Even if you’re solidly pro-choice, a novel celebrating abortion rights sounds about as appealing as reading every bumper sticker in the parking lot at a NARAL convention. Which makes the success of “My Notorious Life” all the more remarkable. While dramatizing one of the most contentious abortion debates in American history, Kate Manning lays out the gray moral landscape where physical imperatives still battle with conscience.

Manning’s novel is loosely based on the life of a 19th-century midwife in New York named Ann Lohman. After arriving from England in the 1830s, Lohman — eventually known as “Madame Restell” — began selling women’s medicines and performing abortions. Though largely unremembered today, the story of her career and trial is another one of those sensational tales carelessly misplaced in the attic of our historical memory.

As Manning freely admits, she’s taken a number of creative liberties with the details of Lohman’s biography, including changing her name to Axie Muldoon. “My Notorious Life” comes to us as a memoir long suppressed by the descendants of this “scandalous American character.” The novel’s most fanciful invention comes right at the opening. While the prosecution of the actual Madame Restell was halted by her suicide in 1878, in this colorful re-imagining Axie fakes her death by substituting the body of one of her patients. Vanishing behind a new identity, she sets down this “true history” in an Irish brogue that’s alternately sentimental and furious. The result is a Victorian melodrama that races along the back alleys and posh avenues of Manhattan for more than 400 pages.

The fundamental fact of mid-19th-century life that Manning impresses upon us is the ready possibility of starvation. It circumscribed women’s lives and influenced their behavior in ways utterly foreign to us today. During Axie’s Dickensian childhood in New York City, 35,000 homeless kids compete for food by begging, stealing and prostituting themselves. Babies are abandoned like unwanted kittens; half die in foundling hospitals before their first birthday. People who can’t work freeze to death or starve. When Axie’s mother gets her arm caught in a laundry mangle, the family’s prospects slip on that gory accident toward certain ruin. Here is America unburdened by all those onerous regulations and entitlement programs that sap initiative in today’s economy.

Manning takes her time getting to the legal confrontation that eventually dominates the novel, but she uses these early chapters to portray the traumas that will help us understand what motivates Axie later in life. Again and again, the girl sees that women bear the burden of men’s sexual desire; there is no choice, no freedom, no escape from grievous risk. To be female is to get pregnant, and yet the costs of that unavoidable condition are determined entirely by men, who maintain the rigid fiction of women’s moral duty to be chaste.

Cover of "My Notorious Life" by Kate Manning. (Scribner/Scribner)

This lesson is taught in blood at the home of Dr. and Mrs. Evans, two elderly quacks who take in Axie as a servant girl. Aside from her sharp eye for the details of domestic life in the city, Manning is also particularly good at capturing the transitional state of medical care when new biological insights were still being ground up with folk cures in the crucible of science. Reliable diagnosis of gynecological conditions was decades away, clouded by wacky ideas about the humors, the magnetic fluids and the risks of female intellectual exertion. (It’s funny to see that when Axie sneaks into her employers’ dusty medical library, she finds what all of us still discover when we type our vague symptoms into Google: You have a rare condition and will die in horrible pain.)

Fortunately, despite how little they know, the Evanses are among the more enlightened practitioners in town. From them, Axie learns that a pregnant woman’s body is “a miraculous machine,” not “a maladie to be relieved by a doctor.” Determined to figure out the source of her mother’s obstetrical misery, she pays special attention to the Evanses’ practice and eventually develops the skills to set up her own office.

Manning isn’t the first to point out that the history of medical science is infected by virulent strains of misogyny, but “My Notorious Life” presents a dramatic demonstration of what women faced as they tried to learn about their own bodies and take control of their health. At first, Axie provides simple advice and midwifery care, but soon, desperate women of all classes are begging her for relief from pregnancies that will ruin their reputations, cast them into poverty or even kill them. Slowly, tentatively, compassionately, Axie begins to help.

These were, as Manning graphically illustrates, desperate times. Given the mechanics of 19th-century prophylactics, it’s hard to believe anybody could ever get in the mood, but the “newfangled rubber pessaries” were apparently better than serial pregnancies. Axie advertises her “Lunar Remedy for Relief of Obstruction” in the highly euphemistic terms of the day, and there’s particularly high demand for her explanatory pamphlets. Her business flourishes under the benign neglect of policemen and legislators who grow queasy at the idea of women’s insides.

There’s no ignoring the strong pro-choice theme of this story, but Manning’s descriptions of abortions performed without anesthetics — “like cleaning the guts of a pumpkin” — are almost too painful to read. Her point, after all, is not the virtue of abortion, but its inevitability and the tragedy of denying that fact. Axie’s teacher tells her solemnly: “The soul of a midwife is a broad soul and a gentle soul, and she delivers the greatest blessing the Lord bestows on us poor creatures. But, a midwife must also keep comfortable with the complexities. What I call the lesser evil.”

Then as now, staying “comfortable with the complexities” is difficult when this most personal decision is thrust by loud, obnoxious men into the public arena. As the second half of “My Notorious Life” plays out, Axie finds herself dogged by yellow journalists and eventually by that towering, pre-satirized defender of American purity, Anthony Comstock. At 250 priggish pounds, he’s the perfect archenemy to keep Axie’s fiery story burning right to the end.

Polemic novels usually suffer from deadening preachiness, but Manning is writing in the venerable tradition of Stephen Crane and Frank Norris. Unburdened by our contemporary obsession with stylistic sophistication and ambiguous irony, those social reformers knew that a powerful tale with memorable characters could draw us into the heat of social debates like nothing else. This year, when asked whether Roe v. Wade should be overturned, a record-high 18 percent of Americans said they were “unsure.”

Axie Muldoon has a story to tell you.

Charles is the deputy editor of The Washington Post Book World. Follow him on Twitter: @RonCharles


By Kate Manning

Scribner. 438 pp. $26.99