MIDWIVES: social issues

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I'm about halfway through the book. Has anyone else started it? Have any thoughts on the social issues that come up? I have lots to say about style and structure and characterization, but I'm not sure how much of an opinion I have on the whole issue of midwives without formal training.

Any thoughts?

-- Beth (beth@xeney.com), March 02, 2000


Okay, I'll get this one started with a question (I feel like an English teacher here):

For those of you who have finished the book or at least a significant portion of it, do you think the author is in favor of home births and midwives who are not medically trained, or does the author think that midwives are irresponsible and that home birth is a bad idea?

I honestly have no idea, now that I think about it. I know the Connie character was supposed to still support a woman's choice to have her baby at home, but I didn't really buy it -- I saw that statement as arising out of guilt or loyalty. On the whole I thought the book was a pretty strong indictment of home birth and midwifery. I haven't done any research into home birth, so I wouldn't say I've formed a strong opinion one way or another, but if I were going to be influenced by this book at all, it would definitely push me away from home birth.

What do you think? Do you think that was the author's intent? Did the book change your opinion about home birth, assuming you had one? Do you think it was unfair to the medical profession, or to midwives? There is a line, spoken by a teenaged boy, about doctors being like pack wolves. I thought the line was out of place, because there was no indication that the boy would have had experience with the pack-wolf behavior of doctors. Was that line also unfair?

If the book was supposed to convince me that the medical profession (mostly male) unfairly seeks to restrict the practice of untrained midwives (mostly women) out of sexism and fear rather than a legitimate concern for patient safety, it failed. In fact, I might have held that opinion beforehand, and the book did a lot to swing me in the other direction.

Any thoughts?

-- Beth (beth@xeney.com), March 07, 2000.

Ah, here's the thing, I am strongly pro-home birth, having witnessed one and planning to have any and all children in that fashion, and view this book as the same. I don't believe that it condemns hospital birth, either, I believe that the POV is that women should be able to have their babies as they choose to.

The interesting thing for me is that home birth is actually illegal in New Jersey (it's legal in New York), and women who want to give birth at home have to go through this underground railroad thing to find a midwife, usually one based in New York, and if the mother needs to be transferred to the hospital during the birth, they have to take them there and pretend that they are friends who just happened to be visiting when the mother started going into labor. And then, when the mother brings the baby to the pediatrician, usually several days after the birth, they have to pretend that they went into labor and, whoops, had the baby at home, I didn't mean to, honest doctor!

Which is, let me say, moronic.

-- Kymm Zuckert (hedgehog@hedgehog.net), March 08, 2000.


Okay, here's the thing: I'm not surprised that you thought the book was strongly pro-home birth, because I think this was a "bring your own baggage" kind of a book. I don't think he made a really strong case either way, so if you came in with a strong set of beliefs one way or the other, the book would reaffirm that. Does that make sense?

On the one hand, I don't expect novels to preach at me or change my mind; in fact, I hate being preached at. On the other hand, I sort of felt like the author was trying to make a strong case for the "choice" aspect, but failed at that task.

Yet another high school English teacher comment: this book had more telling than showing. I would have liked to have gotten inside the head of a woman who chose home birth, and learned some of the reasons why. Instead, we just had Sybil saying (over and over) that how you come into this world makes a difference, and just having those words repeated didn't make a strong impact on me. If you already had strong feelings in that direction, then that aspect would affect you differently.

I think that's why the book pushed me in the other direction -- on the one side you just have Sybil telling you that Home Birth Is Good, and on the other side you have this vivid, visceral picture in your head of a woman hacked open while she might have been alive. If you come into the book without any strong feelings about the topic, of course the latter image is going to affect you more strongly than all of Sybil's commentary.

I mean, my general feeling about any subject is let people decide for themselves, and I doubt this book would be enough to make me support a ban on home birth, but it was damn sure enough to convince me that any babies of mine will be born in a hospital. Or at least a house without kitchen knives.

-- Beth (beth@xeney.com), March 08, 2000.

I agree that this isn't a book that would change your mind one way or the other. Going into it, my personal opinion was something like "not for me, but if that's your thing...". At the end of it, my opinion was exactly the same.

Like you, Beth, I wasn't very clear on whether our narrator had a strong point of view. By the end of the book, I was (slightly) of the opinion that she thought she should be in favor of home birth but that she wasn't really. The "riskiness" of it grew to emcompass not only the risks to mother and baby but also the risks to the midwife (and family). These risks and their aftermath had become her defining experience.

I got the sense that a part of her decision to become an obstetrician was a need for "atonement" of some sort. She felt guilty because of what happened with her mother, both personally (her role in the trial) and in the larger sense (that her mother had "let down" the profession in some way). Connie seemed to feel the need to "make up" to both the medical profession as well as the midwives, but she still seemed conflicted about what

-- Liss (liss@frameshift.com), March 10, 2000.

I actually couldn't finish this book because it seemed so extremist to me. Like Kymm, I'm very pro-home-birth: I saw all three of my siblings born at home, as well as the little sister of my oldest friend. My mother was a midwife for ten years. If I have kids, it'll be at home. It seemed to me that the author concocted a preposterous--not impossible, but wholly unrepresentative--scenario to show the drama of home birth. It seemed sensationalized, overblown, the sort of thing I'd expect from someone who thought of childbirth as a dangerous, medically complex procedure. (In fact it's often pretty boring, at least if you're a little kid and people aren't paying attention to you.)

The midwife in this book (Sybil?) wasn't like the midwives I know. My mom went on to get her master's in public health and now works in the prenatal care/delivery department of a large hospital. Ask her and her midwife friends why they favor home birth and they'll tell you about unnecessary medical interventions, continuity of care, lower rates of infant mortality, and observed differences in mother-child bonding. For instance, in most hospitals the baby is cleaned before it's first handed to the mother, and there's now some thought even among medical doctors that this reduces the hormonal aspect of first bonding. They support home birth because they think it's a better experience and a healthier one, in a medically defineable sense.

So this book seemed quite negative to me. A bit like, I don't know, writing a book about online journaling, with characters who appeared to be in support of it, but featuring a journaler who stalked and harassed and maybe even assaulted. Sure, it could happen. Maybe it has. Women die in childbirth from hospital error, too, but that's not proof that hospitals are less safe.

Most MDs who look down on home birth couldn't tell you whether it's less safe. Childbirth has only been a hospitalized event for about eighty years, if I'm remembering my dates correctly. There was a significant political push by doctors and hospitals to delegitimize midwives as part of an attempt to make hospitals into a place to go when you were sick, rather than a place to die. This campaign was very successful despite the fact that death rates soared for many years, due to the uncontrolled spread of disease in hospital wards. Obviously both the hygiene and the attitude are much better now, but I think there's an assumption about the danger of home birth that's not based on any facts. I grew up hearing horror stories about doctors who routinely induced labor and ordered C-sections because they had golf appointments that afternoon: but those stories weren't fiction. I don't believe any of the midwives I knew ever lost a patient. Part of that was because if they were called to a birth in a blizzard in a remote area, they would advise the mother to go to the hospital.

This all probably demonstrates Beth's point about the bring-your-own-baggage feel of the book; but it bothered me because I felt it was using a lot of scare tactics and giving a very unrepresentative view of a situation that most people know nothing about.

-- Jessie Stickgold-Sarah (sorokin@alum.mit.edu), March 15, 2000.

Reading this book was quite timely, because I just saw the videotape of my older sister giving birth to my nephew, which took place at home. (This is in Holland.) The midwife was featured prominently, and she was obviously competent, even while she was flipping my nephew to and fro like a pancake. It seemed like such a joyous, wonderful way to give birth.

I don't really have any way to tie that smoothly into the book, only that I saw the ending coming (who didn't?) from a million miles away, and I am still pro-midwifery.

-- Monique (megbyb@hotmail.com), March 15, 2000.

Maybe this is more for the structure forum, and *****WARNING SPOLIER****,

but did anyone else feel like the author (his name is too long to type out!) sort of randomly picked his twist-- I mean, she didn't neccessarily have had to have caused the accident for the book to still be effective. I wonder if he started writing the book pro-home delivery, or at least pro-delivery choice, and then changed his mind in writing the book. I think the book could have made an equally powerful and effective point without the 'twist'

-- kate (khh@mail.webforge.com), March 23, 2000.


I very much enjoyed this book, even if I am a bit creeped out now... After hearing the testimony given in the trial it would be my opinion that Charlotte was still alive when Sibyl performed the C-section.

I started out being very pro home birth and have ended up deciding to have a *trained* midwife/doula based birth that takes place *in a hospital*. As a medical professional I know all too well what can happen suddenly. I live in a small Northern Ontario town where the nearest hospital with a delivery unit is 30 mins away in good weather. The closest anesthesiologist/surgeon (in case you need a C- section) is an hour away. I'm sure I could do it if I had to, but not on myself!

I know that women have been giving birth without medical intervention for generations, but I would much prefer to have that intervention readily available should it become necessary.

-- Cathy (capdvm@sprint.ca), April 22, 2000.

*****SPOILERS*****SPOILERS***** (and religious stuff too)

I thought the ending was very well done, foreshadowing and all. I thought it was an excellent commentary on those who accept things as they are (the natural, preordained and 'God-given' way) and those who try to intervene and play God. Asa forgives and accepts, ("Let go and let God" is a phrase that comes to mind), and when Connie goes to visit him at the end of the novel he is remarried, his sons are doing well and he wishes her peace. He ultimately allows God to punish Sibyl, and her family, for what happened to Charlotte. Sibyl's primary concern is that she will no longer be able to practice midwifery. At one point she also worries about not being present for the birth of her future grandchildren if she were convicted and sent to prison. Her daughter intervenes in her trial to ensure an acquittal but divine retribution triumphs in the end. Sibyl no longer finds joy in birthing babies and gives up her midwifery practice. She developes lung cancer and dies of her disease before her daughter has any children. Rand is left a widower and no longer works. Connie is a practicing OB-GYN, unmarried and childless, trying to make up for both the sins of her mother and herself. Perhaps God doesn't appreciate those of us who intervene, whether for charitable or selfish reasons?

Would love to compare this with the themes in The Green Mile. As someone who spends far too much time killing God's innocent creatures that someone else has decreeded should die, the whole playing God issue bothers the hell out of me!

(In case you were wondering, I am agnostic bordering upon atheist, but anything even approaching a religious theme in a novel just seems to jump out and bite me.)

-- Cathy (capdvm@sprint.ca), April 22, 2000.

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