The Birth House is a work of historical fiction written by Canadian novelist Ami McKay and published in 2009. The book was nominated for the International IMPAC Dublin Literary Award and won three Libris Awards from the Canadian Booksellers Association. The story takes place in the early 20th century during World War I and is set primarily in Scots Bay, a small shipbuilding community in Nova Scotia, Canada. While she is originally from Indiana, McKay lives in Nova Scotia in the house that inspired the book.

Plot Summary

Dora Rare is the only girl in a family of six boys and the first female Rare in six generations. Due to this and to the circumstances of her birth, she is viewed as an outcast by the superstitious town and thus is a natural ally of Miss B., the town midwife, who is regarded as a witch. At age 17, Dora moves in with Miss B. and becomes a midwife-in-training.

During Dora’s training in midwifery, Dr. Thomas, an obstetrician, sets up a modern maternity home nearby and tries to persuade the women of Scots Bay to abandon their midwives in favor of his facility. He makes arguments for the supposed benefits of new drugs and instruments that remove the pain and difficulty of birth. However, his heartless approach to his practice proves to be dangerous and removes the mother’s participation in her own birth experience.

Dora’s path to becoming a midwife is interrupted by her marriage to Archer Bigelow, who comes from a wealthy family and is regarded as a very good match. Faced with no real alternatives and blinded by hopes of a grand romance, she agrees to marry him. On the day of her wedding, Miss B. dies, leaving Dora more or less alone. Her husband quickly proves himself to be a selfish man prone to drinking, and he is very sexually demanding of Dora. He frequently leaves Dora alone, disappearing to the nearby city, Halifax. After failing to follow through on his plans to electrify the town with wind power, Archer drowns in a fishing accident.

Although ordered to give up midwifery by Archer, Dora still helps the women of Scots Bay when they need it. She delivers a healthy baby for a girl from an abusive home, and the girl dies. Dora gets the child she always wanted by adopting the baby when her family did not want her. Not long after, the mother of the girl who gave birth to Dora’s daughter, Wrennie, dies in a fall. Dora is blamed for causing her death, since she gave the woman herbs to end her pregnancy shortly before. Dr. Thomas leads the charge in using Dora as a scapegoat and threatens her.

Helpless, Dora flees to Boston, where she stays with her brother and his lover, Maxine. Max is the epitome of a modern, liberated woman and suffragette. While staying there, Dora learns how to embrace her independence while helping with an influenza epidemic.

Back in Scots Bay, the truth of the mother’s death comes out: Her abusive husband caused her death. Exonerated, Dora returns to her home and her daughter, stronger and wiser. In a final confrontation with Dr. Thomas, she defends herself and the young mother under her care. Later, she leads a march on the maternity home, and she and a group of women drive Dr. Thomas from the town. Dora also finds romantic happiness with Hart, the brother of her husband Archer, although she refuses to ever marry him, ultimately favoring her independence. At the end of the novel, Dora has transformed her home into the birth house, a sanctuary where women come to give birth and seek support.