The story begins with an evocation of setting: at the lake shore. It is here where Nick and his father disembark from some vague location, presumably their side of town, and are rowed over to the Indian camp by some Native Americans who live over there.
The lake is the physical boundary that separates the white inhabitants of this town from the natives on the reservation. Metaphorically, it also operates as a racial, cultural, and economic boundary. Nick's father is a doctor and, presumably, the most accessible medical care available to those in the camp. Those in the camp live in shanties.
The dialogue in the story is very terse, a common feature of Hemingway's prose. Also, the only people who speak are the three white people: Nick, his father, and Uncle George. The Native Americans in the camp, however, are the ones who perform all of the action in the story: those who row Nick and his father over to the camp, the woman struggling for two days to give birth, her husband smoking a pipe in the bunk above her, then slitting his own throat out of fear and distress.
Much of the dialogue involves the doctor explaining to his son how a woman gives birth, then talking, very briefly at the end of the story, about suicide. The focus of the dialogue is, thus, on life and death. The doctor is determined to ensure that the baby is born and, therefore, is indifferent to the woman's screams: "But her screams are not important. I don't hear them because they are not important." A Caesarian is performed without an anesthetic, causing the woman to bite Uncle George in pain. His response, "Damn squaw bitch!" echoes the doctor's indifference to the woman and her labor pains.
Arguably, between this indifference to the woman and the doctor's insistence on checking on the father, as "they're usually the worst sufferers in these little affairs," Hemingway's misogyny seems apparent. One could look beyond this, however, and argue that Hemingway's indifference to the "squaw" stems from the notion that she is merely the conduit through which life occurs. Her survival and that of the baby are important only because they confirm the triumph of life over death. The latter is personified by the father's suicide.
It is important that the story ends with Nick and his father rowing home, on the verge of a new day:
The sun was coming up over the hills. A bass jumped, making a circle in the water...It felt warm in the sharp chill of the morning.
At this moment, Nick feels "quite sure that he would never die." One could read this conclusion literally, as a boy's naive feeling of immortality, or symbolically. Though the father in the camp killed himself, his newborn is a part of him and will live on and probably propagate more children. The tragedy of what occurred in the camp is left behind, a memory now in the past, while Nick and his father sail on into the morning and a new beginning. In the water, a bass's jump makes a circle in the water. Circles, too, continue on indefinitely. Thus, the conflict between life and death, as presented in the story, is resolved by the reader's understanding, through Nick, that life goes on.
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