UNTIL I READ this book, I had always thought of Macbeth as a gyp. That thane's downfall, you will recall, occurred because his archenemy, Macduff, was not "of woman born," but rather "from his mother's womb untimely ripp'd." A flimsy plot device, I used to sneer, unworthy of the greatest artist in our language. But I should have known that, as usual, the Bard had it right. For, as Rothman demonstrates in this perceptive, robust, and original analysis of American birthing practices, bringing a baby forth by the natural efforts of its mother is quite a different thing--emotionally, spiritually, physically, and symbolically--from wrenching it out by medical intervention.
Rothman is a feminist sociologist, in the best sense of both words. As a sociologist, she knows that all human events occur within a framework of social meaning--indeed, that it is the social framework that gives them their meaning. And as a feminist she analyzes events from the standpoint of women's perceptions. Because the ruling ideologies of our society arise from male perceptions, this point of view--even on a supposedly familiar scene--can offer some startlingly new vistas, rather like coming upon a familiar street from a wholly unaccustomed direction.
Rothman's book falls squarely into the tradition of the sociology of knowledge. What interests her is how people know what they know, how their position in a network of social interactions influences their beliefs and thus their behavior. Why, for example, do Americans believe that hospitals are the right place to have babies? Why do we believe that male doctors are the right people to attend at birth? Why do we see a surgical table with raised stirrups as the best resting place for a woman in advanced labor?
Well, because it's safe and scientific and modern and doctors tell us so. And yet, Rothman calmly explains, our infant and maternal mortality rate is much higher than Holland's, for example, where nearly everyone delivers at home, attended by a midwife. And the flat-on- the-back position, far from facilitating labor, makes it harder and more exhausting, because the mother must push the baby up, against gravity; it also makes tearing almost inevitable and the episiotomy necessary. But it does place the entire scene of the action in convenient reach of the doctor and his instruments. And that, Rothman believes, is the heart of the matter.
A certain system of beliefs, what Rothman calls the "medical model," has defined childbirth, a wholly normal, uncomplicated process in nine out of 10 women, as a surgical event properly controlled by a physician. Medical thought, she persuasively argues, takes the male body as the norm; those features uniquely female --the cycles, the alternation between pregnancy and non-pregnancy--must thus be "abnormal." Pregnancy, viewed as a woman carrying a man's baby, thus becomes a relationship between a host and an invasive parasite, and an exceptional stress that must be medically "managed."
There is another view of pregnancy abroad in this country--what Rothman calls the "midwifery model"-- but it can hardly be called "competing" because it has so little social power. In this theory, pregnancy is a normal state--one of several normal states--of the female body. The changes in blood chemistry, in weight, in relative size of the organs during pregnancy aren't "symptoms" of "stress" but merely aspects of a particular phase of being. A pregnant woman thus doesn't need to be "managed" and then "delivered" but educated, encouraged, and helped to bring forth her baby through her own efforts, in her own home and surrounded by those who love her if she so desires.
Although hardly an unbiased observer--herself the veteran of two home births movingly described in the book--Rothman is nonetheless a methodical scholar. She marshals her evidence with care and presents it with clarity. She illustrates her conclusions about midwives and their problematic place in our society with both extensive references to the literature and quotations from many interviews. I only wish she had asked some obstetricians to explain why they believe some of the apparently unfounded things they do believe; rather, she relies exclusively on references to articles and books for their point of view.
This book is altogether a bracing foray onto newly mysterious ground. It should be read by women, by men, and especially by doctors. Perhaps it would help them understand the difference between telling pregnant women that they are fragile patients in need of high- tech manipulations and encouraging them, as they enter labor, to "screw up your courage to the sticking place and you'll not fail." And it would certainly encourage some rethinking of the medical management of infertility, Rh incompatability, and infant feeding, among other things.
Rothman is an industrious and clear-eyed guide on this journey. And a lucky one. How many women authors, after all, get to thank their husbands for typing the manuscript?