As Elsie avoids her increasingly erratic husband, Big Ammachi recruits Anna and her little daughter, Hannah, to help at Parambil. They prepare the ancestral bedroom for the birth while Philipose fusses over dates and celebration. Unseen by him, Elsie obsessively builds an outdoor nest sculpture, channeling her restless energy.

When Elsie’s feet swell and the baby drops early, Big Ammachi confines her to the old room. At dawn, Elsie visits the nest with Big Ammachi, voices fears, and extracts a promise to protect the child if she dies. Big Ammachi tries to arrange hospital transport, but labor begins immediately.

Outside, Philipose speaks of “our Ninan,” prompting Shamuel to tell him to go pray. Inside, labor accelerates; Big Ammachi discovers a breech presentation. Elsie suddenly convulses and loses consciousness. Big Ammachi performs a difficult breech extraction, delivering the legs, rotating the trunk, freeing an arm, and, on the next contraction, releasing the trapped head. The newborn is limp until, after gentle stimulation and a remembered invocation, the baby cries.

A crash from the cellar startles the women, and they turn to find torrential postpartum hemorrhage. As Big Ammachi falters, Anna inserts a fist to compress the uterus bimanually and halts the bleeding, holding until the womb firms. They watch and wait; Elsie remains unconscious but alive, and the infant is stable.

Big Ammachi presents the baby to anxious relatives and recounts the ordeal. When she announces the child is a girl, Philipose collapses into despair, saying God has failed them. Big Ammachi fiercely rebukes him for his selfishness and names the infant Mariamma, asserting gratitude for mother and child spared.