Book Reviews

AIMS Journal, 2006, Vol 18 No 1

Blessed Events: Religion and Home Birth in America by Pamela E. Klassen

Princeton University Press 2001. Paperback. 316 pages.

Reviewed by Nadine Edwards, Vice Chair, AIMS

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This book is based on interviews with 45 women in North America who had their babies at home with certified nurse midwives, direct entry midwives, or without midwives. Pamela Klassen was interested in their religious and/or spiritual beliefs and practices, how they defined these and how these impacted on, or were impacted on by having their babies at home. The women came from a variety of religious backgrounds. Some had been brought up in one religion and had moved to another religion, others did not define themselves as belonging to any particular religion, some described themselves as having spiritual rather than religious beliefs, and a few described themselves as having no particular religious or spiritual beliefs. The book provides a context for the women's stories by covering some of the main points about the history of childbirth and the controversy over risk and safety in birth, especially around home birth, in North America.

Using a feminist perspective, this detailed, meticulous and well referenced study looks at the complexities of defining, or confining women through attempting to label them as feminists or traditionalists: we are all combinations of our histories, both shaped by our cultures and yet forging our own identities and decisions from these. The commonalities and differences between the women and their stories thus become a central theme within the book. It examines the complexities of the pregnant and birthing body, which can move, or 'slide' between pain and pleasure, and the language women draw on to describe bodily changes, sensations and intensity. The author teases out the meanings of 'natural' when applied to women, their bodies, and birth and its surroundings, as well as the potential limitations of this concept. It seeks to understand the meaning of birth in a woman's life and how that might impact on her and her family: the transformation though birth. Thus, it picks up on the politicisation that can occur through birth, especially when women challenge dominant views about how, where and with whom birth can and should take place. Throughout these discussions, the author looks at the spiritual and/or religious beliefs and practices that women use to help them make sense of their experiences and looks at how the experience of birthing can bring religious and/or spiritual meanings to their lives.

In studying the meanings of home birth, for these women, Pamela Klassen suggests that religion is still an important means of challenging a medical view of women's bodies and birth, that religion has a much broader meaning than we tend to afford it, and that childbirth can 'foster religious reflection and initiate religious practice'. Through the women's words, she looks anew at the miracle of birth and how women engage with this in their own unique and courageous ways that might display conformity and traditionalism and at the same time, agency and autonomy. Perhaps one of the main messages I take from the pages of this book is that childbirth can be truly a miracle when women are surrounded by loving, supportive relationships, and encouraged to be themselves in ways that inspire possibility.

Ina May's Guide to Childbirth

Bantam Books, 2003, ISBN: 09553-553-38115-6

Reviewed by Gina Lowdon, AIMS Committee member, mother of two (one born by emergency caesarean section, one born at home as planned) and co-owner of www.caesarean.org.uk

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Ina May Gaskin is arguably the most famous midwife in the world. Her involvement in midwifery began in the late 1960s, shortly before The Farm was founded in Tennessee. The Farm is a self-contained community where the majority of births take place either at home or in their own midwifery centre. Their statistics are impressive and include all births where prenatal care has been given by The Farm midwives. They also include all women regardless as to whether they are deemed to be 'low' or 'high' risk by the medical profession. Statistical outcomes are given for 2,028 pregnancies which occurred between 1970 and 2000 and include: 95.1% completed at home, 4.9% transferred to hospital, 1.4% caesarean section, 0.5% forceps, 0.05% vacuum extraction, 5.4% induction and 1% post partum depression.

At The Farm, Ina May and her midwives practice true midwifery. They have regained lost knowledge and have come to appreciate the true capacities of the female body during labour and birth. Ina May's Guide to Childbirth sets out to pass on this knowledge and understanding and to give back to women the confidence that giving birth is something women can do, for the most part, without medical help or intervention.

The book is written in two parts. The first part relates birth stories, each of which has something special to teach. Often the mothers have some barrier to overcome, such as a labour that stalls or is prolonged; a lack of confidence in their birthing abilities or that giving birth unaided by drugs is achievable without undue suffering; a particularly large baby; a baby presenting by the breech, or a brow or face presentation. There are twin births and breech births and VBAC births, births complicated by group strep B, shoulder dystocia, diabetes or high blood pressure. These are birth stories from a range of real women, a selection of those who have birthed at the Farm, not a group of mystic amazons.

In part two of the book Ina May shares her midwifery experience to encourage and inform her readers, and one cannot help but be encouraged and informed. The language is straightforward, plain speaking and easy to understand. Many of the ideas and theories explained seem so natural and obvious I laughed with delight and thoughts of "of course" whilst reading them, but at the same time my reactions were tinged with a deep sadness and anger that these simple truths have been so lost and hidden by present day technological 'care' that we are no longer aware of them and need to have them pointed out.

Ina May writes that women birthing at The Farm "have less fear of birth because we know that our capabilities go beyond medical understanding or that our capabilities are greater without anxiety. Actually both are true." The model midwifery care practiced at The Farm is worlds away from that practiced in western hospitals: it is more than medical knowledge, it is time-honoured wisdom.

This book should be compulsory reading for every midwife, obstetrician and all those involved in maternity care in any capacity. I would also highly recommend it to women, particularly those who lack faith in their birthing abilities or those planning a home birth. My only reservation would be that first time mothers intending to birth in hospital may not realise just how inappropriate the care they are likely to receive will be, and therefore the failure on the part of their care givers to facilitate the natural birth process may come as even more of a shock than it already does to so many.

I would also caution those women who believe they have already completed their family - this book really does make you want to have another baby, just to experience (again) the wonders of giving birth.

Ina May has done the world a great service by writing this book - it is so full of the brand of women's wisdom that is so sorely lacking and so very desperately needed.

Birthing Autonomy. Women's experiences of planning home births by Nadine Pilley Edwards

Routledge 2005

Reviewed by Jean Robinson, AIMS Research Officer

Interviewing 30 women who are planning home births: women just talking about their views to the researcher. It sounds a simple idea, and not unlike hundreds of other studies. But what a listener! It is the integrity, quality, respect and humility of the interviewer here, and all the skills and prior knowledge she brought to her work which place this book among the best in the field. The commonsense and thoughtfulness of the women comes through, but the author places their views, and the difficulties they have in relating to health care professions, within a richly woven tapestry and shows the threads of obstetric patriarchy, midwives' uncertainties, and power of "scientific" knowledge.

It helps us to understand the deep opposition to home birth many encounter.

There is an excellent chapter teasing out different perceptions of risk, which shows how women, who are often regarded as irresponsible in choosing home birth, are in fact being responsible and thoughtful, and are looking at the issue in a much wider context - which may include seeing birth as the beginning of parenthood, and part of developing sibling relationships. I am reluctant to talk about the women as a group, because the author shows how different women were in their approach to home birth, and their priorities - for example avoiding technology, avoiding a repetition of previous experiences, but also there could be a desire for wholeness and spirituality in birth, or looking at birth from the point of view of the baby.

Just as doing a stint on the AIMS telephone helpline increases my respect for the women (and men) who call, so Nadine Edwards brings out the worth, and value in these unheard voices. For example the woman asked to make a choice about vitamin K: "She only told me the good side, and then said 'it's got to be your choice.' And I didn't understand if it was so good, why it needed to be my choice." We also see how woman recognize they often have to be tactful with midwives, who are also caught in the system - but they really want midwives who are free to be true midwives.

I long to photocopy the chapter on ethical implications of obstetrics and send a copy to every FRCOG in the UK. But maybe we should start with the trainees. For those with an open mind, willing to listen, willing to learn from the women who labour and give birth, this is a wonderfully enriching book.

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