Book Reviews

AIMS Journal, 2008, Vol 20 No 3

Holistic Midwifery: A Comprehensive Textbook for Midwives in Homebirth Practice by Anne Frye

Volume I - Care During Pregnancy

Labrys Press 1998
ISBN-10: 189114555X
ISBN-13: 978-1891145551
US$75

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Volume II - Care of the Mother and Baby from the onset of Labor through the First Hours After Birth

Labrys Press 2004
ISBN-10: 1891145606
ISBN-13: 978-1891145605
US$95

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Reviewed by
Laura Jansson
Mother, NCT antenatal teacher and doula

If all midwives embodied the skills and ideology encompassed by these books, the world would be a very different place.

Anne Frye has lovingly created an exhaustive, 2700-page two-volume manual of true midwifery drawing on sources from all over the world. It is written with US home birth midwives in mind, but would be indispensable to independent midwives in any country, and highly instructive to anyone caring for childbearing women and their babies.

The work has much in common with a textbook, as it has a serious approach and provides a scholarly consensus on a comprehensive range of topics. However, it is unlike textbooks I have seen in that the source of its authority rests with true experience of what works and does not work in midwifery, rather than merely on citing clinical research studies done by others. This may strike some as unscientific, however, as we know, midwifery is mainly an art, and a strength of this manual is that it acknowledges and revels in that fact.

This is not to say that the work is in any way poorly researched: each section ends with fulsome reference and reading lists. Neither is it woolly: it is about as practical as it gets, for instance listing about ten possible ways to turn a posterior baby, providing tips on compiling statistics, and exploring the issue of charging for services.

Frye's work is truly woman-centred, retaining a focus throughout on the physiological process of normal childbearing rather than on caregivers' routines, for example titling one major section Being At Births where others might write Delivering Babies. But there is a second, deeper way in which the work is woman-centred. A respect for overlooked feminine ways of being permeates the books. This impacts Frye's language (resulting in the coining of interesting words such as 'intrayoni'.) It also influences her selection of topics, with the inclusion of chapters like Integrating Your Presence Into the Mother's Space along with Abnormal Bleeding During Labor.

Her epistemology, too, places equal store by the insights of intuition as by the results of diagnostic tests. Even the physical reality of the second volume, with its beautifully embossed hardback purple cover reminiscent of a book of spells, lends itself to being passed down through generations, in the same relational way that women have always transmitted their knowledge of midwifery. Yes, it is easy to see how women birthing and midwives attending births under the influence of this book will be greatly re-empowered.

The amount of work that has gone into creating these texts is mind-boggling. The author has incorporated not only her own lived learning as a midwife of thirty years, but that of a huge number of other midwives in countries from Mexico to Russia. Some sloppy work by proofreaders misrepresents this huge effort, however, errata are available to view on the author's website, and I trust that these corrections will appear in further editions. Meanwhile I eagerly await the release of Volume III, which will be subtitled Care During the First 8 Weeks After Birth.

Pregnancy, Birth and Maternity Care: Feminist Perspectives; Edited by Mary Stewart

Books for Midwives, 2005
ISBN-10: 0750656018 ISBN-13: 978-0750656016
21.99

Reviewed by
Jo Murphy-Lawless
School of Midwifery
Trinity College Dublin

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The midwifery students to whom I am teaching social theory have just completed their first year of the new direct entry midwifery degree in Ireland. It was a new under taking in teaching terms for me as well and what I quickly became conscious of is the extent of the pressure on midwives in training. They are asked to absorb a huge range of practical and theoretical teaching on top of their placements, which in themselves are frequently challenging and emotionally draining, especially as they come to terms with the pervasive nature of medicalised birth. Many of our students are experienced mothers with strong views on birth, many are young women in their first learning environment who have felt strongly drawn to working with women and birth. In such circumstances, Mary Stewart's book is a wonderful and supportive teaching resource.

Importantly, the book is truly woman-centred, exploring women's transitions through pregnancy, labour and becoming a mother through a well-articulated feminist perspective. As a critical and evolving body of social theory over the last three decades, feminism has helped us to be much clearer about the positions of women and men enduring the deep inequalities that appear in so many guises in a patriarchal society to the detriment of the lives of both sexes. It can be complex material and not infrequently, streams within feminism have been actively dismissive about childbirth as an undertaking, leaving women somewhat adrift. This book serves to overcome both these dilemmas.

In the Introduction, Tina Kaufmann presents a lucid overview of the origins of feminist theory and how it has evolved in the late 20th century as a set of tools for political change that responds to women in different social milieus. She draws out how women face quite different challenges in relation to an unequal society, for example the needs of black women, of lesbian women, of women who are not part of a privileged avant-garde but who work in low-paid service jobs, in brief the full extent of the women who come to midwives every day requiring excellent and sensitive maternity care. Kaufmann makes the point that feminism is not necessary to practice good midwifery but on the other hand, the strong themes within feminism about bodily health, bodily integrity and empowerment are aspects that midwives work hard to incorporate into their practice. Thus an understanding of feminism becomes a source of support for the midwife in helping each woman to identify her personal and particular needs in pregnancy and birth. The term so often used in feminist theory, agency, is one that midwives can readily relate to in their practice and seek to implant for themselves and the women in their care.

The chapters include a focus on gender and sexuality, pregnancy, holistic birth, breastfeeding, and the many transitions after birth that can include depression as women come to terms with their experiences, good and bad in their births, their new responsibilities and role as mothers, and the value (or so often the lack of value) placed on that role. With efficient adroit editing, the contributor of each chapter presents a topic and uses current feminist theory to help us understand in depth how the medical model of contemporary maternity care reinforces a patriarchal mode and what care can convey to women when it comes instead from a truly midwifery perspective. For example, in the discussion of antenatal care in the chapter on pregnancy, Liz Stephens points out that formalised antenatal care has had a paternalistic agenda since its inception at the beginning of the 20th century, making women feel objects of surveillance and their pregnancies a potential source of problems, so that there has been a seamless extension of the scope of the medical model of care. By contrast, Stephens portrays what a woman-centred practice of antenatal care can do, helping women to articulate their fears, anxieties, and concerns in their terms. Stephens encourages midwives to think how that can be done in concrete ways for example by adapting schedules of care and appointments to each woman's needs, including venue. When a midwife identifies the woman who becomes overwhelmed at an antenatal clinic with soaring blood pressure and stress levels, why not opt to pop into her home instead?

Each chapter is excellently laid out with boxes of questions and suggestions for reflection and key points. In the chapter on intra-partum care and holistic birth by Denis Walsh for example, Walsh asks midwives to reflect on this: 'Does professional bullying occur where you work and, if so, can you think of ways of addressing it?' Such issues are part of confronting unacceptable patriarchal practices. The questions can be used to help initiate a group discussion that can be so helpful for midwifery students, giving them space to articulate their experiences and explore how they might deal with these practices differently. Using the chapters can also help midwives increase their fluency and confidence in being able to discuss how and why these unacceptable practices have arisen as problems of gender.

Stewart's own chapter on feminisms and the body asks midwives to reflect on how their approach to the pregnant body becomes too easily abstracted and medicalised, signally through the use of medical terminology and she offers the sensitive insight that what is portrayed in medical (and most midwifery) textbooks denies a feminist practice of midwifery and can be overturned.

In Carol Bates's chapter on working with feminism as a midwife, she argues that the UK's Audit Commission, a government-sponsored survey of women's experiences of maternity care and actual care outcomes, was meant to focus on value for money. Nonetheless, the survey revealed how different patterns of midwifery care had emerged in different parts of the country from the 1980s that were supportive of women, based on the view that most pregnancies were healthy and that the concept of 'normality' could be a very broad one. This was in sharp contrast to the increasing centralisation of birth in large consultant units wedded to the rationales of the paternalistic medical model that says birth is only normal in retrospect. She argues that government policies have consistently underwritten the paternalism that has denied women and midwives of personal agency. She asks midwives to reflect on what they can define as truly professional midwifery practice.

The book is very well-referenced with further readings at the conclusion to each chapter.

This is a teaching book for midwives but it will also be of immense value in birth resource groups and classes and syllabi for birth education teachers seeking to understand how we achieve changes in practice.

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