In Madras, 1971, Mariamma begins her L&D posting at Gosha Hospital while nausea stirs fear that she might be pregnant after parting from Lenin. Each dawn rickshaw ride with the discreet driver Gopal heightens her anxiety. The hospital’s history and the rule “Better out than in” frame a day already swelling with laboring women.

Inside L&D, Staff Nurse Akila’s authority and humor steady the chaotic ward. Mariamma is assigned a Malayali woman whose labor has stalled: the cervix is fully dilated, but the head is high and the fetal heart rate is around sixty, signaling distress. Determined to deliver, Mariamma prepares forceps and performs an episiotomy. When the blades won’t lock, Akila makes a subtle correction; when the traction bar mismatches, Akila fixes it, then stations a probationer behind Mariamma in case she falls back as the head delivers.

With the next contraction, Mariamma heaves and the head finally crowns and delivers. The baby emerges limp and blue with a molded, forceps-marked head. After suction fails, Akila’s slap provokes a cry, and relief floods the room. Mariamma cuts the cord and repairs the episiotomy, fighting tears as thoughts of Lenin surge, then resolves to share her secret.

At shift’s end, Mariamma confesses her pregnancy fear. Akila laughs off common student pseudocyesis, then listens closely when Mariamma admits she isn’t a virgin. Trusting her seasoned instincts, Akila says Mariamma’s body signals no pregnancy, draws blood under another name for confirmation, and counsels her: this time it’s in the head, but to use her head so next time it isn’t the uterus.