Book Review: Midwives.

Random House, 1998; $13 paperback

Midwives, Chris Bojhalian's bestselling 1998 novel is a well-paced and engrossing novel to read. He articulately describes the effect of a tragic event on a family within a small community and on family members themselves.

The book chronicles the struggle of a direct-entry midwife, Sibyl Danforth, who is taken to trial for the death of a mother during a homebirth. The distinctive fact is that the midwife saved the baby's life by performing an emergency cesarean section on the mother who had already died. Or had the mother died? The startling question keeps coming up in Sibyl's trial. The state accuses her of practicing medicine without a license and involuntary manslaughter. Her defense says she worked to save the baby and did everything possible under conditions of extreme duress. An important fact is that on the evening of the birth there had been a catastrophic ice storm that felled phone lines and made driving too difficult even for snowplow trucks. For those who oppose homebirth, the answer is easy. The mother was at risk the moment she decided not to have her baby at a hospital. To those supportive of direct-entry midwifery, more questions arise and some answers are less clear.

The story is related by Connie, Sibyl's fourteen-year-old daughter, with each chapter introduced with an excerpt from Sibyl Danforth's journals. Connie notices changes in her father's tone, her mother's demeanor, their attentions to her during the trial, as well as what other kids at school are saying in this small Vermont hometown of hers. I especially appreciated the descriptions of mother-daughter communication, with notes from Sibyl's journal revealing her concerns and respect for her teenage daughter. Midwives gives a personal look at how a legal case can strain one's family, community ties, and finances.

One interesting aspect of the story is how the trial lawyers constructed their arguments for this case. At one point Sibyl's lawyer suggests that she plead temporary insanity. Sibyl responds with dignity when she replies "I don't think it will serve anyone to describe midwives as fools." Listening to the state prosecutors as they questioned prospective jurors revealed what kind of attitudes toward birth, hospitals, and medicine often shape public opinion. But in some ways, the novel perpetuates attitudes that undermine midwifery in our time.

This book does not portray Sibyl Danforth as incompetent. There are references to her years of training and practicing without incident, while the efficacy of homebirth is shown through statistics. Sibyl ran her business well: her clinical records were all in order. She does have support from her family and her midwifery community. But all this is damning with faint praise. The novel makes no mention of the real life midwives at The Farm and their superlative statistics, no references to the World Health Organization's recommendations that homebirth should be the standard for all normal pregnancies. Curiously, there are no parallel statistics of difficult or unexpected outcomes in hospitals. The narrator often refers to Sibyl's "hippie past" with apologetic tones. So what remains with the most compelling force is the image of a botched c-section by a midwife at home.

What concerns me about this book, entitled Midwives in the plural, is that it focuses on one horrific story and offers very little of the long, venerable history of midwifery in the world. This is the kind of dramatic story and attitudes the general public is most likely to hear. To truly educate legislators, health care providers, and the public, more thorough pictures of midwifery's history and continuing successes are necessary.

Editor's Note: Midwives was reviewed on the Oprah Winfrey Show in December of 1997 as part of Oprah's Book Club. See the article on page 24 with that review.

--Robin Snyder-Drummond is an ALACE certified childbirth educator and on the Board of Directors for the Massachusetts Friends of Midwives. She lives in Melrose, Massachusetts with her husband and children, Kyle, 8, and Erica, 6.