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The American Way of Birth
Three decades ago, Jessica Mitford became famous when she introduced us to the idiosyncracies of American funeral rites in The American Way of Death. Now in a book as fresh, provocative, and fearless as anything else she has written, she shows us how and in what circumstances Americans give birth.
At the start, she knew no more of the subject, and not less, than any mother does. Recalling her experiences in the 1930s and 1940s of giving birth - in London, in Washington, D.C., and in Oakland, California - she observes, "A curious amnesia takes over in which all memory of the discomforts you have endured is wiped out, and your determination never, ever to do that again fast fades."
But then, years later in 1989 - when her own children were adults, and birth a subject of no special interest to her - she meet a young woman, a midwife in Northern California who was being harassed by government agents and the medical establishment. Her sympathies, along with her reportorial instincts, were immediately stirred.
There was a story there that needed to be explored and revealed. Far more than she anticipated then, she was at the beginning of an investigation that would lead her over the next three years to the writing of this extraordinary book.
This is not a book about the miracle of life. It is about the role of money and politics in a lucrative industry; a saga of champagne birthing suites for the rich and desperate measures for the poor. It is a colorful history - from the torture and burning of midwives in medieval times, through the absurd pretensions of the modest Victorian age, to this century's vast succession of anaesthetic, technological, and "natural" birthing fashions. And it is a comprehensive indictment of the politics of birth and national health.
Jessica Mitford explores conventional and alternative methods, and the costs of having a child. She gives flesh-and-blood meaning to the cold statistics. Daring to ask hard questions and skeptical of soft answers
At the start, she knew no more of the subject, and not less, than any mother does. Recalling her experiences in the 1930s and 1940s of giving birth - in London, in Washington, D.C., and in Oakland, California - she observes, "A curious amnesia takes over in which all memory of the discomforts you have endured is wiped out, and your determination never, ever to do that again fast fades."
But then, years later in 1989 - when her own children were adults, and birth a subject of no special interest to her - she meet a young woman, a midwife in Northern California who was being harassed by government agents and the medical establishment. Her sympathies, along with her reportorial instincts, were immediately stirred.
There was a story there that needed to be explored and revealed. Far more than she anticipated then, she was at the beginning of an investigation that would lead her over the next three years to the writing of this extraordinary book.
This is not a book about the miracle of life. It is about the role of money and politics in a lucrative industry; a saga of champagne birthing suites for the rich and desperate measures for the poor. It is a colorful history - from the torture and burning of midwives in medieval times, through the absurd pretensions of the modest Victorian age, to this century's vast succession of anaesthetic, technological, and "natural" birthing fashions. And it is a comprehensive indictment of the politics of birth and national health.
Jessica Mitford explores conventional and alternative methods, and the costs of having a child. She gives flesh-and-blood meaning to the cold statistics. Daring to ask hard questions and skeptical of soft answers
322 pages, Hardcover
First published November 1, 1992
3 people are currently reading
374 people want to read
About the author
Jessica Mitford
37 books206 followersJessica Lucy Freeman-Mitford was an English author, journalist and political campaigner, who was one of the Mitford sisters. She gained American citizenship in later life.
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Displaying 1 - 26 of 26 reviews
May 6, 2015
Jessica Mitford's The American Way of Death experienced great success so it's no surprise she tried a follow-up with this book. But, as with a lot of follow-ups it's neither so interesting nor so successful.
Giving birth is not mysterious, nor for most women is it complicated and outside of a gaggle of new mothers all anxious to tell their own birth stories, it really isn't that interesting either. But death, ah, now that is forever interesting because it is so mysterious. If you aren't religious, then nothing is known about it, everything is surmised and the only thing we can all be absolutely sure of is that the funeral industry is out to make as much money out of our deaths as they can. It's the one event that we have to spend our money on and generally, we have no control over how it is spent. And that is why The American Way of Death is a better and more interesting book than this one.
Giving birth got taken over by men from midwives not because they were better at it, but because they said they were better at it, and because they charged more money. Women's work traditionally is underpaid, if you want value get in a man, see how much they charge, they must be worth it! This they backed up with legislation shepherded through the UK Parliament and later US Legislature by their professional groups, all male, dealing with politicians, again, all male. Midwives, those untrained old hussies, next to witches, were expelled, and in many US States unless they are also trained nurses, remain so. Essentially, giving birth became a business.
This is taken to extremes with caesarians. Some women want them because they think they won't have to go through the pain of labour - true, but that's only a few hours or a day, the pain of a major abdominal operation is at least three weeks. Doctors want them so they can deliver babies in office hours and plan their daily calendars in advance. Hospitals want them because the mothers will be there up to five days instead of overnight, if that. Insurance companies want them because if the doctor should get sued for a problem relating to the birth they can say that everything that could be done was done (caesarians are lower-risk, but then most births are low risk anyway).
As in any business, the market has to be divided into those that will pay a lot and those that can't pay at all. So at the top are the private hospital suites and the women who have elective caesarians. At the bottom are the women who give birth in a community clinic with a midwife (doctors don't fight the use of midwives where there isn't any money in it for themselves) supervised by a doctor who probably won't attend but will be 'on the end of the phone if needed' and who collects the Medicaid fee. In between it's what you can afford and what you will pay for.
In the UK and countries with National Health Care, midwives are making a come-back. When there is no money to be made from birth, once other objections - sanitary care, complications, etc. are taken care of, even home-births are acceptable.
This was supposed to be a review, but I do wander. Anyway a wonderful nugget about Jessica Mitford to end with (culled from Hitchens' Arguably. Mitford was English but went to live in the US and at her naturalisation ceremony decided at the very last minute not to tell the truth about why she wanted to become an American. Which was that the Communist Party of America would not accept her as a member until she was!
Giving birth is not mysterious, nor for most women is it complicated and outside of a gaggle of new mothers all anxious to tell their own birth stories, it really isn't that interesting either. But death, ah, now that is forever interesting because it is so mysterious. If you aren't religious, then nothing is known about it, everything is surmised and the only thing we can all be absolutely sure of is that the funeral industry is out to make as much money out of our deaths as they can. It's the one event that we have to spend our money on and generally, we have no control over how it is spent. And that is why The American Way of Death is a better and more interesting book than this one.
Giving birth got taken over by men from midwives not because they were better at it, but because they said they were better at it, and because they charged more money. Women's work traditionally is underpaid, if you want value get in a man, see how much they charge, they must be worth it! This they backed up with legislation shepherded through the UK Parliament and later US Legislature by their professional groups, all male, dealing with politicians, again, all male. Midwives, those untrained old hussies, next to witches, were expelled, and in many US States unless they are also trained nurses, remain so. Essentially, giving birth became a business.
This is taken to extremes with caesarians. Some women want them because they think they won't have to go through the pain of labour - true, but that's only a few hours or a day, the pain of a major abdominal operation is at least three weeks. Doctors want them so they can deliver babies in office hours and plan their daily calendars in advance. Hospitals want them because the mothers will be there up to five days instead of overnight, if that. Insurance companies want them because if the doctor should get sued for a problem relating to the birth they can say that everything that could be done was done (caesarians are lower-risk, but then most births are low risk anyway).
As in any business, the market has to be divided into those that will pay a lot and those that can't pay at all. So at the top are the private hospital suites and the women who have elective caesarians. At the bottom are the women who give birth in a community clinic with a midwife (doctors don't fight the use of midwives where there isn't any money in it for themselves) supervised by a doctor who probably won't attend but will be 'on the end of the phone if needed' and who collects the Medicaid fee. In between it's what you can afford and what you will pay for.
In the UK and countries with National Health Care, midwives are making a come-back. When there is no money to be made from birth, once other objections - sanitary care, complications, etc. are taken care of, even home-births are acceptable.
This was supposed to be a review, but I do wander. Anyway a wonderful nugget about Jessica Mitford to end with (culled from Hitchens' Arguably. Mitford was English but went to live in the US and at her naturalisation ceremony decided at the very last minute not to tell the truth about why she wanted to become an American. Which was that the Communist Party of America would not accept her as a member until she was!
May 18, 2020
It’s been years since I read this book— before any of my grown children were born. I do remember that Ms. Mitford’s exposé of the birthing industry as just that—a lucrative industry, blew my mind.
January 3, 2019
If you're lucky like me, you'll find a friend who can show you the future. When I was still unmarried and childless and just starting my career, I found a powerful one. As a boss, this woman showed me what it looks like to run your own business. To invent your own processes and leverage your creative instincts. To follow an "it can't be that hard” philosophy of constant learning. And as my boss became my friend, she also showed me what "for better or worse" looks like a decade or more into the bargain. What might go through a woman's mind in deciding and hoping to become a parent. Plus all the debates and dilemmas that may be attendant upon executing said plan. Unbeknownst to me at that time, the debates and dilemmas involved with baby-having turn out to be myriad. My awakening on this front began with this book, fortuitously borrowed from my future-revealing friend. Came across it at just the right time — close enough to my baby-making years to strike a chord, but far enough ahead to allow me ample time to formulate my own opinion. And to share the journey of discovery this turned out to be with my spouse. He read the book, too. And, with the supreme confidence of youth, many discussions, and a bit of local research, my bae and me decided to have our baby at a birthing center under the watchful eyes of kindly midwives. It's a very funny thing, but in my experience, natural childbirth is one of those areas where crunchy granola lefty types and conspiracy theory anti-science righty types go curving wayyyy 'round the bend to meet up on the other side. Our second midwife, though lovely, was definitely righty-tighty, so that was weird. And while one of my lefty friends chose the exact same birth plan as we did — and had a wonderful experience like we did, thankfully supporting my apparently odd point of view — many of my prego-pursuing friends were horrified. Instinctively kept my plans mostly to myself, but when I chanced to reveal them? Horrified was the typical response. "What if something goes wrong?!" they'd visibly think or audibly gasp. Right. My thinking was this: If all is going well, which I have no reason to believe it won't, we don't need all the crisis-management gear the hospital has on offer. If something does go wrong and I need intervention, I'll be transported and get it from the hospital standing helpfully nearby, and happy to oblige. And, while I'll obviously be distressed about something like that, at least I'll know said intervention was definitely warranted. And otherwise? I'll be protected from itchy medical technology trigger fingers, and more? Blissfully ignorant of exactly measured timelines or baby heart rates or any other extraneous data, that, in our impotence, we really don't know what to do with! Other than to trigger medical technologies that, despite discomfort or deeper consequences, ensure a good outcome in the big picture. And which are, let's admit it, comforting if only in the sense that they help us all feel in control, and give us something to DO. Other than to wait, and to be patient, and to experience various pains as they come and go, slowly but surely ... then fastly and furiously. And to trust that, as it has for untold millennia, the human birth process is capable of wending it's way to successful conclusions, naturally. #MapMyReadingLife
March 22, 2021
Do yourself a favor...read this book and find out the real reasons "they" do what they do. It will shock you and prepare you at the same time.
November 19, 2007
Mitford's whole premise of questioning the "American way of birth" is one I'm very sympathetic to. Also, I think much of the evidence she presents is strong--and that it can speak for itself without her self-righteous, snarking tone. Didn't her editor tell her that those little tidbits you write when you're irritated and that make you feel particularly satisfied with yourself are precisely the ones you need to cut out? I agree with her most of the time, and still her tone grates so much that I am probably going to set the book aside.
I do have one major qualm I have with her argument, however--the intimation that national health care is somehow a panacea that would solve the problems of the "American way of birth." Aaron and I took three months of Bradley classes to prepare for our natural childbirth at home, and one of the most important things I learned from the class was that we are *consumers* of health care. We *hire* our providers. We are not their patients, we are their *clients*, and it is their job to serve us to our satisfaction and respect our choices, or we can go elsewhere. That is where our power lies.
That consumer mindset could prevent so many of the horrific stories I have heard where women assume they have to acquiesce to daddy doctor because he knows what's best (and end up cut up, drugged, hemhorraging, with broken tailbones, etc.). Putting our medical choices in the hands of the State and giving up our consumer choice would, I believe, be catastrophic for women. It would be an even more profound relinquishment of our rights and control over our own bodies. How her sharp eye and extensive research still didn't allow Mitford to see this is sad.
I do have one major qualm I have with her argument, however--the intimation that national health care is somehow a panacea that would solve the problems of the "American way of birth." Aaron and I took three months of Bradley classes to prepare for our natural childbirth at home, and one of the most important things I learned from the class was that we are *consumers* of health care. We *hire* our providers. We are not their patients, we are their *clients*, and it is their job to serve us to our satisfaction and respect our choices, or we can go elsewhere. That is where our power lies.
That consumer mindset could prevent so many of the horrific stories I have heard where women assume they have to acquiesce to daddy doctor because he knows what's best (and end up cut up, drugged, hemhorraging, with broken tailbones, etc.). Putting our medical choices in the hands of the State and giving up our consumer choice would, I believe, be catastrophic for women. It would be an even more profound relinquishment of our rights and control over our own bodies. How her sharp eye and extensive research still didn't allow Mitford to see this is sad.
March 7, 2010
Interesting. VERY comprehensive, and I really liked her treatment of internal fetal monitors, forceps and the rise and fall of twilight sleep. She shed light on the societal views and the rise of intervention related to women's enthusiam for them-- a correlation I had never thought of or heard presented, but it makes complete sense! Of course, don't we get in our own way sometimes!?
A must read for any pregnant woman, at least DEFINITELY the sections on the interventions I have mentioned above. I am staunchly opposed to IFM's ANYWAY, but reading that they have been widely removed from use in the rest of the industrialized world, yet still are used here (with a higher "section" rate) is frustrating!
Definitely will be reading more by her. Quite the writer! THANKS, diana, for recommending and lending!
A must read for any pregnant woman, at least DEFINITELY the sections on the interventions I have mentioned above. I am staunchly opposed to IFM's ANYWAY, but reading that they have been widely removed from use in the rest of the industrialized world, yet still are used here (with a higher "section" rate) is frustrating!
Definitely will be reading more by her. Quite the writer! THANKS, diana, for recommending and lending!
March 17, 2011
Gotta love a little muckraking every once in awhile. What strikes me, reading this now, is how timely it is. Mitford takes a long hard look at our capitalistic medical system and where the money is going. She also shows the disparity of treatment between the classes of the patients. Reading this while the health care bill was being debated and voted on was interesting. Seems we're still dealing with the same issues Mitford was frustrated by in the early 1990s.
August 13, 2008
ummm, i am pregnant right now, so I have to recommend this one. if you or someone you care about ever gets pregnant you NEED to read this, just so you can be prepared for the lingering attitudes to birth that still exist in the American medical community. Also just a fascinating study of how fucked up this country has been in the past.
April 22, 2009
I picked up this book after having a copy of "The American Way of Death" for many years, and I was not disappointed. Jessica Mitford brought her deft research skills, keen insight, and sharp perspective used in the older book to the topic of birth in the United States.
I'd love to get newer versions of both books.
I'd love to get newer versions of both books.
May 22, 2008
Mitford looks at the history of obstetrics and midwifery in a witty and readable way. She also exposes the flaws in the modern birthing industry. The first half of the book is great. I got bogged down in the statistics in the second half.
June 8, 2009
I was conflicted about the book. I used midwives and loved them, but I'm not a fan of home births and lack on medical assistance for births. The book certainly didn't pack the wallop of American Way of Death.
February 6, 2016
This was another good one from Mitford. Interestingly, she uses very different sources from other books I've read on this subject, but still comes up with the same results about the state of the nation regarding American childbirth.
June 10, 2007
This is an amazing story of how people are profiting off a natural process - and how the care of women and babies sometimes suffers for it.
July 7, 2007
Mainstream birth processes in America are pretty messed up. If you insist on having kids, read this book and strive for a home birth, or at the very least hire a doula.
October 4, 2007
Both entertaining and enlightening.
May 27, 2010
Of course Jessica Mitford is the best. i love her humorous approach. Not recommended for anyone about to give birth. Too many medieval horror stories.
June 6, 2010
Insightful view of how labor and delivery has changed in the U.S. over the last 100 years.
August 6, 2009
an historical of childbirth in America.
May 24, 2011
Very interesting! A little outdated (1993), but it has a lot of history that is just fascinating.
August 9, 2011
Disturbing info and enraging facts. But helpful to know. Would recommend to anyone thinking of giving birth
September 6, 2013
An old classic. I was actually laughing out loud at how sassy Jessica Mitford is.
August 7, 2015
I don't know if something is wrong with me but I found "The American Way of Death" much more compelling.......but this is was insightful and makes me pray that more midwives come into the scene!!
June 1, 2015
I found my old reading records from the time I was studying midwifery.
Interesting read (and funny sense of humor) in history of birth and midwives in US.
Interesting read (and funny sense of humor) in history of birth and midwives in US.
July 15, 2013
Very good. Not as good as The American WAy of Death but still entertaining.
August 21, 2013
not what I expected at all.
April 24, 2017
It's really rather devastating that in 2017 we are still having many of the debates that are discussed in this book.
Displaying 1 - 26 of 26 reviews