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People had migrated and coalesced into settlements and villages, pooling knowledge and resources. They lit candles against the dark and waited. Without birth, life is only that wait.

47North - 2016 revised re-release.

47North – 2016 revised re-release.

When she went to sleep—halfway through her endless shift of delivering babies dead and dying from the plague—the world was dying. When she awoke, the world was dead—the majority of men killed off from infection, with one woman left alive for every ten men. Struggling home in search of food and shelter, the unnamed midwife finds only danger, when a stranger attempts to rape her. Realizing her situation, she cuts her hair, dons men’s clothes, and heads off into the wilderness, pretending to be a man to increase her chance of survival. She keeps her journal up to date, a book that contains not just her story but the stories of those she comes across in her travels—everyone searching for the same thing, food, shelter, safety, a semblance of what they’d lost. What does a midwife do in a world without birth? Administer contraceptives and first aid to the few women left alive, many of them sex slaves who would otherwise die in childbirth. And in a way, she’ll become the midwife that helps bring a better world to fruition.

Most of Unnamed Midwife’s elements sound very familiar—post-apocalypse by plague, survivalism in a lawless world, female protagonist, etc. Station Eleven comes to mind, but these are two very different animals; where Station posits that mere survival is not enough and that people need something else (in its case, art/culture) to drive them, Unnamed Midwife focuses on more “realistic” issues, the isolation and terror that comes in the breakdown of civilization, a perpetual series of losses and senseless deaths in a gritty reality. The “waking up in a hospital” unearths memories of The Walking Dead, but again, Midwife takes a different tack: where Walking Dead nods at but tiptoes around the loss of interpersonal bonds and intimacy in a dying world, Midwife charges at those themes headlong. And while both works show that humans are ultimately the most dangerous threat to other humans, Midwife is made more powerful because of its focus on gender roles: it doesn’t shy away from feminist and LGBT issues in a world where women are now the most prized commodity.

And it’s impossible to untie the novel from those themes of gender and identity; not only is the novel’s central concept a world with one woman per ten men where childbirth almost guarantees death, we have a protagonist who’s a bi woman who travels dressed as a man to save herself from a life of sexual slavery. A lot of readers (particularly men) may recoil at a future of misogyny as overly dystopic and unrealistic, but consider: in today’s world, where governments exist to enforce law and order and women make up roughly half the population, the statistics on sexual violence against women are staggering. Elison extrapolates that dark element lurking the real world and uses a dark, apocalyptic tale to examine them. Gender roles and identity, birth control and a woman’s right to her body autonomy, are all central to the plot, examined in the context of societal collapse. It’s an interesting and bold move to deal with those themes, and while Elison’s never preachy and doesn’t overdo it, those issues’ constant presence is felt throughout the book.

There are a few elements that dragged the work back, most of them feeling like “first novel” issues (or “first novel in a series” issues). There’s a notable frame story in this edition, starting off in the future the unnamed protagonist shapes, but the connection between that world and the bulk of the novel felt flimsy and tacked-on at the end, made because there wasn’t much else to say or do in the apocalypse that hadn’t already been said or done. A few things felt too neat or coincidental (the final destination of her pre-pocalyptic lover Jack, for one). And her journal shorthand, a madcap dash of memories tied together by equal signs, wears thin after a while: Started off cute = got tiresome by end. Meh. Not really feeling it. Made me think re: common writing criticism, = nice try but less jargon always more.

The Book of the Unnamed Midwife is a brutal and unflinching descent into a gritty apocalyptic landscape. While it suffers from those “first novel” flaws, Elison injects some complex themes into a subgenre which often feels repetitive and stale; this is a thoughtful and moving work. Does it shake those repetitive shackles off the post-apoc subgenre and transcend the genre’s tropes? No, but it’s an apocalyptic novel that comes at the genre with a new angle feeling fresh and invigorated. At times it’s so bleak it’s painful, and the sad thing is I can’t fault it for being unrealistically so. Maybe I’m too bitter and cynical—with the looming election here in the US, can you blame me?—but it felt viciously real, making the reader as uncomfortable and traumatized as its characters.

I can see why Elison won the Philip K. Dick Award, and was on the Tiptree Award’s shortlist—this is powerful stuff. The Book of the Unnamed Midwife is bleak, troubling, but ultimately optimistic; it’s solid feminist SF in the same vein as Atwood’s The Handmaid’s Tale. Maybe with more Mad Max-esque gunfights and action, plus similarities to The Walking Dead and Children of Men. It’s getting too easy to just list off post-apoc works with similar elements, and it’s also not quite fair, as Book of the Unnamed Midwife uses that subgenre to investigate a new range of themes. It’s not for the squeamish, and its nihilism becomes borderline depressing. But it is an excellent and powerful read that sticks with you. I loved reading this brutal apocalyptic tragedy even as it left me drained. It’s an imperfect novel, but a novel well worth reading; Meg Elison has proven herself to be a talented author, and I’m interested to see where she goes from here.

I received an e-ARC in exchange for an open and honest review. The re-release, featuring editorial revisions, is available now.

Book Details
Title: The Book of the Unnamed Midwife
Author: Meg Elison
First Published Date: 2014
What I Read: 2016 ebook re-release (47North)
Price I Paid: $0 (e-ARC from NetGalley and 47North)
MSRP: $14.95 pb / $3.99 ebook
ISBN/ASIN: 1503939111 / B01DAD218C