In her memoir of nurse-midwifery in West Virginia, "The Blue Cotton Gown," Patricia Harman recalls the superwoman-like endurance of Nila, a mother of six who struggles with the shame of a miscarriage and a potentially dangerous divorce.

Patricia Harman

(WOMENSENEWS)–"Hi, you didn’t expect to see me back so soon, did you?"

Nila looks about like she always looks: tidy, with her mid-length blond-brown hair tied back in a ponytail. Her clear skin is now tanned from the summer sun. She wears size 2 jeans and a blue T-shirt that says world’s best mom on the front of it.

The 37-year-old has been my patient for years. She’s had six kids. I delivered the last three, but because of the medical malpractice insurance crisis in 2004, I’d had to give up deliveries. Now I just do gynecology and early obstetrics. I’d transferred Nila to another midwife months ago. I glance at the woman’s belly wondering why she’s returned and checking for the swelling that should be there.

The patient meets my eyes, placing both hands on her abdomen protectively. "Well, you probably heard. I lost it."

"No, I’m sorry, I didn’t know." Nila begins to spill tears.

I grab the box of tissues and slide my stool closer. "So what happened? How pregnant were you?"

"I lost it," Nila says again. That’s all she says.

"But what happened, did you just start bleeding? What happened?"

"Yeah, I’m sure it’s my fault. My boyfriend Doug told me to slow down. But you remember, I never had problems with my first seven pregnancies, and I kept working as hard as I could. We got that old place on Weimer Road, worked our butts off, me and the kids, cleaning it up. I mean serious cleaning. Doug was at Select-Tech 10 hours a day, and I applied for food stamps.

"The first night Doug and I got settled into our new bedroom we made love. That’s when the bleeding started. Doug blamed himself. I’d spotted once before, with my fourth pregnancy, so I told him it would be all right." Nila stops for a minute. I picture a stocky, good-looking guy in his early 40s who hasn’t had much to do with childbirth. He’s staring down at the streak of red blood on the sheets.

"But it wasn’t all right. When I went to my midwife she couldn’t find a heartbeat. They did an ultrasound, and the baby was dead. It wasn’t the intercourse. I’m sure of it. It was all the hard work. I should have known better. I was four months along, just thought I was superwoman. Now I know that I’m not. Eventually, I had to tell the kids. They didn’t even know miscarriages happened, since all of my pregnancies had gone fine before."

A Deflated Balloon

Nila is quiet for a moment, remembering. She just sits there, a deflated balloon. "Then my sister, you know, Marnie?" I shake my head no. "Yeah, you do. She was at my last birth. Anyway, she’s real Christian and she told me the miscarriage was punishment from God for adultery. You know how she is.

"If I was a drinking woman, I swear, I would have started right in. Doug was crying and blaming himself because the miscarriage happened right after intercourse. And Marnie was telling me it was some kind of holy curse, and the kids were looking all worried. I had to go into the hospital to have the remains removed by suction. My doctor told us that miscarriages just happen sometimes, that it wasn’t anyone’s fault, but I don’t know. . . I was working too hard."

Nila studies my face, waiting to see what I think.

"I agree with the Doc," I tell her. "Sometimes the baby’s not forming right, or the placenta comes loose. You’ve just been lucky before. Will you and Doug try again? I know you were happy about the baby."

Nila shrugs her narrow shoulders. "Maybe, but I want to get the kids settled first, and then we’ll see. School is just starting. And I want to get a divorce from my ex, you know, Gibby . . . He’s driving me nuts. Calling all the time . . ."

Signs of Distress

I’ve never seen Nila so distressed. She’d told me her husband had been injured at his job as a maintenance man and turned mean. "Maybe I can help you with that. Didn’t you tell me that Gibby had been hitting you after his head injury? Wasn’t there something about that?"

"Not really hitting. He always stopped short."

"What, then?"

"Just picking on me. Telling me I was lazy, that the house wasn’t clean, that I wasn’t taking care of the kids. He’d get real angry but he never hit me. One time I thought he was about to. He shoved me against the stove and it was turned on. I burned my arm. He didn’t mean it to happen, but I took the kids and went to Marnie’s that night. A few weeks later, I left in the van." I remember Nila’s impressive dawn getaway with the six kids.

"So did he threaten you with violence? Did he do anything else?"

"Oh sure, he threatened, but it was all hot air. He’d mouth off, say he’d kill me if I ever left. I didn’t believe him. We’d been together forever. I know he loves me in his own way."

‘They May Be Able to Help’

"Nila, I’m going to give you the number for the Rape and Domestic Violence Center. They may be able to assist you. There are lawyers in town who volunteer at the shelter to help abused women get a divorce."

Nila frowns. "I wouldn’t want to get Gibby in trouble. I wouldn’t want that. We were together for so many years and he’s the kids’ father."

I stop the discussion. I’ve heard this before. "Well, I’ll give you the card with the phone number anyway. At least you think about it. Gibby sounds potentially dangerous to me. If a man threatens you with death, it’s serious."

"I’m OK now," Nila reassures me. "He sent me flowers, and I have Doug."

I smile resignedly. No use pursuing it, but I’ll give her the card.

"So what brings you here today? Have you had a period since the miscarriage?"

"Yeah, I’m fine. I just had a few days of spotting but I think I need to get some kind of birth control."

I check Nila’s blood pressure and write her a script for the patches. Then I give her a long hug. "I’m sorry about the baby," I say gently, patting the woman’s flat stomach. Nila peers down at my hand. She takes my fingers and puts them up to her cheek.

"Thanks," she says. "Thanks for listening to me." There are tears in her eyes again.


Patricia Harman has spent three decades caring for women in West Virginia as a nurse-midwife where she still works with her husband OB-Gyn Tom Harman. This essay is adapted from her memoir, "The Blue Cotton Gown," published in October 2008 by Beacon Press and reprinted by permission.

Copyright 2008 by Patricia Harman