What’s It About

A plague has wiped out most of the population.  The bulk of those who have survived are men, which makes women a scare resource.  Our protagonist was once a nurse.  Now she survives by masquerading as a man and offering her services as nurse and midwife.  But what hope is there in a world where pregnancy is a death sentence for both mother and child?

Should I Read It?

Yes.  Of the six books nominated for the PKD, this one just pips Memory of Water as my favourite.

Compared to other end of the world narratives, The Book of the Unnamed Midwife is a brutal novel.  Not unsurprising given in this post-plague world women have become a commodity.  Except, for all the savagery displayed, Elison has done a masterful job in limiting the sexual violence.  It helps that our protagonist, who adopts a number of false names throughout the novel, is smart and resourceful and driven by the need to save the lives of women, not just by freeing them from men but by giving them access to contraception.

But what really struck me about the novel is its eroticism.  No, not rape fantasies, but consensual sex and intimacy.  It’s a surprising and powerful aspect of the book.

Representative Paragraph

A strategy for survival where woman are a commodity.

Apartment in the Mission, found a compression best to hide my tits.  Thanks transman of yesteryear.  Little too small, real tight.  Shaved my head.  Wasn’t easy.  Got men’s cargo pants and combat boots, with a couple of loose shirts and my hoodie on top.  Can’t do anything about a beard.  Couldn’t find one in a costume shop or anywhere.  Settled for rubbing dirt into my jaw every morning.  Candelit mirror tricky tricky.  Look like a young effeminate man… need to do more pushups.  Walk tall, keep hips straight.  Don’t sway.  Feel flat.  Hunch a little, arms straight down.  Don’t gesture.  Stare down.  Make fists while talking.  Sit with knees apart.  Adjust.  Don’t tilt your head.  Don’t bite your lip.  Interrupt.  Laugh low.

Sex while the world ends.

Tension = ridiculous.  Pretty sure Honus feels it too, but Jodi doesn’t have a clue.  Every time she’s out of earshot, we’re talking about sex.  How to touch her, how to talk to her, how to turn her on.  He says he’s not jacking off because it’s wrong but I doubt it.  Think I’m ding a good job of hiding it, but I’m down.  As down as I’ve ever been.  Shit. Trauma, loss, assault, afraid for my life, and yet.  Compulsion to fuck is so strong in our species.  In all circumstances, always.  Remember what it was like when I was with my first girlfriend in college.  Was head-over-heels wanting to fuck her all the time.  We barely went to class until we both flunked that anatomy test.  Ironic.  This feels like that.  Stir-crazy inevitable comes-and-fuck-me crazies.  Probably crazy for nothing.


In a recent post on his excellent blog The Mumpsimus, Matthew Cheney wrote passionately about the apocalypse as comfort fiction.  In short he argues that novels which provide a hopeful outcome to an apocalypse, one where we do survive and thrive, are disingenuous and delusional.  He says,

It is highly unlikely that you, I, or anybody else would be a survivor of an actual apocalypse, and it is even more unlikely that, were we to survive, the post-apocalyptic world would be worth staying alive to see. To imagine yourself as a survivor is to evade the truth and to indulge in a ridiculous fantasy. To imagine yourself as a successful survivor — someone who doesn’t suffer terribly before finally, painfully dying — is even worse.


To tell a story of apocalypse in which people’s lives are not even as difficult or painful as the lives of millions and millions of people currently alive on Earth moves beyond escapist fantasy and into the realm of idiotic irresponsibility. (This, perhaps, is why some of the better apocalypse/dystopia stories are written by people who are not middle-class white Americans.)

Now, while I love Station Eleven precisely because it does reject the nihilism of books like The Road, I can appreciate Matthew’s point.  Apocalyptic and post-apocalyptic fiction that pretends that everything is going to be OK, that we’ll all become happy, chappy farmers free of the evils of the modern world, are, as Matthew points out, indulging in a “ridiculous fantasy”.

One of the key points Matthew makes, especially toward the end of his piece, is that if the aim of apocalyptic fiction is to provide the reader with a cautionary tale, then it’s irresponsible to make extinction seem bearable.  While the protagonist of Meg Elison’s The Book of the Unnamed Midwife does ultimately find stability in her life, the novel goes to great pains to show us a world that’s anything but bearable or desirable.  Elison chooses a plague to wipe out most of humanity because it gives her the ability to kill off more women than men and make pregnancy a near death sentence.  In other words, create an apocalypse scenario that’s not only bad because billions have died, but also puts whatever power remains in the hands of men.  Violent, angry, horny men.

This scenario makes for uncomfortable, upsetting reading, precisely the emotion that Cheney believes apocalyptic fiction should be aiming for.  Having said that, The Book of the Unnamed Midwife is anything but an extended rape fantasy.  Elison makes the smart move of having a protagonist who is competent and resourceful from the get go.  Some might think that’s cheating.  But by having someone who can fend for themselves, and is smart enough to realise that women have become a commodity, we avoid the woman captured, raped, escaped narrative.  Rather we get a female protagonist who not only rescues other women but offers them birth control.

But beyond the conventions of the post-apocalyptic narrative, where The Book of the Unnamed Midwife excels is via its structure and its take on sexuality.  In terms of structure I loved how we moved from abrupt diary entries written by the unnamed midwife to an omniscient third person perspective that provides more details about her journey and the people she meets along the way.  This third person point of view also allows Elison to momentarily move the focus away from America.  Yes, we have an apocalypse novel that isn’t American-centric, that actually recognises that other parts of the world exist.

And then there’s the sexuality.  For one, we have a protagonist who identifies as bi-sexual dressed up as a man to avoid the possibility of entrapment, rape and death.  Beyond the need to survive, Elison recognises the gender issues at play here.  When our protagonist finds herself living with two Mormons (a husband and wife) gender and sexuality is explored further.  And these discussions feed into the most startling aspect of the novel, its eroticism. This element comes to the forefront when she’s cohabiting with the Mormons, but it’s also there, softer and less insistent, earlier in the novel.  It’s startling because you expect a novel of this type only to be about survival and death and barbarism, to be bereft of any sense of intimacy even if it’s just the need to fuck.  And yet, given the novel’s focus on primal urges, such as giving birth and killing to survive, the idea that we would retain our horniness in the most miserable of situations makes perfect sense.

I loved this book.  It may still be a little too hopeful for Matthew Cheney – the indication is that the human race will survive – but it’s an honest novel, both in the way it depicts a post apocalyptic world and how it recognises that human sexuality and the need to fuck and feel pleasure will stay with us even as the human race falls into darkness.