MIDWIVES: A NOVEL by CHRIS BOHJALIAN

The “Swiss Cheese Model” of system failure states that every step in a process has the potential for failure, to varying degrees. The ideal system is analogous to a stack of slices of Swiss cheese. Consider the holes to be opportunities for a process to fail, and each of the slices as “defensive layers” in the process. An error may allow a problem to pass through a hole in one layer, but in the next layer the holes are in different places, and the problem should be caught. Each layer is a defence against potential error impacting the outcome. For a catastrophic error to occur, the holes need to align in each step of the process allowing all defences to be defeated and resulting in an error. Each slice of cheese is an opportunity to stop an error. The more defences you put up, the fewer the holes and the smaller the holes, the more likely you are to catch/stop errors that may occur.

In 'Midwives', the layers were lined up with all the 'holes' in a row and Sybil Danforth, a lay midwife in rural Vermont in the early '80's finds herself on trial for manslaughter.

This book refers to Sybil's personal diaries at the beginning of each chapter, but the story is told by her 14 year old daughter, Connie who provides her perspective on the trial, her mother's midwifery practice and the complex family relationships that are tested during a time of high stress. I first read this book almost twenty years ago and I remembering liking it. When I came across it again recently, I decided to give it another read and had forgotten how much I had liked it. This one will stay on my bookshelf.

Before my retirement, I was lucky enough to work for many years as a labour and delivery nurse - really - the best job ever!  I could really relate to this book.  Sometimes, despite your best efforts things don't go perfectly and in this day and age, it has to be somebody's fault.  My heart went out to Sybil.