Tag Archives: women

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.

These Days, Even Conservative Dads Want Daughters to Lean In

Appeals court judges who have daughters are more likely to make liberal or “feminist” decisions in gender-related cases than are judges who only have sons.  And it is the decisions of Republican-appointed male judges, typically conservatives, which make this pattern most visible.  This fascinating bit of political science research was reported in the New York Times a couple of days ago.


Photo credit: Brian Turner//flickr

This study’s findings are mainly about how judges voted on employment discrimination cases, which made up 92% of the relevant cases in the years under study.  These cases are about protecting women from gender-based discrimination at work, including when they are pregnant and become mothers.

What explains this Daughter Effect?  In the full paper, political science professors Maya Sen and Adam Glynn carefully distinguish amongst several possibilities.  They ask whether judges with daughters could be simply feeling protective and paternalistic.  But no, this doesn’t appear to be the case, because then we would expect these judges to come down harder on rapists and other sex-based assaults, and they don’t.  The Daughter Effect is limited to civil cases.  Similarly, it doesn’t appear to be a simple matter of self-interest, (wanting to protect relatives’ jobs) because the effect is no stronger with multiple daughters, and it does not appear to apply to judges who are the mothers of daughters.  They persuasively argue that this Daughter Effect is in fact the result of fathers vicariously experiencing what it means to grow up female.

The way Sen and Glynn describe it, “By having a daughter—and interacting with her and her peers—judges may learn about these issues [of sexual harassment, maternity leave and family medical leave], and this additional knowledge in turn informs their opinions.”  But I suspect it is something stronger than this, and more specific to our current moment.  I think these are fathers who not just understand their daughters’ struggles, but fathers who have supported their daughters’ ambitions, no differently than their sons’.  These professional men attended their daughters’ soccer games and debate matches, sent them to the best colleges, and cheered them on as they chose rigorous professions.  They saw them as children in their own image.  It didn’t matter that they were female.

And this was a real change.  These conservative professionals are different from their fathers.  They are not the generation that sent daughters to college for their “Mrs” Degree.  And, at least among well-educated men, they are by-and-large not the generation that expected their daughters to pick up their sons’ dirty laundry and make the dinner just because they were girls.  No, they expected their daughters to study for math tests and ace their SATs and be the first-chair cellist in the orchestra.  And when those girls did, their dads expected them to be justly rewarded.

The point is, in every generation fathers witnessed their daughters’ struggles.  But in this generation, they are finally outraged by them.  It is not simply a matter of fathers empathizing with their daughters; they envision a future for their daughters as fully-developed individuals, on par with men.

I find this very heartening.  Not so much because privileged men are able to sustain their families’ economic and social position whether or not they have sons, but because the legal decisions they make will potentially affect all American women.  If the pride and ambition these fathers feel on behalf of their daughters translates into equal protection at work and sensible, supportive maternity policies, we all benefit.