When my husband asked how many copies of The Last Midwife I thought I’d sell, I said a thousand would be amazing. Ten months after publication, around 12,000 readers have picked it up, it has more than 1,500 ratings on Amazon, and it won a gold medal at the 2026 Independent Publisher Book Awards (“IPPY” Awards).
It's my first novel, and I self-published it. But I could never have reached so many readers without professional help, especially a cover that stood out. Here’s how it happened.
From midwife to novelist
I had wanted to be a writer since early childhood — but a busy life of several careers (including finance and midwifery) and bringing up seven children left me with no time. That changed in 2020, when the Covid pandemic finally gave me space to sit down and write.
I worked as a midwife for the NHS, so I knew first-hand the pressures on midwifery care, and how important it is that women are supported to give birth as they choose. I was also worried about the growing medicalisation of birth and what it might mean for women and society.
So I began to imagine a world where midwifery had been outlawed. When I described the idea to a friend one evening, she said, “You've got to write that.”
The Last Midwife is set in a future London where childbirth is controlled by the state. A young nurse, Chiara, discovers the truth behind the walls of the Genesis Centre — while a handful of outlaw midwives risk everything to help mothers give birth in secret. My favourite character is Liz, the old midwife: feisty, down to earth, and with her heart 100% in the right place. She’s a blend of two or three midwives I worked with and loved.
Taking my time, then choosing to self-publish
I wrote the first 50,000 words during NaNoWriMo and had a full first draft within six months. Then it took another three and a half years, and many redrafts, to transform the novel into what I wanted. I read a lot, studied, and took courses, and I wasn't going to publish until the book was exactly right. I don't regret a minute of it. The story had to be about the issues, but first and foremost, it had to be a good read.
I chose to self-publish because I wanted to keep ownership of my work and get my story out without the long delays of a traditional deal. It has been a great choice, and I’ll definitely do it again.
When it was time to find a cover designer, a friend recommended Reedsy.
Finding a cover designer on Reedsy
I browsed several designers’ portfolios on Reedsy. I liked that I could send my brief to several designers at once, compare their offers, and choose the person who suited the way I like to work.
I wanted a designer who would bring his own ideas and deliver a professional, striking cover quickly, as I planned to publish by the end of November. Roderick fit the bill in every way: creative, professional, and responsive.
I liked a lot of the covers in Roderick’s portfolio. I felt he got the dystopian vibe I was after, and all his work looked very professional. The final design was largely Roderick’s idea, with only a few minor tweaks from me. I trusted his artistry and experience, and I was thrilled with the result.
Here’s how Roderick described his approach to the design:
"The idea was to reduce the story down to one simple image: a match flame forming the shape of a pregnant woman. It connects the themes of birth, danger and resistance without illustrating the story too literally. I kept everything else very stark so the neon flame becomes the immediate focal point, with the handwritten line adding a more personal, unsettling element."
I've kept coming back to him. Roderick has since designed the cover for my memoir, Letting the Light In, and I've commissioned him to create a special limited edition of The Last Midwife, out in time for Christmas 2026.
Promoting the book with enthusiasm
I've worked hard to promote the book. I've run Facebook and Amazon ads, posted consistently on social media, built my mailing list, and done book signings at several events, including midwifery conferences. The Last Midwife has also been reviewed and featured in several publications, including the Monkeynut Audiobook podcast. The audiobook and Kindle Unlimited editions have definitely helped sales too.
All that said, word of mouth has made the biggest difference. I’m lucky to have a network of midwife friends and others who were enthusiastic about sharing the book, and many midwives have written to tell me what it means to them and that they’re passing it on to colleagues. It’s wonderful to know that people I’ve never met enjoy my book and recommend it to their friends.
But the journey is just beginning. The book is now available on Kindle in Spanish, German, Italian, French, and Portuguese, and I’m currently looking for a film and TV agent.
What I’d tell other first-time novelists
Play to your strengths, and invest in professional support where it will make your book the best it can be. I think cover design is key: a good cover makes a huge difference to visibility and sales. I also paid for editing advice and marketing help before launch, and for my next novel I plan to add a professional copy edit.
Other than that, once you have a polished product, just throw yourself into promoting it. When you believe in your book, other people will want to know what it’s all about.
As for me, readers keep asking for a sequel, so now I’m writing one! It will pick up on the euthanasia theme from the job advert in the epilogue of The Last Midwife. My next novel, which I’m halfway through, should come together much more quickly — and I can’t wait to see how readers respond.
Karen Lawrence is a former NHS midwife and the author of The Last Midwife. She lives in Essex, UK. Find her at karenlawrenceauthor.com.
