Abstract
While all historians came to be through the process of birth, little attention has been paid to the historical significance of childbirth. Perhaps this is because birth is a natural process, something that is part of human life, rather than a medical condition that needs to be met, that we have neglected to study it. Building upon archaeologist Laurie Wilkie's assertion that there is a tendency to ignore motherhood in her field, Jennifer Hill points out there is a lack of focus on reproduction and childbirth in the field of history also. Hill's historical analysis of reproduction and childbirth at the turn of the nineteenth century fills this gap in scholarship, while challenging previous ideas about mothers and midwives as well as the overall capitalist-individualist narrative of the American West. Framing her work with the human life cycle: conception, birth, life, and death, Hill seeks to normalize childbirth while also emphasizing the historical importance it played in the colonization of the region. The high death rates of mothers who settled in states like Montana and Wyoming have been dismissed as a consequence of relying on midwives to guide the birthing process. Hill argues that it was not the incompetence of midwives that caused a high death rate, although this was the narrative that public health officials at the time pushed. Instead, the harsh material conditions and poverty that settler women faced contributed to high death rates during and after childbirth. While these conditions made childbirth risky, Hill praises the informal network of support that women created for its ability to manage healthcare. Birthing the West is an excellent addition to the historical field, as it elevates previously silenced voices while challenging major arguments about the American West.
Often isolated in their rural settlements, women who settled in the Rockies and plains did not have the same access to healthcare that their urban counterparts had. Despite this challenge, solo birthing experiences were rare, as women formed a community to assist each other. Using personal letters, oral interviews, and journals, Hill maps a unique reciprocal economy that existed among settler women in this region. Still expected to maintain the home and farm, “chronically fatigued mothers living in isolation faced greater physical and emotional burdens than urban women” (58). Hill's research shows that despite their stressful lives, plains and Rockies rural mothers were able to rely on each other in order to safely give birth and recover. Hill's statistical data is from the Children's Bureau, which under Julia Lathrop, interviewed just under five hundred new mothers in rural Montana during the Summer of 1917. According to their findings, the majority of maternity health care during the late nineteenth and early twentieth centuries was provided by midwives. While some of these midwives had formal training, many gained their knowledge from personal experience and through assisting other women rather than formal education. In fact, it was rare for a woman who had never given birth to be a midwife. In the absence of a midwife, community women stepped in to offer any guidance they could, sometimes trading their time and efforts for material goods such as eggs and butter. Women would often stay for many days after the birth, assisting with the duties of the home that could not wait while the new mother recovered.
Susan Armitage and Elizabeth Jameson had pointed out in 1987 that women are often reduced to stereotypes in the field of the American West, and have argued that the inclusion of women's experiences challenge unspoken assumptions about history (see Susan H. Armitage and Elizabeth Jameson, eds., The Women's West, [Norman: University of Oklahoma Press, 1987]). Hill demonstrates this in Birthing the West. She points out that because women's labor cannot be quantified by wages or other measurable units, it is often ignored in history. In fact, the women who stepped up to care for their neighbors and family members frequently diminished their own expertise, “believing their efforts to be part of the necessary work of women,” (67). She argues that historians should not only look at financial exchanges when analyzing economics in the American West, but they should also view time as a stand-in for money in order to understand the economy that settler women created. The network of support created by settler women were based on both relationships and profit, creating what Hill calls, “a pattern of exchange and sociability that questions the raw capitalism of the frontier ethos,” (71). This communal perspective is a bold divergence from the individualistic trope of the American West that was first described in Frederick Jackson Turner's frontier thesis. When the generous and reciprocal economy of settler women is considered, the individualist narrative of the American West becomes unstable; when women are included in historical analyses, the entire narrative changes.
While Birthing the West focuses specifically on the Rockies and Plains regions, Hill also traces an important evolution in maternity healthcare that impacted American women- the transition from midwifery to medical professionals. She identifies three types of midwives: those who trained as midwives and set up solo practices, those who collaborated with physicians, and members of the community who took up the role of midwife because there was no one else who could. Euro-American women came from a long history of midwifery, dating back to Louise Bourgeois’ manuals written in seventeenth-century France. Her instructions and knowledge had been passed down, from woman to woman, for generations, becoming the basis for birthing knowledge during the settler era. During the first few decades of the twentieth century, more women turned to medical doctors over midwives, and childbirth transitioned from being communal to medical. While this historical transition has been previously noted by scholars, Hill does an impressive job of connecting the national move to medical births to the regionally specific issues that women faced in the Rockies and Plains. Her discussions of changes in healthcare policy and legislation only enhances the overall understanding of midwifery in the area.
Hill contrasts the attitudes of midwives to that of the medical doctors who came to dominate the field, arguing that midwives saw what they were doing as important, but “felt constrained about claiming a professional title,” (89). Typical midwife practice followed no hierarchy or bureaucracy, a stark difference from the strict training of nurses and physicians. Tracing the development and professionalization of allopathic physicians, Hill states that male physicians began to push for a larger role in the birthing process in the early twentieth century. While midwives viewed childbirth as a normal part of life, physicians viewed pregnancy as a medical condition that needed to be treated, “preferring action over observation and advocating for the use of new technologies, even when significant harm to the mothers resulted,” (103). This change decentralized mothers from the birthing processes and placed the focus on noble physicians. As the majority of physicians were men at this time, women ceased to be viewed as experts of their own bodies.
While midwives may not have seen their duties as a profession, Hill argues that medical doctors certainly saw them as a threat. Physicians fought against women's loyalty to midwives by promoting the narrative that midwives were not specialized experts and therefore could not provide the same level of care. A public relations campaign during the 1910s told the American public that using midwives was dangerous, because they relied on old traditions and out-of-date methods. Just as mothers were being decentered from the birthing process, midwives were being pushed out, as well. Hill emphasizes that because much of midwifery was based on European traditions that immigrants had brought to the region, and as well as the practice being associated with Indigenous and Black women, the transition to medical births became a part of the larger settler-colonial project. If one wanted to be assimilated into modern American culture, they needed to give birth in a hospital, by a licensed physician. Hill connects the universal shift from midwifery to medical births to national trends, demonstrating clear relationships between the local/rural and the national.
Hill notes that this shift did not occur all at once, as more urbanized regions began to rely on medical doctors for childbirth before the more isolated, rural areas. The transition from midwife-run home births to physician-run hospital births did not occur all at once, but gradually. To illustrate this gradual transition, she discusses the brief fad of Maternity Homes from the 1890s to the 1940s, where expecting mothers could stay before, during, and after the birth of their children, under the care of the midwives who ran the homes. Hill maps how this transitional period allowed for midwives to continue to work, while still following new American Medical Association guidelines. She points out that in South Dakota, laws were passed requiring physicians to be present for the actual births, continuing the pattern of displacement, while negating the expertise of midwives.
Following the life-cycle pattern, Hill includes a discussion of high death rates for mothers in the Rockies and Plains region, which she argues occurred due to poor living conditions, not midwifery. Settler women were expected to keep up with the myriad of household duties while pregnant, and with a lack of social support, had little time for physical recovery. Along with the physical exertion of their daily lives, women also faced poor weather conditions, a lack of access to adequate food and housing, and social isolation. Hill argues that these factors were rarely included in the government documentation of maternal deaths, and instead, public health officials placed the blame solely on midwives. Another factor that Hill invites the audience to consider, was the passage of the 1873 Comstock Act, which made it a federal offense to dispense contraceptives across state lines. As the majority of contraceptives were produced in the more highly populated areas, settler women were essentially cut off from their ability to control reproduction. The lack of contraceptives led to an increase in births, which meant settler women were facing death more frequently than their counterparts back east.
Hill states that the national campaign against midwives frequently used death rates as evidence of midwives’ incompetence. The experience-based practices that Euro-American midwives used ironically mimicked the Indigenous women who had lived there before them. Although Hill's book focuses mainly on white settler women, she does not ignore the fact that long before colonization, Indigenous women were successfully giving birth in these same regions. She points out that the women who struggled to safely give birth in Montana, Wyoming, and the Dakotas could have received help from the Indigenous women who had recently been confined to reservations, as they had long mastered the skills it took to give birth in the region. Constructing and reproducing the dangerous stereotype that women of color felt less pain during childbirth, settlers viewed Native birth as a “simplistic, painless, non-events” (129). A major theme throughout Birthing the West is that in frontier America, being routinely ignored and silenced was part of the female experience, but Hill takes care to note that women of color were especially silenced, by other women.
A common criticism of women's history is that it tends to look at any given period, and simply adds women to it. In the historiography of the American West, scholars often construct a narrative that settler culture was highly individualistic, harsh, and driven by capitalism. Building upon Amy Kaplan's ideas about the ways in which gender and domesticity contribute to settler-colonialism, Birthing the West moves away from common academic tropes by arguing that women were not only important to the colonization of the West, but integral to the overall settler-colonial project. Furthermore, Hill argues that the unique reciprocal economy that rural women created among themselves challenges the narratives of rugged individualism scholars have long clung to. What makes Hill's work so remarkable is that she demonstrates that when one includes the voices of long-silenced women, midwives, and mothers, for example, cultural layers can be peeled back to demonstrate an entirely different narrative of the region.