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Ruth Charlotte
Ruth Olivia
Ruth Abigail
Ruth Amelia
Ruth Angelina
Ruth Sabrina
Ruth Stephanie
Ruth Victoria
Ruth Gabriella
Ruth Lillian
Ruth Natalia
Ruth Madeleine

Ruth Elisheva
Ruth Hadassah
Ruth Evelyn
Ruth Frances
Ruth Susanna(h) / Shoshanna (sp?)
Ruth Sarai
Ruth Esther
Ruth Deborah
Ruth Hannah
Ruth Johanna
Ruth Mariah
Ruth Eleanor(a)

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Please let us know if anyone's suggestions will work. There were a lot of great suggestions by others and I'm curious to see if you like them.

Ruth Alexandra
Ruth Amalia
Ruth Annelise
Ruth Annalisa
Ruth Adriana
Ruth Adrianna
Ruth Catherina
Ruth Carolina
Ruth Catalina
Ruth Daniella
Ruth Emilia
Ruth Emmeline
Ruth Gabriella
Ruth Helen
Ruth Isabella
Ruth Isabel
Ruth Ivy
Ruth Jessamine
Ruth Juliana
Ruth Katarina
Ruth Liliana
Ruth Lilia
Ruth Laurel
Ruth Michaela
Ruth Melania
Ruth Nicolette
Ruth Nicoletta
Ruth Noelia
Ruth Noella
Ruth Natalia
Ruth Naomi

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Ruth Elaine is my favorite, by far. Also,

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Ruth Marie (I like this even though it's fairly boring)
Ruth Emilia
Ruth Sophia
Ruth Marina

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"Hide not your talents, they for use were made. What's a sun-dial in the shade?" -Benjamin Franklin

A friend of mine is using Ruth Elizabeth if her baby is a girl.

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Ruth Naomi
Ruth Evangeline
Ruth Abigail
Ruth Louise
Ruth Zipporah
Ruth Jerusha
Ruth Miriam
Ruth Delilah
Ruth Lilith
Ruth Susannah
Ruth Isabelle
Ruth Catherine
Ruth Theresa
Ruth Juliana
Ruth Beatrice
Ruth Clementine
Ruth Celeste
Ruth Angeline
Ruth Charlotte
Ruth Corinne
Ruth Madeline
Ruth Eleanor
Ruth Zemirah
Ruth Penelope

I think that the difficulty of finding middle names for Ruth has something to do with the ending 'th' sound as well as with the shortness of the name.

Ruth Alexandria / Alexandra
Ruth Amelia
Ruth Elisabeth
Ruth Felicity
Ruth Geraldine
Ruth Isabella
Ruth Josephine
Ruth Louise
Ruth Margaret
Ruth Nicole
Ruth Olivia
Ruth Susanna
Ruth Sophia
Ruth Theresa
Ruth Victoria
Ruth Vivianne

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Paula

You're right Ruth is difficult to make a combo with!

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Ruth Allegra
Ruth Amaya
Ruth Anouk
Ruth Bronwen
Ruth Demeter
Ruth Hermione
Ruth Hester
Ruth Manon
Ruth Morgana
Ruth Vera
Ruth Verona
Ruth Winter

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For short names like Ruth, it always flows better imo if the middle name is quite long.

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Ruth Elizabeth
Ruth Alexandra
Ruth Katherine
Ruth Madison
Ruth Isabella
Ruth Abigail