Midwives

The novel uses the lens of home births and midwifery to explore real-world tension between alternative and institutionalized medicine. As in the real world, the conversation around home births in the novel is polarized, with alternative medicine practitioners viewing clinical settings as unnatural and oppressive and mainstream doctors viewing home births as inherently dangerous. These polarized views are reflected in the loaded imagery and vocabulary each side uses to justify its claims. For instance, an obstetrician in the novel compares a problematic labor to hitting “that patch of black ice and skid[ding] off the road” (19), while a midwife describes a hospital as a sterile, cold environment. The novel unpacks the nuances of each argument to show that the truth is far more complex.

Indeed, Sibyl herself has a nuanced take on home births, despite her dislike of institutionalized medicine. Sibyl always refers pregnancies she deems high-risk to a physician, B. P., even rushing mothers in need to the hospital when necessary—something only the snowstorm prevents her from doing in Charlotte’s case. For his part, B. P. does not deem all midwife-assisted births dangerous, noting that he trusts the judgment of a midwife as competent as Sibyl, with whom he has worked for over a decade. Just as importantly, B. P. notes that since some will always choose to labor at home, the system must support and train competent midwives. An us-versus-them approach is counterproductive and will only push women to hide home births or seek care from unmonitored channels.

B. P.’s argument also draws attention to the ways in which institutionalized medicine fails people—for instance, by pushing them into interventions that may not be necessary. In the novel, Sibyl and her midwife friends call a local obstetrician “Electrolux man—a reference to the skull cap-like vacuum physicians […] would apply to the infant’s cranium to help pull the child from the vagina—because he was so quick to make baby skulls look like turnips with his delivery room toys” (132). Hospitals also discourage the presence of more than one family member of the laboring person in the delivery room. Sibyl notes that one of her clients, Clarissa, wanted not only her husband but also her mother to assist in her labor, which Sibyl gladly allowed. More broadly, the novel implies that institutionalized medicine has often failed to account for women’s particular needs or even dehumanized female patients—a legacy encapsulated in what many characters see as hospitals’ overly controlling and technocratic approach to birth.

At the same time, the novel surfaces real drawbacks associated with alternative medicine, for example, Sibyl’s unfamiliarity with clinical signs of life and death. The solution, the novel suggests, is not to dismiss people’s push for alternative medicine but to make institutionalized settings more accessible, humane, and equitable. Connie does this in the novel, noting that although she does not “use an herb like blue cohosh, [she has] never once had a prenatal exam that took less than half an hour. [She] get[s] to know [her] mothers well” (173).