Audrey Farley Reviews Wendy Kline

“It was the most amazing experience of my life, feeling him come through my body,” Brazilian supermodel Gisele Bündchen told Vogue in 2010, recounting the at-home water birth of her son, Benjamin Rein. The boy’s middle name fittingly means river: “I wanted something always flowing, immortal.” In this interview, the celebrity also described preparing for her drug-free labor with yoga and meditation, psychic tools that allowed her to “experience the transformation” with pleasure and not pain.

Bündchen’s story, which opens historian Wendy Kline’s new book, Coming Home: How Midwives Changed Birth, is hardly original. As Kline demonstrates, efforts to re-spiritualize and re-sexualize birth have been underway for decades, as women and midwives around the Unites States have quietly revolted against mainstream obstetrical practices. However, Bündchen’s story is significant insofar it signals the home birth’s movement from poor and “fringe” communities to celebrity classes. How exactly did home birth and midwifery, destined for extinction in the middle of the century, become culturally desirable?

The author’s insights on this question can inform current debates about home birth, which have become increasingly relevant amidst a crisis of maternal medicine in the United States. With rising rates of fetal mortality, maternal mortality, cesarean section, and other negative outcomes, many women desire alternative birthing methods. But there exist many legal and structural barriers that prevent those without Bündchen’s means from pursuing a home birth. The stories of the politically savvy midwives who comprise Kline’s book will help advocates and policymakers to “think through” some of these barriers.

But the real critical strength of Coming Home is the author’s ability to read beyond midwives’ professional gains, examining their influence on traditional medicine, spiritual movements, psychiatry, civil rights, and the public imagination. This strength has much to do with Kline’s approach. Rather than simply charting midwifery’s development across the century, Kline explores the various settings in which midwifery flourished, bringing to life the individuals within that setting through diary excerpts, poetry, published writings, photographs, and other historical artifacts. This approach gives texture to the midwife, revealing a wide range of motivations for home birth and ideological conflicts with feminist movements. Perhaps most surprising is the conflict that developed between midwives and Roe advocates. This conflict, focused on whether birth was a medical or spiritual event, anticipates the ongoing difficulty of defining medicine’s relationship to feminist interests.

As most readers know, midwives with varying degrees of training oversaw the majority of births before modern medicine. But in the early the twentieth century, middle class women began to visit hospitals for delivery. The field of obstetrics developed to further medicalize birth, making laboring women the prerogative of physicians and not “ignorant, unconscientious” midwives. One physician who particularly wished to see obstetrics flourish was Dr. Joseph DeLee (1869-1942), who believed that physicians could best be trained in the home, where they didn’t have the full resources of a hospital to respond to unexpected challenges. He established the Chicago Maternity Center to increase home births in the interest of providing professional training, while his specialty field was finding its footing.

Kline narrates DeLee’s efforts, whose ultimate vision of hospital birth was realized in the 1950s, alongside those of two Catholic women in the same city. Doing so enables her to show that home birth was not always motivated by progressive or hippie, counter-cultural ideals. Marion Thompson and Mary White, founders of the La Leche League, promoted home birth because they believed sterile hospital environments decreased maternal feelings, which were already seen as under attack by feminist influences. In a domestic setting, a woman could give birth in her own bed, surrounding by plants, her husband, and other familiar objects while music played. (Never mind the economic privilege implicit in this idea that home offered more comfort than the hospital.) Also, at home, a mother was more likely to breastfeed, as her newborn wouldn’t be whisked away to the nursery. For Thompson and White, home birth was essential to restoring the “ideal” mother.

Whether or not the reader sympathizes with these advocates’ mission, she is urged to appreciate their impact on traditional medicine, especially considering their small and informal organization. In contrast to the highly visible, politically defined, and of course, more left-leaning Boston Women’s Health Collective of the next decade, these women and their supporters were not connected to advocates in other cities, if such even existed. They did not march in the streets or to the ballot box, but simply exercised their agency in their kitchens and bedrooms (where women gave birth). Over time, these stay-at-home moms compelled medical professionals to change clinical practices. Obstetricians eventually allowed women to have partners present during delivery, to choose their labor position, to birth without drugs, and to have a say about the equipment used during delivery.

In demonstrating these women’s impact on the field of obstetrics, Kline challenges the popular conception of medicine as a history of scientific, technological, or economic developments. Such a conception attributes changes in clinical practice to new research, tools, or policies, obscuring the role that patients play in shaping the profession. This idea of medicine is typified by popular works like Robert Adler’s Medical Firsts: From Hippocrates to the Human Genome, focused on scientific breakthroughs, and Paul Starr’s Pulitzer Prize-winning The Social Transformation of American Medicine, which examines the impact of doctors, hospitals, health plans, and government programs on medicine. By restoring patients and individuals as historical actors, Kline encourages readers to recognize the power of those who defy medical authority, no matter how calmly or quietly.

But as compelling as this counter-narrative is, Coming Home’s discussion of midwives’ impact beyond medicine is even more so. This is because it tacitly calls upon readers to not simply acknowledge individual agency but also reimagine it. More specifically, it calls upon readers to consider activists’ tangential and accidental influence, and not just their achievement of stated goals. Kline’s discussion of the vibrant intellectual exchange between midwifery and spiritualism, transpersonal psychology, and Roe v. Wade activism exemplifies this kind of inquiry.

The discussion begins with California midwives on a hippie commune, The Farm, led by Stephen Gaskin, who encouraged the use of psychedelics to achieve higher spiritual awareness. Kline explains that Gaskin’s spiritual movement was on life support—until the midwives began to tell stories about their “cosmic” and out-of-body experiences during labor. In writings published in their popular manual Spiritual Midwifery, the women described interacting “on a vibrational level” during birth and achieving a state of enlightenment similar to that brought on by hallucinogens. Kline quotes one laboring woman: “I began having beautiful, rushing contractions that started low, built up to a peak, and then left me floating about two feet off the bed.” And another, describing a telepathic exchange with the others in the room: “We kept passing this energy between us…. I’d rush and the energy would move up their spines and they’d arch their backs and straighten as they’d rush.” This woman’s sentiments were echoed by one of the midwives present: “She seemed to be filling us with her consciousness.”

In Kline’s close reading of Spiritual Midwifery, it becomes clear that home birth extended Gaskin’s teachings, while also demonstrating the relevance of those teachings. In order to experience pleasure in birth, a woman had to enter labor with the right psychic tools. She had to be at one with the universe. The home birth manual sold a half million copies, as many women beyond the commune were eager to learn about the physical and psychic elements of home birth. Of the ten thousand communes that existed in the United States in the early 1970s, few lasted as long as The Farm. Kline makes clear that this “had less to do with Stephen than it did with some of his pregnant female followers, whose determination to stay out of the hospital led to a revolution in birth practices.”

Kline then directs attention to the dialogue between home birth and the scientific research of Stanislav Grof at the Maryland Psychiatric Research Institute. While in his native Czech Republic, Grof had been among a group of psychiatrists who tested 150 micrograms of LSD to better understand patients’ worlds. This unconventional training experience revealed much about his psyche, suggesting the heuristic value of LSD to the struggling profession of psychiatry. When Grof began to test mental health professionals on LSD in his Maryland laboratory, he noted something very curious. Nearly all of his subjects described fluid movement between their bodies and their environments, and many seemed to describe the stages of delivery: “At one point I remember feeling like a great weight was pressing on my physical body and crushing me and I was leaking out of my body,” a male subject reported. A female recalled, “I pushed and pushed and then it was here.” One subject clearly identified “a feeling of being in a birth situation,” but claimed to need the researcher to guide him through the experience: “I had to rely on Stan the midwife. He would help me through this experience of birth.”

These research subjects convinced Grof that psychological disorders originated with the trauma of birth and prenatal life, prompting him to create a rubric of perinatal matrices that connected the stages of labor with the development of the fetus and the human psyche. These subjects also convinced Grof of the extreme importance of proper love and maternal care during and after birth. Midwives lauded his research because it legitimated their work, while also affirming that home birth served babies and not just mothers. (The latter were often accused of being “selfish” for giving birth outside of a hospital setting.)

If midwifery, spiritualism, and transpersonal psychology co-constituted each other, the relationship between midwifery and reproductive rights was somewhat more contentious. This becomes evident in a chapter focused on California midwives charged with practicing medicine without a license. In the highly publicized trial, these women and their attorney deliberately avoided invoking the recent Roe v. Wade decision on the basis that birth, unlike abortion, was not a medical event. When the American Civil Liberties Union filed an amicus brief citing the Supreme Court case, they were furious. The midwives became even more enraged when prosecutors swiftly demonstrated how that case designated the state’s authority to protect unborn children after the first trimester.

But with Roe v. Wade injected into the debate, the defendants appealed to the right of privacy enshrined within the decision. Birth, they claimed, was a sexual act, as demonstrated by Grof and other experts. As such, a woman retained the right to consummate that act with consenting adults in the privacy of her own home. The midwives did not prevail in court, but their efforts were significant because they revealed to feminists the limitations of Roe v. Wade to secure broader reproductive rights for women.

The conflict between the midwives and Roe advocates is significant for another reason: it staged a broader debate about the merits of medicine and spiritualism that persists today. Pro-choice advocates have long depended upon traditional medicine for practical and theoretical reasons. They need trained doctors to safely perform abortions, and they need the institution’s clinical logic and jargon to secure this civil right for women. (It suits to conceive of abortion as a “procedure” involving a “fetus” or “specimen,” rather than as the induced death of a baby.) The problem, as midwives recognized in the 1970s, is that this mechanical model regards human beings as body parts to be fixed or controlled, ignoring the spiritual experiences of those involved. It does not surprise that pro-choice advocates have recently attempted to sacralize the procedure, calling it “a blessing” and “a gift” and singing lullabies during their abortions.

Home birth advocates, on the other hand, have largely thwarted traditional medicine, believing it to have deprived women of the psychological, spiritual, and sexual experiences of which they are capable. By replacing medical men with informally trained or even lay women, these advocates have reclaimed birth as a feminine prerogative—one that empowers those who experience it naturally. Bündchen expresses this mindset when she describes her joy upon delivering her son without drugs: “I never felt so empowered as looking at him and thinking, Oh, my God, we did it together!” Having intuited that a woman’s entire pregnancy—and not just her labor—is sacred, the supermodel elected not to work. Instead, she stayed in her penthouse reading titles found on Amazon with the search terms, “Spiritual books.”

As Bündchen’s Vogue interview tacitly suggests, and as the history of midwifery more plainly demonstrates, purely spiritualist approaches to human acts like birth and death are just as lacking as medical ones. This is especially true for those with greater dependence upon clinical knowledge and technological resources. To say that birth is not a medical event is to take for granted that both mother and infant are sufficiently able-bodied (able to survive delivery without interventions such as emergency cesarean section). It is to plainly ignore the needs of disabled and ill women to protect against negative outcomes with more than yoga and meditation. Those, like Bündchen, touting “mind over matter” also take for granted certain material comforts, such as a clean, safe home in which to labor and the ability to pay for services out of pocket.

Kline’s midwives eventually came to terms with these realities, accepting the need to at least partially integrate with traditional medicine to better protect all individuals and to secure insurance coverage, thereby allowing more women the option of birthing in their bedrooms and through their vaginas. The book’s final chapters describe midwives’ uneasy path to professionalization and their ongoing struggle to maintain sacred traditions while expanding access to home birth.

Coming Home may primarily appeal to midwives, obstetricians, mothers interested in the cause of home birth, and historians of medicine, but its message is likely to resonate with anyone fighting to improve women’s lives within or alongside medicine. This book grapples with the reality that ideological and material interests often collide without undermining the importance of fighting for women’s individual and collective liberation from the institutions that do them harm.

Audrey Farley recently earned a PhD in English and now teaches history and literature at Mount St. Mary’s University. She is the Editor of Pens & Needles and is writing a historical novel about one of the first patients to receive insulin shortly after its discovery in 1921. Follow her on Twitter @AudreyCFarley.