In March, 1981, in Vermont, Charlotte Bedford goes into labor. She has decided to give birth at home with the help of a midwife, Sybil Danforth, but complications develop. Charlotte has a seizure, her heart stops, and she does not respond to CPR. The fetus is still alive, so Sybil delivers him successfully by Cesarean section, with a kitchen knife. But the bleeding when Sybil makes the incision convinces her assistant that the patient’s heart was still beating. She reports this to the police and Sybil is put on trial for involuntary manslaughter.

The story of the trial is told by Sybil’s daughter, Connie, fourteen years old at the time and now an obstetrician-gynecologist. The acquittal comes at a price: the midwife finds herself no longer capable of delivering babies, and both she and her daughter are given a new insight into the uncertainty which underlies so many of medical decisions. At the end of the novel we are left uncertain whether or not Charlotte was still alive when her baby was delivered.


This novel centers on the problem of uncertainty in healthcare, and the risks taken by the caregiver in becoming responsible for a patient. These risks are multiplied in the case of the midwife, who, in the community of this novel at least, faces little support and much hostility from mainstream medicine. Sybil believes in the importance of natural and non-medicalized childbirth, though she has medical backup for complications, and only accepts low-risk cases. When things go wrong, though, especially when "nature" itself plays a part (a blizzard keeps her from taking Charlotte to the hospital), she begins to lose the faith necessary for her to practice.

Set against medicine’s unavoidable uncertainty is the law’s reliance on clear-cut and discoverable truths. The novel refuses us the security of those truths: although Sybil is acquitted, we realize that ultimately the trial and the charge of manslaughter are irrelevant. What remains are the events: the mother died, but her child survived, and the midwife did the best she believed she could in the circumstances.

This novel is a challenging and thought-provoking read for anyone in the healthcare professions, a sobering (and very engagingly written) reminder that, whatever one’s professional status, the commitment to caring for another entangles the caregiver in the frequently rewarding but always uncertain trajectory of another person’s life.



Place Published

New York



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