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Qualitative Sociology, Vol. 24, No. 3, 2001

Review Essay

The Other Side of Alternative Health Care:

Midwifery, Mothers, and Scientific Medicine
William Ray Arney

Medicalized Motherhood: Perspectives from the Lives of African-American

and Jewish Women. By Litt, Jacquelyn S. New Brunswick, NJ: Rutgers
University Press, 2000. 191 pages, paperback, ISBN: 0-813-52782-1.
The Rhetoric of Midwifery: Gender, Knowledge, and Power. By Lay, Mary M.
New Brunswick, NJ: Rutgers University Press, 2000. 241 pages, paperback,
ISBN: 0-813-52779-1.

We have many studies of the institutional power medicine imposes on people’s

lives. Especially after Foucault’s Discipline and Punish, scholars have shown in
elaborate detail how modern medicine became more powerful and more personally
invasive by, among other tactics, incorporating modalities of care that used to be
dubbed “alternatives” under the health care umbrella. Medicine also insisted that
patients join the medical “team,” which is now devoted not just to the control of
disease and the defeat of death but to the management of living. But these studies
tell only half the story. Regardless of how sophisticated our understanding of the
workings of medicine, there remains a question of how people respond. How do
the “alternative” health care providers negotiate their associations with scientific
medicine? How do patients position themselves with regard to medical knowledge
that assures them that everything medicine offers is for their own good?
Rutgers University Press has published two admirable books that reveal the
other side of the expansion of medical knowledge and the extension of medical
power into personal lives. The focus of Mary Lay’s The Rhetoric of Midwifery is
the hearings held in Minnesota on the issue of licensing traditional, direct-entry
midwives (i.e., midwives who do not enter health care through nursing schools).
A professor of rhetoric, Lay reads history and analyzes the Minnesota hearings
to describe the rhetorical strategies that have been used to assert and defend the
Correspondence should be directed to William Ray Arney, Lab II, Evergreen State College, Olympia,
WA 98502; e-mail: arney@evergreen.edu.

413
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C 2001 Human Sciences Press, Inc.
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claim that midwives’ knowledge of birth is authoritative and worthy of legal recog-
nition. Jacquelyn Litt’s Medicalized Motherhood shows how women responded
to “scientific motherhood,” “the idea that mothering should be guided by sci-
entific supervision and principles.” Litt’s study of Jewish and African-American
women who had children in the second quarter of the twentieth century shows how
some mothers embraced medicine’s mothering advice and others resisted it. She
demonstrates that scientific motherhood was based on and heightened ethnoracial
and social class differences among women.
The Rhetoric of Midwifery is a study of professional conflict. Professor Lay
shows how midwives have been marginalized by male birth attendants at least
since the beginning of the seventeenth century. Peter Chamberlen asked for a royal
monopoly over the licensing and training of midwives in 1616. Lay reviews extant
women’s written responses to men’s historical encroachment into birth and finds
there the roots of a dilemma midwives face today: If midwives demand profes-
sional and legal recognition they might gain higher status, but they always lose
autonomy because they have to negotiate the terms of their recognition with medi-
cal men and, later, the state. Even when midwives win battles for state recognition,
professionalized medicine remains the principal authority over birth.
The State of Minnesota conducted hearings on the licensing of direct-entry
midwives between 1991 and 1995. From the start, the terms of the debate were
clear. A pathologist opened the hearings with a statistical study that showed birth
is risky. In fact, there are 25,000 “risk factors best managed in a hospital setting by
health care professionals” (p. 1). It would seem that few women could escape such a
fine net. In contrast, a direct-entry midwife told of how she came to be with women
giving birth. For her and her colleagues, birth is a normal part of women’s lives and
should be treated as such. In fact, one said, “We will be the small group of keepers of
the normal. I read something once . . . that in every generation there is a handful of
people who are given the responsibility of holding the truth. And, I always thought
that’s what traditional midwives are given . . . [the truth] about birth and women”
(p. 178). The contrast is clear: the truth of science and statistics and the possibility
that something might go wrong, requiring medical intervention vs. the truth of ex-
perience, a trusting faith in nature, and the knowledge that comes from the intimacy
of involvement in individuals’ circumstances and history. It is a conflict around
which many states have fashioned compromises; direct-entry midwives practice
in many states with varying levels of legal recognition and protection. In 1994 the
Minnesota story neared its conclusion when, in Lay’s version of it, medicine hege-
monically asserted its authority over birth. “The phone calls and letters from the
Minnesota Medical Association and individual physicians were enough to even-
tually silence the direct-entry midwives” (p. 164). The hearings ended without a
decision and direct-entry midwives were left to their a-legal practice.
A fascinating subplot of Lay’s story concerns the fault lines evident in the
midwifery community in Minnesota. Some, especially members of the Minnesota
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Midwives’ Guild, were willing to give up their practice of attending breech births,
multiple births, and the like, in exchange for the legal right to carry pitocin, per-
form emergency episiotomies, suture, and so forth. Others, relying on reports like
Ina May Gaskin’s Spiritual Midwifery as well as their own experience, were not
interested in ceding their position at births that medicine deemed complicated or
abnormal. In the original hearings, the first group of midwives used the views of
the second group to assure medical practitioners of their own, more sympathetic
alignment with scientific medicine. This gained the midwives a rhetorical advan-
tage. However, when it came time to write rules of practice, the existence of the
group of midwives that saw their knowledge as radically distinct from scientific,
obstetrical knowledge became a sign that midwives lacked consensus about what
“they” actually wanted. This fracture became a “fact” that weakened the midwives’
rhetorical standing and helped sink the hearings. This is just one example of the
subtlety of insight Lay brings to her analysis of the Minnesota situation.
Medicalized Motherhood is also a study of conflict. What happens when
vernacular notions of mothering run into the demanding “advice” of doctors and,
more broadly, popular versions of scientific mothering (epitomized by Benjamin
Spock’s 1946 The Pocket Book of Baby and Child Care, which sold originally
for twenty-five cents)? According to Litt, women are not “passive witnesses to
the march of science; . . . women become agents in the process of medicalization”
(p. 37). But how they become agents—whether they assimilate themselves to
dominant medical ideas, resist completely, or negotiate delicate compromises—
depends on a woman’s social class, her ethnoracial position in society, her circle
of friends, her history, and so forth. Litt’s study is based on in-depth interviews
with thirty-eight women in Philadelphia. The eighteen Jewish women were first-
or second-generation Russian migrants and were relatively homogeneous with
respect to social class. The circumstances of the African-American women were
more varied. Two were upper middle class; most were either “stable working class”
or “working poor” (p. 7). Litt also interviewed seven physicians who had practiced
in Philadelphia at the time these women were raising their children.
The Jewish women in Litt’s sample almost universally embraced medical
advice on mothering and housekeeping. Such knowledge connected women to so-
cially advanced, similarly oriented groups of women (p. 107) and became for many
a mark of their Americanization (p. 43). Medicine was such an important part of
their social world that their own mothers’ practices could be judged scientifically
“unhealthy” and rejected, just as could the “unhealthy” practices of other, espe-
cially lower-class, groups of women. “Unhealthy” was even a standard by which
these women policed themselves and their household practices. The “unhealthy”
marked these women’s social boundaries. Scientific motherhood offered a “unified
motherhood” (p. 157) and, in general, these women sought to unify themselves
around and through it. Trust in scientific progress and in doctors was a way of
life.
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In general, the African-American women in this study were “permanent out-

siders” to scientific medicine and its mothering advice. Their child rearing practices
were, in fact, marks of the “unhealthy” against which medicine tried to establish
its claims of authority and legitimacy. The improvement of health was a concern
in the civil rights movement, “yet for many women who confronted this new sys-
tem of treatment with few resources and with a longing for traditional relations of
healing, alienation and fear predominated” (p. 65). The exceptions that proved the
rule were the few upper-middle-class African-American women Litt interviewed.
Trying to adopt “modern” approaches to child rearing, these women described
the “stigma” that attached to home remedies and traditional approaches to heal-
ing even though they realized one has to have resources (of time and money, for
example) to mother in ways that meet dominant expectations (p. 134). The poorer
women articulated a pattern of education (“All I learned I learned from my mother.
And I learned how to live from my mother.”) and community-based child care that
would, for many, be admirable but that, in the bright light of scientific motherhood
was dubbed “other,” “unhealthy,” “regrettable,” and “bad.”
It is clearly true that medicine exerts a formidable force in our lives. In their
own ways, both of these books show that, on the other side of that force, “the
processes of medicalization are far from straightforward” (Litt, p. 159). These
books show that medicine does not necessarily exert an unnegotiable or irresistible
force. The fact that people and groups remain divided by medicine should be taken
as a sign of social health.