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There are three topics that will almost always make me want to pick up a book: the Great Depression, midwifery, and Appalachia. Put them together, and I HAD to read Patricia Harman’s Hope River novels: The Midwife of Hope River (TMOHR) and The Reluctant Midwife (TRM). While TMOHR, in this reader’s opinion, has much more charm and depth, I am reviewing TRM due to its themes of disability that run through much of the novel.


About the Book

The Great Depression has hit West Virginia hard. Men are out of work; women struggle to feed hungry children. Luckily, Nurse Becky Myers has returned to care for them. While she can handle most situations, Becky is still uneasy helping women deliver their babies. For these mothers-to-be, she relies on an experienced midwife, her dear friend Patience Murphy.
Though she is happy to be back in Hope River, time and experience have tempered Becky’s cheerfulness-as tragedy has destroyed the vibrant spirit of her former employer Dr Isaac Blum, who has accompanied her. Patience too has changed. Married and expecting a baby herself, she is relying on Becky to keep the mothers of Hope River safe.
But becoming a midwife and ushering precious new life into the world is not Becky’s only challenge. Her skills and courage will be tested when a calamitous forest fire blazes through a Civilian Conservation Corps camp. And she must find a way to bring Isaac back to life and rediscover the hope they both need to go on.


A note about Audio

As many readers of this blog read via audiobook, I will say that the narrator, Heather Henderson, is competent but not stellar. There are portions that would have been conveyed more clearly with a second narrator; they are written in first-person point of view, like the majority of the book in Becky’s POV, but Henderson’s voice does not change enough to make this distinct shift. It’s not a bad audiobook, but these are quibbles to keep in mind.


Disability: Center Stage

TRM visits many characters first introduced in TMOHR. It is probably best that TMOHR is read first, but Harman deftly describes what the reader may have missed. In theory, four years have passed since the end of TMOHR, but so much has stayed the same, even as a couple of characters have married or moved on. There are several physically disabled characters in this book (TRM), many of them mothers or women who wish to become mothers, who had brief side roles in TMOHR. This is a terrific departure from most fiction, which seems to portray disabled characters as having no sexuality. What’s also refreshing is that no one seems to bat an eye at Lily, a blind woman (who possesses angelic qualities and finely-tuned senses of hearing and smell – with which I have my own quibbles), raising a child with her husband. Ideally, Harman could have further explored this avenue of Lily’s life – as it’s not uncommon for parents with disabilities to have to prove their fitness as parents – particularly since Lily interacts frequently with Becky Myers, the nurse/midwife. Another character, paralyzed due to polio, uses a wheelchair to navigate her home, and consults Becky when she believes she is pregnant. Again, no one seems to think twice about her carrying a child due to her disability (though there are concerns due to the polio itself and a painful loss of a child years ago). Spouses and employers seem to want to make accommodations as needed for loved ones or employees to maintain their dignity and independence – wider doorways in the home, lower countertops and workbenches, setting up work projects for a blind spouse on bed rest. Again, this is a refreshing dip of the toes in the water of disability, dignity, sexuality, and parenthood, which could have made this book thoroughly enjoyable, but…


Some Big problems

Maybe it was a reflection of the times. Maybe it was the author’s point of view. Maybe it was an ending that was too neat and tidy. But Becky Myers herself was truly unlikable and seemed to lack the compassion of those in the helping professions. She worries about everything and is truly inexperienced as a midwife, something I found bizarre for a woman who ran a women’s health clinic for years. When the doctor she’s been assisting for years develops disabilities of his own, she totes him around like a pet, speaks to him like a dog, resents his presence, presumes him incompetent… Becky may have nursing training, but either has no compassion for some of those in her care or hasn’t developed the skills to avoid burnout. Words like “cripple”, “wheelchair bound”, and “sightless” are used to describe the townspeople with disabilities.

Dr. Blum begins the book unable to care at all for himself, but slowly gains independence once others presume his competence. He poignantly describes having words to say but being frequently unable to express them verbally. But he himself is manipulative, knowing he can perform personal care tasks for himself but allowing Becky to do them for him, reads Becky’s journal without her permission or consent. Even so, he performs complex surgery when pressed into service and recovers too neatly and tidily, feeding the idea that illness needs to be cured completely in order to be happy…



TRM lacks the depth, humour and charm of TMOHR. Even so, it takes some important steps in the right direction, making physical disability intersect sexuality and parenthood. But it missteps in some painful, ableist ways as well. It’s worth a read particularly if you like TMOHR (which is warm and poignant a la “Call the Midwife”), but it’s worth noting some concerns about mental illness or other disabilities whose cause and symptoms are unknown or unpredictable. One can argue, maybe even successfully, that the language and attitudes were products of that particular time and place, but that can only take one so far. Some of the words, attitudes and ideas still persist today – even if beneath the surface – and it’s important to acknowledge that.

3/5 stars.