The Forgotten Midwife

The novel alternates between two timelines: a present-day story set in New Jersey and Ireland, and a historical narrative spanning the 1950s through 1980 in County Tipperary, Ireland. The two storylines converge around the identity of a baby born in a mother and baby home run by the Catholic Church.

In the present day, Riley, a young woman in New Jersey, is preparing for her wedding to Samuel Jefferson Jr. (Sam). Riley lost both parents in a car accident caused by a drunk driver when she was 12; her grandmother, Grammy (Betty), raised her afterward. Grammy now lives in a nursing home, where her dementia has progressed to the point that she rarely recognizes Riley. During a rare lucid day, Grammy grows emotional and directs Riley to a shoebox in her closet. Inside, Riley discovers hand-knitted green baby booties and an Irish birth certificate for a girl named Mary-Kate O'Rourke, born August 1, 1959, in Thurles, County Tipperary. The date matches Riley's late mother Stacey's birthday exactly. Before Grammy can explain, she slips back into dementia. Riley and Sam conclude that Riley's mother may have been adopted from Ireland and fly to Thurles using their honeymoon savings.

The historical timeline begins in 1956, introducing Margaret Lannigan, a spirited 20-year-old in love with Joseph Maloney, who has received her father's blessing to marry her. Margaret and her older sister, Sheila, share a room and secretly read Little Women together. When Sheila contracts diphtheria and dies within days, the family is shattered. Margaret's father, Donny, a devout Catholic under the influence of Father Michaels, the parish priest, forces Margaret to take Sheila's place in the Sisters of Penance at Ballyvale Convent, a cloistered order whose members are forbidden from leaving the grounds. Despite Margaret's protests about her engagement, she is driven to the convent that same night.

At the convent, Margaret attempts to escape but injures her ankle. The groundskeeper, Austin Dolan, returns her by horse and cart, advising her to cooperate. She writes daily to Joseph begging for rescue, but over nearly two years, none of her letters receive a response. Father Michaels delivers further devastation: Both of Margaret's parents have died of diphtheria, and her three younger brothers are sent to relatives in Mayo. Margaret is not permitted to attend the funeral. With her family gone and Joseph silent, she has nowhere to turn.

Margaret and her friend Joyce, a devout novice, graduate to full sisters two years later. At the celebration, Father Michaels casually mentions he is leaving to officiate the wedding of Linda O'Rourke, Margaret's childhood best friend, to Joseph. Margaret is crushed. During her time at the convent, she and Joyce spy on Father Michaels bringing wealthy couples who arrive without children and leave cradling babies, realizing the infants are being sold through the guise of donations. Joyce confesses their eavesdropping, and Father Michaels reassigns Margaret as punishment to Ballyvale Home for Fallen Girls, the building across the road. The home confines unmarried pregnant women, whom the Church labels "fallen," forcing them into laundry labor and taking their babies for adoption. The rules of the cloistered order forbid Margaret from returning to the convent.

At the home, Margaret meets Sister Teresa ("Tee"), the kind elderly nun who delivers babies despite having no medical training, and Matron, the cruel overseer. She assists Tee in delivering her first baby, a boy born to 15-year-old Rosie. When another girl hemorrhages during labor that same night, Matron refuses to call a doctor, and both the mother and her baby die. Mr. Dolan buries them in the garden without ceremony.

Mr. Dolan becomes Margaret's closest ally. Joyce smuggles bread, milk, and wool through a gap in the hedge between the properties, and Margaret knits booties for every newborn so the mothers can send a keepsake with their babies. Delia O'Rourke, the younger sister of Margaret's best friend Linda, arrives pregnant and reveals that Father Michaels told everyone Margaret had run away, explaining why Joseph never came. Margaret realizes the priest intercepted all her letters through the local postman. When Mr. Dolan acquires a delivery van, he begins secretly posting the girls' letters from distant towns. Margaret also discovers a cache of unposted letters in Matron's chambers, confirming years of systematic interception. With medical journals smuggled by Mr. Dolan, she studies obstetrics on her own to improve birth outcomes.

When Delia goes into a dangerous labor, Margaret defies Father Michaels and has Mr. Dolan fetch a doctor. The doctor saves Delia and her baby girl, whom Delia names Mary-Kate O'Rourke. Father Michaels arranges for Derek Carmichael, an American man from New Jersey, to adopt the baby. When Delia fights to keep Mary-Kate, Father Michaels locks her in a windowless room for a week. Margaret, Delia, and Mr. Dolan then devise a plan to smuggle girls out of Ballyvale in laundry bags on the van, funding ferry tickets by skimming a percentage from laundry payments. Over the following months, they rescue multiple girls.

Rosie's mental health deteriorates after her baby is taken and her family cuts off contact. When Matron finds a contraband copy of Little Women in Rosie's possession, the nuns tie Rosie to a tree overnight in freezing weather. Margaret and Tee cut her free, but Rosie develops a fever and dies at 17. Margaret writes to Joseph's parents describing the cruelty at Ballyvale. They give the letters to a newspaper, and an article in the Sunday Independent exposes the abuses. Father Michaels is forced to send Matron away. Joseph and a pregnant Linda arrive and take Delia home, but Margaret refuses to leave, choosing to protect the remaining girls. Years pass as Margaret and Tee continue delivering babies and smuggling girls to freedom. In 1976, Linda dies of cancer, and Margaret attends the funeral, her first time outside Ballyvale in 20 years.

In the present day, Riley and Sam arrive in Thurles and visit JJ Lynch's bar, where the barman, Vincy, introduces them to John Clifford, a local whose wife may be able to help. John's wife, Ita, is Joseph and Linda Maloney's youngest daughter. Ita recognizes the birth certificate immediately and reveals that Riley's mother, Stacey, was originally Mary-Kate O'Rourke, adopted as a newborn by Derek and Betty Carmichael. Delia, Riley's biological grandmother, died three years earlier but never forgot her firstborn. Ita introduces Riley to the elderly Joseph and his wife, Dr. Margaret Maloney, née Lannigan, who married after Ballyvale closed. Margaret takes Riley's hands and tells her that Mary-Kate was a beautiful baby she helped deliver.

In the epilogue, set in 1980, the last baby is born at Ballyvale. Father Michaels has died, and his replacement ensures every remaining girl is reunited with family or given a fresh start. Joyce becomes Mother Superior of an open convent, and Margaret begins formal midwifery training. She walks out of Ballyvale for the last time and makes her way to Joseph's farmhouse, where he embraces her and tells her she is finally home. Eight months later, Riley marries Sam in the Jeffersons' garden with Joseph walking her down the aisle. Margaret, Joseph, Ita, and 19 newly discovered Irish cousins, Delia's grandchildren, attend alongside Grammy, who admires Riley's dress but does not recognize her granddaughter.