By the middle of the twentieth century, the practice of midwifery and home birth appeared to be nearly extinct in the United States with over 99% of births taking place in a hospital setting. That changed when mothers and midwives around the country began to quietly revolt against mainstream obstetrical practices. Who were these determined women and what were their motivations? And how exactly did they manage to transform public attitudes about home birth, once perceived to be a “hippie, counter-cultural” practice but now popular in celebrity circles? Historian Wendy Kline answers these questions and more in her most recent book, Coming Home: How Midwives Change Birth (Oxford University Press, 2019). Here, Kline discusses the book and her broader research in the history of medicine with Pens & Needles editor, Audrey Farley.
AF: What drew you to the history of midwifery and home birth? What makes this history so compelling?
WK: I was first drawn to the history of midwifery and home birth through my previous book, Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health (University of Chicago Press, 2010). Each chapter captures a different theme in women’s reproductive health, such as contraception, abortion, and pelvic exams. My final chapter of that book is on childbirth, drawing on the personal papers of midwife Fran Ventre that I discovered in the Schlesinger women’s history archives at Harvard. I became fascinated with the story, and realized there was much more to be written than I could possibly fit into one chapter of the book, and I decided to devote an entire book to the subject. And yet of course there is still so much more to be written!
AF: Coming Home offers a counter-narrative to popular conceptions of medicine. We tend to think of transformations in medicine as having to do with scientific, technological, or economic developments. Here, you tell the story of individuals who managed to shape clinical practices. Was this important to you?
WK: Yes, as a historian who very much appreciates and values historical agency, it is crucial to investigate and appreciate the role of individuals (often times portrayed or understood as powerless victims) in shaping the medical and social landscape.
AF: Another myth that this book counters is the notion that midwives are either “ancient relics or uneducated buffoons.” Why do you think this characterization of midwives persists in medical and popular culture? And what role does the media play in shaping opinions about home birth and the women who opt for it?
WK: That, of course, is the KEY question that really influenced my desire to breathe life and agency into these women. We need the voices of historical actors – and historians skilled in reviving their stories – in order to confront the myths and stereotypes that continue to dominate the current conversation.
AF: How does public opinion impact policy? Do you think midwives would be more fully integrated with traditional medicine (in turn, improving women’s access to this birthing method), were it not for the negative dialogue surrounding home birth?
WK: Why has midwifery not been more successful? The problem stems from America’s fraught relationship with midwifery and home birth. Once a staple of American society, by the 20th century both midwives and home birth were portrayed by organized medicine and the media as outdated and potentially dangerous. Why would anyone endure the pain of childbirth at home with a midwife when they could have a painless experience in the sterile environment of a hospital under the care of a trained obstetrician? This assumption that midwives are a relic of the past, rather than part of an integrated health-care system of the future, has had a profound effect on 21st century attitudes toward birth, as well as on the health of millions of women and new babies each year.
AF: Coming Home’s discussion of midwifery’s influence beyond the medical profession—on spiritual movements, scientific research, and even civil rights—is fascinating. Were you surprised to realize the extent of midwives’ impact?
WK: Yes and no. Research always comes with surprises, and the stories I discovered while doing research and interviewing midwives did make me realize how important it was (and is) to capture their stories and weave them into a narrative. But it became clear to me very early on that these were an amazing bunch of women with a clear vision and a huge amount of drive and commitment, so actually, I was not that surprised at all they had accomplished!
AF: It may surprise readers to learn that there was some tension between certain home birth advocates and Roe v. Wade advocates, given that both were fighting for reproductive rights. Can you explain this?
WK: Sadly, I think that the division that sometimes occurred stemmed from priorities. Both advocates for abortion rights and supporters of birth rights believed in reproductive choice, but they were sometimes cornered by policies and regulations that forced them to “choose” one cause over the other. And of course there were and still are midwives that continue to identify as “anti-choice.” So it’s not a clear cut issue. I remember the first time I attended a Midwives Alliance of North America conference (in Tennessee) and I was struck by the range of bumper stickers and license plates in the hotel parking lot that covered the spectrum in terms of reproductive politics.
Both advocates for abortion rights and supporters of birth rights believed in reproductive choice, but they were sometimes cornered by policies and regulations that forced them to “choose” one cause over the other.
AF: What’s next for you? Do you have other research projects on the horizon?
Fairly far along in my research for Coming Home, I discovered a curious connection between LSD research and the home birth movement. I touch on it briefly in the book, but realized there was much more I was curious about. When Coming Home was in production, I applied for and received a six-month fellowship from the British Academy to conduct research in Glasgow, Scotland on my next project. (I just returned to the U.S. in January.)
My new project, entitled “Psychedelic Birth: R.D. Laing and the Transformation of Psychiatry,” investigates the rise and fall (and rise again) of psychedelic therapy. While many today view LSD as a symbol of the hedonism of the counterculture, the drug initially enjoyed a positive reputation as a therapeutic psychiatric tool, which has largely been forgotten. Beginning in the 1950s, dramatic changes in mental health research and drug experimentation led to a renewed optimism in psychiatry’s potential to transform lives. By 1961, over 1,000 articles on LSD had appeared in medical articles, just eighteen years since its synthesis. Many scientists believed that the hallucinations produced by LSD enabled a new way of understanding the pathogenesis of schizophrenia and other mental diseases.
Yet, the history of psychedelic treatment within the broader history of psychiatry has received scant attention. With some exceptions, its history has been relegated to the margins, a last gasp effort at a miracle cure by eccentric hippies, rather than a legitimate form of treatment. This is in part due to the moral panic that occurred as LSD also became a recreational street drug, ultimately grinding medical research to a halt by the 1970s. But given the recent attention to the potential of psychedelic drugs (MDMN or ecstasy and psilocybin) to effectively treat mental health conditions such as PTSD, it is important to know how psychedelics affected the field of psychiatry fifty years ago. My research objective is to provide a timely narrative that situates the current debate within the larger historical context. Without a clear understanding of the contributions of influential psychiatrists of the twentieth century, we cannot adequately assess the impact of today’s revived interest in the therapeutics of psychedelics.