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March 2016: Western Maternity and Medicine, 1880–1990

Janet Greenlees and Linda Bryder, (eds). London: Pickering & Chatto, 2013. xiii, 214 pp. £60.00 (hardcover).

Reviewed by: Jane Adams, University of Otago

The late nineteenth and twentieth centuries constituted a hugely important period in the development of maternity services, policies and science in the Western world, Janet Greenlees and Linda Bryder argue in their introductory essay to Western Maternity and Medicine, 1880–1990. Of particular significance from the woman’s perspective was the dramatic shift in the location of childbirth (from the home to the hospital) as well as a steep decline in maternal mortality rates from the 1930s and later in perinatal mortality, and increased public and political attention upon the health of pregnant mothers and their newborn babies.

These historical developments have already received significant scholarly attention (as Greenlees and Bryder acknowledge), particularly as a result of
developments in social history and feminist politics from the late 1970s. As a result of these ideological shifts, they argue that the dominant interpretation of
childbirth history that has emerged has been one of progressive male domination and the corresponding oppression or disempowerment of women (Ann Oakley’s
influential 1984 work The Captured Womb is given as a key example of this ideological trend). But Greenlees and Bryder argue that the actual historical
records convey a far more nuanced story than this dominant historiographical approach might suggest and instead, women have sometimes had far greater
agency into their maternity experiences (an argument developed by the likes of Canadian scholar Wendy Mitchinson, for example).

Accordingly, Greenlees, Bryder and the other contributors to this multiauthored collection of essays aim to focus their readers’ attention upon the mothers’ agency in their interactions with other stakeholders in maternity services, including physicians, midwives, governments and the voluntary sector. They seek to achieve this by adopting a case study approach, drawing upon a rich variety of historical records in their respective studies. These sources include the medical casebooks of particular institutions (Janet Greenlees, for example, uses them in her essay on the Church of Scotland’s home for unmarried mothers, as does Allison Nuttall in her essay on maternity hospitals in interwar Edinburgh and Gayle Davis in relation to an Edinburgh infertility clinic); coroners’ reports into maternal deaths (used by Madonna Grehan to examine midwifery care in the home birth setting); submissions to government inquiries (used by Gayle Davis and Linda Bryder); oral history interviews (used by Angela Davis to consider women’s childbirth experiences); and court cases (used by Allison L. Hepler to trace the development of foetal protection labour legislation).

The modern history of Scottish maternity services is particularly well represented in this volume, with four of the nine contributors (Salim Al-Gailani, Janet Greenlees, Allison Nuttall and Gayle Davis) examining various aspects of Scottish medicine and maternity services spanning the first half of the twentieth century. The other five contributors take as their focus late nineteenth-century Victoria, Australia (Madonna Grehan), New Zealand in the first half of the twentieth century (Linda Bryder), twentieth-century Ireland (Lindsey Earner- Byrne) and the United States (Allison L. Hepler) and late twentieth-century Berkshire and Oxfordshire in England (Angela Davis).

Overall, the contributors make a strong case for their focus upon maternal agency and succeed in framing their case studies within their broader historical contexts, and in particular the underlying ideological and religious concerns. Given the variety of case records and time periods that the contributors consider, it is not surprising that some essays in this volume lend themselves more naturally to capturing women’s perspectives than others. In particular, Angela Davis primarily uses oral history interviews from women recalling their childbirth experiences in relatively recent times (the 1970s and 1980s) to conclude that women were actually less critical of the medical interventions that they received in hospital (such as ultrasounds and episiotomies) than of the culture of the maternity units in which the interventions took place. In relation to the move from home to hospital births in the twentieth century, Allison Nuttall shows that the move was ultimately successful because it was driven by women’s desires (for pain relief, rest opportunities and expert medical care) rather than being medically enforced. Likewise, Linda Bryder argues in the New Zealand context that the move to hospital births succeeded due to lobbying by women’s organisations working in alliance with obstetricians.

Some contributors acknowledge and discuss the difficulties and limitations of using a ‘patient agency’ approach. Salim Al-Gailani, for example, considers Scottish obstetrician John William Ballantyne’s development of antenatal services in early twentieth-century Edinburgh and examines the underlying medico-moral ideologies underpinning the care of pregnant women. He argues that although it is essential to take pregnant women’s agency into account, their experiences can be difficult to recover from the historical record – this type of honest reflection is useful for other historians seeking to emulate a ‘patient agency’ approach.

Western Maternity and Medicine is a robust, well-presented collection of essays that traverses a surprisingly broad range of topics within its umbrella of ‘maternity and medicine’. In particular, Gayle Davis’ essay on infertility (which examines Scottish medical responses to artificial insemination in mid-twentieth-century Scotland) and Allison L. Hepler’s essay on workplace health are both refreshing inclusions in this volume, showing the potential for further scholarship that this fascinating subject area offers.

 

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