A Midwife’s Tale: The Life of Martha Ballard, Based on her Diary, 1785-1812 is a 1990 nonfiction biography of midwife Martha Ballard by American historian Laurel Thatcher Ulrich. Using Martha Ballard’s diary as a primary source, Ulrich utilizes a microhistorical approach to evaluate the life of Ballard, the history of Maine’s Kennebec River region, and the themes of social medicine, women’s role in the economy, and religion’s place in everyday life. A Midwife’s Tale won the 1991 Pulitzer Prize, the Bancroft Prize, the John H. Dunning Prize, the Joan Kelly Memorial Prize in Women's History, the Berkshire Conference of Women Historians Book Prize, the Society for Historians of the Early Republic Book Prize, the William Henry Welch Medal of the American Association for the History of Medicine, and the New England Historical Association Award. It was also adapted into a PBS docudrama film for the American Experience series. 

This guide refers to the Knopf Doubleday Publishing Group Kindle e-book Edition.

Content Warning: The source text and this study guide contain references to child/pregnancy loss, mass murder, and sexual assault.

Summary

The book begins with an Introduction that gives historical context to Martha Ballard and her life. Born in 1735 in Oxford, Massachusetts, Martha came of age in colonial America. In 1754, she married her husband Ephraim, with whom she had nine children. They lost three daughters during the diphtheria epidemic of 1769. In 1775, Ephraim moved north to Maine to work as a land surveyor. In 1777, the rest of the family moved to Hallowell, Maine, in the Kennebec River region, to join him. When they arrived in Hallowell, Martha began working as a midwife, a role usually reserved for older women, which is why she never took on the job in Oxford. By the time she arrived in Hallowell, Martha was one of the older women and was willing and capable of taking on the role of midwife in her new community. She also had some level of education, as demonstrated by her ability to read and write well enough to complete her diary as well as her ample medical knowledge, which she used to aid the laboring mothers and ill people of Hallowell. 

Ulrich explores the tapestry of social webs that existed in Hallowell, especially in terms of the collaborative economy of textile production. She draws a dichotomy between the work of men and the work of women, noting that at times they intersect (as in the Ballard household, when the men would provide the tools for the women to do their textile production), but at times the spheres of men and women were entirely separate. Men were allowed titles and offices in town and county leadership and in the church, while women were relatively invisible and marginalized in official records. Yet, despite their apparent invisibility in public records, Martha recorded the intricacies of women’s social lives. They worked together to produce textiles, they nursed each other when they were ill or postpartum, and they visited each other to offer friendship and support.

Ulrich dissects and examines Martha’s diary throughout the text, as she explains its structure and the repetitive, yet sometimes groundbreaking, content of Martha’s entries that explore historical moments (the Purrington murders, for example) and important moments in the community (such as Rebecca Foster’s alleged rape, for which Martha served as a witness in trial, as Rebecca confided in her about the abuse she endured), alongside the mundane details of her domestic work and the census-like numbers of births and deaths that she observed. 

Ulrich examines the difference between physicians and midwives throughout the text, demonstrating the nuance of the social and medical practices of the late 18th-early 19th centuries in America and Britain, and how they intersect with midwifery. Midwives were more frequently present at births, while doctors were more often concerned with greater medical emergencies and their political aspirations. Martha’s diary displays the care and empathy that she offered her patients, in addition to medical care so effective that she personally had a lower maternal-fetal mortality rate than the male doctors who practiced midwifery in her area.

Martha’s diary also demonstrates the hardships faced by her family. In the first half of the diary, the Ballard family is depicted as thriving, working together to achieve general financial success on their farm. Martha’s daughters all married and started their own families, having children and beginning their successful domestic economies in their homes. The family tree branches with each new marriage, connecting the Ballards more closely with their neighbors and the community at large.

In the second half, as Martha aged and Ephraim faced work difficulties and time in jail for debt, the family struggled to adjust, especially Martha, who tried to pick up the slack of the domestic work without any unmarried daughters still living at home to help. Martha also had conflict with her temperamental son, Jonathan, who misused substances and had anger management issues. Despite these personal challenges, Martha continued her medical practice, working as a midwife until her death, though at times her number of deliveries declined in times of poor health and the presence of another midwife. She found the strength to continue from her faith and her connection to God, though the growing plurality of Christian denominations in New England caused problems and conflict throughout Martha’s life, as demonstrated by the controversy over Reverend Isaac Foster’s theology and the growing Universalist ideas that some attribute to James Purrington’s motive for massacring his family. 

The arc of Martha’s life ends with her death, after a long, fulfilled life, surrounded by her children and grandchildren. Her diary passed between her female descendants until her great-granddaughter, Mary Hobart, worked to organize it before donating it to the Maine State Library. Martha’s diary has been used as a historical document in a number of publications before and since the donation to the library, but Ulrich’s microhistorical approach is unique in that it retains a close focus on both Martha Ballard the woman and midwife and her New England culture as a whole.