Midwives

The novel engages directly with debates over midwifery, home birth safety, and medical oversight, situating its conflict within real-world tensions between alternative and institutionalized medicine. It also distinguishes between the two kinds of midwives: practitioners who are registered nurses and usually assist in births in a hospital setting versus “lay” or community midwives, self-trained freelancers who provide home-birth support. While lay midwives may not possess certification, they can work legally in many states in the US, including Vermont, the setting of the novel. Since 1999, lay midwives in the state are licensed through a regulatory process.

Though midwife-attended home births are a traditional, ancient practice, home births in the US declined steadily in the 20th century. Hospital births had the advantage of mitigating emergencies and complicated labor, such as breech birth, stalled labor, or complications associated with maternal diabetes and hypertension. This led to the prevalent view that childbirth is a dangerous undertaking best monitored in a clinical setting. Another reason for the rising popularity of hospital births was fear of liability. Since obstetricians could be sued if a home birth went wrong, most doctors preferred to deliver babies in a hospital. However, the insistence on hospital births did not accommodate women who preferred to deliver in the comfort of their own homes or were traumatized by institutional medicine.

Advocates of home birth also tend to view pregnancy and childbirth as overmedicalized, potentially altering women’s relationship to their bodies and children in harmful ways. This is a key point of contention in the novel’s exploration of labor as a “natural” process. This aspect of the debate intersects with questions of gender bias, as Stephen indicates in his deposition. Since most midwives are women, while most OBs in the early days of modern medicine were men, misogyny facilitated the framing of midwife-assisted home births as unscientific and incompetent. Thus, for women like Sibyl, home births are a way for women to reclaim agency over their own bodies.

Conflicting points of view around home births and midwifery have persisted well into the 21st century, with many OBs deeming home births unnecessarily risky and alternative-medicine proponents raising concerns around interventions such as inducing labor prematurely or proceeding too fast to C-sections. The continuing debate around home births also reflects the lack of adequate and low-cost prenatal and antenatal care for disadvantaged communities. Home births are rising in the US, especially among people of color (Yang, Maya. “US Women of Color Increasingly Seeking Alternatives to Hospital Births—Study.” The Guardian, 29 Apr. 2022). The rise in part reflects rising costs of insurance and hospital care, as well as institutional biases against marginalized populations. One potential compromise that has gained increasing traction is the creation of safe community birthing spaces that bridge the gap between home and hospital.