Tag Archives: motherhood

Coming Home: How Midwives Changed Birth (review)

It’s a rare academic history book that tempts me to binge-read.  Wendy Kline’s Coming Home: How Midwives Changed Birth is one of those special finds.

Cover for 

Coming Home

Admittedly, Kline writes about a topic I find inherently fascinating: the re-emergence of home birth in the United States in the latter decades of the twentieth century and early decades of the twenty-first.  Kline’s approach is typical of nuanced, heavily-researched academic history in many ways, with topical chapters that provide novel analysis and contribute to the larger literature in the history of reproduction, health care, and women’s rights.  Its special appeal comes from its clear and well-organized writing style that allows the narrative to flow and the arguments to seamlessly emerge, combined with Kline’s evident empathy and affection for the midwives, physicians, and birthing women whose history she locates in a fantastic trove of privately-held documents, institutional archives, and oral histories.

Over the course of the late nineteenth and early twentieth centuries, midwifery nearly disappeared from the American scene, and hospitals became the normative place to give birth.  Middle-class women chose physicians to attend their births, and midwives came under regulatory scrutiny.  While many midwives who served urban immigrants at the turn of the century had been formally trained in Europe, in the United States they were regarded dismissively by physicians’ organizations.  “Granny” midwives continued to serve poor rural African-Americans in the south, under heavily-circumscribed licensure, but they were regarded as a backstop for women too poor to hire a doctor.  Midwives and home births looked like they would become relics of the past.

As Kline shows, though, some the seeds of midwifery’s rebirth were already planted, in some unexpected places, in the decades when birth was gradually moving to the hospital.  Home birth survived in Chicago, provided by the Chicago Maternity Center, founded as the Maxwell Street Dispensary by famed obstetrician Joseph DeLee in 1895.  DeLee is known for his outsized role in moving birth from home to hospital, and yet, because he saw home births as an ideal way to train young doctors, he supervised a robust operation that trained physicians in the skills to attend poor women in their homes.  Some of those physicians would become advocates and mentors for home birth midwives in the 1970s. 

Home birth received another boost from La Leche League, a breastfeeding support group founded in a Chicago suburb in the late 1950s.  La Leche League’s founders were Catholic women who valued large families and saw childbearing and rearing as women’s primary purpose.  Just as they wanted to experience immersive motherhood via breastfeeding, many also regarded natural childbirth as central feminine experience.  This often meant delivering at home, and thus, home birth skills were preserved in the middle-class Chicago suburbs in addition to the inner-city neighborhoods served by the Chicago Maternity Center.

In the late 1960s and early 1970s, a swirl of social changes combined with widespread dissatisfaction with the alienating procedures of typical hospital births provided fertile soil for the emergence of home birth practitioners in many locations simultaneously.  Kline specifically examines the Washington, D.C. area, where childbirth educators led a white, middle-class home birth movement that was largely funneled through the Georgetown University nurse-midwifery training program, as well as the wild and wooly California hippie homebirth scene.  By the time Kline addresses the most iconic of homebirth advocates, Ina May Gaskin, and the anti-war school bus Caravan travels during which Gaskin and her fellow travelers taught themselves midwifery from a manual for third-world rural midwives and the hands-on experience of their own births, it is clear that the homebirth movement was much bigger than just its most colorful figures.  Kline includes mystical, psychedelic births in teepees and school buses, but she situates them in the counterculture’s broader critique of mainstream society and medical culture, in a sensitive and nuanced reading of that counterculture and its place in a larger reaction to dehumanizing medical practice.

Later chapters address homebirth midwifery’s struggles with legal recognition and the challenges of developing a structure for a profession full of practitioners wary of routinization.  A chapter on a sting operation carried out on the Santa Cruz Birth Center in 1974, pitting legal and medical authorities against a successful and popular unlicensed midwifery practice, contains one of the biggest archival treats of the book: material from the diary of Kate Bowland, the midwife at the center of the case.  Kline’s reading of the diary is an insightful peek into the thoughts of a central actor at a moment when midwives’ attempts to weave together their best practices, their spiritual insights, and physician backup broke down under legal pressure.   It is also a powerful homage to historian Laurel Thatcher Ulrich’s iconic close reading of early-nineteenth-century midwife Martha Ballard’s diary in A Midwife’s Tale.  Midwives gain insight and authority from tracing and understanding their lineage; so do feminist historians of birth.

In the late 1970s home birth midwives came together to create their own professional organization, the Midwives Association of North America (MANA), while a group of practitioners in Seattle organized one of the first schools for non-nurse midwives in the United States.  As home birth midwifery developed its institutions, at each step, organizers worked to construct a set of shared commitments, knowledge, practices, and institutional arrangements that they believed would best serve their goal of facilitating safe and meaningful births.  Kline gives her reader a sympathetic picture of earnest and idealistic organizers working through inevitable contention to create organizational structures that would recognize and respect the range of legitimate birth practices its practitioners had developed, while reassuring regulators and birthing families that they were offering high-quality services.

We academics sometimes are tempted to talk over our sources, anxious that without explicit interpretation at every moment, our readers won’t take our point.  Kline knows how to get out of her sources’ way and let them tell their own stories, when she brings them into the narrative.  She uses her oral histories judiciously, with the kind of finesse that lets them shine.

Coming Home is an important book for anyone who cares about the history and future of birth in the United States.  Whether or not we would consider a home birth for ourselves, it is inspiring to understand how home birth midwives sought to improve the experience of birth, dedicated themselves to offering care their clients valued, and worked to create organizational structures to be able to offer consistent, safe, legally-sanctioned care to birthing families across the United States.

“Cherish Every Moment” of Parenting?

“Cherish every moment!  It goes by so fast.” A well-meaning stranger admired my teeny tiny 3-week-old son, as we searched for baby wipes at the local drugstore.  Out on our first foray into an inhabited, public space, I was ready to defend my newborn against strangers’ germy fingers, but I had not been prepared for the free advice I might find just as difficult to handle.  I smiled thinly at the friendly stranger, and said, “uh huh!”  But I was thinking, “are you nuts?!  I’ve been on a forced march around Berkeley for most of the past 18 hours with this crazy baby who won’t sleep unless he is in my arms and I am on my feet.  I am not cherishing.  I am just barely coping.  And soon I will not be coping, I will be crying in a heap on the floor in this CVS.”  And I walked home, wondering what kind of a lousy mother I was, barely able to survive motherhood, when experienced parents seemed to think I should be having a fabulous time.

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“Cherish every moment!”  I heard this while I was with my babies grocery shopping, strolling through town, bouncing them in the lobby during church, even several times on airplanes.  Somehow, it was never when my children were doing something adorable and easy-to-appreciate, like making woodchip ice cream cones at the playground and serving me any flavor I wanted, even when I asked for broccoli and asparagus sorbet.  It was when they must have been looking pretty cute at the moment, but a minute earlier the baby had been destroying the stroller canopy just to get my attention, while the toddler was dragging at my hand and whining that we just had to stop for a donut at the cafe or he wouldn’t walk another step.  For a long time, nearly every time I heard it, I would be left terribly guilty for what I was actually feeling, which was much closer to “tolerating” than “cherishing.”

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When my elder son was six months old, I took a solo cross-country plane flight with him.  He cried on the way up, but he wouldn’t nurse, he just latched on and pulled off repeatedly, until I was in too much pain to keep trying and I just bounced and shushed him helplessly as he wailed.  He did finally calm down, but I was pretty shaken and wondering how we would make it through the flight.  After several touch-and-go hours, while we were pacing up and down the aisle, an older woman stopped me: “It goes by so fast — cherish every moment!”  This time, I just couldn’t agree with her.  I said curtly, “yes, well, sometimes it doesn’t go by fast enough.”  She smiled and replied, “oh, yes, the days can be slow, it’s the years that fly by.”  What a relief.  She didn’t expect me to be enjoying myself necessarily; she was trying to tell me something else.

As my children grow, I have spent a lot of time pondering what that “something else” might be.  I am starting to understand it better, now that I have emerged from the overwhelming experience of parenting babies and toddlers.  My younger son recently turned 7, and lives most of his life as a “big boy,” the baby in him only re-emerging when he is particularly tired or scared.  My two boys have grown so capable, chasing each other on the playground, carelessly dashing and swinging and throwing themselves from one playset to another, and I have to remind them not to run over the little ones.  Now I am one of those friendly strangers who grin at cute babies and chat with wobbly toddlers.  I feel myself light up at the unbearable sweetness of small children with their big eyes and busy hands exploring the world.  I find myself tempted to pass on my own pearls of hard-earned parenting wisdom to the caretakers of these precious little beings.

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Might I be tempted to tell one of my fellow travelers at the playground, as she strategically positions herself under the playset to catch an unsteady but ambitious new walker, to “cherish every moment?”  No — not yet, anyway.  But I am starting to understand the temptation.  At those moments, when the tedium of playground tending turns to reflection, I think about what exactly it is that other parents have been trying to share with me.  At this point in my parenting life, I understand “cherish every moment” to mean several different things.  It can mean, “Watching your child reminds me of the best moments with my own.”  It can mean, “I wish I had had the patience and perspective to enjoy what is so sweet about this stage, when at the time it mostly seemed hard.”  Most profoundly, I think people mean, “Your child is a blessing on the world.  Thank you for bringing her out into the world, for sharing a few moments of her sweetness and life with me.”

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I choose to hear the last meaning ring the loudest. I do not have the strength to take on strangers’ regret, or to regard the present moment with nostalgia that is meant for the past. And parents inevitably have a different relationship to their children than do casual acquaintances, or even extended family members.  Parents’ relationships with their children are deep, and imbued with responsibility, and weather many, many conflicts over time.  We often can’t see pure sweetness in our toddler’s grin, because we know it’s the grin he flashes just before he runs into the playground parking lot just to make us dash after him and scoop him up into safety, our hearts pounding and our voices scolding.

So, if you are a kind stranger chatting with my adorable children, please understand that I cannot, in reality, cherish every moment.  But, now that I understand something more about what you mean, I gladly share this particular moment with you.  And I will try to see it through your eyes, and enjoy it with you.

If you are the frantic parent of the restless toddler on the airplane, or the wriggly baby in the church pew in front of me, thank you for sharing a moment of your little one’s life with me.  He is a blessing on the world, a reminder of why we keep going, of why we become parents.  Thank you for doing the hard part, so that I can savor the sweetness of his tiny fingers and mischievous smile.  I will not tell you to cherish this moment, but you can be sure that I will.

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Maybe my perspective will change again as my children grow, when they start to find my lap too small, and prefer friends’ company over Mommy’s, and don’t need to be tucked in, and make their own plans, and eventually leave for college.  Maybe I will feel more regret, more nostalgia, wish that I had been more patient, and more accepting, and parented with more perspective.  Maybe I will want to urge young parents to cherish every moment, to see what I failed to see myself.  From what I can know right now, though, I hope that I will accept that parenting is bittersweet, and that even the good parts are often too intense to be precisely enjoyable.  And I hope that I will be free to cherish the fleeting moments I will have with adorable babies in church and on airplanes and in grocery stores, all the places where I am so much more likely to enjoy them than are their parents.  And, most of all, I hope that I can let those moments bring back wonderful memories of my own sweet boys, when they were chunky babies and rollicking toddlers, and enjoy those memories with just a faint spice of fond nostalgia.

If You’re Not My Kid, Please Don’t Call Me “Mom”

The dentist peered in my child’s mouth, then turned to me. “Hey, Mom, you did a good job, no cavities!” I brought my kids for a check-up recently, and our wonderful pediatric dentist warmly complimented me. But why on earth did he call me that? And why did it irk me?

Read the rest at Nursing Clio