Midwives

Midwives (1997) by Chris Bohjalian is a literary novel that blends courtroom drama with a coming-of-age narrative, exploring the moral and legal ambiguities surrounding home birth and medical responsibility. Told retrospectively by the daughter of a midwife who is on trial for involuntary manslaughter, the novel examines themes such as The Debate Between Alternative and Institutionalized Medicine, Growing Up in the Shadow of a Family Scandal, and The Legal System’s Power to Define the Truth.

This guide refers to the 1998 First Vintage Contemporaries edition, Random House, US.

Content Warning: The source material and guide feature depictions of death, graphic violence, gender discrimination, racism, substance use, addiction, sexual content, child sexual abuse, illness, and child death.

Plot Summary

Fourteen-year-old Connie Danforth’s life is thrown into chaos when a home birth attended by her midwife mother, Sibyl, goes horribly wrong. A lay midwife, Sibyl is called to the second labor of her client Charlotte Bedford, the wife of Quaker pastor Asa. Sibyl expects the labor to be smooth since Charlotte’s previous son was delivered without trouble. However, as the bitter, icy March evening progresses, Charlotte’s labor proves unduly protracted. Sensing Charlotte’s exhaustion, Sibyl tries to call for the rescue squad, but a storm has brought down all phone lines in the area. With the roads slick with ice and Sibyl’s car stalled in a snowbank, Sibyl has no option but to deliver the baby at home. After hours of pushing, Charlotte goes into respiratory failure. Sibyl administers several rounds of CPR, but Charlotte cannot be revived. When Sibyl is unable to detect a pulse, she believes Charlotte has died of a stroke and decides at least to save the baby, asking Asa and the assistant midwife to bring her a knife. Sibyl performs a home cesarean section on Charlotte and delivers a baby boy. Medical examiners and police officers arrive soon, and Charlotte’s body is taken for an autopsy.

A day after the harrowing incident, Connie sees police officers at her house, here to take Sibyl’s testimony. Since the tone of the officers is less than pleasant, Sibyl and Rand—Connie’s father—realize that the officers may suggest that Sibyl was culpable for Charlotte’s death. They seek out an attorney, settling on high-profile lawyer Stephen Hastings to represent them. Soon, the Danforths receive the news that Sibyl’s assistant, Ann, called Asa and the state attorney to tell them that she thinks Charlotte was alive when Sibyl performed the C-section. Asa now believes that he and Anne saw arterial blood spurting from Charlotte’s body when Sibyl made her incision, proving that Charlotte’s heart was still beating. Charges against Sibyl seem inevitable, a fear realized when the coroner’s autopsy reports that Charlotte died of hemorrhagic shock from the operation. The coroner’s verdict widens the fault lines already present in Vermont. Doctors and ob-gyns who oppose home births because of the risks involved flood the newspapers with op-eds against the practice of lay midwifery. Meanwhile, freelance midwives rally around Sibyl.

The state charges Sibyl with involuntary manslaughter, the maximum term for which is 15 years. Sibyl refuses the plea bargain that could let her off with a reduced sentence on the condition of leaving midwifery. For Sibyl, her profession reflects a commitment to providing women the safe, natural labor they deserve, and it cannot be abandoned. Stephen thus begins preparing for Sibyl’s trial. As Connie fears losing her mother, she finds solace in her boyfriend, 16-year-old Tom Corts.

Sibyl’s trial begins in July, morphing into the larger question of what constitutes a “natural” birth. State Attorney Bill Tanner claims that lay midwives are not qualified to make medical decisions or provide medical care, while Stephen argues that the fear of midwives is rooted in misogyny. Further, maternal and child mortality rates for experienced midwives are the same as those for hospital births. Sibyl has only lost one client in the 15 years that she has practiced midwifery.

While Stephen’s case rests on proving that Anne and Asa’s version of events is highly subjective and based on their own exhausted state and lack of medical knowledge, Connie fears that the state’s case is stronger. This fear deepens when Sibyl finally takes the witness stand. Sibyl lets it slip to Tanner that she keeps a binder in which she jots down all the details of the births she oversees. Stephen, Sibyl, and Connie—who has secretly read her mother’s journals—all know the notes contain Sibyl’s second-guessing of her decision to operate on Charlotte. Stephen has explicitly forbidden Sibyl from mentioning the journals because the state could requisition them as evidence—as it soon does. The judge decides to examine the journals.

Connie and an attorney head to her home to get the binders from Sibyl’s office. Connie removes the pages containing the incriminating entries, folds them, and hides them. The judge goes over the notes, deems them innocuous, and returns them. Stephen and Sibyl cannot understand how the judge came to his decision. Later, Connie replaces the pages, hoping that Sibyl will not notice the folded lines.

The case drags on for a few more days. Contrary to Connie’s fears, the jury delivers a not-guilty verdict against Sibyl, who is let off with a small fine. However, Charlotte’s death leaves behind a chain of impact. Sibyl is unable to practice midwifery, as she has lost confidence in her abilities. Connie grows up to become an ob-gyn, scandalizing her mother’s midwife friends, who believe her choice of profession is a slight to Sibyl. Soon after Connie becomes a doctor, Sibyl passes away from lung cancer.

As the book ends, a diary entry from Sibyl reveals that the night Charlotte died, Sibyl felt her body flinch when she made her careful incision. At the time, Sibyl believed the flinch was a postmortem reflex. However, a day later, Sibyl kept thinking of the flinch, wondering if Charlotte was alive.