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Blessed events. by Pamela Klassen. Princeton university press, 2001. 316 pages. $18.95, paperback
those in control of health care resources, who are generally men. One of Rapp’s subjects describes her experience of ultrasonography: “It was nothing, really, it looked like nothing. Then they showed it to me and made it something.” Within this disempowered context women are given the specific ethical charge of deciding which lives are worth living, “adjudicating the standards guarding entry into the human community for which she serves as normalizing gatekeeper.” This is no surprise to Rapp, who points out that women know they will bear the primary responsibility for whatever child they birth. . . . “Because pregnancy and motherhood are culturally marked as such totalizing female responsibilities in the contemporary United States, women’s decisions surrounding prenatal testing take on a weight they might not have if the burdens were more widely and socially distributed.” Women are held accountable for the future, just as they are made accountable for the present, as evidenced in the ongoing public outcry about teenage mothers and welfare moms. Rapp’s attempt to be inclusive of all team members in the playground of prenatal testing is heroic. She contributes to the struggle for an equitable public life by shedding light on the struggles of individuals. This book is essential reading for anyone involved in the care of childbearing families; a call to attention to anyone who believes themselves committed to “informed consent.” She wisely refrains from extensive commentary on the eugenic issues surrounding the cytogenetic explosion, but her work retains its power by emphasizing the personal, the skin and bones. What does this brave new world tell us about how motherhood is imagined in our culture? And what does it tell us about what mothering really means? Blessed Events. By Pamela Klassen. Princeton University Press, 2001. 316 pages. $18.95, paperback. Reviewed by: Peggy Vincent, CNM, author of BABY CATCHER: Chronicles of a Modern Midwife, Scribner, 2002. In Blessed Events, Pamela Klassen, an assistant professor of religion at the University of Toronto, investigates the relationship between home birthing women and their religious beliefs. Klassen conducted direct interviews to explore the question of how home birthing women use religion to make sense of their birthing experiences, and how these same women draw on their birth experiences to add religious meaning to their lives. For her study, Klassen chose from a broad palette of subjects. The forty-five women in her study included Orthodox Jews, conservative Christians, traditional Roman Catholics, Old Order Amish, and those who practice New Age and Goddess spirituality. All of these women elected an unmedicated birth at home, sometimes defying
the law to do so. Care was also taken to include a broad range of care providers in the study. Birth attendants included both licensed and unlicensed direct-entry midwives as well as certified nurse midwives. A few women chose to give birth with only their husbands in attendance. Klassen explains her methodology in the introductory chapter. She makes a distinction, which she admits she personally does not wholly accept, between religion, with its age-old rituals and traditions, and spirituality, a more immediate, accessible, or New Age interpretation. Klassen states several of her interview subjects responded to an early draft of the manuscript, which resulted in their comments being taken into consideration, and her hope that her rendition “rings true to their own experience, even if they may not always be in agreement with my interpretations,” an interesting and potentially significant disclaimer. Klassen begins her study by attempting to answer a number of questions, including what kinds of women choose home birth and how culture affects their decisions. She discusses the similarities and differences between the viewpoints of conservative traditionalists and their outspoken feminist sisters. While these women may be light years apart on many political issues, they unite in their right to choose the place in which they give birth. Risks, fears, and ethics are addressed as some of the reasons home birth is chosen. From many statements of the women themselves, a fourth factor should perhaps have been added: anger at the management of previous pregnancies. Many of the women elected home birth based on a combination of religious, feminist, obstetrical, and political belief systems. Klassen’s study shows that “despite . . . marked differences in . . . religious tradition and doctrine, these women developed similar religiously-informed approaches to childbirth that depended on seeing birth as not simply a bodily process to undergo, but an experience to be chosen.” In spite of sharp differences between the women interviewed in many areas, most felt strongly that birth could and should be a religious experience. The author delves into the subjects’ insistence that “place of birth matters.” One woman asserts “there is no room for God” or spirituality in hospitals. Home birth afforded these women not only the opportunity for religion to influence their birth experiences, but also for their births to affect their faith. Klassen discusses the struggles of women to interpret the significance of “birthing naturally, within a society that has divergent views on the subject, a society that generally considers birth a medical rather than a spiritual act.” In Sliding between Pain and Pleasure, the final chapter in Blessed Events, Klassen discusses historical theological opinions of childbirth pain as well as more modern
Journal of Midwifery & Women’s Health • Vol. 47, No. 4, July/August 2002
295
medical interpretations. This chapter, perhaps of most interest to the lay audience, is packed with eloquent quotes, including one from a woman who coined the term “spiritual poise,” while admitting that at times during late labor, she was “more not poised.” Three classic styles of coping are restated: enduring, surmounting, and becoming one with the pain; different religious interpretations are associated with each method. Not surprisingly, Klassen finds labor pain often has a profound spiritual impact on the women who choose to birth without drugs. Klassen ponders the integrity of her “true interpretations” of the women’s stories in her epilogue, concluding with the statement, “Childbirth is not merely a physiological process; therefore, a biomedical model is not sufficient to understand its many dimensions. Childbirth transforms women, babies, and their supporters through what many call . . . the miracle of birth.” Blessed Events is a scholarly, extensively footnoted book; indeed, the footnotes, bibliography, and index make up nearly thirty percent of the page count. The sometimes convoluted language may be off-putting for lay readers who, basing their interest on the charming title, might be forgiven for expecting a more userfriendly narrative. Frequent use of religious, sociological, and research terms sent this reviewer scrambling for a dictionary on more than one occasion. It is unlikely that pregnant women will snuggle up in bed with Blessed Events. The book will be most appreciated by those researching sociological trends in the fields of religion and childbirth, with a special focus on home birth. As such, Blessed Events would be an excellent addition to any public, medical, and/or seminary library. The Politics of Fertility Control. By Deborah R. McFarlane & Kenneth J. Miller. New York: Chatham House Publishers, 2001. 197 pages. $22.95 softcover. Reviewed by: Rachel A. Zare, CNM, MSN, Planned Parenthood Mar Monte, Sunnyvale, California. If you have ever known a woman facing an unplanned pregnancy and wondered what external factors contributed to the situation, this book should be on your reading list. The text outlines the historical changes that have occurred along the continuum of fertility control (ranging from abstinence, to family planning, to abortion), and uses political theory to reveal the impact of government policy on fertility in the United States of America. The partnership between the two authors brings together the viewpoints of a political scientist with those of a public health researcher to yield a comprehensive assessment of the problems denoted by fertility politics and related policy implications. The authors argue that family planning and abortion differ from other governmental concerns because they constitute morality poli-
296
tics; the state is trying to delineate acceptable versus unacceptable values. Initially, the text focuses on the social framework inhibiting fertility control in this country, identifying the landmark laws, both bureaucratic and judicial, which have shaped our public policy. This social-historical context, including references to global practices of fertility control policies (from ancient Egypt, through the Middle Ages, and up to today’s world) makes for interesting reading, and reinforces the notion that “in every culture people have attempted to regulate their fertility” (p. 20). The work also examines the politicalhistorical background, focusing on US policy. Which regulatory powers influence fertility politics—and how— can be a cumbersome and confusing topic; however, this book helpfully maps out the various departments and people who exert control over our current public policy. The authors distinguish the difference between federally mandated and state-administered policies—the latter being even more complex as they vary from state to state. Thus, one more readily comprehends the gaps and loopholes that currently exist. Once the authors lay the groundwork showing how the current situation evolved, the focus shifts to evaluating the efficacy of current fertility control policies. The text uses political science models to determine influential factors, both beneficial and malevolent. It assesses the impact of different federal policies, such as Title X spending for family planning and Title XIX for Medicaid programs. By utilizing political science theory to examine current policies, the authors show how strongly government spending for family planning influences pregnancy rates. Such information makes a forceful case for a more integrated fertility control policy. The authors explore the results of their research, and acknowledge the fact that not all of their anticipated hypotheses stand up. They are to be commended for discussing these unanticipated results. This discussion further illuminates the diverse outcomes caused by current policies. There are times when the density of the statistical evidence overwhelms the important arguments being presented. However, the thoroughness of the sources credited, and the scope of resources drawn upon, increase the accuracy of the text. Current research applicable to both public health and public policy is used to support the authors’ arguments and hypotheses. Thankfully, they have constructed many useful tables and charts to clarify complex information; these figures illustrate the primary points in a succinct and accessible format. While tackling this heavy read can be trying at times, the payoff comes in the later chapters when the relevancy of interpretation through the political science structure provides original conclusions. In summary, this text provides useful insight into fertility politics in the United States of America, albeit in
Journal of Midwifery & Women’s Health • Vol. 47, No. 4, July/August 2002
the law to do so. Care was also taken to include a broad range of care providers in the study. Birth attendants included both licensed and unlicensed direct-entry midwives as well as certified nurse midwives. A few women chose to give birth with only their husbands in attendance. Klassen explains her methodology in the introductory chapter. She makes a distinction, which she admits she personally does not wholly accept, between religion, with its age-old rituals and traditions, and spirituality, a more immediate, accessible, or New Age interpretation. Klassen states several of her interview subjects responded to an early draft of the manuscript, which resulted in their comments being taken into consideration, and her hope that her rendition “rings true to their own experience, even if they may not always be in agreement with my interpretations,” an interesting and potentially significant disclaimer. Klassen begins her study by attempting to answer a number of questions, including what kinds of women choose home birth and how culture affects their decisions. She discusses the similarities and differences between the viewpoints of conservative traditionalists and their outspoken feminist sisters. While these women may be light years apart on many political issues, they unite in their right to choose the place in which they give birth. Risks, fears, and ethics are addressed as some of the reasons home birth is chosen. From many statements of the women themselves, a fourth factor should perhaps have been added: anger at the management of previous pregnancies. Many of the women elected home birth based on a combination of religious, feminist, obstetrical, and political belief systems. Klassen’s study shows that “despite . . . marked differences in . . . religious tradition and doctrine, these women developed similar religiously-informed approaches to childbirth that depended on seeing birth as not simply a bodily process to undergo, but an experience to be chosen.” In spite of sharp differences between the women interviewed in many areas, most felt strongly that birth could and should be a religious experience. The author delves into the subjects’ insistence that “place of birth matters.” One woman asserts “there is no room for God” or spirituality in hospitals. Home birth afforded these women not only the opportunity for religion to influence their birth experiences, but also for their births to affect their faith. Klassen discusses the struggles of women to interpret the significance of “birthing naturally, within a society that has divergent views on the subject, a society that generally considers birth a medical rather than a spiritual act.” In Sliding between Pain and Pleasure, the final chapter in Blessed Events, Klassen discusses historical theological opinions of childbirth pain as well as more modern
Journal of Midwifery & Women’s Health • Vol. 47, No. 4, July/August 2002
295
medical interpretations. This chapter, perhaps of most interest to the lay audience, is packed with eloquent quotes, including one from a woman who coined the term “spiritual poise,” while admitting that at times during late labor, she was “more not poised.” Three classic styles of coping are restated: enduring, surmounting, and becoming one with the pain; different religious interpretations are associated with each method. Not surprisingly, Klassen finds labor pain often has a profound spiritual impact on the women who choose to birth without drugs. Klassen ponders the integrity of her “true interpretations” of the women’s stories in her epilogue, concluding with the statement, “Childbirth is not merely a physiological process; therefore, a biomedical model is not sufficient to understand its many dimensions. Childbirth transforms women, babies, and their supporters through what many call . . . the miracle of birth.” Blessed Events is a scholarly, extensively footnoted book; indeed, the footnotes, bibliography, and index make up nearly thirty percent of the page count. The sometimes convoluted language may be off-putting for lay readers who, basing their interest on the charming title, might be forgiven for expecting a more userfriendly narrative. Frequent use of religious, sociological, and research terms sent this reviewer scrambling for a dictionary on more than one occasion. It is unlikely that pregnant women will snuggle up in bed with Blessed Events. The book will be most appreciated by those researching sociological trends in the fields of religion and childbirth, with a special focus on home birth. As such, Blessed Events would be an excellent addition to any public, medical, and/or seminary library. The Politics of Fertility Control. By Deborah R. McFarlane & Kenneth J. Miller. New York: Chatham House Publishers, 2001. 197 pages. $22.95 softcover. Reviewed by: Rachel A. Zare, CNM, MSN, Planned Parenthood Mar Monte, Sunnyvale, California. If you have ever known a woman facing an unplanned pregnancy and wondered what external factors contributed to the situation, this book should be on your reading list. The text outlines the historical changes that have occurred along the continuum of fertility control (ranging from abstinence, to family planning, to abortion), and uses political theory to reveal the impact of government policy on fertility in the United States of America. The partnership between the two authors brings together the viewpoints of a political scientist with those of a public health researcher to yield a comprehensive assessment of the problems denoted by fertility politics and related policy implications. The authors argue that family planning and abortion differ from other governmental concerns because they constitute morality poli-
296
tics; the state is trying to delineate acceptable versus unacceptable values. Initially, the text focuses on the social framework inhibiting fertility control in this country, identifying the landmark laws, both bureaucratic and judicial, which have shaped our public policy. This social-historical context, including references to global practices of fertility control policies (from ancient Egypt, through the Middle Ages, and up to today’s world) makes for interesting reading, and reinforces the notion that “in every culture people have attempted to regulate their fertility” (p. 20). The work also examines the politicalhistorical background, focusing on US policy. Which regulatory powers influence fertility politics—and how— can be a cumbersome and confusing topic; however, this book helpfully maps out the various departments and people who exert control over our current public policy. The authors distinguish the difference between federally mandated and state-administered policies—the latter being even more complex as they vary from state to state. Thus, one more readily comprehends the gaps and loopholes that currently exist. Once the authors lay the groundwork showing how the current situation evolved, the focus shifts to evaluating the efficacy of current fertility control policies. The text uses political science models to determine influential factors, both beneficial and malevolent. It assesses the impact of different federal policies, such as Title X spending for family planning and Title XIX for Medicaid programs. By utilizing political science theory to examine current policies, the authors show how strongly government spending for family planning influences pregnancy rates. Such information makes a forceful case for a more integrated fertility control policy. The authors explore the results of their research, and acknowledge the fact that not all of their anticipated hypotheses stand up. They are to be commended for discussing these unanticipated results. This discussion further illuminates the diverse outcomes caused by current policies. There are times when the density of the statistical evidence overwhelms the important arguments being presented. However, the thoroughness of the sources credited, and the scope of resources drawn upon, increase the accuracy of the text. Current research applicable to both public health and public policy is used to support the authors’ arguments and hypotheses. Thankfully, they have constructed many useful tables and charts to clarify complex information; these figures illustrate the primary points in a succinct and accessible format. While tackling this heavy read can be trying at times, the payoff comes in the later chapters when the relevancy of interpretation through the political science structure provides original conclusions. In summary, this text provides useful insight into fertility politics in the United States of America, albeit in
Journal of Midwifery & Women’s Health • Vol. 47, No. 4, July/August 2002