Title: The Last Midwife
Author: Karen Lawrence
Publisher: Exodus Books
Genre: Dystopian, Futuristic, Speculative Fiction
Release Date: 25th November 2025
BLURB
‘I’m going to snuff out the old witches – every last one of them!’
England has a One-Child Policy. Midwives have been outlawed for decades. Only a handful remain, risking everything to help mothers give birth in secret, but now their very existence is under threat.
When young nurse Chiara arrives from Sicily, her dreams are quickly shattered by the horrifying truth behind the pristine walls of the Genesis Centre. Meanwhile, Rava, the privileged wife of a government official, finds her perfect life unravelling when her pregnancy fails to meet her husband’s requirements.
Their worlds collide in a desperate fight for life, choice, and humanity against a system determined to control the future, one baby at a time.
REVIEW
The cover gives off quite a strong message when you have read the book and could almost be a nod to the suffragettes. “Striking a match” physically or figuratively. Being the one to make a difference and having the courage to literally strike out against the mainstream views and in the case of this book the laws around childbirth.
The cover certainly caught my eye and would definitely encourage me to pick it up in a bookstore or go on to read the blurb online as I did when I bought the book.
In the book the experience of childbirth has totally changed. The world is already over populated so it is strongly encouraged to only have one child and then be sterilised, or even to make the ultimate sacrifice for the planet and have no children by being electively sterilised.
Chiara Santori is a young woman who has left her home in Italy to take up an offer of training and work in the Genesis Centre in London. Not only will she be trained in the new maternity services she will earn money to send home to her mother and her younger sister who are struggling to continue living in the family home.
At first things go well, though the work is tiring, seemingly never ending with long hours, little free time and some questionable practices Chiara find’s herself enjoying it. Until one day she is called to assist in a birth and the baby doesn’t breath straight away and the paediatrician Salvador asks Chiara for an injection which euthanises the baby because it had extra fingers, this is referred to a “lullaby baby” Those in charge put it across as if the baby didn’t make it.
The Genesis Centre is in the business of producing only healthy babies. It’s a lot for Chiara to take in and to get used to. Because of climate change and there being less habitable homes the population needs to be kept under control.
Hence the implementation of the Progressive Population Policy in England, and specifically adhered to in London. Under the policy each couple may generate one live offspring, provided certain conditions are met. Because of this there is also an emphasis on the children being born fit and healthy.
At the Genesis Centre they make a guarantee: if a foetus is, tragically, stillborn, the couple are offered another incubation licence, free of charge, plus a substantial discount on their next round of treatment. The Genesis Centre provide a comprehensive programme of prenatal screening to minimise the occurrence of these sad cases. But sometimes they still happen.
When Chiara brings up what happened with the baby and the paediatrician Salvador with Sister Miller, the sister explains that defective neonates are not born at the Genesis Centre. The Sister goes on to say what happened is called a Lullaby birth, but naively Chiara persists saying yes sometimes babies die but this one was alive and moving about. The Sister becomes very firm with Chiara despite not even being in the delivery room telling her she did not see the neonate moving, that it was in fact a lullaby birth.
Theres lots of new terminology and new procedures for Chiara to get used to.
Lullaby babies - 'defective' allowed to just die or are actively euthanised
Being or getting 'Sealed' = sterilisation, people are actually rewarded for it!
Peaceful rest centre - for old people to go an die so they are not a burden on the community, making way for more productive members of society to be born.
A filly is a single fertile woman. All women wear Fembands, Chaira wears a scarlet band, pregnant women wear blue, sterilised women wear gold and Jewish women wear a yellow one with the Star of David on it. Fresh Start Pills are readily available which are basically abortion pills. Theres the Population Mandate – where couples have to obtain a licence, have to be married and prove they have enough income before they are allowed to incubate (become pregnant) Once the neonate (baby) arrives the mother get Sealed (sterilised) to protect the planet and give everyone a future. A child can’t be registered without a father willing to provide for it. An unregistered child is taken by the state and “taken care of” There is no other maternity care than the official government places. If you have plenty of money to pay there’s places like the Genesis Centre, if you are poor there are hospitals that are overcrowded, understaffed and ill equipped. Midwives have been abolished and are hunted down and dealt with severely especially if caught assisting a labour.
It turns out Salvador doesn’t really agree with the “Lullaby Baby” practice but similarly to Chiara he has family he is sending money home to and needs the job. He does however carry out small acts of rebellion by helping the underground midwives that operate in the area for those who cannot afford a Genesis birth or maternity care or for those having children they do not have licences for. Salvador introduces Chiara to this network and when she meets Liz and older woman who is a traditional midwife who helps women have natural births at her narrowboat home.
However associating with Liz and the other underground network of midwives is extremely dangerous as they are literally being hunted down as though they are witches and the man at the head of the hunt is Martin Robson. He is up for promotion against a younger candidate who is concentrating his policies and campaign on the Peaceful Rest organisation. Martin decides he will not rest until the very last midwife is caught and stopped by whatever means necessary. Ironically his wife Rava becomes unexpectedly pregnant. Martin is initially angry and wants Rava to take the Fresh start abortion pills but Rava quietly chips away at him about keeping the baby. Martin decides that Rava will be taken care of at the ultra-modern Genesis Centre and that he will use this pregnancy to his advantage for his campaign.
So much happens in this excellent futuristic, dystopian, speculative fiction tale that I feel like I could honestly talk forever about it. The plot is so well written and has many twists and turns some you see unfolding others take you completely by surprise, one in particular kind of “knocked me for six”!
Characters I loved were Chiara of course who had the courage to stand and work alongside the underground midwive’s network risking everything. I felt really sorry for her when she realised she was trapped at the Genesis Centre by the contract she’d had to sign. She desperately wanted to leave but to do so would mean finding money she didn’t have to pay tuition fees, accommodation fees and the early get out clause in her contract. I also loved Rava who had courage in her own way. She’d had an abortion when she was younger and was determined to do everything in her power to have the baby she was carrying whether it was a boy or not. The bravery of sticking to her principles when her husband gave her the ultimatum of getting rid of the baby as it wasn’t the ideal sex. The irony of her ending up being treat by the very midwives her oh so high and mighty husband is hunting down.
Liz thought to actually be “the last midwife ”at one point in the book is an amazing character that I absolutely adored, but I can’t say anymore about her as I do not want to give away spoilers.
Martin Robson was a good villain in this book and I have to admit I did enjoy disliking him. I also disliked Sister Miller but did find her comeuppance hilarious!
I had mixed feelings on Salvador, did he redeem himself in the end? I honestly don’t know if he did enough. However, you have to look inwardly if this was in fact reality -I shudder at the thought – where would I stand? What would I do? What would I be risk?
Sadly, the book shows what can happen to society when those in power make certain decisions but it also featured what can happen when the community comes together and fights back against those making the rules.
As a person that was born at my grandmother’s home, delivered by her as the midwife on call didn’t get there in time I found some of the old ways Liz used fascinating and there were things mentioned, remedies etc that I had heard my own grandmother mention. Sadly, if I had been born in this book, I would have been a lullaby baby, as the cord was wrapped round my neck, and I had twisted feet among other issues. The book is all the more poignant to me having suffered a miscarriage and not been treat especially well at the time. Things done without my knowledge and untruths told. I think my personal experiences made the book even more interesting and it’s a book that has you talking about it and recommending it to everyone you meet!
My immediate thoughts upon finishing the book were, wow, then I pondered a little and thought oh wow this is so believable what if it actually happened? Brilliantly written and amazingly strong set of female characters within the book, which is great to read.
Summing up, a book so very well written that its scarily believable, and is full of amazing characters, strong women and a few men prepared to fight for the cause and those who feel too weak to go against the mainstream policies in place. Then those blindly making new policies and putting hurdles in front of normal people having the basic human right to have children, changing maternity care by making it a cold and clinical procedure without a thought for the consequences. An extremely thought provoking read that I will continue to think about and talk about in the future too.
