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The Last Midwife: England has a One-Child Policy. London living a nightmare worse than Gilead - a dystopian thriller you won't be able to put down.
‘I’m going to snuff out the old witches – every last one of them!’
Childbirth in England is a state-controlled procedure. 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.
Childbirth in England is a state-controlled procedure. 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.
472 pages, Kindle Edition
Published November 25, 2025
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Displaying 1 - 30 of 71 reviews
January 14, 2026
There were a lottt of typos in this book (kindle edition) which were hard to look past at times but I loved the story SO much (as twisted as it is)
November 6, 2025
Storyline: In this story, babies, referred to as Neonates, are only allowed to be born via a C-section. Midwifery is banned. Despite the ban, there are some who continue to practise the "dark art" of midwifery in this highly medicalised world. The storyline is compelling, with some unexpected twists to keep it interesting. The narrative arc builds up well, with a well-written rising action for the main characters. I found myself reading faster and faster as it progressed towards the climax. I could not put it down at the end- just as gripping as a Robert Harris novel!
World: A dystopian world with chilling parallels in current events. When is a baby a baby, and can it be disposed off before its status changes? In this world, the babies are only called babies when they are healthy and allowed to be taken home from the Genesis Centre. The sanitised, ultra-efficient city of London stands in stark contrast to the higgledy-piggledy unregistered slums on the outskirts of the city and the lush, natural surroundings of the last midwife's boat. I loved the descriptions of food in the book - Persian food, Italian food, herbs, cake recipes, tea. These details add richness and depth to what remains of humanity. I also love the description of women giving birth. The author writes these events from a deep, lived-through knowledge being a midwife herself!
Characters: A book is a great book with likeable protagonists! The novel features strong, likeable female leads with excellent character developmental arcs in Chiara and Rava. Chiara evolves from am innocent migrant nurse-in-training to someone who finds her true purpose in life. I also liked Rava; she transforms from a compliant wife to a fighter when she gets pregnant with a baby girl that her husband does not wish to keep. Both characters embody resilience, moral conviction, and the enduring strength of women in the face of systemic oppression.
Overall a very enjoyable, thought-provoking novel.
World: A dystopian world with chilling parallels in current events. When is a baby a baby, and can it be disposed off before its status changes? In this world, the babies are only called babies when they are healthy and allowed to be taken home from the Genesis Centre. The sanitised, ultra-efficient city of London stands in stark contrast to the higgledy-piggledy unregistered slums on the outskirts of the city and the lush, natural surroundings of the last midwife's boat. I loved the descriptions of food in the book - Persian food, Italian food, herbs, cake recipes, tea. These details add richness and depth to what remains of humanity. I also love the description of women giving birth. The author writes these events from a deep, lived-through knowledge being a midwife herself!
Characters: A book is a great book with likeable protagonists! The novel features strong, likeable female leads with excellent character developmental arcs in Chiara and Rava. Chiara evolves from am innocent migrant nurse-in-training to someone who finds her true purpose in life. I also liked Rava; she transforms from a compliant wife to a fighter when she gets pregnant with a baby girl that her husband does not wish to keep. Both characters embody resilience, moral conviction, and the enduring strength of women in the face of systemic oppression.
Overall a very enjoyable, thought-provoking novel.
June 12, 2026
interesting premise, very handmaids tale vibes
January 27, 2026
From a healthcare professional view point, the physiological birth stories were sympathetic and heart warming and the characters themselves completely loveable, admirable, and women I see myself in. Whilst I have inside knowledge of the way in which the world is going in terms of the changing attitudes to, and the medicalisation of, childbirth, I just feel some of the content went too far and I feel it would be very upsetting for some vulnerable readers. With that said, I would recommend this book, especially to my colleagues who face a daily barrage of criticism from the media all whilst trying to do their absolute best to accommodate families needs and wishes, but with a little caution for the more vulnerable readers.
January 25, 2026
Fantastic read. Best book I've read so far this year.
Thought provoking and scarey because it's horribly believable!
Well written and fast paced.
Love the main characters and the growth throughout the book.
Thought provoking and scarey because it's horribly believable!
Well written and fast paced.
Love the main characters and the growth throughout the book.
July 17, 2026
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.
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.
May 25, 2026
Oh my goodness. This book 😮
If it's not on your tbr then run to add it.
This is a dystopian thriller written by a midwife and I think that's why I loved it so much, as a midwife I can resonate with her thinking around this story.
This book is set in London and the new law means there is a one child only policy and midwifery is outlawed and If caught practicing midwifery they will promptly be arrested.
Women are not pregnant they are the "incubator", the babies are "neonates" and not officially the woman's until registered.
All babies are born by caesarean and if a healthy child is born the woman is sterilised. Women have no choice and have to wear wrist bands that show their reproductive cycle.
To give birth vaginally is classed as dangerous and midwives are witches. Women who do it this way are usually poor and shouldn't be having unregistered children.
The book follows new nurse Chiara’s journey to becoming “a good nurse” at the Genesis Centre, where women legally go to hand their babies. The author explores the hiarachy of the system and the coersion of how women are treated. It resonates so much as I feel personally as a midwife we are loosing slowly the practice of being a midwife.
The Last Midwife is a reminder of what is at stake if we lose sight of midwifery, autonomy, and our individual integrity. Although this is a made up fictional story it actually is scary to think this could happen in real life in the future. God help us if we step into a governed world like this where women's rights and their choices are ruled by man.
This book is beautifully but scarily written. I did shed a tear because of this story.
If it's not on your tbr then run to add it.
This is a dystopian thriller written by a midwife and I think that's why I loved it so much, as a midwife I can resonate with her thinking around this story.
This book is set in London and the new law means there is a one child only policy and midwifery is outlawed and If caught practicing midwifery they will promptly be arrested.
Women are not pregnant they are the "incubator", the babies are "neonates" and not officially the woman's until registered.
All babies are born by caesarean and if a healthy child is born the woman is sterilised. Women have no choice and have to wear wrist bands that show their reproductive cycle.
To give birth vaginally is classed as dangerous and midwives are witches. Women who do it this way are usually poor and shouldn't be having unregistered children.
The book follows new nurse Chiara’s journey to becoming “a good nurse” at the Genesis Centre, where women legally go to hand their babies. The author explores the hiarachy of the system and the coersion of how women are treated. It resonates so much as I feel personally as a midwife we are loosing slowly the practice of being a midwife.
The Last Midwife is a reminder of what is at stake if we lose sight of midwifery, autonomy, and our individual integrity. Although this is a made up fictional story it actually is scary to think this could happen in real life in the future. God help us if we step into a governed world like this where women's rights and their choices are ruled by man.
This book is beautifully but scarily written. I did shed a tear because of this story.
March 3, 2026
A harrowingly conceivable story that as a midwife was frightenly close to current maternity affairs.
The role of a midwife is illegal and in this dystopian story follows nurse Chiara and wife Reva in their journey.
I scored the book 4 stars as there are a few typos that distracted my flow when reading but overall this was a gripping enjoyable read that could infact be the future of maternity services in the UK
The midwife’s skills and advice were on point and not exaggerated to make for dramatic reading, the experiences of Chiara were at some point harrowing and would encourage the reader to check the triggers as #baby death/ loss does feature in the earlier chapters and was for myself difficult to read. Push through the dark times and the ending of the story is actually kind of bitter sweet but there is hope that the midwives will once again rise
The role of a midwife is illegal and in this dystopian story follows nurse Chiara and wife Reva in their journey.
I scored the book 4 stars as there are a few typos that distracted my flow when reading but overall this was a gripping enjoyable read that could infact be the future of maternity services in the UK
The midwife’s skills and advice were on point and not exaggerated to make for dramatic reading, the experiences of Chiara were at some point harrowing and would encourage the reader to check the triggers as #baby death/ loss does feature in the earlier chapters and was for myself difficult to read. Push through the dark times and the ending of the story is actually kind of bitter sweet but there is hope that the midwives will once again rise
June 20, 2026
This book is a cautionary tale about autonomy, freedom, women’s rights, greed and corrupt power. I really enjoyed this book and highly recommend it, even if only to encourage you to get involved in the fight for women’s rights and safe maternity care. For a debut non-fiction novel, I am impressed with the steady and engaging pace, which made it difficult to put down.
Set in a future dystopian London, the book follows Chiara, a nurse who has come to the UK from Sicily who wants to make her Nonna proud and care for others. Chiara begins work at the Genesis Centre, a high-end hospital where pregnant women are referred to as “incubators”, babies are referred to as “neonates” until they have both passed assessments to be released, only then are they called mother and baby. At the Genesis centre all babies are delivered via c-section and if the baby is assessed as healthy, the mother is immediately sterilised due to the one child government policy for a “fair world”. Giving birth vaginally, breast feeding and initial bonding are considered very dangerous and midwife’s are outlaws often scapegoated as witches. In a small amount of time, Chiara realises the truth about the “care” the Genesis Centre provides, which goes against everything she believes in and knows as a nurse. We are then introduced to Rava, a Muslim woman from a challenging low income background, who has married a soon-to-be powerful politician who just so happens to be the one overseeing the one child policy. The husband is very keen to have a boy only, he believes women are an expensive drain on society, so when Rava finds out she is pregnant, her world begins to fall apart and collapse. Chiara’s and Rava’s lives intertwine as they navigate the hellish maternity system, fighting for their own survival and the meaning of womanhood in a world dominated by corrupt men.
Population control is a central theme throughout the book. A one-child policy is in effect, with sterilisation pre-pregnancy being strongly encouraged and forced sterilisation occurring immediately after the birth of a healthy child. Furthermore, a euthanasia system is advertised as “peaceful rest” for those who feel their life is over and want to make room for the next generation. These measures are presented as personal choices by the government but corruption, social class, money and power ultimately change the rules.
If you enjoy dystopian future societies that feel scarily close to reality, books by Christina Dalcher, Margaret Atwood and John Marrs then this book is for you. I am really looking forward to the sequel which explores the euthanasia theme more.
Set in a future dystopian London, the book follows Chiara, a nurse who has come to the UK from Sicily who wants to make her Nonna proud and care for others. Chiara begins work at the Genesis Centre, a high-end hospital where pregnant women are referred to as “incubators”, babies are referred to as “neonates” until they have both passed assessments to be released, only then are they called mother and baby. At the Genesis centre all babies are delivered via c-section and if the baby is assessed as healthy, the mother is immediately sterilised due to the one child government policy for a “fair world”. Giving birth vaginally, breast feeding and initial bonding are considered very dangerous and midwife’s are outlaws often scapegoated as witches. In a small amount of time, Chiara realises the truth about the “care” the Genesis Centre provides, which goes against everything she believes in and knows as a nurse. We are then introduced to Rava, a Muslim woman from a challenging low income background, who has married a soon-to-be powerful politician who just so happens to be the one overseeing the one child policy. The husband is very keen to have a boy only, he believes women are an expensive drain on society, so when Rava finds out she is pregnant, her world begins to fall apart and collapse. Chiara’s and Rava’s lives intertwine as they navigate the hellish maternity system, fighting for their own survival and the meaning of womanhood in a world dominated by corrupt men.
Population control is a central theme throughout the book. A one-child policy is in effect, with sterilisation pre-pregnancy being strongly encouraged and forced sterilisation occurring immediately after the birth of a healthy child. Furthermore, a euthanasia system is advertised as “peaceful rest” for those who feel their life is over and want to make room for the next generation. These measures are presented as personal choices by the government but corruption, social class, money and power ultimately change the rules.
If you enjoy dystopian future societies that feel scarily close to reality, books by Christina Dalcher, Margaret Atwood and John Marrs then this book is for you. I am really looking forward to the sequel which explores the euthanasia theme more.
February 21, 2026
I love dystopian fiction and the premise for this one appealed to me when I saw an advert on instagram .i bought a copy and it went straight to the top of my reading list
The novel is setting in a dystopian England where the population has been confined to cities and and certain people are allowed to have children. This story follows a young girl who moves to England to work in a Birthing Centre. It quickly becomes clear that things are not right all babies are born by Caesarean section their mothers have no choice and babies showing any signs of Disability are euthanised at birth and women can only take their children home as a father signs for them. Our new nurse becomes quickly disillusioned and discovers an underground midwifery system with women who want to give birth naturally having to contact these black market midwives in order to do so.
The novel sets up well you’re quickly aware of what the dystopian world consists of. I quickly enthralled in the novel and didn’t want to put it down.
The author has a clear flowing writing style. This is an easy. Enjoyable Read.
The characterisation is detailed and the characters including some of the minor ones seemed really real
I’ve read a lot of dystopian novels and this is amongst the best if you like The Handmaid’s Tale you’ll love this novel or the the books of Christina Dalcher Viox and Q then I’m sure you’re going to really enjoy this book
I haven’t seen anyone writing about this on social media however I did see an advert which is the main reason I bought the book
It would make a great TV series
This review will appear on Goodreads, StoryGraph, and my book blog bionicSarahS books.wordpress.com. I will also publish it on Amazon UK.
The novel is setting in a dystopian England where the population has been confined to cities and and certain people are allowed to have children. This story follows a young girl who moves to England to work in a Birthing Centre. It quickly becomes clear that things are not right all babies are born by Caesarean section their mothers have no choice and babies showing any signs of Disability are euthanised at birth and women can only take their children home as a father signs for them. Our new nurse becomes quickly disillusioned and discovers an underground midwifery system with women who want to give birth naturally having to contact these black market midwives in order to do so.
The novel sets up well you’re quickly aware of what the dystopian world consists of. I quickly enthralled in the novel and didn’t want to put it down.
The author has a clear flowing writing style. This is an easy. Enjoyable Read.
The characterisation is detailed and the characters including some of the minor ones seemed really real
I’ve read a lot of dystopian novels and this is amongst the best if you like The Handmaid’s Tale you’ll love this novel or the the books of Christina Dalcher Viox and Q then I’m sure you’re going to really enjoy this book
I haven’t seen anyone writing about this on social media however I did see an advert which is the main reason I bought the book
It would make a great TV series
This review will appear on Goodreads, StoryGraph, and my book blog bionicSarahS books.wordpress.com. I will also publish it on Amazon UK.
December 29, 2025
Brilliant! I couldn’t put it down, reading late in to the night.
A clever story of love & survival with plenty of twists, turns & heart in the mouth moments.
A clever story of love & survival with plenty of twists, turns & heart in the mouth moments.
January 10, 2026
Very interesting
Very well written. Flows and good character development. Makes you think of what is happening in the world today. Thank you for a good read.
Very well written. Flows and good character development. Makes you think of what is happening in the world today. Thank you for a good read.
June 16, 2026
Wow what a ride! Call the Midwife meets Handmaids Tale. Very dystopian yet something that very well "could happen" Emotional and gripping from start to finish!
August 4, 2026
Tried listening as an audiobook but just couldn't get into it, not sure if the narrator I was listening to wasnt a right fit. Will maybe circle back when I can read it myself.
February 5, 2026
Very much enjoyed this book. Great originality. Scary peek into the future if men are allowed to rule women’s healthcare again
June 23, 2026
But the gateway to the world
Was still outside the reach of him
Would never belong to angels
Had never belonged to men
Was still outside the reach of him
Would never belong to angels
Had never belonged to men
February 2, 2026
wow what a book!!!
this booked had me hooked
this booked had me hooked
February 28, 2026
Chilling - I hated it but couldn't put it down
February 8, 2026
Karen Lawrence’s The Last Midwife is one of those dystopian thrillers that feels less like speculative fiction and more like a warning flare. Set in an England where childbirth has been fully absorbed into state control, the novel imagines a world in which midwives have been outlawed and reproductive autonomy has been reduced to a bureaucratic process. It’s chilling precisely because it feels so plausible.
The story follows two women whose lives sit on opposite sides of the regime. Chiara, a young nurse newly arrived from Sicily, enters the Genesis Centre with idealism and ambition, only to discover the violence and coercion hidden beneath its immaculate surfaces. Rava, the privileged wife of a government official, believes she is protected by her status—until her pregnancy fails to meet the state’s strict requirements. Their narratives converge in a way that exposes the system’s totalising reach and the fragility of any illusion of safety.
Lawrence’s world‑building is sharp and economical. She doesn’t rely on grand dystopian spectacle; instead, she shows how oppression embeds itself in paperwork, medical protocols, and the quiet erasure of traditional knowledge. The tension builds steadily, driven by the knowledge that every choice these women make carries enormous risk.
What makes the novel so compelling is its focus on humanity: the whispered solidarities, the courage required simply to help someone give birth, the stubborn persistence of care in a world determined to control it. The Last Midwife is both a gripping thriller and a thoughtful exploration of power, autonomy, and resistance.
A timely, unsettling, and deeply resonant read.
The story follows two women whose lives sit on opposite sides of the regime. Chiara, a young nurse newly arrived from Sicily, enters the Genesis Centre with idealism and ambition, only to discover the violence and coercion hidden beneath its immaculate surfaces. Rava, the privileged wife of a government official, believes she is protected by her status—until her pregnancy fails to meet the state’s strict requirements. Their narratives converge in a way that exposes the system’s totalising reach and the fragility of any illusion of safety.
Lawrence’s world‑building is sharp and economical. She doesn’t rely on grand dystopian spectacle; instead, she shows how oppression embeds itself in paperwork, medical protocols, and the quiet erasure of traditional knowledge. The tension builds steadily, driven by the knowledge that every choice these women make carries enormous risk.
What makes the novel so compelling is its focus on humanity: the whispered solidarities, the courage required simply to help someone give birth, the stubborn persistence of care in a world determined to control it. The Last Midwife is both a gripping thriller and a thoughtful exploration of power, autonomy, and resistance.
A timely, unsettling, and deeply resonant read.
February 21, 2026
If you like The Handmaid's Tale, you'll love this!!
June 16, 2026
4.5 ⭐️
As a midwife and someone who loves a dystopian novel, this was right up my street.
I really liked the characters and the world created was utterly horrifying.
As a midwife and someone who loves a dystopian novel, this was right up my street.
I really liked the characters and the world created was utterly horrifying.
February 14, 2026
great read!
This book was pretty good! It’s something so dystopian but sadly something you could see happening possibly in years from now. It’s a story of grit, perseverance, and courage!
This book was pretty good! It’s something so dystopian but sadly something you could see happening possibly in years from now. It’s a story of grit, perseverance, and courage!
May 25, 2026
as a midwife, this made me terribly sad for the women & families, but it was still so full of some lovely & precious moments. god bless liz & the rosie lee. god bless chiara.
February 2, 2026
Beautifully written Story
The Last Midwife is a beautifully written, emotional, and gripping story that I truly enjoyed from start to finish.
Karen Lawrence does an amazing job bringing the world to life and creating characters you quickly become invested in. I found myself genuinely caring about what happened to them, and that connection made the story even more powerful. The main character’s strength, vulnerability, and determination felt real and deeply human.
The pacing kept me turning pages, and the mix of tension, heart, and hope made this more than just a compelling story—it was an experience. I especially loved how the relationships between the characters developed naturally and added depth to every challenge they faced.
This was an engaging, heartfelt read with memorable characters, and I would absolutely recommend it to anyone who enjoys character-driven stories with emotional impact.
The Last Midwife is a beautifully written, emotional, and gripping story that I truly enjoyed from start to finish.
Karen Lawrence does an amazing job bringing the world to life and creating characters you quickly become invested in. I found myself genuinely caring about what happened to them, and that connection made the story even more powerful. The main character’s strength, vulnerability, and determination felt real and deeply human.
The pacing kept me turning pages, and the mix of tension, heart, and hope made this more than just a compelling story—it was an experience. I especially loved how the relationships between the characters developed naturally and added depth to every challenge they faced.
This was an engaging, heartfelt read with memorable characters, and I would absolutely recommend it to anyone who enjoys character-driven stories with emotional impact.
January 11, 2026
A really great read.
Excellent thought provoking read about a dystopian future in the U.K. Great believable characters I struggled to put it down.
Excellent thought provoking read about a dystopian future in the U.K. Great believable characters I struggled to put it down.
January 10, 2026
Honestly just read it. It’s a brilliant book although it’s a tad uncomfortable at times due to the nature of it. Thank you to our NHS midwife’s and Nurses
December 10, 2025
As someone who is very passionate about birth this book ticked so many boxes for me. Set in a dystopian London where physiological birth and midwifery is now illegal and all mothers “incubators” are subjected to c-sections and all of these other regulations on women’s bodies. Following Chiara and her journey as a nurse turned traditional midwife leads to unexpected turns and a fight to the end for what is right.
It gives hand maids tale vibes and some of the storylines are truly harrowing. I think the concept of neonatal 2 will always make me shudder. But also the joy of all the births on the Rosie Lee, it makes me tear up and brings me back to my own birth experience. Liz is such a character and I genuinely feel like we all know a “Liz” in midwifery!
But honestly, it’s not that far fetched to imagine some of this ideas could be our reality with the current maternity system being what it is and with increasing c-section rates!
Loved it and will recommend to all my other birth enthusiasts.
It gives hand maids tale vibes and some of the storylines are truly harrowing. I think the concept of neonatal 2 will always make me shudder. But also the joy of all the births on the Rosie Lee, it makes me tear up and brings me back to my own birth experience. Liz is such a character and I genuinely feel like we all know a “Liz” in midwifery!
But honestly, it’s not that far fetched to imagine some of this ideas could be our reality with the current maternity system being what it is and with increasing c-section rates!
Loved it and will recommend to all my other birth enthusiasts.
January 18, 2026
Surprisingly excellent
Wasn't to sure if I'd get into this book as not usually my thing , dystopian futures, but totally enjoyed it and read it in no time...a different take on wot may lie ahead for us as a population but not an impossible reality, if u enjoy books on midwives fighting not to become a thing of the past from being hunted out of existence I'll enjoy this book
Wasn't to sure if I'd get into this book as not usually my thing , dystopian futures, but totally enjoyed it and read it in no time...a different take on wot may lie ahead for us as a population but not an impossible reality, if u enjoy books on midwives fighting not to become a thing of the past from being hunted out of existence I'll enjoy this book
January 18, 2026
A must read
So clever on many levels. Really got me thinking about so many real world issues.
But that's not to say it's a boring or dull book, far from it. I read it in 2 days.
If you're even in the slightest bit interested in this book then I recommend you buy it, just make sure you've got enough time to binge read it!
So clever on many levels. Really got me thinking about so many real world issues.
But that's not to say it's a boring or dull book, far from it. I read it in 2 days.
If you're even in the slightest bit interested in this book then I recommend you buy it, just make sure you've got enough time to binge read it!
February 23, 2026
Not quite unputdownable — but definitely memorable.
I enjoyed this book and didn't guess the twists regarding Liz until just before it was revealed - it's scary to think of a future like this but I suppose anything is possible.
A mix between Call the Midwife and The Handmaids Tale
I enjoyed this book and didn't guess the twists regarding Liz until just before it was revealed - it's scary to think of a future like this but I suppose anything is possible.
A mix between Call the Midwife and The Handmaids Tale
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