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.