Each transition of the midwife character reflects the following themes throughout the novel. Aliases include Karen, Alex, Dusty for most of the novel, and finally, Jane. The unnamed midwife uses aliases throughout the novel. Through the midwifes travels, patriarchal confrontation propels the themes of the novel. The unnamed midwife travels north from San Francisco, North to East Oregon, and the East to Utah, finally settling in Missouri. The story of the unnamed midwife is narrated in both personal diary, short narratives.
The setting begins in San Francisco California after a fever has decimated the world's population.
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