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Portions appear in the following works:
“Back to Bed: From Hospital to Home Obstetrics in the City of Chicago,” Journal of the History of Medicine and Allied Sciences, Vol. 73 (1), pp. 29–51, January 2018.
“The Little Manual That Started a Revolution: How Hippie Midwifery Became Mainstream,” in David Kaiser and Patrick McCray, eds., Groovy Science: The Countercultural Embrace of Science and Technology over the Long 1970s (Chicago: University of Chicago Press, 2016).
“Communicating a New Consciousness: Countercultural Print and the Home Birth Movement in the 1970s,” Bulletin of the History of Medicine, Vol. 89 (Fall 2015).
Library of Congress Cataloging-in-Publication Data Names: Kline, Wendy, 1968– author.
Title: Coming home : how midwives changed birth / Wendy Kline. Description: New York : Oxford University Press, [2019] | Includes bibliographical references and index.
Identifiers: LCCN 2018027018 (print) | LCCN 2018046609 (ebook) | ISBN 9780190232528 (Updf) | ISBN 9780190232535 (Epub) | ISBN 9780190232511 (hardcover : alk. paper)
Subjects: LCSH: Midwifery—United States—History. | Midwives—United States. | Childbirth—United States.
Classification: LCC RG950 (ebook) | LCC RG950.K57 2019 (print) | DDC 618.200973—dc23
LC record available at https://lccn.loc.gov/2018027018
1 3 5 7 9 8 6 4 2
Printed by Sheridan Books, Inc., United States of America
For Brigette
CONTENTS
Acknowledgments ix
Introduction: From Hospital to Home 1
1. Back to Bed: From Hospital to Home Obstetrics in the City of Chicago 9
2. Middle-Class Midwifery: Transforming Birth Practices in Suburban Washington, D.C. 34
3. Psychedelic Birth: The Emergence of the Hippie Midwife 64
4. The Bowland Bust: Medicine and the Law in Santa Cruz, California 95
5. From El Paso to Lexington: The Formation of the Midwives Alliance of North America 133
6. From Professionalization to Education: The Creation of the Seattle Midwifery School 164 Epilogue: In Search of Common Ground 198
Notes 205
Index 235
ACKNOWLEDGMENTS
Researching and writing this book has been an incredible adventure. My children were both born in the hospital, and I never imagined I would be drawn to the topic of home birth when I became a historian. And yet, as I hope the following pages demonstrate, the history of home birth is both fascinating and important. The sources and stories that I discovered along the way kept me reading, researching, asking questions, and hungry for more.
None of this would have happened without support from several institutions. Through their generosity, I was able to attend multiple midwifery conferences, take a weeklong midwifery assistant workshop on The Farm in Summertown, Tennessee, and travel all over the globe to meet with midwives, activists, consumers, and doctors to learn more about the subject. A fellowship in the history of medicine from the American College of Obstetricians and Gynecologists enabled me to spend a month in Washington, D.C., working in the ACOG library as well as the National Library of Medicine, which houses the papers of the American College of Nurse-Midwives. The Sophia Smith Collection at Smith College provided funding for me to research the papers of the Midwives Alliance of North America, along with the personal papers of Carol Leonard. Numerous grants from the University of Cincinnati, including a yearlong fellowship and summer support from the Charles Phelps Taft Center, gave me the much-needed time to research and write. I also received support from Purdue University’s College of Liberal Arts, including several travel grants and an Enhancing Research in the Humanities and the Arts summer support grant.
This is a book about personal stories, and it could not have been written without the trust and generosity of many people. The following individuals donated their time, sharing memories, experiences, and oftentimes personal documents that helped to shape this book, taking me everywhere from Manhattan to Tenerife to Bali: Diana Altman, Suzanne Arms, Alice Bailes, Rahima Baldwin, Linda Bennett, Kate Bowland, Erica Chapin, Beth Coyote, Gene Declerq, Andrea Dixon, Karen Ehrlich, Jan Epstein,
Acknowledgments
Mary Fjerstad, Kay Furey, Ina May Gaskin, Faith Gibson, Cara Gillette, Patsy Harman, Esther Herman, Pamela Hunt, Rhona Jacobs, Roberta Kvenild, Karen Laing, Raven Lang, Carol Leonard, Robin Lim, Judy Luce, Marian Tompson, Elan McAllister, Marion McCartney, Shafia Monroe, Jo Anne Myers-Ciecko, Suzy Myers, Jane Reyes, Joanne Santana, Paul Schattauer, Phil Schweitzer, Mary Sommers, Phyllis Stein, Fran Ventre, Eva Wax, Siobhan Whalen, and Rachel Dolan Wickersham. I can’t thank you enough—this is your history and I am honored to be entrusted with it. It was impossible to include as much as I wanted to, but I hope this is just the beginning and that there will be many more histories to follow.
Writing can be a lonely and intimidating process, but I found myself surrounded by support. Three archivists in particular have been extremely helpful in tracking down important materials and finding good images for the book: Debra Scarbrough of the American College of Obstetricians and Gynecologists; Susan Sacharski of the Northwestern Memorial Hospital Archives; and Stephanie Schmitz of the Purdue University Archives and Special Collections.
Thank you also to the following colleagues who generously read through chapter drafts and provided extremely helpful feedback: Evie Blackwood, Katie Brownell, Carrie Janney, Becky Kluchin, Judy Leavitt, Paula Michaels, Yvonne Pitts, Randy Roberts, Margaret Tillman, Dominique Tobbell, and Jackie Wolf. And a very special thank you to my editor, Susan Ferber, who did an incredible job of making this a more readable book, along with the two anonymous reviewers. My good friend and historian Tiffany Wayne deserves huge credit for producing the book’s index—third time in a row! As always, I received excellent feedback from friends and colleagues at the annual meetings of the American Association for the History of Medicine, where I presented much of this material. Special thanks to the regulars who are always supportive: Rima Apple, David Barnes, Charlotte Borst, Winifred Connerton, Pat D’Antonio, Jackie Duffin, Erika Dyck, Julie Fairman, Janet Golden, Jeremy Greene, David Herzberg, Margaret Humphreys, Judy Houck, Laura Kelly, Baron Lerner, Anne Kviem Lie, Beth Linker, Jessica Martucci, Rich McKay, Susan Reverby, Naomi Rogers, Dominique Tobbell, Nancy Tomes, Keith Wailoo, Liz Watkins, Jackie Wolf, and John Warner. And Becky Kluchin, as always, you’ve kept me going not just at conferences but through our weekly check-ins.
Over the years of working on this book I left one history department and joined another. Many thanks to my former colleagues at the University of Cincinnati who shared support and feedback, especially Isaac Campos, Erika Gasser, Stephen Porter, Kate Sorrels, and David Stradling. Thank you to my former graduate students, Evan Hart, Brittany Cowgill, Alyssa McClanahan, and Anne Steinert for your invaluable insights, and for your
help on this project. At Purdue University, I’ve been blessed with terrific colleagues who have taught me so much over the past few years. Special thanks to David Atkinson, Jean Beaman, Evie Blackwood, Katie Brownell, Fritz Davis, Will Gray, Ellen Gruenbaum, Cole Jones, Carrie Janney, Brian Leung, Silvia Mitchell, Yvonne Pitts, Randy Roberts, Margaret Tillman, Sharra Vostral, Whitney Walton, and Laurel Weldon.
I’m very grateful to friends and family members who have been patient and supportive during this long process, especially Tara Greene (who took the author photograph), Susan Shorr, Laurie Hermundson, Sylvia SellersGarcia, Jennifer Lloyd, Cinda Macrory, Chandrika Kasturi, Diana Hardy, Tamara and Tony Hazbun, Kate and Neil Mascarenhas, Regan Bailey, Libby Richards, Jason Brownell, Nick Palmer, Tiffany Wayne, Rachel Young, Susie McPeck, Nancy Kline, Peter Kline, Syril Kline, Maureen Kline, Stephanie Desjardins, and Barbara Gardner. Thank you to Stefan Paula for all of your incredible support and encouragement and for being a terrific father to Emily and Max. When I began this project Emily was only eight years old and Max was twelve. They’ve grown up with this project and know more about midwives and home birth than they ever wanted to—thanks, guys. A special thank you to little Ben, who provided me with solitude and a clean desk to write the final words of this book. And finally, thank you to Brigette, for believing in me. It has made all the difference.
Coming Home
Introduction
From Hospital to Home
On December 8, 2009, Brazilian supermodel Giselle Bundchen and Patriots quarterback Tom Brady welcomed their son Rein into the world. Unlike the majority of babies born in the United States, Rein’s first view was not of a hospital delivery room, but of his parents’ Beacon Hill penthouse overlooking the Charles River in Boston. Why was he born at home? “I wanted to experience the transformation,” Bundchen explained in an interview for Vogue. “It was the most amazing experience of my life, feeling him come through my body. And once he was born, I never felt so empowered as looking at him and thinking, Oh, my God, we did it together!” If she had given birth in a hospital, either domestically or in her home country of Brazil, her chances for a vaginal birth would have been greatly reduced. American cesarean section rates had increased by 46 percent during the first decade of the twenty-first century, up to 32 percent, while in Brazil, rates had risen to 55 percent.1
Bundchen joined a number of celebrities—Demi Moore, Meryl Streep, Julianne Moore, Jennifer Connelly, and Cindy Crawford, to name a few— who have opted for a home birth and generated flashy headlines about the birthing practice.2 “Gisele Bundchen Makes Water Birth Sexy,” announced ABC News. Because hers was a water birth, reporters quipped that though the practice wasn’t new, Bundchen’s delivery “brings a lot more splash to the concept.”3
The idea that home birth could be sexy, splashy, or even desirable shocked many Americans, who have little knowledge of the history of midwifery or home birth. If they know anything at all, it was probably from having watched The Business of Being Born, a 2008 documentary produced by and featuring another celebrity, Ricki Lake. Bundchen and many others attribute their decisions to give birth at home to that film. Attended by a home birth midwife, Lake had her son in her bathtub and included footage of the birth in the documentary. The film quickly jumped to #28 on the Netflix top fifty streamed films. One midwife with a home birth practice noted that nine out of every ten of her home birth clients have come to her as a result of Lake’s documentary.4 Medical anthropologist Robbie DavisFloyd, featured in the film, told Associated Press that although home birth was a “hippie, countercultural thing in the 1970s,” midwives have become “increasingly sophisticated, [and] so has their clientele.”5
The reasons for the recent trend are, of course, far more complex than a single film and are part of the longer history of midwifery and home birth in the United States. In colonial America, childbirth practices resembled those of England, where it was entirely a female affair.6 Beginning in the 1760s, American physicians developed an interest in normal obstetrics and gradually replaced female midwives.7 William Shippen, for example, provided a series of lectures on midwifery to male physicians after returning from medical training in England in 1762. He opened a practice of midwifery in Philadelphia and “became a favorite of Philadelphia’s established families.”8 Others followed suit, expanding their practices to include laboring women. Women who opted for this new “man midwife”—and could afford him—believed him to possess a skill lacking in the female midwife.9 Men had far greater access to medical education than did women and were more likely to use obstetrical tools, such as forceps or anesthesia. Midwife Martha Ballard revealed her frustration when a new male physician was called in to help at a birth. “At Mr. Sewall’s,” she wrote in her diary on October 10, 1794. “They were intimidated & Calld Dr. Page who gave my patient 20 drops of Laudanum which put her into such a stupor her pains (which were regular & promising) in a manner stopt till near night when she pukt & they returned & shee delivered at 7 hour Evening of a Son, her first Born.”10 She believed that Dr. Page was more of a nuisance than a help. “It is probable that physicians’ techniques created new problems for birthing women and actually increased the dangers of childbirth,” notes historian Judith Leavitt.11 By the early twentieth century, physician-attended birth had become the norm. In 1900, midwives participated in approximately half of all births; by 1930, that number was down to 15 percent. “Midwifery was left to become a curious historical artifact with a sometimes dubious reputation,” explains one historian of childbirth.12 Within the decade, hospital replaced home as
the primary location of childbirth. Thus both the attendant and the place of birth shifted in the early twentieth century and ushered in a new era of medicalized birth.
Not everyone viewed the new medical model of childbirth as a sign of progress. Patricia Cloyd Carter, who delivered six of her nine children at home without any assistance, ranted against the practice of hospital births. “Already in some pain as the average parturient is at the end of dilation, being held tied down, slapped, shaken by the shoulders, ordered ‘Stop bearing down’ in tones you wouldn’t use to a dog. Imagine yourself struggling against not one, but several nurses, as there always seem plenty on hand for this sadism, no matter how short they are of nurses to change a baby’s wet diaper. (Six ganged me.)”13 Carter wrote and self-published what might be the first “how to” home birth manual in 1957.14 “EXTRA!! NEWBORN IN PRESENCE OF FATHER WITH NO PROTECTIVE GLASS BETWEEN THEM,” she quips in a caption beneath a photo of her with her ten-minute-old son and husband. Her husband’s clothes were not sterile, she continued. “They are merely his pajamas, and Mrs. Carter still has on the dress she wore when he was born. [Baby] Douglass does not appear to be alarmed at this, or at the absence of masks.”15
Carter was one of a growing number of consumers dismayed by the emotional and physical toll of medicalized childbirth. “What should have been the most exalting and exulting of experiences was riddled with horrors at a big inner-city hospital where I felt like I was going to the Bastille, not to be seen again,” reflected one woman. “The delivery room was an immensely bloody spectacle in what seemed at the time like a butcher shop where everyone was wearing rubber gloves and I was in the middle like a trussed-up turkey.”16 The new American midwife, “not the muslin-skirted, mule-riding, frontier type, but a medically competent, highly skilled professional,” would help to reform childbirth.17 In 1977, the founders of the consumer organization NAPSAC (National Association of Parents and Professionals for Safe Alternatives in Childbirth) predicted at a conference that “childbirth of the future will not primarily be in hospitals, but in the home, and the primary health professional for most women will not be the physician, but the midwife.” Even the title of the conference and resulting book, 21st Century Obstetrics Now! hinted at the optimism that the mainstreaming of home birth lay just around the corner. They were wrong, of course. And yet, in 1977, their optimism seemed justified. Things had come a long way; a short time before, both midwifery and home birth appeared destined for extinction. As recently as 1970, the percentage of hospital births reached an all-time high of 99.4 percent. Then, seemingly out of nowhere, a host of new alternative organizations, publications, and conferences appeared, signaling a very different
demographic trend. By 1977, the percentage of out-of-hospital births had more than doubled. 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. Coming Home narrates the ideas, values, and experiences that led to this quiet revolution and its long-term consequences for birth, medicine, and American culture.
Who were these self-proclaimed midwives, and how did they learn their trade? Because the United States had virtually eliminated midwifery in most areas by the mid-twentieth century, many of them had little knowledge of or exposure to the historic practice. Instead they learned their craft from obstetrical texts, trial and error, and sometimes instruction from the few remaining home birth physicians. While their constituents were primarily drawn from the educated white middle class, their model of care (which ultimately drew on the wisdom and practice of a more diverse, global pool of midwives) had the potential to transform birth practices for all women, both in and out of the hospital.
This is a story not just about midwives, but also about birthplace. By the 1970s, a significant number of white middle-class parents began opting out of the standardized medicated hospital birth. By doing so, they recast home birth as a legitimate choice for those seeking more control over the birthing process, rather than as a low-cost alternative for the poor or geographically isolated, as it had been before. This transition indicated a shift in the demographics of home birth advocates, who from their economically privileged position viewed the hospital setting as inferior to the home. “Most home deliveries used to result from economic need or lack of hospital facilities,” noted Dr. William C. Scott in 1980. “The kind of family that today is demanding a different type of delivery is a far cry from the economically and socially deprived patients who used to be cared for by lay midwives.”18
Many women who chose home birth linked their decision to power dynamics. “It had something to do with control, power, and authority,” sociologist Barbara Katz Rothman explained of her own decision to choose home birth in the early 1970s. “At home, I would have them; in the hospital they were handed over to the institution.”19 Three members of the Boston Women’s Health Book Collective, which had authored Our Bodies, Ourselves, had given birth at home. As Judy Norsigian and Jane Pincus wrote on behalf of the collective, “several of us . . . know firsthand the joys and comforts of having our babies in a warm, familiar setting surrounded by loved ones and skilled, sensitive birth attendants.”20 While Katz Rothman focused on the power of place, Norsigian and Pincus emphasized the comforts of home. Warm and familiar, it was, in essence, womblike.
Other home birth advocates, however, emphasized home as an idea rather than an actual physical place. “Home birth is not really about where a baby is born but is, rather, a metaphor for an attitude,” wrote Diana Altman, co-founder of Birth Day, a home birth organization in Boston in the 1970s. She believed that it spoke to a woman’s willingness to take responsibility for the important events of her life. Furthermore, it was an attitude that acknowledged “that the birth process is, usually, just as it should be, a perfect expression of a woman’s sexuality.” To Altman and many others, home birth was about privacy and intimacy, not about familiarity or comfort.
Their stories need to be told. Over thirty years ago, historian Judith Walzer Leavitt published her groundbreaking study, Brought to Bed: Childbearing in America, 1750–1950, which established the legitimacy and value of historicizing childbirth and inspired a new generation of scholars to research the intersections between reproduction, medicine, and feminism, emphasizing women’s active roles in changing birth practices. Other works have detailed important aspects of postwar birth practices such as the growing interest in the Lamaze method, concerns about the effects of drugs used in hospital deliveries, the rise of cesarean sections, and the role of fathers in reforming maternity ward protocols, but they have not examined how alternative practitioners and the consumers who sought them out challenged obstetric practice and assumptions about birth, and how organized medicine responded.21
In reconstructing this history, this book draws on the papers of midwives, educators, and activists; organizations of midwives and obstetricians; and interviews with some of the key figures in the home birth movement. To have access to both archival papers and their original owners is a historian’s dream. Frequently, the presence of a historical document triggered a memory or inspired a fruitful conversation. Sometimes, it was the reverse; a 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. And witnessing them in action—whether in their offices or at professional conferences—served as a reminder that these women were practitioners as well as revolutionaries.
This book moves from mid-century Chicago to suburban Washington D.C. to the more countercultural West Coast. At the beginning of this movement, it was very much a local phenomenon, with very little awareness that other communities were experiencing similar trends. Each chapter is situated in a different geographic locale, but also tackles a different issue that addresses why a small though increasing number of women chose home over hospital in the late twentieth century, and how a growing number of women decided to organize and professionalize around the issue of home
birth. This book challenges six basic assumptions surrounding birth and society in the late twentieth century: the process of medicalization, the meaning of counterculture, the psychology of birth, the legality of licensure, and the processes of midwifery professionalization and education. While the book’s focus is on a specific type of birthplace and birth practitioner, it paints a broader picture of reproductive revolution and reform in modern America.
The story begins in Chicago, where two movements converged that lay the groundwork for a burgeoning home birth movement. Chapter 1, “Back to Bed: From Hospital to Home Obstetrics in the City of Chicago,” analyzes the home obstetrics training practiced at the Chicago Maternity Center alongside the emergence of what would become an international breastfeeding organization, La Leche League (LLL). Interest in breastfeeding also galvanized a movement of primarily white middleclass women in suburban Washington D.C. to challenge hospital birth practices. Chapter 2, “Middle-Class Midwifery: Transforming Birth Practices in Suburban Washington D.C.,” investigates the individuals and organizations that began to promote home birth in the 1970s. Many of the D.C. area women attribute their “calling” to midwifery at least in part to their experiences as mothers, LLL leaders, and childbirth educators. When they opted to take the further step of becoming midwives, they enabled the transition of home birth as a practice primarily supervised by doctors to one facilitated by midwives. On the West Coast, a 1970s home birth was far more likely to occur in a teepee or a commune than a ranch house, as in suburban Maryland. Chapter 3, “Psychedelic Birth: The Emergence of the Hippie Midwife,” focuses on the spirituality and psychology of birth more frequently espoused on the West Coast. In this context, childbirth became a catalyst to spiritual transcendence. Chapter 4, “The Bowland Bust: Medicine and the Law in Santa Cruz, California,” traces the role of the hippie midwife from the perspective of a legal case. In the spring of 1974, three women were arrested in an undercover sting operation in Santa Cruz and charged with practicing medicine without a license for their involvement in out-of-hospital births coordinated by the Santa Cruz Birth Center. The birth center bust and the players involved showcase the potential for collaboration—between midwives and doctors, feminists and back-to-thelanders, politicians and activists—as well as the obstacles that ultimately prevented them from doing so.
The final two chapters address the politics of direct-entry midwifery professionalization and education. What had previously been “isolated pockets of consciousness,” as midwife Kate Bowland described the relatively small groups of midwives practicing underground, had become by the late 1970s a burgeoning profession. This was facilitated by efforts to create a
national organization to represent lay midwives. Chapter 5, “From El Paso to Lexington: The Formation of the Midwives Alliance of North America,” closely tracks the push to organize, beginning with the first international conference of practicing midwives in El Paso in 1978 and ending with the formation of MANA.
One of the biggest hurdles to professionalizing non-nurse midwifery was the lack of any standardized training opportunities in the United States. Historically, midwives had learned their trade by apprenticing with more experienced members of their community. By the late twentieth century, however, the home birth trend triggered a regulatory backlash in many states, resulting in new and more restrictive licensure laws requiring education and certification. The final chapter, “From Professionalization to Education: The Creation of the Seattle Midwifery School,” traces the evolution of the first and arguably the most successful fully accredited directentry midwifery program recognized by the U.S. Department of Education.
The status of midwifery care in the United States has improved in the twenty-first century, but it lags well behind those of other countries. In the United Kingdom, midwives deliver half of all babies, while in the United States midwives attend approximately 10 percent of all births. The vast majority of the 15,000 midwives in the United States are Certified NurseMidwives (CNMs) practicing in hospitals. The rest are Certified Midwives (CMs) or Certified Professional Midwives (CPMs), both “direct-entry” midwives without nursing credentials. While CNMs can practice legally in all fifty states, CPMs can obtain licensure in thirty states and CMs in five. CPMs work primarily in home and birth center settings and “typically cannot obtain hospital practice privileges and often have difficulty establishing reliable systems for referral and collaborative care.” “It’s very confusing,” admits a former president of the American College of NurseMidwives. “The title ‘midwife’ has multiple meanings,” making it more challenging to promote the profession.
In 2014, the medical journal Lancet published a series of four articles and five comments on the status of midwifery worldwide. “Midwifery is commonly misunderstood,” explained the editors. They were intent on correcting that misunderstanding. Increasing collaboration by integrating midwives into health care systems could potentially prevent more than 80 percent of maternal and infant deaths, they found. “Midwifery therefore has a pivotal, yet widely neglected, part to play in accelerating progress to end preventable mortality of women and children.”22
That recommendation does not sit well with many Americans, despite the fact that maternal mortality is on the rise, and access to affordable healthcare is shrinking. Many of them continue to see the midwife as either an ancient relic or an uneducated buffoon, unaware of her rich
history and present practice in hospitals, birth centers, and homes. Midwifery organizations are challenging this by creating public education campaigns about their important role in maternity care. “Is it really such a radical idea that midwives take over low risk maternity care?” MANA president Vicki Hedley asked in May of 2018. “What is the status quo in this country? It is a system with little regard for women’s bodies and no respect for their intelligence,” she adds. “Let’s set the table, let’s invite those who truly want to serve birthing people, let’s find a way to define midwifery in this country that is autonomous, inclusive, respectful, and sacred.” 23
In order to do this, we need to invest not only in midwifery’s future, but also its past. We must explore the varied pathways and particular places, including the home, which shaped the profession. This book is intended to further that story.
