“Bloody fucking hell,” I said, and Susannah made a noise that might have been a groan or an exhausted laugh. The rest of my attention was focused on the thing under my hand. It wasn’t the curve of a spine, nor yet of buttocks. It was the curve of another head.

It vanished with a new contraction, but I kept my hand doggedly on the spot, and as soon as the spasm waned, I felt frantically, to and fro. My first panicked thought—a memory of a double-headed infant, seen in a jar of spirits of wine—disappeared, succeeded by something that was partly relief, partly new alarm.

“It’s twins,” I said to Susannah. “Did you know that?”

She shook her head to and fro, slow as an ox.

“Thought … maybe. You … sure?”

“Oh, yes,” I said, in a tone that made her laugh again, though the sound was cut off abruptly by the next contraction.

The relief caused by the thought that we probably weren’t dealing with a gross deformity was fading fast, replaced by the next thought—if the first baby wasn’t moving, it was perhaps caught in an umbilical cord, possibly dead, or entangled with its twin in some fashion.

Further palpations, pushing when I thought I had an idea what I was pushing on, groping for a mental picture of what might be going on inside … but even the best midwife can tell only so much, and the only thing I was reasonably sure about was that the placenta—one placenta, or two? If it was one, it might rip loose with the first birth and then we’ll have an abruption that will kill the mother—hadn’t yet detached, though given the position of the baby’s head, there could easily be gallons of blood backed up behind the infant …. No. I looked up at Susannah’s face. No, if she were hemorrhaging, she’d be white and losing consciousness. As it was, she was bright red and clearly still fighting.

But we didn’t have much time. Two umbilical cords, either of which could be wrapped around a neck, or slip down between the child and the pelvic bones and be crushed with a contraction, starving one child of oxygen … and that was the least of it …

My mind ran rapidly down the list of potential problems—some I could dismiss on the grounds of what I could see and feel, some (like the faint horror of its being conjoined twins) I could dismiss on grounds of high odds against, others, on grounds that I couldn’t do a thing about them, even if I knew what was going on. That still left a few to be worried about.

And the child was not moving. It was alive; I could feel a pulse when I got my fingertips briefly on the head. And it was oriented properly, facedown; I could feel the biparietal sutures in the skull. But it wasn’t moving!