Initially, I thought this might be like Christy (anyone else remember reading that?) but from a midwife's point-of-view. And in some ways, it was. But the author has crammed in a few things that made this just a little too difficult to give a 4 or 5 star to.
Patience was born Elizabeth, daughter of Illinois parents and apparently product of a good home. Then her parents die, and she's made a ward of the state. One day she runs away from the orphanage to join a show as a chorus girl... she meets a boy, gets pregnant, he dies and a little later she miscarries. New career: wet nurse. She runs away from her employers after the husband attempts to rape her and ends up in Pittsburgh. New career: assistant to a midwife. Then she meets and falls in love with a union agitator, accidentally kills him, and she (and the midwife) run away to the hills of West Virginia, where she keeps the profession but changes her name.
Now, any of that would have been enough back story for Patience/Elizabeth. But all together? It felt like it was a little too much. When she wept, was she crying for her lost life? her lost child? her finacee? her husband? killing her husband? It got a little tiring.
Her life as a midwife during the Depression was far more interesting. The people she meets, the different births and circumstances, ranging from wealthy to poor, calm to agitated, Old Order Amish to A.M.E., etc. are all part and parcel of life in that part of the world. She travels by bike, burro, horse and car; gets paid in food, coal, cash and promises; and ultimately takes over the entire birthing practice for the county, after the doctor leaves for Charlottesville and the black midwife, Mrs. Potts, dies.
The question of race is also discussed. Patience is race-neutral at a time when the KKK is resurrecting. Jim Crow laws exist, but she's largely unaware of them until her assistant, Bitsy, points them out (Bitsy is black). What got confusing, and felt a little anachronistic, was the flipping from "black" to "Negro" and back again.
ARC provided by publisher.