Book Review: Devries et al. Birth by Design

Raymond Devries, Cecilia Benoit, Edwin R. van Teijlingen, and Sirpa Wrede, eds.
Birth by Design: Pregnancy, Maternity Care, and Midwifery in North America and Europe.
Routledge, 2001, 301 pp.
CDN $37.95 paper (0-415-92338-7), CDN $120.00 cloth (0-415-92337-9)

Birth by Design as a volume and a title was conceived at a Midwifery Today conference in 1997. The editors and authors lived in North America and throughout Europe and, as documented in the foreword, introduction, and appendix, pushed collaboration to its limits using all forms of interaction to create the volume (face-to-face, telephone, snail mail and email). The result is a well-organized volume addressing the complexities of maternity care cross-culturally, as well as within specific countries.

The editors realized that much of the literature on birthing and maternity care was ethnocentric, that is, focusing primarily on one or a few countries and rarely looking at cross-cultural patterns. Birth by Design was written under the premise that maternity care systems must be studied in the cultural, historical, and societal settings in which they operate. Additionally, the authors examine the role of midwives cross-culturally in the context of birthing alternatives. The relationship between midwifery and birthing alternatives is a complex one and cannot be disentangled. Not only does this anthology place maternity care systems in cultural and historical context, but the contributing authors examine how maternity care is affected on multiple levels within a particular society. The volume is organized in three sections, each part focusing on one of the levels at which maternity care is designed.

The first section of the book focuses on how the polity, or the arrangements of national states and political party systems affect birth. The section begins broadly, with the first essay examining the historical trajectories of locations of birth in five countries through the lens of political influence. The essays become more narrow in their focus, as the authors begin to examine more specific political influences on maternity care. Wrede, Benoit and Sandall compare the United Kingdom, Canada and Finland in the evolution of maternal health policies and show that ideological contexts play a large part in whether and when maternal health and maternal care are considered national welfare issues. Bourgeault, Declercq, and Sandall analyze the influence of consumer interest groups on maternity care policy and show specifically the differential effect these non-representative groups have on gaining and maintaining access to policymakers and affecting policies. Daviss extends this analysis by questioning whether the decision to include midwifery as a part of the health care system in Canada alters the national policy on maternal care and birthing or simply co-opts the alternative birth movement’s agenda. Nelson and Popenoe examine intra-societal differences in maternal health care, reminding us that the experience of birth varies greatly within as well as across nations.

The second section of the book explores the meso level, focusing particularly on how the relationships between the professional groups that provide maternity care affect the kind of care offered within a cultural context. This section begins with an essay outlining the differing processes of professionalization of maternal health caregivers, specifically midwives, in four countries. This essay facilitates the transition from the first section to the second, as the authors note the importance of the national health care policies on the level of professionalization of midwives supported within each country. The remaining essays place maternal care and birth in the context of the interactions between midwives and other professional caregivers. Benoit and her colleagues analyze three models of midwife education using the midwives’ own experiences as the basis of whether the education prepared them for their work. This professional centered approach is continued in Van der Hulst’s case studies of midwifery practices and how the the level of care midwives chose for each client was culturally and ideologically based. Finally, Rothman gives Dutch midwives an outlet to voice their view that the globally and locally escalating use of technology in birthing “spoils the pregnancy,” thus distancing themselves even further from other professional maternal caregivers.

The third section examines the experience of birth as an outcome of the interaction between caregivers and birthing mothers. More specifically, the authors in this section address two specific themes: “(1) the views of maternity clients on their access to and utilization of maternal health services and (2) the varied ways technology shapes the work of midwives and the experiences of birthing women (p. 201).” Erikson’s essay examines the ways in which differing beliefs about women’s work in East and West Germany affected whether women used advanced technology during their pregnancies and during their births. Cartwright and Thomas, and Pasveer and Akrich note the importance of the notion of risk in choice of place of birth and use of technology; both essays comment on the construction of pregnancy and birth as risky in the context of either the best interest of the caregiver (Cartwright and Thomas) or the best interest of the woman and her child (Pasveer and Akrich). DeVries and his co-authors end this edited volume by addressing what women want in birthing, showing how women’s desires during pregnancy and birth can both be constructed by and can construct the maternity care they and other women receive.

The editors suggested in their introduction that their “goal is to ‘decenter’ the study of maternity care from particular national contexts, to move it analytically in a direction in which any and all contexts are perceived as problematic (p. xiii).” Through their comparative and multi-leveled analyses, the editors and contributors remind readers that while birth is a natural physiological phenomenon, our understandings of birth, the birthing process, and how and from whom mothers should receive maternity care are culturally based and are continually constructed and reconstructed. By re-focusing our attention on birth outcomes as women’s experiences and the reproduction of societies and culture, the editors and contributors to Birth by Design do problematize all contexts of maternity care, and by doing so, challenge birthing mothers, caregivers, and policy makers in our thinking about the birthing process.

Shannon N. Davis
North Carolina State University
sndavis@server.sasw.ncsu.edu

Shannon Davis is currently working on her dissertation, a project examining the social and cultural factors which affect both the division of household labor and the perceptions of fairness of that division of labor using data from the International Social Justice Project.



		Canadian Journal of Sociology Online March - April 2002 Raymond Devries, Cecilia Benoit, Edwin R. van Teijlingen, and Sirpa Wrede, eds. Birth by Design: Pregnancy, Maternity Care, and Midwifery in North America and Europe. Routledge, 2001, 301 pp. CDN $37.95 paper (0-415-92338-7), CDN $120.00 cloth (0-415-92337-9) Birth by Design as a volume and a title was conceived at a Midwifery Today conference in 1997. The editors and authors lived in North America and throughout Europe and, as documented in the foreword, introduction, and appendix, pushed collaboration to its limits using all forms of interaction to create the volume (face-to-face, telephone, snail mail and email). The result is a well-organized volume addressing the complexities of maternity care cross-culturally, as well as within specific countries. The editors realized that much of the literature on birthing and maternity care was ethnocentric, that is, focusing primarily on one or a few countries and rarely looking at cross-cultural patterns. Birth by Design was written under the premise that maternity care systems must be studied in the cultural, historical, and societal settings in which they operate. Additionally, the authors examine the role of midwives cross-culturally in the context of birthing alternatives. The relationship between midwifery and birthing alternatives is a complex one and cannot be disentangled. Not only does this anthology place maternity care systems in cultural and historical context, but the contributing authors examine how maternity care is affected on multiple levels within a particular society. The volume is organized in three sections, each part focusing on one of the levels at which maternity care is designed. The first section of the book focuses on how the polity, or the arrangements of national states and political party systems affect birth. The section begins broadly, with the first essay examining the historical trajectories of locations of birth in five countries through the lens of political influence. The essays become more narrow in their focus, as the authors begin to examine more specific political influences on maternity care. Wrede, Benoit and Sandall compare the United Kingdom, Canada and Finland in the evolution of maternal health policies and show that ideological contexts play a large part in whether and when maternal health and maternal care are considered national welfare issues. Bourgeault, Declercq, and Sandall analyze the influence of consumer interest groups on maternity care policy and show specifically the differential effect these non-representative groups have on gaining and maintaining access to policymakers and affecting policies. Daviss extends this analysis by questioning whether the decision to include midwifery as a part of the health care system in Canada alters the national policy on maternal care and birthing or simply co-opts the alternative birth movement’s agenda. Nelson and Popenoe examine intra-societal differences in maternal health care, reminding us that the experience of birth varies greatly within as well as across nations. The second section of the book explores the meso level, focusing particularly on how the relationships between the professional groups that provide maternity care affect the kind of care offered within a cultural context. This section begins with an essay outlining the differing processes of professionalization of maternal health caregivers, specifically midwives, in four countries. This essay facilitates the transition from the first section to the second, as the authors note the importance of the national health care policies on the level of professionalization of midwives supported within each country. The remaining essays place maternal care and birth in the context of the interactions between midwives and other professional caregivers. Benoit and her colleagues analyze three models of midwife education using the midwives’ own experiences as the basis of whether the education prepared them for their work. This professional centered approach is continued in Van der Hulst’s case studies of midwifery practices and how the the level of care midwives chose for each client was culturally and ideologically based. Finally, Rothman gives Dutch midwives an outlet to voice their view that the globally and locally escalating use of technology in birthing “spoils the pregnancy,” thus distancing themselves even further from other professional maternal caregivers. The third section examines the experience of birth as an outcome of the interaction between caregivers and birthing mothers. More specifically, the authors in this section address two specific themes: “(1) the views of maternity clients on their access to and utilization of maternal health services and (2) the varied ways technology shapes the work of midwives and the experiences of birthing women (p. 201).” Erikson’s essay examines the ways in which differing beliefs about women’s work in East and West Germany affected whether women used advanced technology during their pregnancies and during their births. Cartwright and Thomas, and Pasveer and Akrich note the importance of the notion of risk in choice of place of birth and use of technology; both essays comment on the construction of pregnancy and birth as risky in the context of either the best interest of the caregiver (Cartwright and Thomas) or the best interest of the woman and her child (Pasveer and Akrich). DeVries and his co-authors end this edited volume by addressing what women want in birthing, showing how women’s desires during pregnancy and birth can both be constructed by and can construct the maternity care they and other women receive. The editors suggested in their introduction that their “goal is to ‘decenter’ the study of maternity care from particular national contexts, to move it analytically in a direction in which any and all contexts are perceived as problematic (p. xiii).” Through their comparative and multi-leveled analyses, the editors and contributors remind readers that while birth is a natural physiological phenomenon, our understandings of birth, the birthing process, and how and from whom mothers should receive maternity care are culturally based and are continually constructed and reconstructed. By re-focusing our attention on birth outcomes as women’s experiences and the reproduction of societies and culture, the editors and contributors to Birth by Design do problematize all contexts of maternity care, and by doing so, challenge birthing mothers, caregivers, and policy makers in our thinking about the birthing process. Shannon N. Davis North Carolina State University sndavis@server.sasw.ncsu.edu Shannon Davis is currently working on her dissertation, a project examining the social and cultural factors which affect both the division of household labor and the perceptions of fairness of that division of labor using data from the International Social Justice Project. http://www.arts.ualberta.ca/cjscopy/reviews/birthbydesign.html April 2002 © CJS Online