Mainstreaming Midwives: The Politics of Change (review)

In Mainstreaming Midwives, anthropologist Robbie Davis-Floyd and sociologist Christine Barbara Johnson document the developments in midwifery in the United States from the 1970s to the present. The book covers the struggles and successes of lay midwives who sought to create an independent profession of midwifery, known since the 1990s as "direct-entry midwifery." Historians of twentieth-century midwifery often end their investigations at mid-century, when midwifery declined among such groups as Japanese Americans and African Americans. In this exhaustive collection of case studies and recent histories, the authors present the latest phase in the long history of American midwifery, this time among predominantly middle-class, white women.

The collection is strongly influenced by the birth activism and scholarship of Davis-Floyd, a medical anthropologist at the University of Texas, Austin: not only did she write or cowrite six of the thirteen chapters, but the other contributors make references to her encouragement and insights. The authors, mostly midwives and/or social scientists, frequently refer to the political motivations for their research, identifying their approach by such terms as "activist anthropology" (p. 314). These ethnographic studies of grassroots midwifery are built on dozens, even hundreds, of interviews with the various players.

The book's overall argument is that the efforts to legalize and professionalize midwifery through political activism, litigation, and legislation came at a price. The midwifery renaissance, the authors convincingly demonstrate, entailed competing cultures of midwifery. In particular, competition between nurse-midwives and lay midwives grew, and disagreements erupted among members within each group. Distinctions and power inequalities between nurse-midwives and lay midwives have a long history, as Laura Ettinger showed in Nurse-Midwifery: The Birth of a New American Profession (2006). The goal of the editors, therefore, is to provide a better understanding of the different perspectives and to urge collaboration and unity in the interest of midwife survival.

The book is divided into three parts that fit together nicely to reveal the hotly contested, multiple meanings of midwifery. Part 1 provides discussion of the two major national midwife organizations, the American College of Nurse-Midwives and the Midwives' Alliance of North America, and their creation of direct-entry midwife options. Nurse-midwives, who increasingly sought independence from nursing, nonetheless were dismayed by lay midwives' disregard for formal midwifery educational requirements and hospital training. Lay midwives, who struggled to retain the home as the site for birth and apprenticeship as a method of midwife training, were offended by efforts to turn midwives into university-trained practitioners. Part 2 details midwife activism and the legislative battles with state medical organizations and nursing organizations in Florida, Minnesota, Colorado, Virginia, Iowa, and Massachusetts. Part 3 explores key issues in moving midwifery into the mainstream, including the presence of "renegade midwives."

Overall, this is a fascinating book, although I take issue with a few assertions. First, Davis-Floyd labels this latest population of birth attendants "postmodern midwives" in order to highlight their differences from previous midwives who served various ethnic communities. She argues that postmodern midwives are "educated, articulate, organized, political, and highly conscious of their cultural uniqueness and importance" (p. 4)—yet, many of the Japanese American midwives who practiced along the American west coast and in Hawaii in the first half of the twentieth century also fit this description. Second, drawing on the case of Ontario, Davis-Floyd asserts that American midwives should follow the Canadian model of unified midwifery in which "all midwives can practice at home or in hospital and can offer the full range from low- to high-tech birth" (p. 65)—but this is simply not an accurate description of the situation for midwives in many Canadian provinces, including my own. Still, this book is a significant resource for scholars interested in American...