Writing in The New Yorker about the BBC's Call the Midwife, Emily Nussbaum praised the television series, calling it "a portal to a primal experience" and "a safe place for dark truths, among them the many ways in which birth can be a terror, something that no one is designed to go through alone." Most mammalian species find a quiet place to hide when their time to deliver draws near, but it is a peculiarity of humans to seek not just companionship but help through the storm of labor. Human pelvises are shaped such that the optimal position for pushing a baby out is with the baby facing its mother's spine; bipedalism being what it is, it's not easy for a woman to catch her own baby safely as it emerges, much less unwind the umbilical cord from its neck if need be. Hence midwifery, a word whose etymology expresses its essence: a midwife is a 'with-woman.'

It is also a peculiarity of humans—and perhaps women in particular—to regard this primal passage as rich in metaphorical meaning: not without reason does Genesis, in its earliest chapters, assign a theological etiology to pain in childbirth. To be human in a world that is not as its Creator wishes it to be is to accept that the transcendent joy of new life is inextricably wedded to blood and sweat, to pain and to death: in Jewish tradition, beginning in the Torah, a woman must be purified after giving birth not because she is 'dirty,' but because in giving life she has touched death. "When a woman gives birth," says Francie Nolan's Catholic grandmother in A Tree Grows in Brooklyn, "death holds her hand for a little while."

Even so, most fictional accounts of childbirth are either laughably inaccurate—involving montages of screaming women, baffled husbands, and babies arriving with improbable rapidity—or else neatly excised from the narrative. Call the Midwife is, as Nussbaum notes, an exception, turning its unblinking, gracious gaze on working-class Londoners straining and grunting their babies into the world, and on the midwives and nuns who kneel in their flats and their lavatories to hold them up, catch their babies, urge them on, and wipe the sweat from their brows.

Pamela Erens' novel Eleven Hours centers on a pair of women: Lore (pronounced as a single syllable like the 'lore' in folklore), who is about to give birth to her first child, and Franckline, the nurse who is caring for her. Franckline is pregnant but has not yet been able to tell her husband; her last pregnancy ended in miscarriage, and the one before that—when she was just a teenager in Haiti—ended in the birth of a baby boy who lived just three days. Lore comes to the hospital alone, self-possessed and sure of what she wants: nothing to blunt the pain, unshrinking from the unpleasant possibilities, no one to make decisions for her. Franckline and Lore form an implicit, if reluctant, bond for the eleven hours until Lore's labor—and Franckline's shift—ends.

Erens' command of the physical, social, and psychological details of pregnancy and labor is impressive. There is, in labor, a sense of being confined, of passing through some strange, isolating tunnel; Lore thinks of how incongruous it seems that the father of her child, who betrayed her with her best friend, "should be rising for his day, comfortable, while she would soon be twisting in pain on a hospital bed." Bit characters, like the falsely cheerful nurse who repeatedly mispronounces Lore's name and the "Hispanic, probably Dominican" father who waits in the hallway and "tips up his chin in acknowledgment of Franckline's greeting" are rendered vividly, and Franckline's rush to the bathroom to check for blood on her underwear that would signal the impending miscarriage that she fears is the kind of episode that many people have experienced and few have put into literature.

Lore is a believable character. We are given to know that she grew up without a father and that she was a mother to her ill, now-deceased mother—they were "two females, doing what females do: getting by." We know that Lore has refused all prenatal tests: "she would accept this child in whatever condition it arrived." We know that she has neither brought home a rocking chair nor decorated a room for the baby: "it is not good to tempt fate." And we know that she has a detailed, many-page birth plan, which indicates her wishes in a variety of possible eventualities: if the baby dies, she wants to hold it, to plan the funeral herself, and "not to be given tranquilizers or drugs that blunt feeling." Without Franckline's guidance, though, she fights the pain, trying to muscle through it, as she does through life, instead of giving in to it—riding its waves wherever they take her, which is how it must be done. ("Having a child is usually just a long patience," Franckline says, teaching Lore how to groan in a way that helps labor along instead of impeding it.)

Silently Franckline—who is far less developed, and doesn't quite become more than a cipher of an honest, compassionate, hardworking Haitian nurse—muses: "How pointless it is to fight the body and the pain it sends, stretching and widening one to make new life, demanding that the self fall back and make space." Lore learns this "strange glee" of falling back, of having "flung her pain into [a] public space, not caring who observed it, whom she discomfited."

Birth's paradoxes are many, and as such, it is potent metaphor: babies arrive drenched in their mothers' blood, a woman at the peak of labor looks weakest when her muscles and her will are working their hardest, and the earthiest of experiences is—or can be—the most transcendent. Eleven Hours disappoints, however, in its rigid adherence to the titular conceit. All that we know of Lore's background we learn from her musings in between contractions, and this is where plausibility breaks down.

The well-known hippie midwife Ina May Gaskin often invokes "the monkey brain" when speaking of the optimal mental state with which to endure an unmedicated childbirth, and with good reason: thinking about complicated relationships and tragic personal histories has no place in the birthing room. More often, the physical experience simply drives out thought. (Emily Dickinson: "Pain has an element of blank; / It cannot recollect / When it began, or if there were / A day when it was not ./It has no future but itself.") It is possible to imagine a literary work evoking with verisimilitude the span of a woman's labor; such a project would likely be labeled 'experimental.' Additionally, Erens tends to overexplain: Lore, a single mother in a childbirth class of expectant couples, felt awkward because she "stood precisely for the fact that things did not turn out as you planned." Erens conjures the roomful of happy pairs and lets us know that Lore had to partner with the instructor to practice support exercises. Erens could have trusted the reader to understand, but over and over, she doesn't.

In an essay for The Slate Book Review, Erens asks, "why shouldn't stories of labor and delivery become vehicles for exploring … will and fate, courage and terror, love and hatred, meaning and emptiness, power and impotence, the fleshly and the transcendent?" If the nauseating violence of war—of bodies flayed, stopped and bloating on battlefields—can "provide the backbone of our literary tradition," as Erens writes, why shouldn't we write of the writhing, the bloodshed and tears of that journey each of us must make from our mother's body? Eleven Hours is a welcome attempt to right the balance, and give women's labor due literary attention. But labor, finely rendered, should need little explanation; the author should be the midwife of the reader's conception, not its commanding officer.

Rachel Marie Stone teaches English at The Stony Brook School in New York, and is the author of several books, including most recently the 40th anniversary edition of the More-with-Less cookbook, coming later this year from Herald Press.

Copyright © 2016 by the author or Christianity Today/Books & Culture magazine.
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