs of metabolic research with this Amish farmer.
Today Amos King probably knows more about certain metabolic disorders than most researchers in the country. He makes intricate calculations for each of the afflicted children as to what they can eat, when, and in what quantities.
The controls aren’t perfect – no one knows how to do that yet – and each time a child’s system goes out of balance, some brain damage is done. So in Amos and Barbara’s home, a number of the children have difficulty talking and walking. It doesn’t make any difference – well, yes, it does. The household seems blessed. The children are generally crawling all over each other, laughing and playing. ‘We just do what we can each day,’ Amos says easily and saunters off as if he were a man without responsibility or a thought in the world.
But I’ve said that Amish come in all kinds.
Abysmal November. A resentful dawn is ragging at the eastern sky. The phone rings.
‘You gotta come here quick.’
‘Who is this?’
‘You don’t know me.’
‘Do I know your wife?’
‘No.’
‘What’s the problem?’
‘The wife, she just had a baby about an hour ago and it looks sort of funny, and the afterbirth never came yet. The wife, she still didn’t want me to call you, but I didn’t know what to do.’
‘Who’s your doctor?’
‘The wife didn’t want no doctor. You gotta come.’
I hated these calls. I had no choice. He’d never call the ambulance and I couldn’t leave a woman with an afterbirth still in her an hour after the baby’d come.
‘All right. I’ll come. You get back to that house as fast as you can. Make sure that baby is wrapped warm and you stay right next to your wife – don’t you dare let her get up.’
I drove in a straight line overland through somebody’s hay field, pounding my fist in fury on the steering wheel as I went, ‘It’s all right to put your baby’s life in danger,’ I screamed, ‘and to put your wife’s life in danger – she’s probably just waiting until I get there to begin to hemorrhage. One hour, for Pete’s sake – just because you’re too something or other to make sure your wife gets to the doctor. So what if “she didn’t want no doctor”. So what!’
I marched into the kitchen. For an Amish kitchen, it was strangely disordered.
‘Where’s your wife?’
He looked at me dully and pointed the way.
I could see it now. The first lawsuit brought by an Amishman in four and a half centuries.
I brushed past the father and went to the bedroom.
Absolutely nothing had been prepared for this baby. I could see that. After it had come, the girl must have simply rolled over and pulled a heap of blankets over herself. She was lying with her face towards the wall, clutching the blankets, her new baby apparently hidden somewhere among them.
‘How are you doing, Barbara?’ I asked.
She didn’t answer.
‘Barbara, my name is Penny and I’m the midwife. I’ve come to see you and your baby. We’ll have to deliver your afterbirth, otherwise you might begin to bleed heavily. And then we need to see if you and the baby are all right. It’ll go better for both of you if we do this together.’
Still she didn’t reply. She pulled the blankets farther up over her face, and even through the mound of them, I could see her spine stiffen.
She stayed that way. She wouldn’t talk or look at me. I had to search for the child, who turned out to be fine, and delivered the afterbirth without the hemorrhage I’d expected. Apparently it had separated well enough, but she may have resisted pushing it out. Throughout these operations, she never spoke. With perfect consistency, she kept her head turned away from me, as if I were loathsome. She submitted to my taking the baby away to wash it only because her husband made her, and when I brought it back, ready for nursing, she grabbed it to her and turned her back to me again.
Her husband sat in a chair in the kitchen most of the time, his head dropped, his eyes focused on the floor.
Never had I had a delivery like this. It can’t happen; even if young people aren’t able to get ready for the birth themselves, even if there are mental problems, the girl’s mother or a neighbor will step in and get things ready.
‘Who’s going to help with this baby?’ I asked the father.
‘She wants to do it herself,’ he said helplessly.
‘She can’t do it herself. Surely you can see that now. That baby could have died; your wife could have died. Where’s this girl’s mother? Who’s going to help with this baby? You make it your business to work this out and in case you think I’m not serious, I want you to know that I’m not leaving this house until I know.’
He went into the bedroom and I went out to the car to see if I could find extra boxes of diaper samples. When he came back he said his wife’s younger sister would be coming.
I went back the next day. The sister and a neighbor were there. Barbara sat in a rocking chair with its back to the center of the room. The baby was in her lap and she stroked it and cooed. I asked her questions; she answered each of them in a word or two and cooed in the space between answers, successfully making the cooing a battering ram to drive me away.
On the way out, I was able to ask the neighbor how it happened that they were allowed to be so unprepared. ‘We didn’t know them,’ she said. ‘They just moved here from another county; we thought their family would be helping them. Now we found out that the girl’s mother died not so long ago and we didn’t realize how it was with them. But we see how they are and can help.’ The father was nowhere to be seen.
A few weeks later I went back one more time. The sister was still there and the house had gained some order, but the mother hadn’t changed. Again, she talked only to her baby during the visit. It was as if with the soft, beating patter she could keep all of us away and slowly herself slip inch by inch inside the baby and live within her.
This time I found the father around the back of the barn. While I talked, he looked out towards the fields and ran a leather harness nervously through his fingers. I told him that the baby was doing fine, but that I thought his wife would still need some help.
‘I suppose you’ll be wanting your money now then,’ he said.
‘Yes,’ I answered, wondering if he’d heard a word I’d said about his wife. There was little I could do about it. ‘I’ll be sending you a bill and it will be less than I normally would charge because you didn’t have the prenatal office visits, but I want you to understand that I should actually charge you more. A woman who hasn’t had prenatal care is at much higher risk. Furthermore, I want to make it clear that I will never deliver another child of yours under circumstances like that. Never. Do you understand?’
‘Oh,’ he said, almost blithely. ‘I don’t believe we need to worry about that. Ever since you delivered her baby, my wife never pays me any attention.’ Then he paused for a moment and his fingers stopped roaming the edge of the harness. He looked at me and only slowly did his eyes move away from mine. His defences must have abandoned him. His young body sagged and after a while he said in a low voice, ‘So I believe I’ll just be paying you this once.’
When I’d be hit by that reflexive fear – ‘They’re gonna get me’ – as I was in this case, I’d calm myself by reaching back into the memory of another night that began just as this one had.
Middle of the night, didn’t know the man, didn’t know the woman. Then: ‘We had prenatal care from Dr Blake and he’s not here now and my wife and I, we haven’t had a baby for seven years and would you please come?’
I went as fast as I possibly could.
When I pulled up in this farmyard, the father’s Ichabod Crane body came soaring out the door to give me a hand with my suitcase. When he bent over, his face skin fell in thin, worn folds around his mouth. His sweater, with its baggy pockets and leather buttons, hung as if from a peg off his backbone. Nevertheless, he hoisted the suitcase and swung it off towards the house, leaving, I’m sure, black and blue spots on his legs for weeks.
Once inside, he rushed from drawer to cupboard; climbed, scurried, put back, folded, unfolded, shook his head in frustration, nibbled and sniffed; and soon he had something that resembled everything we needed. He stopped now and again when he heard his wife moan and stared painfully and helplessly at her, his long fingers dragging on the hem of his sweater. Then, coming to, he’d wipe the palms of his hands on his pants and patter off to find something else.
Like the other women, this one said little. But she didn’t turn her head away. ‘I’m not such a young woman anymore,’ she said when we began and then, seeming to fully understand the physiological barriers that age puts up before childbirth, she concentrated on having the baby.
All went well.
As I was leaving, the husband said, ‘Thank you. We wouldn’t have known what to do.’ And his wife, who had remained silent even in the aftermath of the birth, called me back. ‘I want to thank you,’ she said. ‘Every night I’ll pray for you and the good work you are doing.’
At Booth in Philadelphia, Sue Yates had harped on professional responsibility. Nurses, she said at every opportunity, took orders from doctors. Certified nurse-midwives gave their own orders, made their own decisions; they and they alone had to carry the burden of responsibility for what happened at delivery. In the hospital, we had to fight for that responsibility because doctors were constantly second-guessing us.
With my home delivery practice, I had unrestricted responsibility – and thrived on it. Among other things, it allowed me to give women what I thought was the best possible care. I wanted responsibility – even when I was so tired that I didn’t know if I could carry it anymore.
But I found it peculiarly difficult to know that somebody was praying for me; to have an Amishwoman asking God to look after me and my work. All of these people, all of my patients, believe in God and in prayer, and I don’t care what I might have believed – I could have been an avowed atheist when I arrived – when I’m out there among them, it’s different. What I believed or didn’t believe was beside the point. In my patients’ minds, God was in there helping or hindering my work.
It was the final responsibility. That woman said she’d pray for me and these people do what they say they will do. Every night, before she drops into bed she’s saying, ‘And God bless Penny and her work.’ I try very hard.