African American Midwifery in the South: Dialogues of Birth, Race, and Memory; From Midwives to Medicine: The Birth of American Gynecology.

By Gertrude Jacinta Fraser. (Cambridge, Mass., and London: Harvard University Press, 1998. Pp. xii, 287. $39.95, ISBN 0-674-00852-9.)

From Midwives to Medicine: The Birth of American Gynecology. By Deborah Kuhn McGregor. (New Brunswick, N.J., and London: Rutgers University Press, c. 1998. Pp. xii, 273. Paper, $23.00, ISBN 0-8135-2572-1; cloth, $55.00, ISBN 0-8135-2571-3.)

Both of the works under review address issues that led to the decline of midwifery in the United States. However, the approaches and methodologies of the two authors are quite different. Gertrude Jacinta Fraser, an anthropologist, relies on oral interviews and fieldwork to examine the demise of African American midwifery in Virginia during the first half of the twentieth century. By contrast, historian Deborah Kuhn McGregor shows how the emergence of gynecology in the nineteenth century resulted in increased medical intervention in the lives of women, which ultimately undermined the work and status of midwives.

From Midwives to Medicine is a revised edition of McGregor's book Sexual Surgery and the Origin of Gynecology: J. Marion Sims, His Hospital and His Patients (New York, 1989). Yet the title of McGregor's new work is somewhat misleading, for the author's discussion of midwives and midwifery is fairly limited. One needs only to consult the index to find evidence of this. Instead, it is the familiar story of J. Marion Sims, the so-called father of gynecology, that forms the nucleus of this book. McGregor recounts how Sims experimented on unanesthetized slave women in the South and immigrant women in the industrial North to develop a surgical "cure" for vesico-vaginal fistulas caused by the tears of childbirth. She also describes how Sims performed cervical surgeries on upper-class white women who sought help for their "hysterical" symptoms.

The controversial career of Sims has been the subject of numerous studies, including Seale Harris, Woman's Surgeon: The Life Story of J. Marion Sims (New York, 1950) and G. J. Barker-Benfield, The Horrors of the Half-Known Life: Male Attitudes Toward Women and Sexuality in Nineteenth-Century America (New York, 1976). The one area where McGregor significantly enlarges on these earlier works is in her discussion of the history of the Woman's Hospital of the State of New York, founded in the 1850s to facilitate Sims's surgeries for vesico-vaginal fistulas. Drawing from archival materials of the hospital's Board of Lady Supervisors, McGregor shows how this volunteer organization of mostly upper-class women became increasingly critical of Sims and the radical therapies that he and many of his medical colleagues embraced. By the early 1870s it was clear that the Lady Supervisors' vision of the hospital as a place where women patients could find a safe and private retreat during their illnesses conflicted sharply with the medical men who defined the hospital as a public teaching institution where physicians could receive clinical instruction and visitors could witness surgeries. Ultimately, the Lady Supervisors secured the resignation of Sims from the hospital, but according to McGregor, "their efforts came too late. Their voluntarism was more than anything else a contribution to the medicalization of female bodies" (p. 220).

Familiar historical themes also emerge in African American Midwifery in the South. Although Fraser's focus is African American midwifery in Virginia, she readily acknowledges that African American midwives throughout the South shared much in common during the first half of the twentieth century. She shows how physicians and public health officials often held "ignorant" and "dirty" African American midwives responsible for the high maternal and infant mortality rates of the region. Consequently, these medical professionals campaigned for the regulation and ultimately the elimination of midwifery.

The contours and complexities of the early-twentieth-century midwife debate and the campaign to eliminate midwives in the South and throughout the U.S. are well known. Works by Frances E. Kobrin, Judy Barrett Litoff, Dorothy and Richard Wertz, Judith Walzer Leavitt, Linda Janet Holmes, Molly C. Dougherty, Debra Anne Susie, and Eugene Declerq have enhanced our understanding of this subject in significant ways. Using specific examples from Virginia, Fraser does a skillful job of retelling this story. She makes extensive use of the published writings of Dr. William A. Plecker, the registrar of vital statistics in Virginia and a strong advocate of midwifery regulation and control. She compares the racist southern discourse about early-twentieth-century black midwifery with the nineteenth-century debate about the appropriateness of white female midwifery, in which issues of modesty and delicacy were emphasized. However, it would have been more appropriate had Fraser drawn comparisons between southern racist notions about African American midwifery and the anti-immigrant prejudices of early-twentieth-century white northern opponents of immigrant midwifery.

Fraser makes her greatest contribution to our understanding of southern African American midwifery when she analyzes and contextualizes her oral interviews, all of which were with family members, friends, or clients of former midwives. In doing this, she constructs new voices and offers us new and important ways to think about traditional African American midwifery and its decline. Fraser tells us that many of her informants were initially hesitant to talk about birthing and midwifery practices, for they thought that they were remembering a past that would reflect negatively on their families or community. Nonetheless, counterbalanced against this silence was the creation of detailed narratives that marveled at the ingenuity of a people who made the best of what was available to them. Through these interviews, we learn of the importance of the African American midwife's "calling" and spirituality, and how her knowledge relied upon a type of creative improvisation known as "mother wit" (p. 26). Fraser demonstrates that African American women and their birth attendants actively expressed a desire to take advantages of the benefits offered by medical science, but that they probably did not realize that this would result in the eventual elimination of "traditional" midwifery practices. This is not unlike the argument of Judith Walzer Leavitt that childbearing women changed their birthing practices because they believed that medicalization would make birth safer for them, yet they failed to recognize that they were also relinquishing authority to a powerful medical establishment.

African American Midwifery in the South and From Midwives to Medicine provide fresh insights on important historical themes that have received considerable scholarly attention in recent years. Both are a welcome addition to the growing body of literature on the medicalization of women's bodies and the decline of traditional birthing practices.

JUDY BARRETT LITOFF
Bryant College