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  • Coming Home: How Midwives Changed Birth by Wendy Kline
  • Elizabeth Reis

Midwifery, Medicalization, Obstetrics, Home Birth Movement, Race and Medicine

Wendy Kline, Coming Home: How Midwives Changed Birth. Oxford: Oxford University Press, 2019. 264 pp.

In Coming Home: How Midwives Changed Birth, Wendy Kline explores midwifery as a worldview as well as a profession. Midwives have always had a vision of how babies should come into the world, and generally that meant eschewing the medicalized version of childbirth. Kline has written an engaging history of how midwives accomplished this feat in light of the reach and power of institutionalized medicine. Anyone interested in learning where and how babies were born will want to read this book.

Midwives have been delivering babies at home forever. In early America, women bore their children there, typically surrounded by their female family members and friends. Hospital birth was a later innovation, as men entered medical school, became obstetricians, and convinced white women that it was safer to deliver in an institutional setting. But as we know that venue was not initially safer. Nineteenth-century hospitals exposed women to puerperal fever, as physicians and their instruments carried bacteria from one patient to the next. It was not until the mid-twentieth century and the advent of penicillin that medicine could control the infections that so frequently caused women's deaths.

Kline's story turns to late-nineteenth-century Chicago, the birthplace of the modern home birth movement. Readers will learn of the surprising confluence of events that led Dr. Joseph DeLee, a famous proponent of hospital births, to facilitate the work of La Leche League, then a rather conservative breastfeeding support organization not known for its radical politics, but committed to unmedicated births and breastfed babies. DeLee, by contrast, wanted to bring obstetrics into the modern era, which valorized the technological innovations of the hospital setting. But he needed a place for his trainees to learn modern medicine, and so he sent them to observe home births in Chicago's black community.

Many women of color in Chicago had their babies at home for financial reasons, but even if they could afford a hospital birth they did not get the treatment they deserved there, according to Kline, because of racial discrimination that has persisted. In 1972, one woman noted what many Black women are still saying today: "They don't treat you nice, like they do at home" (p.12). The Chicago Maternity Center oversaw the delivery of thousands of home births in the first half of the twentieth century, boasting a lower rate of maternal mortality than the rest of the country and teaching countless medical students about hospital obstetrics and home births at the same time; the medical students would later deliver babies largely in hospitals, where 95% of Chicago's women began to give birth by the mid-1950s.

Coincident with the women's health movement of the 1960s and 1970s, women progressively became interested in "natural" births and breastfeeding, and they wanted to be treated respectfully, with their own needs prioritized. Home births started to increase in urban areas as more women and even physicians learned about unmedicated [End Page 223] methods of delivery, particularly the one espoused by the American Society for Psychoprophylaxis in Obstetrics (a.k.a. Lamaze). There were "hippy dippies and then the ladies with white gloves," as Fran Ventre, one of La Leche League's founders characterized their clientele (p.45). Alternative deliveries, including those enhanced with psychedelic drugs, announced to the world that birth could be exciting, inspirational, empowering, and above all spiritual. Ina May Gaskin oversaw hundreds of births on "The Farm," a popular commune in Tennessee, and her philosophy spread even further when she published her bestselling book, Spiritual Midwifery. No matter their politics, many women wanted more control of their own bodies. And many became convinced that hospitals and physicians need not be part of the birthing process.

In some places, however, laws have prohibited unlicensed lay midwives from ministering to pregnant women. Kline's chapter on the arrests of midwives at the Santa Cruz Birth Center in California in the 1970s and 1980s is both fascinating and harrowing...


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pp. 223-224
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