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Midwives in history and society
Midwives in History and Society. By Jean Towler and Joan Bramall. Dover, NH: Croom Helm, 1986. 316 pages. $26.00, softcover. by: Cynthia S. Bechtel, CNM, Graduate student, University of Missouri, St. Louis, MO.
Reviewed MSN,
Jean Towler and Joan Bramall, authors of MidLoiues in History and Society, state that little has been recorded about midwifery; even less, they state has been written by midwives themselves. This claim is correct as far as it goes. But most feminists, this reviewer included, would suspect that, because midwifery has traditionally “belonged” to women, it has suffered the same fate as much of women’s history in general: it has been selectively filtered through eyes and pens of predominantly male historians who distort, trivialize, malign, and, worst of all, omit women’s contributions and roles in the evolution of humanity. According to the authors, most midwives prior to the 20th century have been uneducated (that is not to say unintelligent) peasant or working-class women who, for financial reasons or because of social restrictions, have been denied accessto formal schooling and who have been unable to record their experiences. Though midwifery is one of the oldest professions, midwives through the centuries have been scorned, harassed, and persecuted. The Church’s allegation that midwifery and witchcraft are closely aligned resulted in the execution of thousands of midwives and other women healers. Journal
of Nurse-Midwifery
Copyright
0 1987 by the American
l
The book reinforces one fact that every contemporary midwife should know: that midwives’ struggles are not recent phenomena. Towler and Bramall, both experienced midwifery practitioners, have extensively researched the history of midwifery, investigating archives and obscure documents and manuscripts. The result is a detailed overview of British midwifery from the Stone Age to the present. The book is organized chronologically, with each chapter devoted to a particular period in history. Each time segment begins with an introduction to the historical, social, and religious context in which midwives practiced. Specific chapter topics include: childbearing customs in the Dark Ages and the Medieval period, the 18th century controversy over male versus female midwives, the increasing involvement of male physicians by the 19th century, and British midwives’ current struggles for recognition and survival The authors chart the evolution of midwifery that corresponds to the changes in childbearing from home births to the technology of hospital deliveries. This book is packed with data and some fascinating excerpts from old records and documents. For example, the author of a 1612 textbook for midwives suggests that the ideal midwife should have, among other qualities, “a pleasant and merry disposition and [should] be accustomed to hard work so that if necessary she could stay awake two or three nights.” There are guidelines for midwives’ theoretical knowledge
Vol. 32, No. 6, November/December
College of Nurse-Midwives
and behavior, along with expense accounts for the servicesof an 18th century midwife. And there is a wonderful description of a group called the Society for the Prevention of Cruelty to Pregnant Women, a childbirth activist organization still in existence under a different name. Illustrations are interesting, illuminating, and of good quality. Many reproductions of old woodcuts show midwives in action in a variety of settings. Of particular interest are several drawings and frequent references to the use of birth stools, the earliest being among Egyptian midwives around 1600 BC. The amount of information compiled by the authors is stunning, but sometimes the massive array of facts, dates, and organizations becomes complex and difficult to follow. Though the book is organized chronologically, the individual chapters tend to skip back and forth in time, which may lead to reader confusion. The book is clearly written for British audiences; the references and bibliographic materials cited may be, for the most part, unavailable outside Britain. In the preface, Towler and Bramall urge vigilance against the medical takeover of childbirth which emphasizestechnology, pathology, and hospitalization, and which, also, threatens the survival of the midwifery profession. Furthermore, they assert that: Role changes creep into a profession and tend to go unnoticed by the individual rank-and-file midwife until a point of no return is reached. Some midwives have in fact opted out and
1987
369 0091-2182/87/$03.50
are content to be doctors’ assistants:in this respect the greatest threat to the future of the midwife may come from the midwife herself. It is up to midwives, both individually and collectively, to ensure that they do not lose the position won by the midwife pioneers of the past. These are important words for midwives anywhere. Midtoiues in History and Society consistently reinforces that midwives must remain advocates of birthing families and, even more basic, they must continue to be advocates of midwifery itself. Upon reading this book, one realizes that the underlying and essential principle is self-determination by the profession as a whole: the responsibility for the survival of midwifery, then, lies within the profession itself. Out of respect for the bravery and sacrifice of their predecessors, midwives must be willing to challenge. Towler and Bramall’s book provides a good look at the groundwork that has already been laid. Miduriues in Histoy and Society is intended for midwives, health professionals, and the interested general reader. It would be an excellent reference work for American CNMs and, particularly, for nurse-midwifery students. All midwives can learn from their profession’s history. And so the struggle continues. Infection in the Female. Second Edition. By William J. Ledger, MD. Philadelphia: Lea & Febiger, 1986. 293 pages. $38.50, hardcover. Reviewed by: Kenneth Bromberg, MD, FAAP, Assistant Professor of Pediatrics and Medicine; Attending Physician in Infectious Diseases, SUNY Health Science Center at Brooklyn, NY.
In this short, compact overview of common and uncommon infectious diseases, the author has blended a review of the literature (much of which he wrote) with his own clinical experiences. As the Chairman of Obstetrics and Gynecology at Cornell Medical Center, former Director of Maternal and Fetal Medicine at Los Angeles County Hospital, a member of the Infectious Diseases Society of America, and a microbiologist, he has both the academic qualifications and the practical experience to write about infections in the female. The book opens with an historic overview and proceeds to a review of basic 370
microbiology and specimen collection. Laboratory testing and host response to infection are then presented as are a clinical overview of infections, a practical discussion of antibiotic agents, and a specific discussion of both community-acquired and hospital-acquired gynecologic and obstetric infections. The second edition contains a new chapter on those infections with adverse fetal and newborn outcomes. The book is well-written and easy to read. References are current to 1984 and are used to support the author’s arguments. This is not the definitive work on any of the subjects covered: a definitive work would not be as portable or as readable as this volume. The book stresses both concepts and practical methods of managing problems. The eight guidelines on prophylactic antibiotics are outstanding: using these principles, prophylactic antibiotic use can be evaluated in any surgical situation. Women with postoperative infections and those who are seriously ill are unlikely to be cared for by midwives, although midwives could serve as advocates for women with infections. Midwives, however, are likely to be directly involved in treating infections in ambulatoy patients. How well does the book address ambulatory problems? The section on vulvar lesions is complete and complements the section on laboratory diagnosis. The author presents a very caring positive attitude about dealing with genital herpes. The chapter on vaginal infections is comprehensive and integrates therapy and diagnosis but the use of pH in the diagnosis of non-specific vaginitis is not addressed. The short section on Toxic Shock Syndrome is clinically accurate but the discussion of toxins is (as expected) outdated, as is the short discussion on Acquired Immunodeficiency Syndrome. Discussion of urinary tract infections, the concept of significant bacteriuria, and the acute urethral syndrome are followed by a management plan. The general review of maternal infections leading to adverse fetal and newborn outcomes is complete. The concept of STORCH is examined in individual sections. Unlike most of the information on bacterial infections, the microbiologic information in this chapter is outdated. No mention is made of enzyme-linked immunosorbent assays (EIA) and comJournal
of Nurse-Midwifery
l
plement fixation is presented as readily available when it is not. Hemagglutination inhibition testing for rubella has been replaced by either EIA or agglutination. The section on toxoplasmosis includes the Sabin-Feldman dye test that is rarely obtainable. The author advocates termination of pregnancy if a woman was immunized with rubella vaccine during the first 20 weeks of gestation. This is an extreme position with no strong justification in the literature. The author also advocates pregnancy termination for primary cytomegalovirus (CMV) infection detected by an Immunoglobulin G (IgG) prenatal serology; he advises that Immunoglobulin Macro (IBM) titers be done on those patients with high IgG titers; Another extreme recommendation, use of IgM titers would create a nightmare because of the unreliability of CMV serology and the lack of available IgM specific tests. The author’s presentation of Bartlett and Gorebach’s work on intraabdominal sepsisis extremely clear and provides interesting reading. The sections on antimicrobial agents provide a helpful discussion of the problems with aminoglycoside use in pregnancy. On the positive side, the emphasis on concepts and the rational laboratorybased approach to infectious diseases will be valid for many years. Negatively, the suggestions put forth here about rubella immunization and CMV infection are controversial, and the clinical virology is dated. Although not a necessary personal resource, this book should be in the libraries of all midwifery education programs and hospital-based midwifery services. The Patient Within the Patient: Problems in Perinatal Medicine. Edited
by Bruce K. Young. March of Dimes Birth Defects Foundation, Birth Defects: Original Article Series Vol. 21, No. 5. New York: Alan R. Liss, 1985. 224 pages. $38.50, hardcover. by: Nancy A. McCluggage, MA, Assistant Professor, MaternalNewborn Nursing/Nurse-Midwifery Program, Yale University School of Nursing, New Haven, CT.
Reviewed CNM,
This is an excellent collection of 14 articles by 23 recognized obstetricians, pediatricians, and research authorities whose “efforts are directed toward adVol. 32, No. 6, November/December
1987
Reviewed MSN,
Jean Towler and Joan Bramall, authors of MidLoiues in History and Society, state that little has been recorded about midwifery; even less, they state has been written by midwives themselves. This claim is correct as far as it goes. But most feminists, this reviewer included, would suspect that, because midwifery has traditionally “belonged” to women, it has suffered the same fate as much of women’s history in general: it has been selectively filtered through eyes and pens of predominantly male historians who distort, trivialize, malign, and, worst of all, omit women’s contributions and roles in the evolution of humanity. According to the authors, most midwives prior to the 20th century have been uneducated (that is not to say unintelligent) peasant or working-class women who, for financial reasons or because of social restrictions, have been denied accessto formal schooling and who have been unable to record their experiences. Though midwifery is one of the oldest professions, midwives through the centuries have been scorned, harassed, and persecuted. The Church’s allegation that midwifery and witchcraft are closely aligned resulted in the execution of thousands of midwives and other women healers. Journal
of Nurse-Midwifery
Copyright
0 1987 by the American
l
The book reinforces one fact that every contemporary midwife should know: that midwives’ struggles are not recent phenomena. Towler and Bramall, both experienced midwifery practitioners, have extensively researched the history of midwifery, investigating archives and obscure documents and manuscripts. The result is a detailed overview of British midwifery from the Stone Age to the present. The book is organized chronologically, with each chapter devoted to a particular period in history. Each time segment begins with an introduction to the historical, social, and religious context in which midwives practiced. Specific chapter topics include: childbearing customs in the Dark Ages and the Medieval period, the 18th century controversy over male versus female midwives, the increasing involvement of male physicians by the 19th century, and British midwives’ current struggles for recognition and survival The authors chart the evolution of midwifery that corresponds to the changes in childbearing from home births to the technology of hospital deliveries. This book is packed with data and some fascinating excerpts from old records and documents. For example, the author of a 1612 textbook for midwives suggests that the ideal midwife should have, among other qualities, “a pleasant and merry disposition and [should] be accustomed to hard work so that if necessary she could stay awake two or three nights.” There are guidelines for midwives’ theoretical knowledge
Vol. 32, No. 6, November/December
College of Nurse-Midwives
and behavior, along with expense accounts for the servicesof an 18th century midwife. And there is a wonderful description of a group called the Society for the Prevention of Cruelty to Pregnant Women, a childbirth activist organization still in existence under a different name. Illustrations are interesting, illuminating, and of good quality. Many reproductions of old woodcuts show midwives in action in a variety of settings. Of particular interest are several drawings and frequent references to the use of birth stools, the earliest being among Egyptian midwives around 1600 BC. The amount of information compiled by the authors is stunning, but sometimes the massive array of facts, dates, and organizations becomes complex and difficult to follow. Though the book is organized chronologically, the individual chapters tend to skip back and forth in time, which may lead to reader confusion. The book is clearly written for British audiences; the references and bibliographic materials cited may be, for the most part, unavailable outside Britain. In the preface, Towler and Bramall urge vigilance against the medical takeover of childbirth which emphasizestechnology, pathology, and hospitalization, and which, also, threatens the survival of the midwifery profession. Furthermore, they assert that: Role changes creep into a profession and tend to go unnoticed by the individual rank-and-file midwife until a point of no return is reached. Some midwives have in fact opted out and
1987
369 0091-2182/87/$03.50
are content to be doctors’ assistants:in this respect the greatest threat to the future of the midwife may come from the midwife herself. It is up to midwives, both individually and collectively, to ensure that they do not lose the position won by the midwife pioneers of the past. These are important words for midwives anywhere. Midtoiues in History and Society consistently reinforces that midwives must remain advocates of birthing families and, even more basic, they must continue to be advocates of midwifery itself. Upon reading this book, one realizes that the underlying and essential principle is self-determination by the profession as a whole: the responsibility for the survival of midwifery, then, lies within the profession itself. Out of respect for the bravery and sacrifice of their predecessors, midwives must be willing to challenge. Towler and Bramall’s book provides a good look at the groundwork that has already been laid. Miduriues in Histoy and Society is intended for midwives, health professionals, and the interested general reader. It would be an excellent reference work for American CNMs and, particularly, for nurse-midwifery students. All midwives can learn from their profession’s history. And so the struggle continues. Infection in the Female. Second Edition. By William J. Ledger, MD. Philadelphia: Lea & Febiger, 1986. 293 pages. $38.50, hardcover. Reviewed by: Kenneth Bromberg, MD, FAAP, Assistant Professor of Pediatrics and Medicine; Attending Physician in Infectious Diseases, SUNY Health Science Center at Brooklyn, NY.
In this short, compact overview of common and uncommon infectious diseases, the author has blended a review of the literature (much of which he wrote) with his own clinical experiences. As the Chairman of Obstetrics and Gynecology at Cornell Medical Center, former Director of Maternal and Fetal Medicine at Los Angeles County Hospital, a member of the Infectious Diseases Society of America, and a microbiologist, he has both the academic qualifications and the practical experience to write about infections in the female. The book opens with an historic overview and proceeds to a review of basic 370
microbiology and specimen collection. Laboratory testing and host response to infection are then presented as are a clinical overview of infections, a practical discussion of antibiotic agents, and a specific discussion of both community-acquired and hospital-acquired gynecologic and obstetric infections. The second edition contains a new chapter on those infections with adverse fetal and newborn outcomes. The book is well-written and easy to read. References are current to 1984 and are used to support the author’s arguments. This is not the definitive work on any of the subjects covered: a definitive work would not be as portable or as readable as this volume. The book stresses both concepts and practical methods of managing problems. The eight guidelines on prophylactic antibiotics are outstanding: using these principles, prophylactic antibiotic use can be evaluated in any surgical situation. Women with postoperative infections and those who are seriously ill are unlikely to be cared for by midwives, although midwives could serve as advocates for women with infections. Midwives, however, are likely to be directly involved in treating infections in ambulatoy patients. How well does the book address ambulatory problems? The section on vulvar lesions is complete and complements the section on laboratory diagnosis. The author presents a very caring positive attitude about dealing with genital herpes. The chapter on vaginal infections is comprehensive and integrates therapy and diagnosis but the use of pH in the diagnosis of non-specific vaginitis is not addressed. The short section on Toxic Shock Syndrome is clinically accurate but the discussion of toxins is (as expected) outdated, as is the short discussion on Acquired Immunodeficiency Syndrome. Discussion of urinary tract infections, the concept of significant bacteriuria, and the acute urethral syndrome are followed by a management plan. The general review of maternal infections leading to adverse fetal and newborn outcomes is complete. The concept of STORCH is examined in individual sections. Unlike most of the information on bacterial infections, the microbiologic information in this chapter is outdated. No mention is made of enzyme-linked immunosorbent assays (EIA) and comJournal
of Nurse-Midwifery
l
plement fixation is presented as readily available when it is not. Hemagglutination inhibition testing for rubella has been replaced by either EIA or agglutination. The section on toxoplasmosis includes the Sabin-Feldman dye test that is rarely obtainable. The author advocates termination of pregnancy if a woman was immunized with rubella vaccine during the first 20 weeks of gestation. This is an extreme position with no strong justification in the literature. The author also advocates pregnancy termination for primary cytomegalovirus (CMV) infection detected by an Immunoglobulin G (IgG) prenatal serology; he advises that Immunoglobulin Macro (IBM) titers be done on those patients with high IgG titers; Another extreme recommendation, use of IgM titers would create a nightmare because of the unreliability of CMV serology and the lack of available IgM specific tests. The author’s presentation of Bartlett and Gorebach’s work on intraabdominal sepsisis extremely clear and provides interesting reading. The sections on antimicrobial agents provide a helpful discussion of the problems with aminoglycoside use in pregnancy. On the positive side, the emphasis on concepts and the rational laboratorybased approach to infectious diseases will be valid for many years. Negatively, the suggestions put forth here about rubella immunization and CMV infection are controversial, and the clinical virology is dated. Although not a necessary personal resource, this book should be in the libraries of all midwifery education programs and hospital-based midwifery services. The Patient Within the Patient: Problems in Perinatal Medicine. Edited
by Bruce K. Young. March of Dimes Birth Defects Foundation, Birth Defects: Original Article Series Vol. 21, No. 5. New York: Alan R. Liss, 1985. 224 pages. $38.50, hardcover. by: Nancy A. McCluggage, MA, Assistant Professor, MaternalNewborn Nursing/Nurse-Midwifery Program, Yale University School of Nursing, New Haven, CT.
Reviewed CNM,
This is an excellent collection of 14 articles by 23 recognized obstetricians, pediatricians, and research authorities whose “efforts are directed toward adVol. 32, No. 6, November/December
1987