I'm going to start by being pretty clear about 'The Birth House': it's primarily a novel about women - their foibles, their relationships, their friendships, their loves - so steer clear if that sounds soppy or if you're after some gritty action! Set in an isolated fishing village in Nova Scotia in the years up to and during WW1, the novel follows the trials and tribulations of Dora Rare, the first girl to be born in 5 generations of her family.
Growing up, she befriends and then is apprenticed to the local midwife, Miss Babineau, and learns all the tricks of her trade, from births and infertility to unwanted pregnancies. And when Miss Babineau dies, Dora steps into her shoes - except with the advent of World War 1, modern medicine and marriage, she finds herself fighting against a whole host of problems: a doctor who wants to 'revolutionise' the process of giving birth and shut Dora out of the picture, the loss of her brothers, and a marriage which is, shall we say, less than satisfactory.
On paper, this all sounds fantastic and in some ways the novel really delivers: Nova Scotia is beautifully evoked in all its windswept, isolated glory, and McKay is particularly good at depicting the bitchy, gossipy atmosphere of a small town. I also thought the shift into the more serious world of WW1 was well handled. Dora herself is the narrator and she is a vivid character, likeable, independent and resourceful, and the frustrations of her life are related with enough verve to sustain interest in them throughout the book. The friendships and companionships between the women are also well described, with a real compassion for their sufferings and the limitations placed on them by the society they lived in.
However, I did have a big problem with the unrealistic elements of the novel, which sometimes verged into the cringeworthy. Too often, it felt as if McKay was forcing the plot to do strange leaps and bounds in order to fit something in - for example the scene in which Dora's uptight aunt (who disapproves highly of her niece) comes to Miss Babineau for a, well, frankly dodgy procedure. You'd think Dora's aunt would make Dora leave. Or come back another day when her disapproved-of niece wasn't around. No, no, she just gets on the table and whips her knickers off in front of Dora and Miss Babineau. Come on!
Come to that, the character of Miss Babineau was another cringeworthy sticking point for me. She's supposed to be from Louisiana, and consequently speaks in a weird kind of Creole patois. Fine (if a little corny), but the reason for her leaving Louisiana and choosing, of all places, the coast of Nova Scotia is never fully explained other than that she WALKED ALL THE WAY, which leads me to suspect McKay just wanted to stuff in an exotic character so she could have a bit of fun with the accent and talk about witch-doctors and mysterious Southern medicine women. There just wasn't enough coherence to this character.
I think a lot of the problems I had with the novel were to do with loose ends, unexplained events and things being too quickly tied up, of which there were just too many. A few would be okay, but as it was the whole thing was just too meandering to be a truly satisfying read. I mean, Dora leaves Nova Scotia and then returns again, seemingly for no real reason. A terrible thing that happens is sorted out with no repercussions or troubles at all. Troublesome or difficult people are conveniently dispatched, babies appear when they're needed, wives are found for lonely men, etc, etc.
I also found it all perhaps a bit too 'cosy', for example the constant references to "mamas" (as in, "mamas need looking after", yuck) cutesy 'recipes' given at the end of the book: "Write your wishes on leaves of bay, burn them and they'll come true the same day" (double yuck).
It wasn't a bad read, and I certainly kept going until the end, but I did finish it with a sense of vague disappointment. It didn't need to be grittier - there's a place for comforting, reassuringly pleasant books - but it could have done with tightening up overall and having some of the hokier bits taken out and certain characters (Miss Babineau, Dora's aunt, the Bad Husband and the Liberated Woman in Boston all spring to mind) modified to remove the cringe-factor. It's not a terrible book, but there are definitely better examples of cosy, women-centric fiction out there if that's what you're after.