The Birth of a Book by Anna Kent

I started keeping a diary aged 10, describing my day or what food I’d eaten. Later, during my teen years, my writing would pendulate dramatically between the shock and confusion surrounding the Iraq War – to which boy I hoped to snog at the school disco. Writing became my safe space, my place to explore and understand my own thoughts and I would feel a sense of relief after being able to put the jumble in my brain down on to paper.

Aged 26, I was a qualified nurse with 3 years A&E experience when I joined the international humanitarian aid organisation Médecins Sans Frontières (MSF or Doctors Without Borders). Anticipating the new diary I’d purchased would become filled with stories of saving lives in South Sudan, I eagerly stepped aboard the rickety cargo plane that was to fly me into the conflict zone. This was to be my new home for the next year, living in a one-man tent and running the only health facility in a geographical area the size of Belgium.

I soon discovered how naïve I’d been. My ideas of aid work had been shaped through the lens of my privilege (and a feel-good Hollywood script or two). Now my writing spoke of how war inflicted unimaginable pain and horror on people. Of how the pregnant women I worked with seemed to bear the worst of the brunt: no access to a hospital, midwife or medications. This suffering was compounded by low social status, food instability and disease outbreaks, making South Sudan one of the most dangerous places on Earth to be pregnant. There was a disturbing local saying that a pregnant woman has one foot in the grave.

I never imagined that in my diary I would admit my shame for wanting to leave, to run away, to worry that I’m not cut out for this.

One diary entry talks vividly of a humid April evening. The frogs were croaking, and my colleague James and I were trying to sleep between emergencies. Shouts came to us from our clinic, and as we took the 10 steps to our facilities – just four mud and straw huts – our head torches attracted the night insects which bombarded us from every direction. Nyabol, a young Sudanese woman, lay bleeding in the mud. Her newly born baby clutched by her husband, her placenta retained and exsanguinating. Though I wasn’t, at that point, a trained midwife, Nyabol had no other access to trained medical help, the war had taken everything from her. An there in the darkness, I donned sterile gloves and manually removed the placenta, reading how to do it in my text book.

Though my colleague later patted me on the back, celebrating Nyabol’s survival, I was left reeling and scribbling in my diary how she deserved better. All women deserve access to dignified care and skilled medical assistance, regardless of where in the world they happen to have been born. I made a vow in the pages of my diary, I will become a midwife.

I also saw the best of humanity in South Sudan; the care neighbours gave to each other, the generosity of strangers, the celebrations of mothers and babies surviving against all odds. It was a privilege to work for a year with these amazing people.

Following my return to the UK, and joyfully gaining my First Degree in Midwifery, I returned to work for MSF in Haiti where there had been a catatastrophic earthquake. The following year I worked in Bangladesh, within an extensive refugee camp for stateless Rohingya people. In Bangladesh, the women I worked with were often traumatised. They had fled persecution in Myanmar and were forced to live in small shacks made of mud and plastic waste. By day I worked in the bamboo hospital, by night my diary would be filled with stories of obstructed labours, postpartum haemorrhage and eclamptic seizures, or victims of rape and trafficking. I scribbled down my dream about creating a birth unit where women could have 24 hour access to trained midwives.

My writing also described how I had fallen in love with a beautiful, but emotionally unavailable French man who would eventually break my heart. Despite the challenges, we achieved our goals and women today still have access to safer births at the birth unit in Kutupalong.

Returning home from overseas missions was tough. My suffering was obviously so much less than the women I had worked with, and I tried to ignore my symptoms of PTSD and moral injury, burying myself in NHS hard work and partying even harder. I was writing less in these times, not wanting to stop and think and reflect. Despite the thousands of women we had saved, the women and babies who had died came to visit me in my tortured dreams and I felt too ashamed to share this with anyone. One day, the pressure burst and I had a vivid flashback which scared me enough to finally seek professional support.

‘Have you tried writing these memories down?’ my therapist asked me kindly. Such an obvious thing to do and yet one I had been avoiding. But it helped, alongside cognitive behavioural therapy and exploring mindfulness.

The words I wrote became chapters, and those chapters became a book. The more I wrote, the more I understood my own story and my own responses, remembering all of the amazing and even hilarious moments, but also tough and harrowing times.

It wasn’t my intention to release my memoir when I first started to write, but I soon realised these words had become a testimonial. I felt the women who I’d had the honour to work with, especially those unable to tell their own story or who had died, deserved some ceremony. Some proof of their important existence. I still wanted to feel I was speaking up for them, in the only way I had left to do so. My book also felt like a tribute to the mental health burden of being a midwife, and how I was able to heal and become strong again.

To my amazement, four publishers offered to bring out Frontline Midwife. Eventually, I chose Bloomsbury Publishing UK.

I was so nervous in advance of publication – it’s hard to pinpoint for what, but I think I was afraid of rejection. I’d decided before I wrote the book, that there was no point in writing at all unless it was the truest version of what I had witnessed, and of my own successes and failings under the most extreme pressure. After years of keeping these secrets, disrobing in this way felt terrifying.

In fact, the feedback has been astounding! Brilliant authors such as Delia Ephron, Henry Marsh and Oliver Burkeman have not only read my book, but given tremendous reviews. I was so honoured to be chosen as one of The Independent’s non-fiction books of the month, and Emma Barnett gave me a great interview on Woman’s Hour. We’re even in the early development stages for a potential film or TV series.

Inevitably I get my unwanted share of online trolls, haters and unsolicited nude pics too, but the vast majority of feedback I get is positive. It’s been great too, to meet many new people online or at midwife conferences. A highlight was speaking alongside Joeli Brearley (founder of Pregnant Then Screwed) at The Hay Literary Festival, discussing how we could improve birth experiences in the UK.

I still work as an NHS nurse and midwife and have throughout the pandemic and my book release. I’m a single parent to an energetic 6 year old but I’m still writing, as it is so good for my mental health, it’s free and I can literally write anywhere.

The paperback of Frontline Midwife – Finding hope in life, death and birth, will be published in May 2023. It has been a wild year of taking risks and so many new things to learn, but also a year of unexpected surprises and catharsis, after having kept my secrets locked up in a diary for so long.