“Just a second.” Sara gave Marie a firm look: No more nonsense. “Are we clear on this?”

“Fine,” the woman huffed. “Have it your way.”

Sara followed Jenny to admissions, where the new woman lay on a gurney, her husband standing beside her, holding her hand. She was older than the patients Sara was used to seeing, maybe forty, with a drawn, hard face and crowded teeth. Shocks of gray ran through her long, damp hair. Sara quickly read her chart.

“Mrs. Jiménez, I’m Dr. Wilson. You’re thirty-six weeks along, is that correct?”

“I’m not sure. About that.”

“How long have you been bleeding?”

“A few days. Just spotting, but then this morning it got worse and I started to hurt.”

“I told her she should have come sooner,” her husband explained. He was a large man in dark blue coveralls; his hands were big as bear paws. “I was at work.”

Sara checked the woman’s heart rate and blood pressure, then drew up the gown and placed her hands on her belly, gently pressing. The woman winced in pain. Sara moved her hands lower, touching here and there, searching for the site of the abruption. That was when she noticed the two boys, young teenagers, sitting off to the side. She exchanged a look with the man but said nothing.

“We have a birthright certificate,” the man said nervously.

“Let’s not worry about that now.” From the pocket of her coat, Sara withdrew the fetoscope and pressed the silver disk against the woman’s abdomen, holding up a hand for silence. A strong, swishing click filled her ears. She recorded the baby’s heart rate on the chart, 118 bpm—a little low, but nothing too concerning yet.

“Okay, Jenny, let’s get her into the OR.” She turned to the woman’s husband. “Mr. Jiménez —”

“Carlos. That’s my first name.”

“Carlos, everything’s going to be fine. But you’ll want your children to wait here.”

The placenta had separated from the uterine wall; that’s where the blood was coming from. The tear might clot on its own, but the fact that the baby was in a breech position complicated matters for a vaginal delivery, and at thirty-six weeks, Sara saw no reason to wait. In the hall outside the OR, she explained what she intended to do.

“We could hold off,” she told the woman’s husband, “but I don’t think that’s wise. The baby might not be getting enough oxygen.”

“Can I stay with her?”

“Not for this.” She took the man by the arm and looked him in the eye. “I’ll take care of her. Trust me, there’ll be lots for you to do later.”

Sara called for the anesthetic and a warmer while she and Jenny washed up and put on their gowns. Jenny cleaned the woman’s belly and pubic area with iodine and bound her to the table. Sara rolled lights into place, snapped on her gloves, and poured the anesthetic into a small dish. Using forceps, she dipped a sponge into the brown liquid, then placed this into the compartment of the breathing mask.

“Okay, Mrs. Jiménez,” she said, “I’m going put this on your face now. It will smell a little strange.”

The woman looked at her with helpless terror. “Is this going to hurt?”

Sara smiled to reassure her. “Believe me, you won’t care. And when you wake up, your baby will be here.” She positioned the breather on the woman’s face. “Just take slow, even breaths.”

The woman was out like a light. Sara rolled the tray of instruments, still warm from the boiler, into place and drew up her mask. With a scalpel she cut a transverse incision at the top of the woman’s pubic bone, then a second to open the uterus. The baby appeared, coiled head-down in the amniotic sac, its fluid tinged pink with blood. Sara carefully punctured the sac and reached inside with forceps.

“Okay, get ready.”

Jenny moved beside her with a towel and a basin. Sara drew the baby through the incision, sliding her hand beneath its head as it emerged and hooking her thumb and pinkie beneath its shoulders. Her arms; the baby was a girl. One more slow pull and she came free. Holding her in the towel, Jenny suctioned her mouth and nose, rolled her onto her stomach, and rubbed her back; with a wet hiccup, the child began to breathe. Sara clamped the umbilicus, snipped it with a pair of shears, drew out the placenta, and dropped it into the basin. While Jenny put the baby in the warmer and checked her vitals, Sara sutured the woman’s incisions. Minimal blood, no complications, a healthy baby: not bad for ten minutes’ work.

Sara drew the mask off the woman’s face. “She’s here,” she whispered into her ear. “Everything’s fine. She’s a healthy baby girl.”

Her husband and sons were waiting outside. Sara gave everyone a moment together. Carlos kissed his wife, who had begun to come around, then lifted the baby from the warmer to hold her. Each of the sons took a turn.

“Do you have a name for her?” Sara asked.

The man nodded, his eyes shining with tears. Sara liked him for this; not all the fathers were so sentimental. Some seemed barely to care.

“Grace,” he said.

Mother and daughter were wheeled down the hall. The man sent his boys away, then reached into the pocket of his jumpsuit and nervously handed Sara the piece of paper she was expecting. Couples who were going to have a third baby were allowed to purchase the right to do so from a couple who had had fewer than their legal allotment. Sara disliked the practice; it seemed wrong to her, buying and selling the rights to making a person, and half the certificates she saw were forgeries, purchased on the trade.