A hard look at birthing practices

February 04, 1993|By Joan Mooney | Joan Mooney,Contributing Writer

When Jessica Mitford wrote an expose of the funeral industry in "The American Way of Death," Time magazine called her "Queen of the Muckrakers." Now she has investigated the industry surrounding the other most vulnerable moment in a person's (read: woman's) life, besides the death of a loved one -- childbirth.

This topic has the added dimension of male (since most obstetricians are men) exploitation of women (since all mothers and midwives are women). Ms. Mitford addresses that, but she also ties her topic into the economic inequalities in the U.S. health care system.

Ms. Mitford opens with quotes from "The Hammer of Witches," a treatise by two 15th century monks, who see midwives as the most dangerous of all. She then quotes a woman who had made a contemporary documentary on midwives. The woman says the modern medical establishment's attack on them is just an update of the medieval monks' attitude.

Much of the book is about midwives, for, as Ms. Mitford sees it, their persecution by the medical establishment has a lot to do with why childbirth is so expensive and is often arranged to accommodate obstetricians rather than mothers.

First, she gives us historical background. In Victorian times, women were so modest they were not always properly examined by doctors before childbirth. When chloroform was discovered in 1847, the Church of England opposed its use for women, saying they should suffer during childbirth to atone for Eve's original sin.

These topics offer much scope for Ms. Mitford's acerbic wit and no-nonsense style, but she is just warming up for her real task: showing how badly the medical establishment treats women in childbirth, particularly poor women. She writes about Montgomery, Ala., where in 1987 only three overcrowded

hospitals accepted impoverished women for childbirth. They rotated "Emergency Room of the Day," so women who were near labor had to listen to the radio at 6 a.m. to make sure they went to the right hospital.

Obstetricians develop their attitude early. Ms. Mitford quotes a disturbing study by sociologist Diana Scully, who spent three years in the mid-1970s as an observer in two hospitals with training programs in obstetrics and gynecology. Ms. Scully reported: "Over and over, residents told me they disliked institutional patients; especially young, unmarried black women who lost control during delivery were a source of scorn."

Ms. Mitford does not have much good to say about obstetricians. She makes a good case that their objections to midwives are largely financial: Midwives charge much less for assisting at a birth and are direct competitors. By the time Ms. Mitford describes the efforts of the Federal Trade Commission and World Health Organization on behalf of midwives, it is easy to be convinced that this alternative should at least be universally available (it is illegal in some states).

She ends with a plea for nationalized health care. It is hard to argue with statements such as this one by Dr. Kevin Grumbach, of Physicans for a National Health Program: ". . . while the U.S. guarantees well-insured patients bypass surgery at the first whiff of chest pain, the U.K. guarantees that every woman gets prenatal care, and home visits for a week after the delivery of her baby." Perhaps this book at least will bring the problem to the forefront of public debate.


Title: "The American Way of Birth."

Author: Jessica Mitford.

Publisher: Dutton.

Length, price: 322 pages, $23.

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