Chapter 40: Oxford, Massachusetts – Summary and Analysis

⚠️ Spoiler Warning: This guide contains detailed spoilers for the entire novel. Proceed only if you've finished reading or are comfortable knowing the plot.

Summary

On February 28, 1760, Martha Ballard is at home with her husband Ephraim and their two young children, Cyrus and Lucy, when a boy of about ten arrives at their door. He insists that Elspeth Horne, the town’s elderly midwife, has sent for Martha. Martha protests that she knows nothing about delivering someone else’s baby, but the boy is impatient and Ephraim urges her to go. Reluctantly, Martha leaves her children with Ephraim and follows the boy to a tavern in Oxford. The boy, Walter, leads her to an attic room where a young, unmarried girl lies in labor. To Martha’s shock, Elspeth Horne is now completely blind. Elspeth explains that she called for Martha because she needs a steady-handed assistant and wants to pass on her knowledge to someone who does not panic in a birthing room. Martha, without prior consent, finds herself apprenticed to the blind midwife. She learns the girl’s name is Triphene Hartwell and begins to assist Elspeth. The chapter ends with Elspeth telling Martha that by the end of the night she will know whether midwifery is her true calling.

Key Events

A boy summons Martha to attend a childbirth, claiming Elspeth Horne sent for her.
Martha initially refuses, but Ephraim insists she go; he will watch their children.
Martha walks a mile to a tavern and climbs to an attic room.
She discovers that Elspeth Horne has gone blind since they last met.
Elspeth tells Martha she has been chosen as an apprentice because she is calm and competent.
The laboring girl, Triphene Hartwell, is young and alone; she resists at first but eventually trusts them.
Elspeth begins teaching Martha the tools and procedures of midwifery.
Elspeth declares that by the end of the night Martha will know if she is called to be a midwife.

Character Development

Martha Ballard: Martha begins the chapter reluctant and uncertain. She believes she lacks the skills to help another woman give birth. Yet when faced with the frightened girl Triphene, she instinctively offers comfort and reassurance. Her willingness to learn from Elspeth, despite her initial hesitation, shows her inner strength and compassion. This chapter marks a turning point: Martha stops seeing herself as just a mother and starts to accept a public role as a healer.
Elspeth Horne: Once a feared and competent midwife, Elspeth is now blind and physically vulnerable. Yet she remains sharp, direct, and authoritative. Her decision to take Martha as an apprentice shows her judgment: she values calmness and attentiveness over youth or sight. Elspeth is passing the torch, recognizing Martha’s potential.
Triphene Hartwell: A young, unmarried girl in labor. She is frightened and alone, reluctant to give her name. Her vulnerability highlights the risks women faced in childbirth and the importance of trust between patient and caregiver.
Ephraim Ballard: Though mostly offstage, Ephraim’s quiet insistence that Martha go shows his support for her emerging independence and his own capability as a father.

Themes, Symbols, or Motifs

Blindness and Inner Sight: Elspeth’s physical blindness contrasts with her deep insight into character and childbirth. She cannot see the room, but she perceives Martha’s steady nature and knows exactly how to guide her. This motif suggests that true wisdom and skill come from experience and intuition, not just sight.
Apprenticeship and the Transfer of Knowledge: The chapter is built around the passing of midwifery knowledge from an elder to a younger woman. Martha is chosen not because she is eager but because she is capable. This theme connects to the historical reality that women’s medical knowledge was transmitted informally through hands-on practice.
Trust and Vulnerability: The birthing room becomes a space where Martha must earn Triphene’s trust. Elspeth’s instruction to always ask the woman’s name underscores the importance of establishing a personal connection before touching her body. The scene emphasizes the emotional and relational aspects of medical care.
Calling versus Duty: Elspeth frames midwifery as a vocation—a thing to which one is “called.” Martha does not actively seek this role; it is thrust upon her. The chapter leaves open whether she will embrace it as her life’s work.

Why This Chapter Matters

Chapter 40 is a pivotal moment in Martha Ballard’s arc. It introduces her formal training as a midwife, a profession she will practice for decades and for which she will become historically known. The encounter with Elspeth Horne is a direct nod to the real Martha Ballard’s apprenticeship under an older midwife. Thematically, the chapter lays the groundwork for Martha’s growing independence and her shift from private domestic life to public service. It also reinforces the novel’s focus on women’s lives, community care, and the transmission of female knowledge in the colonial era. For the reader, this chapter deepens our understanding of Martha’s courage and the quiet heroism of everyday women.

Study Questions

1. Why does Elspeth Horne choose Martha as her apprentice, and what does this reveal about Martha’s character?
Elspeth says she chose Martha because Martha does not panic in a birthing room, having remained calm during her own difficult labors with Cyrus and Lucy. This reveals that Martha has a natural composure and strength that Elspeth values more than formal training. It also shows that Martha’s reputation for steadiness has preceded her.

2. What significance does Elspeth place on learning the laboring woman’s name?
Elspeth insists that the first and most important step is to ask the woman’s name. She explains that trust is essential when placing hands on a woman’s body, and that trust begins with knowing what to call her. This moment highlights the intimate, personal nature of midwifery and the respect a caregiver must show.

3. How does Martha’s attitude change from the beginning to the end of the chapter, and what does that suggest about her future?
At the start, Martha is reluctant and feels unqualified. By the end, she has spoken kind words to Triphene, accepted Elspeth’s guidance, and begun to work. Her willingness to learn suggests that she will indeed embrace midwifery as her calling, setting her on the path that defines much of the novel.