Book Review: A Social History of Maternity and Childbirth: Key themes in maternity care

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AIMS Journal, 2020, Vol 32, No 3

Reviewed for AIMS by Gemma McKenzie

A Social History of Maternity and Childbirth: Key themes in maternity care By Tania McIntosh Published by Routledge, 2012 ISBN: 978 0 415 561 631 188 pages Publisher’s recommended price £37.99 Find this book on Amazon

This book was a joy to read; indeed, I would describe it as a little gem of a book. Slim, with only 150 pages of main text, it manages to incorporate discussion on over 100 years of maternity care in England. As someone who enjoys reading history books – especially when they relate to women’s lives – I found it fascinating to delve into this history.

Tania McIntosh, who is both an historian and midwife, focuses in detail on the years 1902-2002, although there are passing references to earlier periods. She highlights the charged nature of the history surrounding maternity care. Although pregnancy and childbirth are private events, Tania notes how they are also events which have importance for wider society. Consequently, there has been a great deal of societal interest in where and how women should give birth, and who should attend them. In outlining the context of her book, she questions whose narrative has constructed our understanding of this period of history and explores what role the conflict between obstetrics and midwifery has played in our interpretation. Importantly, Tania highlights the lack of mothers' voices in the records, especially those from poorer backgrounds who left limited written documentation. Notably, there is also exploration of the role of AIMS in promoting improvements in the maternity system and a focus on our former AIMS president Jean Robinson.

One interesting section is the detailed discussion Tania provides on the role of the GP. This adds a unique dimension to our understanding of maternity care, which does not usually feature in typical discussions on the subject. Of most relevance is her exploration of a power struggle between obstetricians and GPs, with the latter being blamed for the high number of maternal deaths due to puerperal fever. Similarly, Tania notes how formally trained midwives lamented their ‘untrained’ peers, who were termed 'handywomen'. Some midwives accused handywomen of having no formal education, while handywomen accused midwives of learning everything from books and of having little knowledge or experience of birth (p.42). This interpretation is very different to the narrative that is often provided with regards to the development of the maternity system and which tends to argue that a male-dominated obstetric system overran the female-led midwifery style of care.

The chapter discussing birth between 1960 and 1980 and the way its management became increasingly scientific was of particular interest to me. Of relevance was the way Tania describes how the focus of care became the unborn baby as opposed to the health of the mother. This revolution in maternity care resulted in the use of 'technology' and 'machines' and heralded an era of the '"heroic" individual researcher', who created 'new technologies with little idea as to what benefits they might bring (and no research to back it up)' (p.102). This chapter explores the increased use of induction of labour, episiotomies and ultrasound, and may be of interest to people who wish to understand the origins of the medicalisation of childbirth in England.

Although this text is not a hard, dense book, it is the result of serious scholarship and therefore it reads somewhat ‘academically'. However, the inclusion of the insights of ordinary women, midwives and doctors serves to elevate it from what could have been a heavy text on various laws, policies and mortality studies, to a digestible and readable book (albeit one that does require some concentration). Indeed, the quotes Tania has included are really illuminating. At times they include humour – for example the way in which some women acknowledged their lack of understanding of birth (p.66) – and at other times there is sadness. There was a lot of signposting to other interesting sources, and having followed many of them, I would recommend Letters from Working Women (1915), which is accessible free of charge¹. These letters from women regarding their birth complement the arguments Tania has made and serve as a fascinating insight into the era.

My only bugbear with this book was the continued use of the word ‘delivery’ instead of 'birth'. There is also the occasional slip into the phrase 'their women' in reference to the pregnant women midwives were supporting. An example reads "… midwives working on the district were not able to offer [gas and air] to their women until 1951” (p.96). Both of these terms are rather dated and ‘un-PC’, but, nevertheless, they do not detract too much from the quality of this excellent book.

In short, there are very few books of this quality and breadth on the English maternity system. For those interested in how we got to this point - a system which is overly medicalised, largely hospital based, and which often does not adequately support pregnant women and families, nor the midwives attending them - this book by Tania McIntosh provides a fascinating insight.

1 Llewelyn Davies (editor), Letters from Working Women (1915) - http://www.gutenberg.org/files/50077/50077-h/50077-h.htm