Coming Home: How Midwives Changed Birth by Wendy Kline (review)

In Coming Home: How Midwives Changed Birth, Wendy Kline offers an engaging read about an important chapter in the feminist health movement and the history of childbirth. The fight to revive midwifery and home birth in the United States has largely been seen in a binary that flattens a complex story. Opponents characterize home birth as a reckless return to the past; supporters see it as a victim of patriarchal, physician-led obstetrics. Kline's work moves our understanding beyond these oversimplifications, pointing to a long history of cooperation and collaboration among lay midwives, nurse-midwives, physicians, and consumers that could serve as a road map to rapprochement.

Kline organizes her book chronologically around flashpoints in the history of modern American home birth. She begins in Chicago, with obstetrician Joseph DeLee's support of home birth as a way to provide medical students with access to patients on whom they can hone their skills. This chapter serves as a touchstone through the remainder of the book, which focuses on consumer-led advocacy for home birth in the 1970s and 1980s. The reader encounters La Leche League activists in suburban Chicago and learns about middle-class midwives in Washington, DC. These women contrast with the hippies on The Farm, a commune in rural Tennessee, where midwife Ina Mae Gaskin practiced and trained others for decades. The narrative moves to a 1974 sting operation against lay midwives in Santa Cruz, California. The last two substantive chapters cover the contentious shift toward professionalization through the establishment of the Midwives Alliance of North America (MANA) and the Seattle Midwifery School (SMS).

The book's strengths lie in two areas: the accessibility of the writing, and the rich use of interviews and privately held papers. Kline deserves credit for crafting a page-turning book with clear crossover potential. This book will undoubtedly become standard reading among midwives and the families they serve. Kline put time and effort into building relationships with the midwives whose stories she recounts. Her investment yielded interviews and access to personal papers gathering dust in these women's basements. The author also makes good use of collections in public repositories, archived interviews, and press accounts.

The strength of Kline's intimate connection to the midwives is at times a hindrance to her analysis. Coming Home derives primarily from midwives' themselves, whose words are not always subjected to critical examination. The Farm midwife Pamela Hunt "discovered that the caesarean section rate in Mexico was 75 percent" in the 1960s, a figure that cannot possibly be true, but is repeated as fact (p. 73). The Santa Cruz midwives' lawyer told them, "'you're under attack by the white male establishment largely because you're women and you're stepping on their toes'" (p. 157). Is sexism (and competition for business) the whole story? The reader is left to wonder, because opponents' objections are presented almost exclusively from the vantage point of the midwives. Even advocates who are not midwives get short shrift. Seattle obstetrician Steven Gloyd supported the SMS (e.g., 180–81), but Kline makes no reference to an interview with him.

By not following through with leads that the midwives' oral and archival sources generate, the narrative at times raises questions that go unanswered. For example, Kline suggests that Gaskin did not meet with resistance from local authorities because "plenty of home births occurred in the region, as a large Amish community lived nearby" (p. 81). She then, without probing further, quotes Gaskin as saying that nurses at the nearby hospital "'were fascinated that the babies [from The Farm] had been born at home'" (p. 83). Why were the nurses so intrigued, if home birth was common? Coming Home persuasively puts Gaskin's "Spiritual Midwifery" in dialogue with Stanislav Grof's work on LSD and transpersonal psychology (pp. 85–94), but notes in passing that Grof's early work was "inspired by Freudian analysis" (p. 88...