The Birth of Love, By Joanna Kavenna

A complex exploration of madness and motherhood
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Four starkly disparate stories, all anchored in the agonising mystery of childbirth, lock together in Joanna Kavenna's ambitious second novel. Each account is framed by its character's grasp, perhaps partial, of the elemental force of procreation, either as an instinctive urge or a physically shattering, dangerous process. Fulsome with gory detail, Kavenna's rich emotional palette conjures mortal terror, exhausted surrender and endorphin-soaked, unalloyed bliss as well as subtler responses to her maternal material: indefinable yearning, humility in the face of the miraculous, a persistent questioning of women's ownership of their bodies.

Kavenna's opening thread, set a century-and-a-half ago in Vienna, finds a visitor to an asylum interviewing a raving inmate who claims to have killed hundreds of women. This inmate, Dr Semmelweis, had established a link between medics who moved from autopsy to maternity ward without washing, and the horrific ravages of puerperal sepsis – childbed fever, a hideously painful, epidemic killer. The scornful repudiation by the medical profession of Semmelweis's simple hygiene theory precipitates his mental instability and his assumption of personal guilt for failing to prevent future epidemics at the insalubrious hands of his patrician peers.

Meanwhile, in contemporary London, Brigid Hayes shuffles her cumbersome body slowly around her home while enduring both the pointed observations of her ghastly mother, and the onset of labour – which she desperately hopes will improve on her previous surrender to medical interventions. Elsewhere Michael Stone, a nervy and monastic novelist, is finally bringing forth his cherished work on Semmelweis, which, belatedly, he realises is the pompous product of his own sterility.

Set in 2153, Kavenna's fourth thread is an interrogation of prisoners who escaped their proscribed, artificial existence to subsist, half-starved but free, in what remains of the overheated natural world. This loveless future dystopia of eugenic species-maintenance coheres ideas roiling within the earlier narratives – of ties between parent and child, of the fundamental humanity of conception that, in some respect, men have always tried to control, or possess – but it also betrays a certain unevenness in Kavenna's prose style.

For all its Orwellian presence, this last tale is a hollow transcript, deliberately denuded of life but also lacking in conviction as an imagined future. The dialogue is forced and lacklustre, with little interest beyond delivery of Kavenna's mythic scenario. The Viennese asylum has similar drawbacks, with its line of enquiry resembling a congested pastiche of a Poe discovery or a Conan Doyle interlocution. Both sections contrast with the delicate skill of Kavenna's contemporary segments, which confidently navigate the emotional fog of Brigid's laborious position and the prickly idiosyncrasies of Stone's awkward heritage. These London narratives bear out the promise of Inglorious, Kavenna's courageous debut novel of untethered nervous breakdown, which used spare prose and arresting imagery to chart the decline, mental and social, of a seemingly competent professional into a homeless woman.

Mental instability clearly fascinates Kavenna; The Birth of Love is replete with complex nuances and presumptions that surround the state of motherhood and tangentially connect to ideas of madness in ways that recall the spiky outrage of Kate Millett's seminal The Loony Bin Trip. For all the unevenness of her quartet of lives, The Birth of Love is still elegantly crafted and compelling, and touches a core of humanity articulated, rather surprisingly, by the hermit-like Stone, when he reflects how we are all "governed by ancient impulses – a desire for human company, love, intimacy, family, a fear of darkness and the unknown, an aversion to pain, a curious sense of hope, despite everything". And Kavenna gives that "everything" a pretty thorough work-out.