Reading Birth and Death: A History of Obstetric Thinking (review)

Jo Murphy-Lawless. Reading Birth and Death: A History of Obstetric Thinking. Bloomington: Indiana University Press, 1998. vii + 343 pp. $39.95 (cloth), $19.95 (paperbound).

Childbirth is a subject that lends itself to examination from many disciplinary perspectives. In this book, Irish sociologist Jo Murphy-Lawless suggests how her discipline might "read" obstetric texts from the eighteenth and nineteenth centuries, and then she uses that reading to interpret current obstetric practices. Through this approach, she analyzes and categorizes the historical texts in ways that sometimes set this historian's teeth on edge; for example, gliding too easily over changes between time periods, or using the evidence of the texts' multiple voices with too little attention to their variations. Nonetheless, medical historians can learn from this sociological approach and especially from the evidence presented here about how the obstetricians at the famed Dublin's Rotunda hospital contributed to general debates in the field. Also valuable here is Murphy-Lawless's interpretation of current debates between active-intervention obstetricians, who she believes represent common hospital practice, and birthing women and midwives, many of whom resist hospitalized and medicalized birth practices.

Murphy-Lawless reviews the writings of some major British obstetricians, including Fielding Ould, Robert Collins, Joseph Clarke, James Hamilton, and Alexander Gordon. She emphasizes in often compelling ways how these texts categorized birth as something that could be determined to have been normal only in retrospect; how the obstetricians used risk and death as threats to increase medical intervention in labor and delivery; and how obstetric science made convincing "truth claims" for its own exclusive and theoretical (as opposed to women's more experiential) knowledge. She believes strongly that obstetricians-- acting as one, over time and in the present, throughout "North Atlantic countries" (p. 4)--have depicted women as physically and mentally weak and incapable of judging and taking action concerning birth practices, and have themselves usurped women's agency in the process of creating their own powerful profession. The evidence she provides in trying to sustain these claims is varied and interesting, and the meanings she suggests are often creative and significant, if also provocative and controversial.

But I found the context in which Murphy-Lawless sets these useful historical data more problematic than her conclusions, with which I might disagree but for which she makes a fair case. Her repeated insistence on binary categories of the historical players (powerful obstetricians who viewed women as weak and unintelligent vessels on one side, and sensitive midwives and birthing women who understood women's strength and agency on the other) has kept her from understanding some of the historical complexities and made especially difficult any effort to see how the sides might have changed over time, negotiated with one another, or even agreed on various issues. Murphy-Lawless, in short, is not sufficiently sensitive to the nuance and differences among the texts, and (I think) unnecessarily confrontational--as when she accuses male midwives of "seek[ing] to overcome the female body, rather than to work with it" (p. 63), or when she describes obstetric medicine as "a fine example of patriarchal power which systematically enforces a position of subordination on women" (p. 233). Sometimes, too, she is downright misleading, as when she concludes that obstetrics "was never to accept responsibility for . . . the role it played in epidemic puerperal fever" (p. 112), and then quotes from Gordon: "It is a disagreeable declaration for me to mention that I myself was the means of carrying the infection to a great number of women" (p. 134). And, most disappointing to this reviewer, rarely does she consider the birthing woman's point of view as a necessary part of the analysis, concluding too easily: "There is an acute problem in locating women's own stories in relation to the growth of obstetrics" (p. 144).

Let one example suffice of how her reading emphasizes the most adversarial...