Exploring the Dirty Side of Women’s Health
Edited by Mavis Kirkham

[2007. New York: Routledge; 320 pages, paperback.]

[Review first published in Midwifery Today Issue 90, Summer 2009, © 2009, Midwifery Today, Inc. Review by Elise Hansen.]

Mavis Kirkham, a midwife and researcher for over 30 years, has compiled a group of essays surrounding the theme of “bodies, leakage and boundaries.” Using an underlying definition of dirt as “matter out of place,” these essays explore dirt—something that straddles boundaries, does not fit into a particular category and crosses from one category to another—in relation to women’s health issues.

The book is divided into four sections. The first section, Mothers, Midwives and Dirt—Past and Present, deals with birth dirt across time, management and control of that dirt, the boundaries established to contain the dirt and preventing dirt from crossing those boundaries. The second section, Breastfeeding as Pollution, examines societies that seem to promote breastfeeding but in which the majority of women actually bottle-feed (the US for one) and how women in those societies try to keep their “leakage” (breast milk) and their breasts and babies in the “proper” place—including a fascinating discussion around the isolation of breastfeeding moms and the designated places for breastfeeding (public restrooms/toilets!).

The next section, Dais, focuses on the indigenous midwives of India and highlights the relationship of caste/gender/family duties to “dirty” work, leaving the lower caste dais as the only appropriate people for the dirty work surrounding birth. The last section, Leakage and Labeling, expands the discussion into health care in general, not just regarding birth—in other words, dirty work without the pleasures surrounding birth, including female urinary incontinence, miscarriage and sexually transmitted infections (STIs) and the concept of “dirt.”

Women, especially birthing women and midwives, are considered “dirtier” than men. They discharge menstrual blood, excrete a baby, and produce lochia, amniotic fluid and colostrum—all dirty fluids. Therefore women are considered more appropriate to do the dirty work related to home and baby. Because of how Western culture views disease, contamination, pollution, dirt and impurities, our health system aims to contain everything that originates from the body. Labor and childbirth are particularly dirty: labor is hard, physical work—always viewed as dirty; women “leak” throughout labor—dirty fluids abound; and laboring women are about to excrete a “dirty” (because it comes from inside a dirty body) being. Who and what is seen as dirty (powerless) and clean (powerful) affect how this hierarchy plays out in birth. Removing women from the birth process, through anesthesia, forceps or vacuum delivery, emphasizes the knowledge/power/“cleanliness” of the medical profession and creates women’s need for their expertise. Of course, the ultimate method of cleansing dirt from birth is the c-section.

Regardless of whether you appreciate this book from an anthropological, midwifery or research perspective, you will appreciate it. These essays examine some of the nitty-gritty, “down and dirty” issues of our health care beliefs and practices.

Reviewer Elise Hansen has been involved in women’s health care for over 25 years, has naturally birthed four children (including a footling breech), is a proofreader for Midwifery Today, academic copyeditor, a Spanish-language medical interpreter and is currently practicing as a homebirth midwife in Oregon. She still has implicit trust in gentle, non-interventive birth.

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