A/N: Given then revelation in previous chapters that Tom and Sybil struggled to have baby number two, this one was long overdue. And, since earlier chapters also hinted at the difficulty she had with Bobby's birth, this chapter (and the next) also offers the obligatory rewrite of 3x05. The most significant change (other than the obvious) is Dr. Clarkson's recommended treatment – there's a long A/N at the other end explaining why. It also has some timeline/storyline tweaking that will be more evident in the next chapter.

Continued thanks to foojules for taking the time to beta and snag my mistakes! And thanks to all who continue to read the story.

"For the hand that rocks the cradle is the hand that rules the world."

~ William Ross Wallace, 1865

WHAT RULES THE WORLD, PART I

Downton, Early September, 1923

Tom and Sybil were enjoying a rare breakfast alone, aside from Carson looming over them. Lord Grantham and Matthew had been called to London to meet Mr. Murray and both Cora and Mary were keen to follow for a bit of shopping; Edith was already there, hard at work on her latest article. This reminds me of being in Dublin, Sybil thought until her teacup clinked on the saucer. The sound reverberated in the cavernous room. Well, not quite.

Hidden behind the blind of his newspaper, Tom sipped his coffee. He muttered a profanity before reading from an editorial, his voice clipped with derision. "The recent Irish election makes clear that the republican faction was always a minority and was trying to establish minority rule through violence. De Valera's policy would have set up a republican military dictatorship..." He peered over the paper to gauge Sybil's reaction, saw her pursed lips, and continued. "Ireland preferred a practical form of independence. The republicans would have sacrificed everything to an idea without substance. But the Irish public has shown political realism by accepting the fact of freedom and turning its back on the unattainable idea of an absolute republic." His fingers wadded the edge of the paper and he mumbled, "Trying to reverse four hundred years of having the British boot on our necks and we're the military dictators..."

Sybil understood the distance he felt from his home country. It had become her home as well, for a few short months. Returned to Downton for more than three years now, they had finally settled in with their respective jobs, determined to move onward. Staring absently out the tall windows beyond her husband, she drew in a deep breath and winced at the whiff of her breakfast. Her stomach churned and she nudged her plate away.

Standing by the sideboard, Carson frowned. "Lady Sybil, are you finished?"

"Yes, thank you, Carson."

He stared at the full plate. She'd hardly even nibbled at it. "Was something not to your liking?"

Despite Sybil's dramatic sigh, her husband's nose stayed in the newsprint. "I'm sure everything is delicious as always. I'm just not very hungry this morning." She paused, waiting. "In fact, my appetite has been rather subdued lately."

Lifting the plate from in front of her, the butler asked, "Are you ill?"

"I was earlier this morning. It must not have been too serious since no one noticed."

Tom rambled through another headline. "At least the League of Nations accepted the Free State delegation..."

Carson glowered at his former charge. "Perhaps you should see Dr. Clarkson, milady."

She sighed again. "Oh, I already have. He says it's nothing to worry about and guarantees my appetite will come back shortly. And that I will be fine in a few months...about six to be exact."

The paper suddenly flopped over Tom's fingers. His eyes widened. "Sybil...are you...I mean...after all this time, are we..." She nodded with a radiant smile and he leapt to his feet, the chair thudding behind him on the rug. Carson jumped to avoid his toes getting squashed.

"It took you long enough," she said, laughing as he hoisted her in his arms.

Tom smacked several kisses against her lips before capturing her mouth, two years of subdued hope liberated at last. "Oh, my darling," he finally breathed. "I do love you so very much."

"I've had my suspicions, but didn't want to say anything. I didn't think either of us could take the disappointment."

Mouth agape at the spectacle in his dining room, the butler sputtered an apology that somehow managed to sound like a rebuke. He sought escape, twisting awkwardly toward one door, then another.

Sybil giggled under her husband's renewed smattering of playful kisses. "It's alright... Carson... we're..."

"...we're having another baby," Tom finished for her, tears pooling in his eyes. "All will be well this time," he whispered against her lips. "I know it."

Downton, Last Week of June, 1920

Sybil had insisted Tom go downstairs for dinner. I've caged you enough already, she thought, watching as he sluggishly donned his evening wear.

The exile at Downton, their home for the foreseeable future, would soon stretch into its third week. The first two been bearable when they could escape on walks across the estate or drives in the Renault; only meals and tea thrust them into pleasantries with her family. But now, as Sybil's body prepared for the birth of their child, she was disinclined to stray from their room. Her presence at meals grew irregular – she ate very little anyway – and her energy waned. On the one occasion she conjured enough strength to navigate the long stairwell down to the library, she found herself wishing she hadn't on the way back up.

Like mothers throughout history, Sybil had simply reached a point where she was tired of being pregnant: everything seemed to ache or swell, or both, as her body steadily expanded. And her fortitude had begun crumbling around Tom at the most inconvenient moments. He had been horrified one morning when she burst into hiccuping sobs watching him nimbly bend over to pull on his socks. His clumsy assurances that she would be able to put on her own stockings soon enough had had little effect on her distress, because it wasn't really about the silly stockings. She wanted to hold her child; she wanted to feel normal again; she wanted to be anywhere but at Downton.

She had slept restlessly the previous night and throughout the day, unable to find a position in which she was remotely comfortable. When Anna brought a tray up for her on that hot evening in late June, Sybil nibbled on a piece of bread, sipped a half cup of tea, and declared herself full, all before Tom even finished dressing for dinner.

He looked up, worried, as she lifted the tray away from her. "You have to eat, love."

"It just doesn't taste as good as I thought it would." She dropped her legs over the side of the bed; the weight of her body sank into the mattress.

Tom checked his watch and hurried with his waistcoat buttons, fumbling three into the wrong holes. Sybil motioned him towards her. "Here." Her thickened fingers made it a challenge, but she finished the job properly.

"Your father would say I needed a valet." He kissed her forehead. "Please don't tell him your husband can't even dress himself."

"There's no need to rush. You have plenty of time."

"Well, according to Lord Grantham, five minutes early is late," he replied, and then saw her brow tense. "What is it?"

She pressed a palm to her forehead. "Another headache. If Sir Philip's right that I won't deliver for several weeks, I may not get any rest at all. I'll fall asleep during the delivery."

Upon their return to Downton, Lord Grantham had cast Dr. Clarkson aside in favor of London's Sir Philip Tapsell, famed physician to noble wives. Sybil immediately distrusted the Harley Street doctor after his – in her opinion – arrogant initial examination. Sir Philip had made his own calculations for her delivery date, which included questioning when the child might have been conceived. When Sybil couldn't point to a particular day, Sir Philip had coolly remarked: Right - your husband is Irish.

The slur came as such a shock – she certainly didn't tell Tom - that she couldn't even form a coherent response. If she had felt remotely like herself, she would have demanded another doctor. But with Tom already in Papa's bad graces after the escape across the Irish Sea, Sybil was reluctant to make it seem as though the Bransons were fighting her family at every turn. So in spite of their desire for independence, she and Tom gave concessions on smaller matters, such as Lord Grantham's engagement of Sir Philip and Lady Grantham's excited selections of baby clothes and accoutrements. But through it all, they shared an unspoken promise: stay the course until the baby was born, and then they would move forward.

Taking her hand, Tom sank next to her on the bed. "Shall I call Sir Philip back up here?"

Sybil shook her head and leaned into his shoulder. Sir Philip's visit this week had been little more than a symbolic pat on the head. As far as she was concerned, all he needed to do was manage the birth and leave. "I'll be alright."

Twisting Sybil's wedding ring, Tom frowned – it had become a vise on her finger. He couldn't imagine how uncomfortable she was. "Love, did Sir Philip say anything about the swelling?"

She sighed with a nod. "He said that it's perfectly normal."

"Is he sure?" He turned her hand, brushing his fingertips across the taut skin – it had no texture. "Sybil, love, I think we should..."

With nothing but time on his hands, he fretted constantly these days. She laid a soft palm against his cheek and kissed him when he opened his mouth to object. "Darling, try not to worry. Just a few more weeks," she promised, and then pulled their hands across her middle in time to feel a few healthy kicks. "I think someone's ready to meet his Da. He's been a feisty one since we got here." Guiding his fingers over a lump at the peak of her stomach, she laughed. "I think that's a foot...or an elbow. Either way, he's running out of room."

As his fingers followed the little movements, his eyes twinkled. "You keep saying he. What if it's a girl?"

"Then she'll have to fight me every day for your attention," she replied with a haughty smile. Content, just the two of them, they sat quietly until he saw her eyes start to droop.

"Here," he said, helping her maneuver back onto the bed. "Try resting while I'm downstairs. I'm not in the mood for billiards tonight. I'll come back up as soon as dinner's done." He fluffed the pillows behind her and wedged another beneath her feet.

"Who needs a household of staff when they have a husband like you?"

"Did I not promise to devote every waking minute to your happiness?"

As Tom bent to kiss her stomach, she sifted her fingers through his hair. "That you did, Mr. Branson."

Sitting in Downton's dining room without his wife, Tom felt like a ship set adrift in uncharted waters. Only the kindness of Mary, Matthew and Edith tempered his frustration and made these family gatherings bearable. Lord Grantham and the Dowager were firmly set against him. And while Lady Grantham seemed pleasant enough, he suspected she had yet to forgive him for leaving her youngest daughter alone in Dublin. Tonight Tom let the conversation go on without him, which was easy enough considering Sir Philip was doing quite a good job of monopolizing the table.

Poking absently at his fish, Tom hardly noticed the course had ended until Alfred drifted by to clear the setting. Cora, seated next to him, had noticed that his plate was still full. "Tom," she asked discreetly, "is something the matter?"

He sighed. "I apologize, Lady Grantham. My mind is all over the place." Dropping his hands into his lap, he cursed these moments of weakness. "Sybil and I had everything planned in Dublin, but here..."

"Something will turn up," Cora assured him with a maternal smile. "The only thing you need to focus on now is Sybil and your baby. He or she will be the delight of this house, you know, being the first baby here since Sybil was born. And I'm very much looking forward to meeting my first grandchild."

"Matthew said you accompanied him out on the estate today," Mary said from his other side.

Tom nodded. "He needed to look over some of the farms and talk with the tenants, so I drove him round."

"I hope he's not just using you as chauffeur," Edith teased.

"Certainly not," Matthew frowned. "Tom insisted on driving."

Mary lofted a cautionary brow at her husband. "Knowing how fast you like to go, darling, I don't blame him."

"Tom's certainly more patient than Matthew," Edith conceded. "Though I'm not sure he was thrilled with the idea of teaching me how to drive."

Recalling the terror that had ripped through his soul when Lady Edith released her first clutch, Tom's lip curled into a smile. "Neither was the car."

Matthew chuckled into his glass, leaned towards Cora and whispered in a conspiratorial tone, "Your other son-in-law drives at a snail's pace."

Cora laughed; despite her initial reluctance at having the former chauffeur as a son-in-law, she had been pleasantly surprised at how well he and Matthew got on. "So, how did you two find the estate?"

Matthew wavered a bit. "Well...we've some work to do, but Tom had some promising suggestions about grazing sheep at the old Burns place. I think we should look into it. In fact, I'd like to take him to my meeting at the Parks farm..."

Their conversation was cut short by Sir Philip Tapsell's reply to the Dowager Countess across the table: "Never fear, Duchess, I'll get a baby out of you one way or another!"

Tom looked up from his plate in time to witness his father-in-law choke on a sip of wine and he smiled inwardly at Lord Grantham's prudishness. Then again, Sir Philip's smug proclamation of Lady Truro's heirs and spares was somewhat inappropriate for dinner conversation.

Hacking out a cough, Lord Grantham tugged his collar before glancing down the table at the Irishman, eager to change the subject. "How was my daughter earlier?"

"She's very tired. I'm afraid she didn't get much sleep last night, nor anytime today."

Cora offered an encouraging smile. "The last few weeks can be horribly difficult, Tom. Try not to worry."

"Precisely," Sir Philip added. "Lady Sybil is a model of health and beauty, Mr. Branson. I assure you, everything is progressing normally."

Tom pressed his lips. Despite his promises to Sybil to not make a fuss, the doctor's arrogance had finally roused the rebel in him. "I'm sure you know your business, Sir Philip, but I know my wife. She's not been herself."

Isobel, seated at the far end of the table, knitted her brows. "What do you mean, Tom?"

"She's had terrible headaches and doesn't want to eat. And the last few days, she's had trouble with her hands and feet."

"Are they swollen?"

"Quite so."

"I saw her myself earlier," Mary said, and then glanced toward Sir Philip. "She didn't feel well at all. This baby has been the one thing keeping her spirits up since she and Tom returned from Ireland, but now she seems...not Sybil."

"Primiparae anxiety, Lady Mary," the doctor explained. "It's a natural reaction for first time mothers. I expect you will be the same when your time comes." He tipped his glass toward her jauntily. Mary's head twitched in irritation and Matthew shifted uncomfortably in his chair.

"Perhaps I shall pay Sybil a visit this evening," Isobel suggested.

"That's a kind gesture, Mrs. Crawley," Sir Philip returned with a flat smile, "but Lady Sybil needs her rest. Perhaps you can come back another time."

Cora's eyes narrowed into disapproving slits.

"Thank you, Isobel," Mary interjected on her mother's behalf. "Sybil's been devoid of company beyond her immediate family. I should think she would enjoy a short visit if you can spare the time." She glared at Sir Philip, daring him to object, and then smiled pleasantly at her brother-in-law. "Sybil mentioned you plan to be with her when the baby is born."

The Dowager Countess's head bobbed up. "What's this?"

"Sybil asked, and I promised I would," Tom said.

Sir Philip brushed the serviette against his mouth. "Mr. Branson, men don't usually have the constitution for this sort of thing, unless they're practiced physicians, of course. Besides, I think the room might be too crowded to accommodate such a request."

Lord Grantham sipped from his goblet and added, "Tom, at times like this women prefer their privacy. I assure you Sybil will have ample support with her mother and sisters."

"I don't expect either of you to have much say in the matter," Tom snapped.

Edith saw her father's face redden and cut in quickly. "It wouldn't be the first time such a thing has happened. Wasn't Prince Albert present when each of his royal brood were born?"

"With all due respect to my first great-grandchild, it's hardly the same thing," the Dowager declared.

Matthew cleared his throat. "And with all due respect to both you and Lord Grantham, Tom and Sybil have made their decision. None of us have the right to interfere."

"Well, I certainly think the Lloyd George government has admirable intentions," Sir Philip droned in the drawing room after dinner, "but I'm afraid ambition has outstripped pragmatism with the new Ministry of Health."

With one hand secured on the mantel, Robert gently swirled his tumbler with the other. "Granted, but I do believe the government had to do something," the earl replied.

Matthew plucked a glass of brandy from Carson's offered tray. "From our experience here, Sir Philip, the local boards are frequently overwhelmed by all their responsibilities - everything from roads to health," he said, and then wistfully added, "the recent flu epidemic was a real calamity for them."

Sir Philip's mouth twisted in a condescending smile. "That may be true, Mr. Crawley, but administering medicine from a higher level of government may also invite calamity." He laughed. "Not only have they nationalized the local health responsibilities, but they've absorbed duties from the Board of Education and Home Office as well. Mark my words, this will lead to disaster...and the care of the patient is at most risk."

Across the room, Cora muttered to her mother-in-law, "Why do I get the impression Sir Philip's concern has little to do with the patient?"

Violet leaned sideways, her voice low. "According to Shrimpie, Sir Philip favored the re-organization until he was overlooked as the first Minister of Health."

"What else do you know of him?"

"Lady Truro certainly sings his praises. Then again, I understand she was willing to try anything to produce a few boys and get out of that house." The Dowager raised a shrewd brow. "I've heard that her husband does not favor the company of women..."

Mouth agape, Cora asked, "Does Robert know this?"

"I doubt it. Men are conveniently ignorant when their pride hangs in the balance."

"It won't be easy for the government," Matthew suggested to Sir Philip, "but consolidating all matters related to health under a single ministry makes perfect sense. I'd rather a health ministry oversee the welfare of mothers and children as opposed to the Home Office..." He trailed off as Isobel and Mary strode into the room.

Robert sipped his drink. "I suppose Tom won't be joining us?" he asked. "I apologize for my son-in-law, Sir Philip. He's not quite mastered the formalities yet."

"He's staying with Sybil, Papa," Mary said. "Surely you can lengthen the leash under the present circumstances."

"Hmm."

"He's a bit concerned, actually. As am I," Isobel offered delicately. "Has Dr. Clarkson seen Sybil?"

"Of course. After she returned from Ireland. But I thought it best to solicit the services of Sir Philip for the duration. I'll not trust Sybil's care to a man that misdiagnosed Matthew's condition and didn't observe the necessary precautions with Lavinia."

"But Dr. Clarkson has attended far more births than he has spinal injuries or flu epidemics," Isobel replied in her friend's defense. "And he knows these young ladies better than anyone."

Robert forced a smile. "Isobel, I assure you Sybil will have the best care for the remainder of her pregnancy..."

"I for one am always curious to know Mrs. Crawley's opinion," the Dowager interrupted. She seemed unperturbed by the unanimous surge of skepticism this brought forth.

Even Isobel was taken aback and hesitated before speaking. "She's rather uncomfortable with a terrific headache."

Sir Philip's reply dripped with condescension. "As I'm sure you know, Mrs. Crawley, the occasional headache is not uncommon in expectant mothers."

"That's true. But Tom was correct - her ankles are quite swollen."

The doctor exhaled a laugh. "Again, not uncommon. It's been my experience that some women have thicker ankles than others."

Lady Grantham glowered. "I beg your pardon?"

"Cora, please. I'm sure Sir Philip meant nothing by that," Robert assured softly, then cut his eyes to Isobel. "Sir Philip is one of the finest physicians in the country. There's no need to interrogate him."

"Papa, Isobel is only concerned about Sybil..." Mary added.

"Sir Philip, have you checked for albumen?" Isobel asked abruptly.

"Of course," he answered. "On my visit last week and traces of it were almost non-existent."

"And on your present visit?"

"I've seen no reason to run further tests..."

"What tests?" Cora asked.

"Albumen is protein in the urine..." Isobel supplied.

Turning his back to the group, Lord Grantham rolled his eyes.

"...an excess of which can lead to toxemia. It's a serious condition which threatens both mother and child."

"Mrs. Crawley," Sir Philip hissed. "Just because your husband was a physician, that does not mean you have a working knowledge of medicine."

"I've worked as a nurse and, unlike the men in this room, I have a working knowledge of childbirth, Sir Philip."

The doctor stiffened, forced a flustered smile to his host and said, "Lord Grantham, if you'll excuse me, I am a bit tired after my trip up from London this morning."

Robert sidestepped as Sir Philip huffed by, shoving his tumbler into Carson's hands on the way to the door. Cora drifted towards Isobel and Mary; somehow the room had become a division of the sexes. Matthew waffled near his father-in-law. "Robert, perhaps it would be best to solicit an opinion from Dr. Clarkson. After all, he knows Sybil and may recognize something out of the ordinary."

Mary nodded. "I would agree. In fact, Tom asked Isobel to speak with him first thing in the morning..."

Robert clanked his glass on the mantle. "Tom has not hired Sir Philip. He is not master here. And, as long as my daughter is under my roof, I will see to her protection."

Cora flushed. "Robert, Tom is her husband..."

"Then he should have considered that when he was in Ireland," he snapped, and snatched the door open before Carson could get a hand on it. "He has put her at risk before and I'll not allow it to happen again!"

With Robert and Sir Philip both gone, Matthew was left alone with the ladies. He motioned for another drink and broke the silence with a cough. "Robert's as concerned about Sybil as anyone and I'm sure he would be glad to hear what Dr. Clarkson has to say. He's brought Sir Philip all the way from London and simply doesn't want to hurt his feelings."

Perched regally on the edge of her chair, Violet piped in, "If there's one thing I'm quite indifferent to, its Sir Philip Tapsell's feelings."

Frustrated, Isobel stared at the closed door. "I should have come straightaway when I heard Lord Grantham had hired Sir Philip."

Matthew's brows furrowed. "Do you know him, Mother?"

"Your father did, and didn't care for him much. Sir Philip may have delivered countless Lords and Royal Highnesses, but he's more concerned about dynasties than the wellbeing of mothers." She inhaled derisively. "If one wife dies in childbirth, a new one can always be found." Turning to Cora, she said, "I'll discuss my observations with Dr. Clarkson in the morning. Perhaps another physician might hold more influence with Lord Grantham, particularly after a night's rest."

"I wouldn't count on it," Mary demurred.

Cora's eyes scanned the room, drawing a furtive battle line, and then fixed on Isobel. "We mustn't let Sir Philip bully us...or Dr. Clarkson. For Sybil and Tom's sake. And their baby's."

When they settled into bed that evening, Sybil had assured him she was fine, but Tom was too disquieted to sleep. Until recently, he - and Sybil to a certain extent - had accepted the changes in her as side effects of her pregnancy, as well as the stress of having had to seek refuge at Downton. But during the past few days Tom had begun to see a worrying glint of resignation in her eyes. This wasn't his Sybil: pregnant or not, she would never willingly surrender her independence.

Staring absently across the darkened room, He splayed his palm across her stomach and held her close as he replayed Mrs. Crawley's visit in his mind. Matthew's mother had always struck him as the inquisitive sort, but when her casual questions had shifted from swollen ankles to urine output, he'd panicked and readily agreed for her to speak with Dr. Clarkson.

With an exhausted groan, Sybil shifted in his arms. Tom flipped over to switch on the lamp, nearly knocking it into the floor, and turned back to find her struggling to sit up. "Sybil?"

"It's just a bit of indigestion, darling," she gasped. "I didn't mean to wake you."

Tipping her chin, he paled at her pinched expression. "How? You hardly ate any dinner." When she didn't answer, he kicked at the covers. "I'm going for Sir Philip..."

"Tom, please..." She grabbed his hand and then released it when her head pounded with a sudden throb.

He thumped across the carpet to the adjacent bathroom and returned with a damp cloth. Sinking onto the mattress beside her, he bathed her face, panic leaching into his mind as she labored to breathe. "Something's wrong," he whispered. "You need to see a doctor."

Sybil's hand reached protectively for their child. Reassured by the gentle movements, she nodded. "Alright. But...not Sir Philip."

Tom snatched his dressing gown and trotted down the hall, his breath shuddering with each step. Rapping on the only door he could think of, he heard a groan and mumbles from the other side before it squeaked open.

"Tom?" Matthew's blonde hair stood on end.

Mary appeared behind her husband. "Is something wrong with Sybil?"

"Please," Tom said, his eyes bloodshot with desperation. "Can you fetch Dr. Clarkson?"

As the gray light of dawn seeped through the curtains, Dr. Clarkson measured Sybil's pulse for the second time since his arrival. He called a number to Isobel, who scratched it in a pocket-sized book, and then turned back to his patient. "The medicine will take some time," he said calmly and then positioned the stethoscope against her middle.

Glancing around the room first to Matthew and Mary, then to Isobel, Sybil settled her eyes back on her old mentor. "The baby?"

He smiled. "I hear a strong heartbeat."

With a relieved sigh, Sybil squeezed Tom's hand. This little being had been the only thing salvaged from their life in Ireland. "Our little stowaway," she said.

"Our little Irish stowaway," he corrected in a whisper, and kissed the tip of her nose.

Mary stood behind her brother-in-law, a supportive hand on his shoulder. "Half Crawley, half Branson...I expect this baby to be quite a stubborn addition to the family," she teased, and then glanced to the door as it swung open to admit an indignant Sir Philip.

"What's the meaning of this?" Sir Philip's eyes flitted accusingly from Dr. Clarkson to Isobel. "Mrs. Crawley, you had no right to divulge my patient's information to a complete stranger!"

Mary's expression cooled. "Dr. Clarkson isn't a stranger. He's treated us since we were girls."

"She is my patient!"

"And she's my wife," Tom spat. "And she's not well. You don't have to be a doctor to see that."

Matthew motioned toward the door. "Sir Philip, Dr. Clarkson, perhaps we should take this outside," he quietly suggested.

In the corridor, Sir Philip immediately turned confrontational. "I demand you leave at once," he blustered at Dr. Clarkson. "You've not only entered Lord Grantham's house without permission, but you've conspired to issue unsolicited medical advice to my patient."

Matthew's face flushed. "You haven't heeded any of my sister-in-law's complaints..."

"All first time mothers complain of one ailment or another," he scoffed. "It's the responsibility of the physician to reassure them, not bow to their fears..."

"What's going on?" Lord Grantham's voice boomed down the corridor as he and Cora approached in their dressing gowns. "Dr. Clarkson, what on earth are you doing here?"

Sir Philip pointed at the other doctor. "When the staff brought my breakfast just now, they asked why Dr. Clarkson had been called in the middle of the night. In all honesty, I'm waiting for the answer to that question myself!"

Dr. Clarkson turned towards the earl. "Lord Grantham, Mr. Branson was anxious about his wife's condition and with good reason. I fear Lady Sybil is at risk of eclampsia."

"The good doctor is trying his best to justify his presence. She is at no risk for eclampsia..."

"She's suffering from edema in the ankles, as well as her hands and face, and her blood pressure is well above normal," Dr. Clarkson blurted, and then turned to Cora. "That's the source of her headaches."

Shaking his head, Sir Philip rolled his eyes in annoyance. "...all symptoms of any pregnancy..."

"Independently, perhaps, but together they may pose a serious threat to her life," Clarkson pressed. "And she has a high level of albumen in her urine..." Ignoring the sanctimonious tsk from Lord Grantham, he continued, "It's a definitive symptom of toxemia. If left untreated, she runs the risk of eclamptic seizures before or during the delivery. And by then, the prognosis is quite grave."

Cora's face was ashen. "What must we do?" She asked.

"We start with a strict diet of milk, fruits, vegetables – no meat; I've already administered one dose of veratrone for her blood pressure, and we should start her on magnesium sulfate for the edema. If we can bring her symptoms under control, she may be able to deliver naturally."

Sir Philip shook his head. "Even if she were at risk of suffering from eclampsia, which she is not," he emphasized with a twitch of his finger, "the proper course of treatment would be immediate delivery by caesarian."

"Is that safe?" Robert asked, his mind awhirl in the unexpected blitz of medical information.

"No," Clarkson argued, his hands clenched in frustration. "Caesarians should only be performed with the lack of any other option. And, in cases of eclampsia, studies have shown the shock of operative intervension to result in a painfully high mortality rate for both mother and child."

Sir Philip raised a condescending hand. "Dr. Clarkson, you have already frightened Lady Sybil's husband, and now you have needlessly frightened her parents as well. I'm afraid I must ask you to leave."

Cora's eyes flashed to him. "Sir Philip, you've no right to demand anyone's departure from this house," she hissed, and pushed past the men into her daughter's room.

Stuffing his hands in the pockets of his dressing gown, Matthew strode over to his father-in-law and spoke softly. "Robert, if this were Mary, I wouldn't hesitate in my decision, nor would I allow you to risk her life."

"You think I would purposely risk my daughter's life?"

"I think there's a point where pride becomes impractical. When did you last see her?"

A vein twitched in Lord Grantham's neck at the implied accusation. It was true that he hadn't visited Sybil since she'd last appeared at dinner more than a week before. When the Bransons had come for Mary and Matthew's wedding, he had been able to tolerate the sight of her big with the former chauffeur's child, knowing they would soon return to Ireland. But with them cast back at Downton for the foreseeable future, he supposed he had surrendered reason to his pride. He hesitated before shuffling slowly toward the door.

Sir Philip's brow furrowed. "Lord Grantham..."

Stepping into Sybil's room, he closed the door on the sputtering doctor. His breath hitched when he saw his youngest daughter sagging into a mound of pillows. She was alarmingly swollen, her skin sallow and covered in a sheen of sweat.

"I've asked Dr. Clarkson to take charge of the birth," Sybil muttered. She sounded tired and weak, devoid of the spark he had fought so long to tame.

Robert felt sharp feminine glares from around the room. "Sybil, I remind you that Sir Philip is one of London's most respected physicians. I wouldn't have called him to Downton if I didn't have absolute faith in his abilities. He's delivered countless children..."

Tom's head snapped up. Robert saw something unfamiliar – fear – clouding the younger man's eyes. "You can see for yourself how unwell she is. And yet Sir Philip insists there is nothing wrong."

"Papa, please," Sybil sighed. "Trust me. I wouldn't demand this if I didn't believe the life of my child, your grandchild, depended on it."

Robert eased onto the bed and took her hand. "Of course I'm concerned about the child, my dear, but what about you?"

"I'm putting my faith in Dr. Clarkson, as should you..." She gave his hand a gentle squeeze. "...and whatever happens, happens."

Tom blanched at this and exchanged a disbelieving glance with his father-in-law. "Sybil, love, you'll be fine." With a forced smile, he tucked a damp tuft of her hair behind her ear.

"I hope so too, darling, but we can't know that..."

Robert stood abruptly, watching as his daughter pressed a reassuring hand to her husband's cheek and brushed away a stray tear. Tom turned his head to kiss her palm and bent to press his lips to her middle. Since their marriage more than a year before, Robert had had few opportunities to see them together, and when he did he usually gave in to the urge to look away. Mary had once told him how much Sybil loved the young man – how much they loved each other – and perhaps he would never understand it. But now, he wondered if Matthew was right – if his pride had sentenced Sybil to an uncertain fate. The young couple seemed not to notice as he retreated to the door.

Sir Philip stopped pacing when the earl reemerged in the corridor. "I hope you talked some sense into her."

Robert cleared his throat. "Sir Philip, I'm sorry," he replied after a long moment. "I appreciate your services here, but I believe they're no longer required."

Sybil had finally managed to fall asleep. From the edge of the bed, Dr. Clarkson offered Tom a reassuring smile. "She's resting well," he said quietly. "Her pressure has dropped a bit. That's a good sign."

Seated in a plush chair across the room, Tom felt the summer sun trickling through a gap in the curtains over his shoulder. Judging by its angle, he supposed it near noon. He sat numbly in his dressing gown, watching the gentle rise and fall of his wife's chest as she slept. "She hasn't seemed herself…I should have called you here earlier, and to hell with what her family thought."

Dr. Clarkson pulled up a chair beside the young husband and began shaking his head. "Mr. Branson, the truth is that toxemia can manifest itself incrementally or without warning. But I'll do everything I can to see her through this."

"You mentioned seizures…"

"It's a possibility if she doesn't improve. But I'll have a nurse come and stay with her round the clock," he said, and then smiled. "And I know you'll not be far either. She shouldn't be left unattended until after the baby comes."

Tom nodded. "When will we know?"

"We'll monitor her symptoms day-by-day. The treatments..." he explained, hesitating a bit, "aren't pleasant. The magnesium sulfate basically acts as a purgative, eliminating the excess fluids and toxins from her system. By limiting the protein in her diet, I hope to control the albumen levels as well." He paused, gauging the younger man's reaction; Mr. Branson certainly seemed more receptive than his father-in-law. "There are a few more things we can try – steam baths and sweat packs. It's a bit of a process, but if her blood pressure steadily decreases and her urine output increases – with a lower content of albumen of course - that means we're making progress."

"And if not?"

Dr. Clarkson sighed. "Then we'll take her to hospital and deliver by induction or caesarian. I hope it doesn't come to that, though, for both their sakes."

Tom swallowed the painful knot in his throat. "She loves this baby, Dr. Clarkson. It would break her heart if..."

"Mr. Branson, I'll not lie to you. We're in a precarious situation. By my estimation, she's at thirty-seven weeks. A normal mother could deliver a healthy child at that stage, but your baby is quite small, which isn't unusual for toxemic mothers. The longer she carries the child, the better its chances, but if her symptoms don't improve..."

"I can't lose her," Tom whispered, blinking back tears. "If you're asking me to make a decision, that's my answer."

With a nod, the older man patted Tom's shoulder and stood to return to his patient.

Watching Sybil sleep, Tom's mind drifted back to that day on St. Stephen's Green when she'd told him about the baby. They had kissed and held each other, warmed by the anticipation of parenthood despite the brisk December winds swirling through the park. In the months after, they had often lain awake in their narrow Dublin bed, laughing through ridiculous names and wondering who their child would favor. In all the nights spent holding her as she slept, his palm spread across her stomach, he had never considered the possibility of losing her - of losing them both.

A/N 2: Couple of items here (its times like this I wish had FF had footnoting capabilities). First, the editorial Tom reads from is largely extracted from a contemporary New York Tribune editorial. Secondly, the Ministry of Health discussed by Robert, Sir Philip, and Matthew had been formed by the Lloyd George government in 1919, culminating close to eight decades of debate about health regulation and administration (also included the first provision for registering nurses and doctors).

Lastly, the way I mentioned Bobby's 'difficult' birth in earlier chapters put me in a corner (damn non-chronological writing) - I had to figure a way to make this chapter consistent with those (and didn't entirely hit the mark). Initially, I didn't even want to tackle the eclampsia storyline, but after tripping up with other birthing catastrophes, I just went with it. I combed through a few period medical/obstetrical books and even some case studies (BTW, yowch). In the early twentieth century, preeclampsia/eclampsia was still a 'disease of theories' and there wasn't one commonly accepted treatment. Beginning in the late 1800s, some doctors advocated 'radical' intervention through surgery, but didn't necessarily treat the symptoms, so mortality remained high. In the early 1900s, there began a shift towards a more 'conservative' method, that focused on prenatal care and proactive treatment of symptoms during the preeclamptic stage. And, at least in milder cases, that seemed to lower infant and maternal death rates. Magnesium sulfate was given mainly as a purgative to eliminate the toxins from the system (its true value wasn't really understood). Medicine, of course, was still very much a man's field and much of the literature (including gynecological and obstetrical textbooks – again, yowch) is pretty condescending from a modern perspective. So, I tried to play Sir Philip as the 'old school' physician versus the more 'enlightened' Dr. Clarkson. [AND, after scanning through those medical textbooks, I'm convinced more than ever that Sir Philip must have been a complete and total quack – even though the disease wasn't entirely understood, any obstetrical doctor with a 'knowledge of childbirth' would have recognized the symptoms as soon as they started to manifest. So, the writer in me couldn't help but give him that dastardly little backstory with Lady Truro...]

Wow, that's a long A/N, but writing historical fiction that deals with medicine can be a rather tricky balance between what we know today and what was actually known then. I say that only because I'm tackling the same issue in a future chapter...