Nursing Clio

A couple of weeks ago The New York Times ran an article that asked its readers, “are midwives becoming trendy, like juice cleanses and Tom’s shoes?”  Turns out, yes.  At least for “the famous and the fashionable.”

Although the article highlights an increased social acceptance of midwifery, the idea of midwives as being the marker of social status seems to diminish its value somewhat. My midwife, I thought, was an advocate, not…a fashion accessory. Still, the New York Times piece got me thinking. What might it mean that midwives have become the newest trend for the trendy?  Does mainstreaming midwifery ultimately lead to increased access to it, or serve to privilege it to an already privileged class of people? In a weird way, I think the Times article put a finger on something I have been wondering for some time now: Is American midwifery gaining legitimacy primarily through its association with affluent white women?  And if so…does that matter?

It would not be the first time that race and class has had a hand in changing the way women give birth in the United States.  In fact, as Judith Walzer Leavitt argues in Brought to Bed: Childbearing in America, 1750–1950, native-born white women of means were the primary agents in the shift from homebirth to hospital birth, and primary motivators in the shift from natural non-interventionist techniques to medicalized birth.  The historical record demonstrates that the women of this demographic largely dreaded the pain of childbirth, were worried about personal or fetal injury and death, and had an increasing faith in science and medicine.  These women actively decided who would attend their confinements, and they requested the drugs, technologies, and attendants that were viewed as being on the cutting edge of American progress.

Ironically, this agency had unintended consequences.  By expressing their power to make choices about their own childbirth experiences, and by increasingly relying on the power of scientific expertise, affluent women effectively moved childbirth into the hospital – not just for themselves, but for the majority of American women, and contributed to a decrease in decision-making childbirth options for women.  By the 1950s it was no longer laboring women, but physicians, lawmakers, and hospital administrators, who were the primary motivators for change in American childbirth.

When the Times piece states the idea that midwifery has become the “enlightened” birth choice of the upper crust, I wonder what kinds of effect, if any, celebrity endorsement might have on American birth options.  Mainstreaming midwifery through popular culture certainly makes it less radical, which might make it more socially acceptable.  Is it possible that mainstream acceptance will also affect policy?  Is there some kind of childbirth trickle-down effect and, if so, will it expand laboring women’s options?  Or will it, as in the case of the shift to hospital birth, ultimately limit the possibilities for other women?

If I’m being honest, I worry about midwifery only becoming an option for affluent white women.  Safe, affordable, and compassionate birth attendants are largely unavailable for many women, especially those who cannot afford an option.  Midwifery could definitely provide a realistic solution to this problem.  But let’s be cautious of taking too many of our cues from those who have the opportunity to purchase choice.  And let’s think about the possible consequences.  Midwifery, and a widespread acceptance of it, is a good thing.  But let’s not throw the organic baby out with the locally grown bathwater in an attempt to satisfy a fetishized vision of what childbirth “should” be.

For more, see Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750-1950, (New York: Oxford University Press, 1986).