Laboring On: Birth in Transition in the United States
by Wendy Simonds, Barbara Katz Rothman and Bari Meltzer Norman

[2007, New York: Routledge; 339 pages, paperback.]

[Review first published in Midwifery Today Issue 82, Summer 2007, © 2007, Midwifery Today, Inc. Review by Susan Delaney.]

When Barbara Katz Rothman first published In Labor: Women and Power in the Birthplace in 1982, she hoped that changes in the birthplace might bring about changes in obstetrical practice. Thirty years later, Rothman and her colleagues look back on the power dynamics among childbirth professionals in the US with the realization that setting continues to determine practice and that practice determines knowledge. The addition of “homelike” features to institutional birthing rooms was merely a superficial update to established birthing facilities and has done nothing to empower birthing women. The authors now place their hope in the postmodern midwife—one who combines traditional midwifery with modern communication devices and updated research.

Laboring On relies on qualitative interviews with direct entry midwives, nurse-midwives and midwifery students to provide an analysis of midwifery reform in the United States since the 1970s. The book begins with a brief history of childbirth in America, along with a description of the current midwifery and medical models of birth. It moves on to an analysis of midwives’ stories—both their “origin stories” (midwives’ personal reflections on how they came into the profession), as well as stories about their ideals and how those ideals interface with practical realities. The relationship between hospital-based midwives and homebirth midwives is explored. Interviews with obstetricians, nurses and doulas provide a point of comparison with midwives. A discussion of the labor doula profession demonstrates the conflict between doulas’ ideals and the limitations inherent in working within the medical system and concludes that doulas are unable to effect significant change in childbirth practices. The authors conclude that medicalization has transformed birth practices, and they call for a revolution in which doctors, nurses, and doulas turn to the postmodern midwife as the overseer of normal birth.

The authors are all sociologists: one who is a newcomer to the study of childbirth practices, another with 15 years of experience in the field and one with more than 30 years of accumulated knowledge. The range of knowledge of the three authors brings depth to this sociological analysis. Laboring On illuminates American childbirth practices today, especially how those practices are affected by the inherent power differences and relationships among separate groups of birth practitioners. This updated work incorporates over 20 years’ worth of new information, adding valuable insights to the current knowledge of childbirth in this country.

Reviewer Susan Delaney, MA, is an aspiring midwife and a homeschooling mom of one. She has studied midwifery in Maine and the Philippines, and is currently apprenticing in the greater Philadelphia, Pennsylvania, region.

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