The Bowland Bust

Chapter 4 traces the role of the hippie midwife from the perspective of a legal case. In 1974, three women were arrested in an undercover sting operation in Santa Cruz and charged with practicing medicine without a license for their involvement in out-of-hospital births. Over a period of nearly three years, the case moved from the district to the state supreme court, which ruled that pregnancy was a physical condition and that the law prohibited unlicensed persons from “diagnosing, treating, operating upon or prescribing for a woman undergoing normal pregnancy or childbirth.” Bowland v. Municipal Court, which established a precedent of state restrictions over parental choice in childbirth options, suggested the near impossibility of unifying reproductive rights groups under the larger rubric of “choice.” The birth center bust showcases the potential for collaboration (between midwives and doctors, feminists, politicians and activists) as well as the obstacles that ultimately prevented them from doing so.

Psychedelic Birth

Chapter 3, “Psychedelic Birth: The Emergence of the Hippie Midwife,” explores the home birth experience from the perspective of the counterculture. In this context, childbirth became a catalyst to spiritual transcendence. At the same time, new developments in psychiatric research and the proliferation of psychoactive substances created a vibrant, albeit surprising, intellectual exchange between hippies, midwives, and some psychiatrists about the meaning and significance of birth. This chapter exposes the resulting unexpected entanglements between psychedelic psychiatry and spiritual midwifery by focusing on the creation of the longest lasting hippie commune, The Farm. Though The Farm was established in Summertown, Tennessee, its founders traveled from San Francisco to build their utopia and they brought with them intellectual and practical tools gathered from as far away as Communist China and Czechoslovakia. The story illustrates how alternative pathways to mainstream medicine, in both childbirth and psychiatry, came into fruition in the 1970s.

Introduction

On December 8, 2009, Brazilian supermodel Giselle Bundchen and Patriots quarterback Tom Brady welcomed their son Rein into the world. Unlike the majority of babies born in the United States, Rein’s first view was not of a hospital delivery room, but of his parents’ Beacon Hill penthouse overlooking the Charles River in Boston. Bundchen joined a number of celebrities—Demi Moore, Meryl Streep, Juliane Moore, Jennifer Connelly, and Cindy Crawford, to name a few—who have opted for a home birth and generated flashy headlines about the birthing practice. The idea that home birth could be sexy, splashy, or even desirable shocked many Americans, who have little knowledge of the history of midwifery or home birth. This introduction provides a brief overview of the history of childbirth in the United States in order to explain the recent home birth trend.

From Professionalization to Education

One of the biggest hurdles to professionalizing non-nurse midwifery was the lack of any standardized training opportunities in the United States. Historically, midwives had learned their trade by apprenticing with those more experienced within their community. By the late twentieth century, however, the home birth trend triggered a regulatory backlash in many states, resulting in new and more restrictive licensure laws requiring education and certification. This chapter traces the evolution of the first and arguably the most successful fully accredited direct-entry midwifery program recognized by the U.S. Department of Education. As the school evolved, its founders faced philosophical and financial hurdles that required them to reconsider how to train students and promote midwifery as an inclusive, meaningful, and practical profession.

From El Paso to Lexington

Chapter 5, “From El Paso to Lexington: The Formation of the Midwives Alliance of North America,” closely tracks the push to organize direct-entry midwives, beginning with the first international conference of practicing midwives in El Paso in 1978 and ending with the formation of MANA. Ideologically, many of them viewed midwifery as a feminist endeavor that enabled women to reclaim their bodies, rather than a medical profession. Barred from membership in the already established American College of Nurse Midwives, they sought to create a more inclusive organization that could provide them with the protection, legitimacy, and visibility needed to sustain and grow their trade. This would turn out to be an enormously challenging task.

Epilogue

In September 2014, 93 delegates participated in the third Home Birth Summit at the “discreet, quintessentially Northwest hideaway” Cedarbrook Lodge outside of Seattle, Washington. Nurse-midwives, direct-entry midwives, obstetricians, general practitioners, nurses, activists, philosophers, historians, epidemiologists, activists, a documentary filmmaker, and representatives from ACNM, MANA, and ACOG wrangled with the current policies, regulation, evidence, and ethics of home birth in the United States. This epilogue explores the impact of the Home Birth Summit on current debates on childbirth and midwifery. What is missing in 21st-century reports of the current status of midwifery, birthplace options, and birth outcomes is an awareness of the earlier collaborative efforts between some doctors, midwives, and consumers. Despite competition, criticism, and crises, attempts to improve the birthing experience started well before the year 2000. Many individuals and organizations confronted legislative, professional, and educational hurdles, determined to make birth both safe and meaningful for everyone involved.

Back to Bed

Chapter 1, “Back to Bed: From Hospital to Home Obstetrics in the City of Chicago” analyzes the home obstetrics training practiced at the Chicago Maternity Center alongside the emergence of what would become an international breastfeeding organization, La Leche League. One focused on the inner-city’s working-class population, while the other catered more to the suburban white middle-class. Both the Chicago Maternity Center and the La Leche League relied on the promotion of home birth, but for very different reasons. Under the CMC, home birth provided essential training for obstetrical students, while under the LLL, it enabled mothers to breastfeed and bond with their babies. The different rationales underscored the extent to which race, class, and context shaped ideas about home birth. Taken together, these two examples reveal the complex origins of what would become a contested yet increasingly popular practice by the 1970s.

Middle-Class Midwifery

Chapter 2, “Middle-Class Midwifery: Transforming Birth Practices in Suburban Washington, D.C.,” investigates the individuals and organizations that began to promote home birth in the 1970s. Many of the D.C.-area women attribute their “calling” to midwifery at least in part to their experiences as mothers, La Leche League leaders, and childbirth educators. When they opted to take the further step of becoming midwives, they enabled the transition of home birth as a practice primarily supervised by doctors to one facilitated by midwives. Aware of the significance of this shift, these women carefully positioned themselves as responsible, educated, middle-class midwives, representing the least threatening version of the midwife to organized medicine. With the establishment of the area’s first nurse-midwifery program at Georgetown University in 1974, many trained and worked with established doctors and hospitals.