Nurse-midwife pens her first novel


So many stories about nursing are truly stranger than fiction. But that hasn’t stopped certified nurse-midwife Patricia Harman from penning her first novel.
The Midwife of Hope River is an inspiring tale about a strong, independent, courageous midwife fighting poverty and prejudice in Appalachia during the Depression. Read the excerpt from Harman’s book below and put this novel on your must-read list.

The Midwife of Hope River

Excerpt from The Midwife of Hope River:

Most of my life I’ve felt I was dreaming. Now and then I wake up, sometimes for months, sometimes for minutes. I’m a character in a play, and I can’t tell if I’m making it up or if a great puppeteer is making me dance.

—From the private diary of Patience Murphy, Midwife Wild Rose Road, Liberty, West Virginia, U.S.A. 1929–1930


“How long do you think my baby’s been dead?” Katherine turns toward me, and I can tell she’s still crying.

“Five days, maybe less,” I answer my patient. “I heard the heartbeat when I checked you last Friday, and you said the baby moved during church. Shut your eyes now. Try. You need to rest.”

I place my new leather-bound journal on the maple table, lean my head back, and gaze across the dark room. Fire crackles in the blue-tiled fireplace, flickers on the armoire, the canopy of the birth bed, and the wallpapered walls. A watery image in the dressing table mirror catches my eye. It’s me, a small woman with long auburn hair, a straight nose, and a round chin, pretty enough but not beautiful.

I’m sitting at the bedside of Mrs. Katherine MacIntosh, the wife of William, owner of the MacIntosh Consolidated Mines. Yesterday was Black Tuesday, that’s what they’re calling it. Wall Street fell, and then I had to tell the MacIntoshes that their unborn baby was dead. The crash, a faraway earthquake, rumbled even here in Appalachia, and I’m thankful I don’t keep my money in the bank; not that I have any.

As I desperately searched for signs of life in Katherine’s womb, moving my wooden fetoscope over her round belly, up and down and then across, a line of customers fought to get their money out of the First Mountain Federal in Liberty. The queue of men snaked down Chestnut and around the corner to Fayette, though any fool who strolled along Main and saw the closed shops should have known what was coming. When the coal mines begin to shut down in Union County, everything else does.

“Hold me, Patience. I’m so cold.” Katherine reaches for my hand and pulls me toward the bed.

Mary Proudfoot, the MacIntoshes’ cook, and her grown daughter, Bitsy, are asleep in their room by the kitchen, curled around each other like kittens. William MacIntosh snores in his bedroom down the hall. This room is not chilly. It’s Katherine’s heart that is cold, knotted up like a chunk of ice thrown up on the banks of the Hope River. It doesn’t seem proper for a midwife to sleep with her patient, but if I rest a few hours, what harm can it do? I’ll need my strength to get us all through this.

I breathe out a long sigh, carefully place my wire-rimmed glasses with the journal, kick off my slippers, move over to the bed, and fold myself around Katherine, giving her comfort where there is no comfort, remembering Pittsburgh when, in the winter, I used to sleep with Mrs. Kelly and Nora.

I’d like to tell this mother about my own stillborn baby, the one I carried when I was sixteen, the very same baby whose father died before he was born, but I can’t add to her burdens.

I pull the covers over Katherine’s shoulder and put my arms around her as she sobs in her sleep. The loss of this child is all the sadder because her first son, not yet two, a little blond boy just learning to talk, died of pneumonia last winter.

Her contractions are mild and come every ten minutes.


At 6:30 a.m., as light crawls under the heavy drapes illuminating the rose carvings on the tall maple armoire and the pattern on the red-flowered carpet, Katherine sits straight up in bed, her hand on her belly.

“I felt it,” she says. I rub sleep from my swollen eyes, thinking she dreams.

I’d listened for the sound of the infant’s heartbeat with my wooden horned fetoscope for a full hour yesterday as the room got quieter and Katherine’s eyes rounder. There was nothing to hear but the rumbling of the woman’s bowels. No tick-tick-tick of a baby’s heartbeat. No baby kicks, either. I’d even called for Dr. Blum—tall, thin, hair thinning on top—and he listened for another thirty minutes . . . still nothing. Katherine screamed when I first told her the baby was dead, and when the physician nodded agreement, patted her hand, and took her husband out of the room, she screamed again.

The sound of that wail goes right to your heart. I’d only heard it once before, at Manny McConnell’s delivery in Pittsburgh, when Mrs. Kelly, the midwife, told her the twins had expired, but you never forget. Even if you were outside on a warm summer evening and heard it through an open window, you would know what I mean.

Downstairs, on William MacIntosh’s new RCA console, we could hear the faint voice of a newscaster describing what was hap- pening to the stock market. Then, before I had time to discuss the case with Dr. Blum, he was called away to attend a sick child and left the stillbirth to me. I was the midwife, and she’d signed up to deliver at home instead of in his small private hospital. He must have thought I’d know what to do.


Katherine is still kneading her white belly like bread dough, pushing it back and forth. “I felt it,” she says. “I felt something!”
I stretch and sit up.

“It was probably just a gas bubble or maybe a labor pain. Do you need to go to the bathroom?”
In addition to electric lights, the MacIntoshes have an indoor latrine and running water. In town this is not unusual, but in most of rural West Virginia both electricity and plumbing are still rare.

“I felt it. I did. I know I did.”

“Katherine . . .” I straighten my rumpled flowered shift, embarrassed at the impropriety of sleeping with a patient, and put on my glasses. “Let’s go to the toilet. I’ll listen for a heartbeat again after you’ve relieved yourself, but don’t get your hopes up. Your baby’s spirit has gone back to Heaven.” I talk like this, as if I’m a believer, but in truth I haven’t been to church, except for funerals and weddings, since my husband, Ruben, died on Blair Mountain along with 150 other union men. This was back in the fall of ’21, a bad time.

“I think I felt it . . . something woke me.” She’s no longer sure.

In the MacIntoshes’ water closet, I study the apparatus. The high porcelain potty has a round polished oak seat, more like a piece of furniture than a commode. When Katherine finishes, she pulls the brass chain and water rushes in to rinse out the contents.

Stepping out of the small green mosaic-tiled room, my patient turns. “I have to go some more!” She’s a tall woman, taller than I, with the face of a film star and a rumpled short blond bob like Jean Harlow. The pregnant woman lifts her white embroidered nightdress and plunks down on the seat again.

I let out my air, glance at the rumpled covers, and decide to straighten the bed. While I’m fluffing the feather pillows, I hear a low grunt. “Uhhhhhg!”

“No, you don’t, Katherine!” I know that sound well. I jump over the needlepoint footstool, trip on the edge of the red-flowered carpet, and skid across the shiny wood floors in my sock feet. It’s the grunt of imminent birth.

Nothing’s ready! Katherine showed no signs that she was in hard labor or any labor at all. Maybe that’s how it is with stillbirths; the woman’s body desperately wants to get rid of the baby. I wouldn’t know. In the births I’ve attended before, the infants were alive, at least for a while.

I have packets of needles with suture in case Katherine tears, I have clean cloth pads, I have sterilized scissors, I have oil to help the vagina stretch, but everything’s wrapped in my satchel downstairs, where I left it by the front door.

“Bitsy!” I call. “Bitsy! Mary! Help!” A door downstairs flies open, and bare feet pound up the stairs. “Somebody bring Mrs. Kelly’s bag.” The feet pound back down again. I don’t know why I said “Mrs. Kelly’s bag.” Mrs. Kelly, my mentor, my unofficial guardian, my friend, died a year after we moved to West Virginia, and I’m alone again.

“Mr. MacIntosh!” Ordinarily I don’t have fathers in the room when women give birth—they can’t take the intensity—but I need someone fast.

The husband arrives in his white-and-blue-striped pajamas, rubbing his eyes. He’s a big man with short sandy hair and a mustache, a handsome guy with the build of an ex-athlete gone to seed. Mary and Bitsy, still in their nightclothes, their eyes white and wide in their brown faces, their dark braids flying, crowd in behind him.

“William, bring clean sheets, towels, anything.”

I’m dragging Katherine back to bed when her water bag breaks. She understands now that it’s not a bowel movement but a dead baby coming.

Katherine growls again and squats on the floor. She’s uncon cerned about the expensive red carpet, aware only of the terrible pressure, the need to push. I put my hands under her bottom and am startled to feel a head right there, as round and hard and warm as a living baby’s head.

I’d read, in Mrs. Kelly’s worn text The Principles and Practice of Obstetrics by Joseph DeLee, that stillborn babies, when held in the womb for more than a week, start to decompose, and I had expected to feel something starting to get squishy.

“No, you don’t, Katherine! Up on the bed.” I twist her around and guide her backward. Bitsy lowers her down and gets clean towels underneath her. Mr. MacIntosh still leans against the rose- covered wallpaper, his face so white it would make the sun blind.

There’s no time to pull on the special-order rubber gloves I just purchased from Stenger’s Pharmacy, so I place my bare hands like a crown around the head. Katherine grips the sheets, wide-eyed and frightened, staring up at the chandelier. I motion to Bitsy to lift the woman’s head.

“Look in my eyes, Katherine. Look at me! With the next pain I want you to pant. The head is right here. You don’t have to push. Your womb will do the pushing. If you pop the head out, you’ll tear.” Out of the corner of my eye, I catch sight of the father as he swoons and slides down the flowered wall, but we let him lie there.

“Okay, Mary, be ready with a towel to wrap the baby.” I’m not worried about keeping the dead infant warm; I’m thinking that the child may be deformed or the skin already peeling.

The head, with dark hair, turns and emerges between my hands, first the brow, then the chubby cheeks, then the chin. “Pant, Katherine, pant!”

There’s a cord around the neck, but it’s loose. Once, twice, I loop it over.

“Now the shoulders. Just a gentle push.” I give the wet, lifeless infant to Mary, the cook, whose hands shake so hard I fear she might drop it. “Hold steady now. Hold tight.”

The limp baby boy, gray blue as Lake Michigan, is placed in the towel, and I drape the tail end over the body. At a glance, he looks perfect and the cord wasn’t too tight. I wonder why he died. Maybe a heart defect, I’ve heard that can happen. Or a missing kidney.

The cook, a six-foot-tall, big-bosomed colored woman, hasn’t moved. Her arms, outstretched, like the limbs of a maple, still hold the corpse. What do you do with a dead baby? Take it to the kitchen? Put it into the new white cradle? I had never thought of this.

While I wait for signs that the afterbirth is separating, I motion Mary over and lift up a corner of the towel again. The dead baby’s eyes are glazed and wide open.

Then the ribs move, just a tremble like an old lady’s hand. Holy cow! If I hadn’t been staring I wouldn’t have seen it, a sucking-in action.

“Give me that baby!” I grab the wet infant, almost dropping him on the bed, then, without hesitation, kneel as though I’m praying, put my mouth to his tiny blue lips, and breathe for him three times the way I saw Mrs. Kelly do once. Three tiny puffs.

As the air fills his lungs, Katherine’s son coughs weakly and lets out a mew. He turns from blue-gray to pink, starting in his face and trunk and then out to his hands. Katherine rolls slowly on her side. “My baby,” she whispers. “My baby. My baby!” She’s sitting up now, reaching out, crying over and over “My baby. My baby!” And the baby is crying for his mother too. I lay him on her lap so she can see his little face.

“Praise Jesus!” sings Mary, her hands clutched to her chest, holding her joyous heart in.

Bitsy, who’s sharp as a briar and half the size of her towering mother, has the good sense to cover the crying newborn with another dry towel and rub him all over. I finish cutting the cord and deliver the afterbirth, all the time staring at the Madonna and Child. William MacIntosh, who has missed the whole event, wakes up from his faint and crawls across the carpet toward the bed.

“Mother of God! It’s alive?” he asks, turning to Bitsy, unwilling, I imagine, to trust the blunt-headed midwife who had told him his baby would be dead.

I recall Katherine’s proclamation that she had felt the baby kick a few minutes before. I’m new at this, but it wasn’t just me. Dr. Blum, the family physician, confirmed the absence of a heartbeat. Now I wonder . . . had the unborn child been lying in Katherine’s womb with his limbs curled up in a way that we couldn’t hear his heart with my wooden fetoscope or even the physician’s new metal one? Even in the best of positions it’s hard to hear that faint sound. Had the cord been pinched, causing the fetal heart to slow so that I confused it with the mother’s pulse?

I feel like a fool and maybe a dangerous one. What makes me think I can be a midwife with only a few years’ apprenticeship and no Mrs. Kelly to guide me? On the other hand, the baby’s alive . . .

I show Bitsy how to gently massage Katherine’s womb every ten minutes so that it stays rock hard. She’s a quick study and repeats everything I say. Then I show her how to inspect the placenta for any missing pieces and how to weigh the baby in the old-fashioned hanging scale that Mrs. Kelly left me.

Finally I sit back in one of the satin chairs and observe the new family. The mother is already breastfeeding. When I pull up the fringed window shade, the sunlight bursts into the room.

This child will be stronger than any of us.

October 30, 1929. New moon high in the daytime sky.

Seven-pound live-born male, thought to be dead. Name: William MacIntosh the second. Son of William MacIntosh the first and Katherine Ann MacIntosh. Active labor, five minutes. Pushing, one minute. Blood loss minimal. No birth canal tears. I had to breathe for the baby three puffs. Also present, Mary and Bitsy Proudfoot, the MacIntosh servants, and the father, although he fell down in a faint.


Pick up a copy of The Midwife of Hope River, written by Patricia Harman.


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