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“Transverse Lie”

Copyright 2009 Diana Gabaldon

The world was dripping.  Freshets leapt down the mountain, grass and leaves were wet with dew and the shingles steamed in the morning sun.  Our preparations were made and the passes were clear.  There remained only one more thing to do before we could leave.

“Today, d’ye think?” Jamie asked hopefully.  He was not a man made for peaceful contemplation; once a course of action was decided upon, he wanted to be acting.  Babies, unfortunately, are completely indifferent to both convenience and impatience.

“Maybe,” I said, trying to keep a grip on my own patience.  “Maybe not.”

“I saw her last week, and she looked then as though she was goin’ to explode any minute, Auntie,” Ian remarked, handing Rollo the last bite of his muffin.  “Ken those mushrooms?  The big round ones?  Ye touch one and poof!”  He flicked his fingers, scattering muffin crumbs.  “Like that.”

“She’s only having the one, no?”  Jamie asked me, frowning.

“I told you–six times so far–I think so.  I bloody hope so,” I added, repressing an urge to cross myself.  “But you can’t always tell.”

“Twins run in families,” Ian put in helpfully.

Jamie did cross himself.

“I’ve only heard one heartbeat,” I said, keeping a grip on my temper, “and I’ve been listening for months.”

“Can ye not count the bits that stick out?”  Ian inquired.  “If it seemed to have six legs, I mean…”

“Easier said than done.”  I could, of course, make out the general aspect of the child–a head was reasonably easy to feel, and so were buttocks; arms and legs a bit more problematical.  That was what was disturbing me at the moment.

I’d been checking Lizzie once a week for the past month–and had been going up to her cabin every other day for the last week, though it was a long walk.  The child–and I did think there was only one–seemed very large; the fundus of the uterus was a good bit higher than I thought it should be.   And while babies frequently changed position in the weeks prior to birth, this one had remained in a transverse lie–wedged sideways–for a worryingly long time.

The fact was that without a hospital, operating facilities, or anesthesia, my ability to deal with an unorthodox delivery was severely limited.  Sans surgical intervention, with a transverse lie, a midwife had four alternatives:  let the woman die after days of agonizing labor; let the woman die after doing a Caesarian section without benefit of anesthesia or asepsis–but possibly save the baby; possibly save the mother by killing the child in the womb and then removing it in bits (Daniel Rawlings had had several pages in his book–illustrated–describing this procedure), or attempting an internal version, trying to turn the baby into a position in which it might be delivered.

While superficially the most attractive option, that last one could easily be as dangerous as the others, resulting in the deaths of mother and child.

I’d tried an external version the week before, and managed—with difficulty—to induce the child to turn head-down.  Two days later, it had turned right back, evidently liking its supine position.   It might turn again by itself before labor started—and it might not.

Experience being what it was, I normally managed to distinguish between intelligent planning for contingencies and useless worrying over things that might not happen, thus allowing myself to sleep at night.  I’d lain awake into the small hours every night for the last week, though, envisioning the possibility that the child wouldn’t turn in time, and running through that short, grim list of alternatives in futile search for one more choice.

If I had ether…but what I’d had had gone when the house burned.

Kill Lizzie, in order to save the new child?  No.  If it came to that, better to kill the child in utero, and leave Rodney with a mother, Jo and Kezzie with their wife.  But the thought of crushing the skull of a full-term child, healthy, ready to be born—or decapitating it with a loop of sharp wire…

“Are ye no hungry this morning, Auntie?”

“Er…no.  Thank you, Ian.”

“Ye look a bit pale, Sassenach.  Are ye sickening for something?”

“No!”  I got up hastily before they could ask any more questions–there was absolutely no point in anyone but me being terrorized by what I was thinking–and went out to fetch a bucket of water from the well.

Amy was outside; she had started a fire going under the big laundry kettle, and was chivvying Aidan and Orrie, who were scrambling round to fetch wood, pausing periodically to throw mud at each other.

“Are ye wanting water, a bhana-mhaigistir?” she asked, seeing the bucket in my hand.  “Aidan will fetch it down for ye.”

“No, that’s all right,” I assured her.  “I wanted a bit of air.  It’s so nice out in the mornings now.”  It was; still chilly until the sun got high, but fresh, and dizzy with the scents of grass, resin-fat buds, and early catkins.

I filled the bucket and made my way down the path, slowly, looking at things as you do when you know you might not see them again for a long time.  If ever.

Things had changed drastically on the Ridge already, with the coming of violence, the disruptions of the war, the destruction of the Big House.  They’d change a great deal more, with Jamie and me both gone.

Who would be the natural leader?  Hiram was the de facto head of the Presbyterian fisher-folk who had come from Thurso–but he was a rigid, humorless man, much more likely to cause friction with the rest of the community than to maintain order and foster cooperation.

Bobby?  After considerable thought, Jamie had appointed him factor, with the responsibility of overseeing our property–or what was left of it.  But aside from his natural capabilities or lack thereof, Bobby was a young man.   He–along with many of the other men on the Ridge–could so easily be swept up in the coming storm, taken away and obliged to serve in one of the militias.  Not the Crown’s forces, though; he had been a British soldier, stationed in Boston two years [ck. date of Boston Massacre] before, where he and several of his fellows had been menaced by a mob of several hundred irate Bostonians.  In fear for their lives, the soldiers had loaded their muskets and leveled them at the crowd.  Stones and clubs were thrown, shots were fired–by whom, no one could establish; I had never asked Bobby–and  men had died.

Bobby’s life had been spared at the subsequent trial, but he bore a brand on his cheek–”M,” for “Murder”.   I had no idea of his politics–he never spoke of such things–but he would never fight with the British army again.

I pushed open the door to the cabin, my equanimity somewhat restored.

Jamie and Ian were now arguing as to whether the new child would be a sister or brother to little Rodney, or a half-sibling.

“Well, no way of telling, is there?” Ian said.  “Nobody kens whether Jo or Kezzie fathered wee Rodney, and the same for this bairn.   If Jo is Rodney’s father, and Kezzie this one’s…”

“It doesn’t really matter,” I interrupted, pouring water from the bucket into the cauldron.  “Jo and Kezzie are identical twins.  That means their…er…their sperm is identical as well.”  That was oversimplifying matters, but it was much too early in the day to try to explain reproductive meiosis and recombinant DNA.  “If the mother is the same–and it is–and the father is genetically the same–and they are–any children born would be full sisters or brothers to each other.”

“Their spunk’s the same, too?” Ian demanded, incredulous.  “How can ye tell?  Did ye look?” he added, giving me a look of horrified curiosity.

“I did not,” I said severely.  “I didn’t have to.  I know these things.”

“Oh, aye,” he said, nodding with respect.  “Of course ye would.  I forget sometimes what ye are, Auntie Claire.”

I wasn’t sure what he meant by that, exactly, but it didn’t seem necessary either to inquire, or to explain that my knowledge of the Beardsley’s intimate processes was academic, rather than supernatural.

“But it is Kezzie that’s this one’s father, no?” Jamie put in, frowning.  “I sent Jo away; it’s Kezzie she’s been living with this past year.”

Ian gave him a pitying look.

“Ye think he went?  Jo?”

“I’ve not seen him,” Jamie said, but the thick red brows drew together.

“Well, ye wouldn’t,” Ian conceded.  “They’ll ha’ been gey careful about it, not wantin’ to cross ye.   Ye never do see more than one of them—at a time,” he added, off-handed.

We both stared at him.  He looked up from the chunk of bacon in his hand and raised his brows.

“I ken these things, aye?” he said blandly.

[end section]

After supper, the household shifted and settled for the night.  All the Higginses retired to the back bedroom where they shared the single bedstead—all but little Catherine Redbud, who enjoyed the snug privacy of her own cradle.   Jamie had built it, and Jemmy and then Amanda had slept in it; I wondered how many more children might occupy it, down the years?

Lizzie had a cradle, too; her own father had made it for Rodney.   Now the new baby—I hoped—would occupy it.

Obsessively, I opened my midwifery bundle and laid out the kit, checking everything over once more.  Scissors, white thread for the cord.  Clean cloths, rinsed many times to remove all trace of lye soap, scalded and dried.  A large square of waxed canvas, to waterproof the mattress.  A small bottle of alcohol, diluted fifty percent with sterile water.  A small bag containing several twists of washed–but not boiled–wool.  A rolled-up sheet of parchment, to serve in lieu of my stethoscope, which had perished in the fire.  A knife.  And a length of thin wire, sharpened at one end, coiled up like a snake.

I hadn’t eaten much at dinner–or all day–but had a constant sense of rising bile at the back of my throat.  I swallowed and wrapped the kit up again, tying the twine firmly round it.

I felt Jamie’s eyes on me and looked up.  He said nothing, but smiled a little, warmth in his eyes, and I felt a momentary easing–then a fresh clenching, as I wondered what he would think, if worst came to worst, and I had to–but he’d seen that twist of fear in my face, and with his eyes still on mine, quietly took his rosary from his sporran, and began silently to tell the beads, the worn wood sliding slowly through his fingers.

[end section]

Two nights later, I came instantly awake at the sound of feet on the path outside, and was on my own feet, pulling on my clothes, before Jo’s knock sounded on the door.  Jamie let him in; I heard them murmuring together as I burrowed under the settle for my kit.  Jo sounded excited, a little worried–but not panicked.   That was good; if Lizzie had been frightened or in serious trouble, he would have sensed it at once–the twins were nearly as sensitive to her moods and welfare as they were to each other’s.

“Shall I come?” Jamie whispered, looming up beside me.

“No,” I whispered back, touching him for strength.  “Go back to sleep.  I’ll send, if I need you.”

He was tousled from sleep, the embers of the fire making shadows in his hair, but his eyes were alert.  He nodded and kissed my forehead, but instead of stepping back, he laid his hand on my head and whispered, “O Blessed Michael of the Red Domain…” in Gaelic, then touched my cheek in farewell.

“I’ll see ye in the morning then, Sassenach,” he said, and pushed me gently toward the door.

To my surprise, it was snowing outside.  The sky was gray and full of light and the air alive with huge, whirling flakes that brushed my face, melting instantly on my skin.  It was a spring storm; I could see the flakes settle briefly on the grass stems, then vanish.  There would likely be no trace of snow by morning, but the night was filled with its mystery.  I turned to look back, but could not see the cabin behind us–only the shapes of trees half-shrouded, uncertain in the pearl-gray light.  The path before us looked likewise unreal, the trace disappearing into strange trees and unknown shadows.

I felt weirdly disembodied, caught between past and future, nothing visible save the whirling white silence that surrounded me.  And yet I felt calmer than I had in many days.  I felt the weight of Jamie’s hand on my head, with its whispered blessing.  O, Michael of the red domain….

It was the blessing given to a warrior going out to battle.  I had given it to him, more than once. He’d never done such a thing before, and I had no idea what had made him do it now–but the words glowed in my heart, a small shield against the dangers ahead.

The snow covered the ground now, in a thin blanket that hid dark earth and sprouting growth.  Jo’s feet left crisp black prints that I followed upward, the needles of fir and balsam brushing cold and fragrant against my skirt, listening to a vibrant silence that rang like a bell.

If ever there were a night when angels walked, I prayed it might be this one.

[End Section]

It was nearly an hour’s walk to the Beardsley cabin, in daylight and good weather.  Fear hastened my footsteps, though, and Jo—I thought it was Jo–was hard-pressed to keep up with me.

“How long has she been at it?”  I asked.   You could never tell, but Lizzie’s first labor had been fast; she’d delivered little Rodney quite alone and without incident.  I didn’t think we were going to be that lucky tonight, though my mind couldn’t help hopefully envisioning an arrival at the cabin to find Lizzie already holding the new baby, safely popped out without difficulty.

“Not long,” he panted.  “Her waters came all of a sudden, when we were all abed, and she said I best come fetch you at once.”

I tried not to notice that “all abed”—after all, he and/or Kezzie might have slept on the floor—but the Beardsley menage was the literal personification of double entendre; nobody who knew the truth could think of them without thinking of…

I didn’t bother asking how long he and Kezzie had both been living at the cabin; from what Ian had said, they’d likely both been there all the time.  Given the normal conditions of life in the backcountry, no one would have blinked at the notion of a man and his wife living with his brother.   And so far as the general population of the Ridge was aware, Lizzie was married to Kezzie.   She was.  She was also married to Jo, as the result of a set of machinations that still caused me to marvel, but the Bearsdley household kept that fact quiet, on Jamie’s orders.

“Her Pap’ll be there,” Jo said, breath pluming white as he pulled alongside me where the trail opened out.  “And Auntie Monika.   Kezzie went to fetch ‘em.”

“You left Lizzie alone?”

His shoulders hunched defensively, uncomfortable.

“She said to,” he said simply.

I didn’t bother replying, but hastened my step, until a stitch in my side made me slow a little.  If Lizzie hadn’t already given birth and hemorrhaged or had some other disaster while alone, it might be a help to have “Auntie Monika”—Mr. Wemyss’s second wife—to hand.   Monika was a German lady, of limited and eccentric English, but boundless courage and common-sense.

Mr. Wemyss had his share of courage, too, though it was a quiet sort.  He was waiting for us on the porch, with Kezzie, and it was clear that Mr. Wemyss was supporting his son-in-law, rather than the reverse.   Kezzie was openly wringing his hands and jigging from foot to foot, while Mr. Wemyss’s slight figure bent consolingly toward him, a hand on his arm.  I caught low murmurs, and then they saw us and turned toward us, sudden hope in the straightening of their bodies.

A long, low howl came from the cabin, and all the men stiffened as though it had been a wolf springing out of the dark at them.

“Well, she sounds all right,” I said mildly, and all of them exhaled at once, audibly.  I wanted to laugh, but thought better not, and pushed open the door.

“Ugh,” said Lizzie, looking up from the bed.  “Oh, it’s you, ma’am.  Thank the Lord!”

“Gott bedanket, aye,” agreed Auntie Monika, tranquilly.  She was on her hands and knees, sponging the floor with a wad of cloth.   “Not so long now, I hope.”

“I hope not, too,” said Lizzie, grimacing.  “GAAAAARRRRRGH!”  Her face convulsed into a rictus and went bright red, and her swollen body arched backward.  She looked more like someone in the grip of tetanus than an expectant mother, but luckily the spasm was short-lived, and she collaped into a limp heap, panting.

“It wasna like this, last time,” she complained, opening one eye as I palpated her abdomen.

“It’s never the same,” I said absently.  One quick glance had made my heart leap; the child was no longer sideways.  On the other hand….it wasn’t neatly head-down, either.  It wasn’t moving–babies generally didn’t, during labor—and I while I thought I had located the head up under Lizzie’s ribs, I wasn’t at all sure of the disposition of the rest.

“Let me just have a look here…”  She was naked, wrapped in a quilt.  Her wet shift was hanging over the back of a chair, steaming in front of the fire.  The bed wasn’t soaked, though, and I deduced that she’d felt the rupturing of her membranes and made it to a standing position before her water broke.

I’d been afraid to look, and let my breath out in audible relief.  The chief fear with a breech presentation was that part of the umbilical cord would prolapse when the membranes ruptured, the loop then being squeezed between the pelvis and some part of the fetus.  All clear, though, and a quick feel indicated that the cervix was very nearly effaced.

The only thing to do now was to wait and see what came out first.   I undid my bundle, and—shoving the coil of sharpened wire hastily under a packet of cloths—spread out the waxed canvas, hoiking Lizzie onto it with Auntie [ ]‘s help.

[ ] blinked, rather,  and glanced at the cradle where little Rodney was snoring when Lizzie let out another of those unearthly howls.   She looked to me for reassurance that nothing was wrong, then took hold of Lizzie’s hands, murmuring softly to her in German while she grunted and wheezed.

The door creaked gently, and I looked round to see one of the Beardsleys peering in, his face showing a mixture of fear and hope.

“Is it here?” he whispered hoarsely.

“NO!” bellowed Lizzie, sitting bolt upright.  “Get your neb out of my sight, or I’ll twist your wee ballocks off!   All four o’ them!”

The door promptly closed, and Lizzie subsided, puffing.

“I hate them,” she said through clenched teeth.  “I want them to die!”

“Mm-hm,” I said sympathetically.  “Well, I’m sure they’re suffering, at least.”

“Good.”  She went from fury to pathos in a split second, tears welling in her eyes.  “Am I going to die?”

“No,” I said, as reassuringly as possible.


Gruss Gott,” Auntie [ ] said, crossing herself.  “Ist gut?

Ja,” I said, still reassuring.  “I don’t suppose there are any scissors…?”

“Oh, ja,” she replied, reaching for her bag.   She produced a tiny pair of very worn, but once-gilded embroidery scissors.  “Dese you need?”



Monika and I both looked at Lizzie.

“Don’t over do it,” I said.  “They’re frightened, but they aren’t idiots.  Besides, you’ll scare your father.  And Rodney,” I added, with a glance at the little heap of bedclothes in the cradle.

She subsided, panting, but managed a nod and the ghost of a smile.

Matters proceeded fairly rapidly thereafter; she was fast.  I checked her pulse, then her cervix, and felt my own heart rate double as I touched what was plainly a tiny foot, on its way out.   Could I get the other one?

I glanced at Monika, with an eye to size and strength.  She was tough as whipcord, I knew, but not that large.  Lizzie, on the other hand, was the size of—well, Ian had not been exaggerating when he thought it might be twins.

The creeping thought that it still might be twins made the hair on the back of my neck stand up, despite the humid warmth of the cabin.

No, I said fimly to myself.  It isn’t; you know it isn’t.  One is going to be bad enough.

“We’re going to need one of the men, to help hold her shoulders up,” I said to [ ].  “Get one of the twins, will you?”

“Both,” Lizzie gasped, as Monika turned toward the door.

“One will be—”

Both!  Nnnnnnggggg…

“Both,” I said to Monika, who nodded in a matter-of-fact manner.

The twins came in on a rush of cold air, their faces identical ruddy masks of alarm and excitement.   Without my saying anything to them, they came at once to Lizzie, like a pair of iron filings to a magnet.  She had struggled into a sitting position, and one of them knelt behind her, his hands gently kneading her shoulders as they relaxed from the last spasm.   His brother sat beside her, a supportive arm round what used to be her waist,  his other hand smoothing back the sweat-soaked hair from her brow.

I tried to arrange the quilt round her, over her protruding belly, but she pushed it away, hot and fretful.   Well, presumably the twins were somewhat more familiar with her anatomy than I was, I reflected, and handed the wadded quilt to Auntie Monika.    Modesty had no place in childbirth.

I knelt in front of her, scissors in hand, and snipped the episiotomy quickly, feeling a tiny spray of warm blood across my hand.  I pressed one of my clean cloths to the cut, but the amount of bleeding was negligible, and the insides of her thighs were streaked with bloody show in any case.

It was a foot; I could see the toes, long ones, like a frog’s, and glanced automatically at Lizzie’s bare feet, planted solidly on the floor to either side of me.  No, hers were short and compact; it must be the twins.

The humid, swampish scent of birthwaters, sweat and blood rose like fog from Lizzie’s body, and I felt my own sweat running down my sides.  I felt upward, hooked a finger round the heel, and brought the foot down, feeling the life in the child move in its flesh, though the baby itself was not moving, helpless in the grip of birth.

The other one, I needed the other one.  Feeling urgently through the belly wall between one contraction and the next, I slid my other hand up the emergent leg, found the tiny curve of the buttock.  Switched hands hastily, and with my eyes closed, found the curve of the flexed thigh.  Bloody hell, it seemed to have its knee tucked up under its chin…felt the yielding stiffness of tiny, cartilaginous bones, solid in the squish of fluid, the stretch of muscle…got a finger, two fingers, circling the other ankle, and snarling, “Brace her!  Hold her!” as Lizzie’s back arched and her bottom scooted toward me, brought the second foot down.

I sat back, eyes open and breathing hard, though it hadn’t been a physical strain.  The child was coming face-up.  Not ideal.  The little froggy feet twitched once, then drooped, as the legs came into view with the next push.

“Once more, sweetheart,” I whispered, a hand on Lizzie’s straining thigh.  “Give us one more like that.”

A growl from the depths of the earth as Lizzie reached that point where a woman no longer cares whether she lives, dies, or splits apart, and the child’s lower body slid slowly into view, the umbilicus pulsing like a thick purple worm looped across the belly.  My eyes were fixed on that, thinking, Thank God, thank God¸ when I became aware of Auntie Monika, peering intently over my shoulder.

Ist das balls?” she said, puzzled, pointing at the child’s genitals.

I hadn’t spared time to look, concerned as I was with the cord, but I glanced down and smiled.

“No.  Ist eine Maedchen,” I said.  The baby’s sex was edematous; it did look much like a little boy’s equipment, the clitoris protruding from swollen labia, but wasn’t.

“What?  What is it?”  One of the Beardsleys was asking, leaning down to look.

“You haff a leedle girl,” Auntie Monika told him, beaming up.

“A girl?” the other Beardsley gasped.  “Lizzie, we have a daughter!”

“Will you fucking shut up?!?” Lizzie snarled.  “NNNNNNNGGGGG!”

At this point, Rodney woke up, and sat bolt upright, open-mouthed and wide-eyed.   Auntie Monika was on her feet at once, scooping him out of his cradle before he could start to scream.

Rodney’s sister was inching reluctantly into the world, shoved by each contraction.  I was counting in my head, One hippopotamus, two hippopotamus… From the appearance of the umbilicus to successful delivery of the mouth and the first breath, we could afford no more than four minutes before brain damage from lack of oxygen began to occur.

“Push, sweetheart,” I said, bracing my hands on both Lizzie’s knees, my voice calm.  “Hard, now.”

Thirty-four hippotamus, thirty-five…

All we needed now was for the chin to hang up on the pelvic bone.   When the contraction eased, I slid my fingers hastily up onto the child’s face, and got two fingers over the upper maxilla.   I felt the next contraction coming, and gritted my teeth as the force of it crushed my hand between the bones of the pelvis and the baby’s skull, but didn’t pull back, fearful of losing my traction.

Sixty-two hippopotamus…

Relaxation, and I drew down, slowly, slowly, pulling the child’s head forward, easing the chin past the rim of the pelvis…

Eighty-nine hippopotamus, ninety hippopotamus…

The child was hanging from Lizzie’s body, bloody-blue and shining in the firelight, swaying in the shadow of her thighs like the clapper of a bell—or a body from a gibbet, and I pushed that thought away…

“Should not we take…?” Auntie Monika  whispered to me, Rodney clutched to her breast.

One hundred.

“No,” I said.  “Don’t touch it—her.  Not yet.”  Gravity was slowly helping it to deliver.  Pulling would  injure the neck, and if the head were to stick…

One hundred ten hippo…that was a lot of hippopotami, I thought, abstractedly envisaging herds of them marching down to the hollow, there they will wallow, in mud, glooooorious…

“Now,” I said, poised to swab the mouth and nose as they emerged–but Lizzie hadn’t waited for prompting, and with a long deep sigh and an audible pop!, the head delivered all at once, and the baby fell into my hands like a ripe fruit.

[end section]