‘Middenrammers’ by John Bart

MiddenrammersReviewed by Rachel Carlson

Abortion and reproductive justice are divisive and iconoclastic issues rarely treated with any nuance or measure by mainstream media or literature despite the general acceptance of reproductive choice (in principle) by most Canadians. It’s a surprising topic for a first novel, even for a doctor like John Bart who places it at the centre of his debut novel, Middenrammers.

Bart graduated from the Royal Free Hospital School of Medicine in the UK in 1969 and moved to Toronto in 1973 to practice family medicine. While Bart is not an abortion provider, he told Eric Volmers of the Calgary Herald that he “can’t imagine any family physician who hasn’t met the effects of denial of reproductive rights face to face… people who are against termination of pregnancy or even contraception make their opinions known and the effect, the impairments are disastrous on some people’s lives.” Middenrammers attempts to chronicle and unpack these disastrous effects.

Set in the fictional coastal town of Sweport in 1970s Yorkshire, England, Middenrammers is primed for political and social conflict. Disillusioned by a recent stint as a student activist and revolutionary in 1960s Paris and Berlin, protagonist Dr. Brian Davis wants nothing more than to practice medicine and pay his bills. But, when he arrives in Sweport to practice obstetrics and gynaecology at the local hospital, he is confronted by economic and reproductive injustices he can’t ignore. He finds a likely partner and love interest in senior midwife Helena Woods – commonly known as Woodie. Together they challenge the conservative Catholic hospital administration threatening to eliminate the town’s access to abortion and contraception.

Middenrammers has an obvious mandate to advance the conversation around reproductive justice and choice, but the narrative has many gaps that don’t bridge the historical and present moments. The messages contained in the book may have been radical in a historical context, but the contemporary movement for reproductive justice continues to transform and respond to contemporary need and urgency.  There are new battles that need our attention, including the stigma and shame that continues to haunt reproductive choice.

While Middenrammers is written in a clean, clear prose with a penchant for extraordinary description, its focus is unsatisfying and confused. It relies heavily on outdated narratives of victimhood and predictable outcomes for stereotypical “fallen” women. It is a novel rich with missed opportunity.

One of the most remarkable and striking aspects of the novel – as one might expect from a doctor – are the vividly wrought medical procedures and imagery. As Dr. Davis performs an episiotomy, for instance, the technique is easily imagined and free from cumbersome medical language: “Making the incision was not as easy as I expected, though the tissues had been stretched tight as could be. They sprang apart as the scissors did their work. Small yellow pearls of fat glistened. Blood ran down and onto the thin, brown, rubber mat.”

Indeed, Dr. Davis is most alive while delivering babies: “My life now centred round the Delivery Suite. When I was there life was technicoloured, urgent, fulfilling; outside of it there was nothing of any importance. I was unbalanced, like a soldier in a distant war, cut off from home, but needed where I was.” This vivid aliveness, joy and urgency stand out along the continuum of the narrative’s concern with reproductive justice and choice. The Delivery Suite’s new mothers “who cried and laughed by turns, relieved, delighted—and ready to go through it all again if this were always the outcome,” stand in sharp relief against the dead women in the novel who sought abortions elsewhere.

Indeed, abortion is always something happening elsewhere in the novel. Even our pro-choice protagonist has never performed one. Instead, he imagines one during a procedure to remove abnormal tissue from a patient’s uterus: “It was easy to imagine how an early foetus, which resembles a cashew nut in shape and size but with time limb buds, would have looked in among the curettings.”

The reproductive-justice arc of the narrative is weakened by such subtle distancing from abortion and in its remarkable medical absence. There is an echo of the contemporary moment in this erasure. While the anti-choice movement in Canada has largely lost, many providers continue to work behind bulletproof glass and security doors. The unfounded stigma and inaccurate perception of abortion and what a procedure actually entails continues to loom large. Middenrammers is a missed opportunity to normalize abortion procedures, making the novel’s climax all the more deeply confused and problematic.

Spoiler alert: the novel culminates in the gruesome death of a local sex worker named Edna. She’s characterized as a sort of tragic clown and acts as a foil to the ultra-conservative hospital administration – in particular, to the grave, hard-edged surgeon Dr. Cooper. We are first introduced to Edna on the streets of Sweport: “She had large breasts and hips, and dyed yellow hair … Edna’s brown eyes were not quite aligned properly. Her crooked smile was amplified by bright-red lipstick. It was not well-applied. Neither was her mascara.”

Edna is a one-dimensional character primed for the advancement of the novel, but endowed with little humanity or consequence. She feels disposable and she is. At the end of the novel, she is abandoned inside a car at the front entrance of the hospital, semi-conscious, her uterus contracting and a baby’s arm hanging from her vagina. Dr. Cooper proceeds to use a pair of Richardson’s – an instrument resembling a bolt cutter – to dismember the half-birthed foetus, killing Edna in the process. Dr. Davis ponders the gruesome result of Dr. Cooper’s ministrations: “They lay on the seat, red, anatomically correct, but out-of-place pieces of a person who would never be.” This is the same rhetoric and imagery used by the anti-choice movement to stigmatize and sensationalize abortion and misrepresent the vast majority of procedures performed in North America. A visit to almost any “pro-life” website will show you this very image and claim it represents all abortion procedures.

One of the final passages in the book ends with a reference to Romans 6:23: The wages of sin is death. While the climax is attention-grabbing, it remains unpacked and relies too heavily on the dehumanizing stereotype of the fallen woman, the archetypical whore, who “pays” for her “sins.” It’s a confused message that does little to dismantle the anti-choice and fundamentalist Christian messages around abortion meant to shame the people who seek them and those who provide them.

Middenrammers ends with an ennobling (if a little on the nose) call to action: “We talk about Edna and the others, and we try to honour their memory. We may not succeed in freeing the women of Sweport, but, as Dr. Van says, ‘Your reach should exceed your grasp.’ We are reaching; I want you to know that.”

Ultimately, this novel is reaching to advance reproductive rights, but that reach exceeds the grasp.


Freehand | 192 pages | $21.95 | paper | ISBN 978-1-55481-318-6

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