Nathan waits, and when it's time, he picks her up and carries her into the delivery room.

This surgery has historically been performed with a vampire tooth, but apparently Bella's been using her coins, as Rosalie is holding a scalpel instead. "So," she says, peering between the Joker and Nathan, "if she - he? - if your mate's not going to turn, how's this going to work? You going to magic the shell away or something?"