Midwives: A Novel
is a 1997 novel by American author Chris Bohjalian. Set in rural Vermont, it follows midwife Sibyl Danforth who is sued after one of her patients dies after receiving an emergency C-section in a remote house during a blizzard. Though the woman’s medical report states that she died of a stroke, uncertainty surrounds whether Sibyl was responsible for the woman’s death. Meanwhile, Sibyl’s daughter, Connie, watches helplessly as the trial threatens to destroy her family. The story details Sibyl’s emotional struggle with self-doubt and memory. Reaching a wide popular audience in the United States, the novel was adapted into a 2001 film of the same name.
The novel begins with the perspective of Charlotte Fugett Bedford, the woman who becomes Sibyl’s patient and ultimately dies in her care. Charlotte and her husband, a minister, have recently moved from Arkansas to Vermont. Because she is a quiet and insular woman with few friends and overshadowed by her husband’s public persona, little is known about her other than she is a good mother to her young child. One day, Charlotte becomes pregnant with a second child. For religious reasons, she decides to give birth with a midwife instead of at a hospital. She picks Sibyl to help her deliver the baby. Charlotte’s pregnancy goes well, convincing Sibyl that she will have a normal birth.
On the night Charlotte goes into labor, all goes well until Charlotte starts to bleed profusely. Sibyl recommends that they move Charlotte to a hospital. However, a sudden blizzard has just hit the area, and the phone lines are down. Sibyl decides to drive Charlotte to the hospital herself, but on their way out of the driveway, the car slips on a patch of ice and slides into a snowbank. Luckily, the profuse bleeding stops, and they seem to be clear of serious danger. For the next several hours, Sibyl guides Charlotte through her contractions. The baby moves through the birth canal, but as it reaches the end, Charlotte falters. After trying one more time to push, Charlotte suffers a seizure. Suspecting that the seizure is due to an underlying stroke, Sibyl performs CPR. Charlotte’s pulse fades, then disappears. In an effort to save her baby, Sibyl performs a C-section.
Charlotte’s body is examined in an autopsy. The examiner’s assistant interrogates Sibyl, then calls her backup midwife, Asa, and the police. She explains what happened to the police, then hires a lawyer. Her lawyer discovers that the state plans to charge her both for practicing medicine without a medical license and for involuntary manslaughter. The autopsy report is released, and Sibyl is shocked to see that no evidence of stroke was found. Rather, the report claims that Charlotte died from massive blood loss after Sibyl performed the C-section. The report causes Sibyl to doubt her own memory and judgment.
In the following months, a heated trial proceeds. Central to the case is the complex question of whether home birth is ethical or safe. The prosecutors assert that Sibyl is not trained to assist someone in childbirth and that her stated role of “midwife” was a misleading label. Sibyl’s lawyers counter that her track record is better than a typical OB/GYN. They also point to the fact that Charlotte concealed part of her medical record, which indicated a risk of stroke. As the trial culminates, it is revealed that Sibyl has a journal at home in which she documents her accounts of midwiving. The judge requests the notebook be brought to the trial. Before it can be retrieved, Sibyl’s daughter, Connie, reads the journal, removing any pages that might be used against her mother. The judge unknowingly reads the edited journal and rules that Sibyl is not guilty of manslaughter.
The end of the novel takes place many years later. Connie, now an adult, follows in her mother’s footsteps, ultimately deciding to become an OB/GYN rather than a midwife. Her mother resents her choice, which she believes suggests that Connie perceives midwiving as a lesser role. Connie argues that the medical profession and midwives have to keep an open and honest dialogue to improve the quality of care for all people. In the plot’s final twist, it is revealed that one of the pages Connie removed from her mother’s journal said that she felt Charlotte’s body flinch when she started the C-section. Midwives
ends on this moment of ambiguity and ethical complexity, giving no answer as to whether its protagonist made the right or wrong choice or should be ultimately held accountable for her patient’s death.