Giving Birth in Canada, 1900-1950.

Giving Birth in Canada, 1900-1950. By Wendy Mitchinson (Toronto: University of Toronto Press, 2002. 432pp.).

While the history of childbirth in Canada has been discussed under the rubric of other, related issues, such as maternal and infant welfare, the eclipse of midwifery and the concomitant professionalization and specialization campaigns in medicine, Wendy Mitchinson's study is the first in-depth, monograph-length examination of a topic that sits at the critical juncture of women's, family, and medical history. In the carefully-documented manner that has established her among the leading historians of Canadian medicine, Mitchinson outlines a half-century of the development--never remotely "linear" or unconflicted--of modern maternal care, both within the aegis of conventional medical practice, including the on-going specialization in obstetrics/gynaecology, and also, to some degree, on the margins of mainstream medicine.

Mitchinson makes meticulous use of the diverse sources required to fill in the picture of an experience that, while becoming increasingly "public" during this period, nonetheless remained fundamentally private. She deftly balances such official records as those of hospitals and government agencies with the professional writings represented in medical journals and texts and the more "popular" versions circulated apace in contemporary advice literature and magazines geared to women's interests--at the centre of which, within the confines of gendered understandings of role and nature, were childbirth and childrearing. While these are the historian's customary store of resources, Mitchinson also adds a more personal, individual dimension to the story by incorporating actual childbirth narratives from oral testimony and the precious and all-too-small supply of women's private writings in diaries and letters, from the famous (author Lucy Maud Montgomery) to the "ordinary".

Situating herself within the feminist historiography on women's roles and especially on maternity, Mitchinson's objective is essentially revisionist. She aims to deepen and fill out what she regards as the simplistic arguments of earlier analyses that established a false divide--or at least one too stark--between the positive, "woman-centred" pre-twentieth-century experiences that highlighted giving birth, with its requisite attendance of midwives, female family members, friends and neighbours, as integral to traditional women's culture, and the "clinical", increasingly hospital-based, disempowering, male-doctor-focussed and interventionist scientific experiences that allegedly became the norm by 1950. As Mitchinson posits, neither the women "patients" nor their attendants, whether midwives or medical professionals, played roles so rigidly scripted. Even as doctor-supervised and hospitalized childbirth became more commonplace, the balance of power was never entirely in the (primarily male) doctors' hands, any more than "traditional" woman-centred childbirth could have allowed mothers to control a process that can readily become complicated and necessitate unplanned, unforeseen, perhaps unwanted measures to be taken. As a whole, then, and tracked over time, a process as "natural" as childbirth has often demanded, or at least permitted, intervention, sometimes as much in home as in hospital births, in cities as in rural and outpost settings, in Aboriginal communities and among recently-arrived immigrants as among the native-born of both English and French-Canadian heritage. Changes in science as well as changes in the culture of childbirth--which saw this "natural" and central womanly function become increasingly pathologized as doctors rose to dominate its experience--must be taken into account as vital explanatory factors. All of these are important points that are capably supported in this study. What suggests occasion for further consideration are the historic material realities that also shaped women's actual experiences of childbirth as well as the medical response: the class, race and, especially relevant for the Canadian setting, the regional elements are considered, but stand to be explored more deeply for their formative aspects where the "patient", more so than the practitioner, is concerned. The wider contexts of a modernizing nation and its peculiar anxieties about gender, family and state responsibility can also be seen to affect the medical/professional and personal/familial pictures more than might be implied here. And while Mitchinson's argument about the blunt nature of some of the inaugural feminist analyses is valid, it, too, is a bit on the blunt side. It can also be argued that this very "bluntness" characterizes initial forays into new subject areas. More to the point, just as there is a case to be made for the variety of childbirth experiences and medical responses at any given time, and over time, there is a similar case at hand for a range of feminist historical interpretations of childbirth, evolving from the avidly anti-doctor to those not unlike the author's own more complex interpretations. In the end, Giving Birth in Canada is a much-needed study whose findings should engage an international readership interested in the history of women, childbirth and medicine.

Cynthia Comacchio

Wilfrid Laurier University