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From Hospital to Home: Wendy Kline’s Coming Home: How Midwives Changed Birth

Wendy Kline has delivered a new addition to the history of childbirth in America. In her engaging and well-researched book, Coming Home: How Midwives Changed Birth, Kline presents a new and necessary chapter in the story of the medicalization of childbirth in the United States: the history of the home birth movement. Kline has a keen eye for entertaining anecdotes and knows exactly when to sprinkle in intriguing biographical details. Throughout the book, we get a real sense of who these midwives were, how they fit within a broader home birth movement, and how, between the 1970s and the present, their practices and Americans’ reception of them evolved. More than a history of the home birth movement, Coming Home updates the history of American childbirth and complicates a number of big ideas in the history of modern medicine, making it a terrific addition to the field of women’s health.

Thanks to Judith Leavitt’s enduring classic Brought to Bed, many NC readers will know the story: Between the late nineteenth and mid-twentieth centuries, American childbirth moved from home to hospital. Traditional midwifery was eschewed in favor of the new, increasingly technologized field of obstetrics.1 (The ghost of Martha Ballard wept.2) The case of childbirth remains the prime example of the process of medicalization, brought on by a professionalizing, modernizing, and gatekeeping medical profession.

Hardcover art for Coming Home: How Midwives Changed Birth. (©Oxford University Press)

But what happened next? As Leavitt and others building on her work have shown, we made room for daddy.3 Some women sought “natural” childbirth alternatives from the hilarious-sounding Grantly Dick-Read or the very French Fernand Lamaze.4 Eventually, Ricki Lake made a documentary.5 But these familiar developments are only the tip of the late twentieth-century iceberg. As Kline shows, the story of childbirth and its medicalization (and perhaps its demedicalization — or remedicalization?) is far richer and more complicated than we knew. Today, a sizable majority of births still take place in the hospital. And of those, a disturbingly high number are cesarean sections.6 But beginning in the 1970s, “a quiet revolution spread across cities and suburbs, towns and farms, as consumers challenged legal, institutional, and medical protocols by choosing unlicensed midwives to catch their babies at home.”7

It would be a mistake to call Coming Home an epilogue to Brought to Bed, or to reach for some kind of satisfying narrative symmetry in that trend reversal. Rather, Kline reveals an opening-up of birthing options for women in the second half of the twentieth century. The real revolution, I would argue, was in how midwives and their clients fundamentally transformed how women thought about their relationship to health care and its providers. These women asked, what do these interventions into childbirth mean and do we really need them? Do we really want these boundaries — including both the metaphorical ones, around birthing expertise, and the physical ones, in the form of hospital room walls? Truly reckoning with these questions, as Kline shows her midwives doing across the decades, was groundbreaking.

Poster for The Chicago Maternity Center Story. (©Kartemquin Films/Wikimedia)

Kline begins her story in Chicago, investigating the pre-history of the home birth movement at midcentury through the efforts of the Chicago Maternity Center and the La Leche League. These two divergent organizations laid the groundwork for massive change by challenging the new norms of a highly medicalized obstetrics. She then turns her attention to the movement itself, exploring home birth in two very different contexts: middle-class suburbia and the 1960s counterculture movement. Later chapters follow midwives as they organize into professional organizations (e.g., the Midwives Alliance of North America), tackle the issue of credentialing, and advocate for changes in childbirth education.

A standout chapter gets to the heart of questions about expertise and lay practitioners. Chapter 4, “The Bowland Bust: Medicine and the Law in Santa Cruz, California,” uses one 1974 legal case to great effect. That spring, after an undercover investigation of the Santa Cruz Birth Center, authorities charged three women with practicing medicine without a license. The fight over the births they oversaw outside the walls of a hospital distills a much broader debate about who, legally speaking, “gets” to be in charge of childbirth into a very readable drama.

The case raises intriguing questions about childbirth specifically, but also the expert vs. layperson divide and medical expertise more broadly. The legal framing, particularly as it pertains to women’s reproductive health, reminded me of similar episodes in the history of abortion. It would be interesting, for example, to think through this raid and the subsequent legal case alongside the nearly contemporaneous raid of the “Jane” lay abortionists across the country in Chicago.8

Coming Home also offers a model for historians exploring the very recent past. Many of the midwives Kline features throughout the book are still alive and well, practicing their craft and lobbying for their profession to this day. As she notes in her introduction, “To have access to both archival papers and their original owners is a historian’s dream.”9 She was able not only to draw on the personal papers of her historical actors but also to interview them. In her experience, these twin processes worked synergistically: “Frequently, the presence of a historical document triggered a memory or inspired a fruitful conversation. Sometimes, it was the reverse; the memory would result in a discovery of an old document stored in a midwife’s attic or garage. Interviewing midwives in groups reunited for the first time in years enabled individuals to spark collective memories and to assess challenges and successes together from hindsight.”10

Having blurred the historical and contemporary myself on occasion, I understand this appeal very well. Kline makes excellent use of her mixed sources. However, perhaps due to her closeness to these informants, Kline misses an opportunity to reflect a bit more critically on the role of memory and the possible limitations of oral history here. Were these “revolutionaries,” as she calls them, at times telling her “a good story,” like the women of the Boston Women’s Health Book Collective, whose deliberate self-fashioning Kline and others have already documented?11 Still, these contacts granted her unique access to sources, which she used to great effect.

The home birth movement, Kline explains, “has enabled parents to navigate an increasingly complex health care system in order to make well-informed choices about where and how to give birth.” Most Americans, however, “have no idea how unique or arduous the path has been that brought us where we are today.”12 To get a sense of that evolution and its implications, Coming Home should be a new starting point for the history of childbirth.

Notes

  1. Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750-1950 (New York: Oxford University Press, 1986). Return to text.
  2. Laurel Thatcher Ulrich, A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812 (New York: Knopf, 1990). Return to text.
  3. Judith Walzer Leavitt, Make Room for Daddy: The Journey from Waiting Room to Birthing Room (Chapel Hill, NC: University of North Carolina Press, 2009). Return to text.
  4. Paula A. Michaels, Lamaze: An International History (New York: Oxford University Press, 2014). Return to text.
  5. The Business of Being Born, dir. Abby Epstein (January 2008). Return to text.
  6. Jacqueline H. Wolf, Cesarean Section: An American History of Risk, Technology, and Consequence (Baltimore, MD: Johns Hopkins University Press, 2018). Return to text.
  7. Wendy Kline, Coming Home: How Midwives Changed Birth (New York: Oxford University Press, 2019), 4. Return to text.
  8. Incidentally, Kline devoted a chapter to Jane and these issues in her previous book, Wendy Kline, “Learning from the Uterus Out: Abortion and Women’s Health Activism in Chicago,” in Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave (Chicago: University of Chicago Press, 2010), 65–96. See also Kelly O’Donnell, “Reproducing Jane: Abortion Stories and Women’s Political Histories,” Signs: Journal of Women in Culture and Society 43, no. 1 (2017): 77–96. Return to text.
  9. Kline, Coming Home, 5. Return to text.
  10. Kline, Coming Home, 5. Return to text.
  11. Wendy Kline, “Transforming Knowledge: The Making of Our Bodies, Ourselves,” in Bodies of Knowledge, 9-40; Kathy Davis, The Making of Our Bodies, Ourselves: How Feminism Travels across Borders (Durham, NC: Duke University Press, 2007); and Susan Wells, Our Bodies Ourselves and the Work of Writing (Stanford, CA: Stanford University Press, 2010). Return to text.
  12. Kline, Coming Home, 203. Return to text.

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