You say she’s been trying for a full hour and three-quarters, Nurse? The head should be much lower than this.

I resisted the urge to say, That’s why I called for a doctor.

Hm, said MacAuliffe. Clearly some disproportion.

The word I always dreaded to hear—a mismatch between a narrow woman and a big-skulled foetus.

He went on: I estimate the occipitofrontal diameter to be four to five inches and the pelvic outlet rather less than four, but I can’t be sure without taking thorough measurements with a Skutsch’s pelvimeter, and that would probably require general anesthesia.

This girl might pass out at any minute, and he wanted to put her to sleep so he could fiddle with instruments and formulas to determine the exact ratio of the problem?

MacAuliffe went on, But all in all, I believe it’s time to intervene surgically.

I stared, thinking, What, here, in a makeshift fever ward with barely inches to spare between the cots?

He murmured, The mortality rate for caesareans is so high, I’d rather try a symphysiotomy. Or actually, better still, a pubiotomy.

My heart sank. These operations to widen the pelvis were common in Irish hospitals because they didn’t scar the uterus and limit future childbearing. Pubiotomy did have one advantage over a caesarean: it was less likely to kill Mary O’Rahilly even if it was performed under local anesthetic only on a camp cot by a young general surgeon who’d learnt it from a diagram. But it would mean two and a half weeks of her lying here with her legs bound together afterwards, and it could very well do her damage; I’d heard stories of patients left limping, leaking, or in pain permanently.

I tried to think of how to phrase my objections.

Mary O’Rahilly pushed and groaned, but quietly, as if trying not to draw attention to herself.

MacAuliffe leaned into the girl’s sight line and said, I’m going to numb the area and deliver you now, Mrs. Rahilly. A simple little procedure that means you’ll have no further trouble having this baby or his little brothers and sisters to come.

She blinked up at him in fright.

Shouldn’t the man warn her that he was about to saw her pubic bone in half?

Shouldn’t I?

I pleaded, Dr. MacAuliffe—

Message for you, Nurse Power.

I spun around to find that junior nurse from before panting in the doorway. What is it?

Dr. Lynn says, have you tried Walcher’s?

Vol-curse? I didn’t understand the nonsense syllables. Then they resolved into German and made sense.

I asked MacAuliffe, almost stuttering in my rush, What about Walcher’s position, Doctor—can’t that open the pelvis a little and draw the head down?

He pursed his lips, irritated. Perhaps, but at this point—

The junior added, Oh, and you’re wanted urgently in Men’s Fever, Dr. MacAuliffe.

I seized my chance. I said in my humblest tone, Why don’t I try her in Walcher’s while you’re gone just to see if it might help at all before the surgery?

Mary O’Rahilly’s eyes shifted between us.

The young surgeon sighed. Well, I’ll need to get hold of a hand-cranked wire saw, anyway. But do get her prepared, won’t you?

The moment he was gone, instead of shaving, washing, and disinfecting Mary O’Rahilly for a pubiotomy, I pulled Jellett’s Midwifery from the shelf. I thumbed through the book, but my hands were shaking so much I couldn’t find the page describing Walcher’s position; I had to look under W in the index.

Rarely used supine dorsal recumbent…it could encourage the pelvis to widen by half an inch, I read. Employ for no more than two to four uterine contractions or a quarter of an hour. Because it hurt the woman so much? Dr. Jellett didn’t say.

The instructions for positioning called for a surgical table or at least a hospital bed that could be winched up at either end. I had a cheap, low cot.

But it was open at the foot and there was room for her legs to dangle, so all I had to do was raise it.

Let’s get you standing up for a minute, Mrs. O’Rahilly.

She resisted; she sagged; she wailed in my arms.

I said in a level voice, Bridie, could you look in that bottom cupboard and get out the bedrests—

Which of them?

(She was already there.)

All of them. Stick them under the end of this mattress to make it as high as you can.

Bridie couldn’t possibly have understood what I was up to, but she didn’t ask anything else, only wrenched up the mattress and fitted the wedges on top of each other on the bed frame like a puzzle.

Another pang seized Mary O’Rahilly. I held her under the armpits as she cried, crouched, and sagged. I knew I should take her pulse to see if she was going into shock again, but I didn’t have a hand free.

I told Bridie, That’s it.

Or, rather, it would have to be, since there were no more bedrests.

She let the mattress fall. It was tilted up now, as if there’d been an earthquake. The sheets were loose but she pulled them straight.

Lucky that Mary O’Rahilly was so tiny; this mad arrangement would never have worked with a tall woman. I said, Let’s get her bottom on the end of the bed and her legs hanging right off.

Bridie stared but then helped me move the young woman into place.

Finding her hips lifted higher than her head, her back arched, helpless as a pinned insect under her huge bump, Mary O’Rahilly wailed, No!

Trust me, I told her. The weight of your own legs will help open you up to let the baby down, to let it out.

(That made it sound as if Mary O’Rahilly was the captor, but wasn’t she a prisoner too?)

Oh, oh, but the pain’s coming—

She let out a scream loud enough to be heard all down the passage. She sobbed, couldn’t catch her breath. I’ll snap in two!

I was a torturer, breaking this girl on the wheel. No more than two to four uterine contractions. Did that mean I should give up after two? Three? Four? Wait for MacAuliffe to arrive with his saw to do his necessary butchery?

You’ll be all right, Mrs. O’Rahilly.

But there was no relief for this girl, no respite. She was a canoeist shooting the rapids; nothing stood between her and her fate. The air in the narrow ward seemed to prickle with static.

Hold her so she doesn’t slip, Bridie.

I ducked and squatted between Mary O’Rahilly’s dangling feet. I fixed my eyes on the violent red flower of her privates. Your strongest push this time, Mrs. O’Rahilly. Now!

As she growled and heaved, a dark disk revealed itself just for a moment.

I told her, I saw the head! One more big effort. Third time’s the charm.

Collapsed, she barely breathed the words: I can’t.

You can, you’re splendid.

Then I had a wild idea and stood up. Your baby’s head’s right there. If you felt it…

Red in the face, Mary O’Rahilly writhed and panted.

I seized her right hand, to be ready.

Her pain stalked around her, doubled back, waited, hit.

Push!

But this time I pulled her hand around her bump, between her splayed thighs. Not hygienic, but maybe just what she needed. As soon as I glimpsed the black circle I pressed her fingers to it.

Mary O’Rahilly’s face went stark with surprise.

In the brief lull, I straightened up. A shilling-size bit of the head was still visible.

She gasped. I felt hair.