On the first hours of New Year’s Day, Martha Ballard buries the stillborn son of Ruth Emery, an eighteen-year-old unmarried mother whose labor ended with a premature dead child and no declaration of the father’s identity. Because the law requires the attending midwife to bury infants born dead, Martha has already hacked a grave from the frozen ground beneath a pine. Ephraim Ballard joins her, insists that the baby should not go into the earth unnamed, and quietly names him Nathan before he and Martha cover the body with dirt, snow, pine needles, and stones.

The next morning, Martha drinks coffee and begins her yearly review of the births she attended in 1789. She notes that she delivered thirty-nine of the fifty babies born in Hallowell and takes comfort in the fact that most were girls, because older midwives taught her that too many male births foretell war. Martha also lingers over the year’s four stillbirths, including Ruth Emery’s baby, and records in her diary that Ruth remains in grief after the loss.

As Martha studies her entries, she reflects on the hardships and judgments bound up in her work. She rereads the case of Clarissa Stone’s stillborn breech baby and angrily blames Dr. Benjamin Page’s incompetence for the child’s death, contrasting his inexperience with the trust some women place in a Harvard-educated man. Martha also remembers the danger of reaching patients at all, recalling a stormy spring journey across river, streams, and fallen trees, and she notes the vulnerability of unmarried mothers by revisiting the births of two illegitimate children, including Sarah White’s daughter.

Finally, Martha pauses her annual survey to honor a more personal grief: the twentieth anniversary of the deaths of her daughters Triphene, Dorothy, and Martha. She opens the family Bible Ephraim gave her when they married and traces the record of all nine of their children, grieving that she has already buried a third of them. Remembering that she was eight months pregnant with Hannah during that terrible summer, Martha acknowledges that the pain has never faded, then puts away the books and returns to the kitchen to be with the family she still has.